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Non-Medication-Based Treatment

Common Treatments

Bronchiectasis is a long-term condition. Early treatment is important to help improve how you feel and to keep your condition well managed. If left untreated, your symptoms may progress causing further damage to the airways in your lungs.16

Treatment goals for bronchiectasis in children and adults are: 5,17

  • Treat lung infections
  • Clear mucus from your lungs through airway clearance therapy
  • Prevent further damage
  • Reduce your symptoms
red lungs in x-ray


 

Airway Clearance

Airway clearance is an important way to manage bronchiectasis in infants, children and adults. Airway clearance therapy (ACT) uses non-invasive techniques to help loosen mucus or sputum so it can be cleared from your airways by coughing or huffing.

There are many different airway clearance techniques. It’s important to speak with your health care provider to find the type and frequency of treatment that’s best for you or your child.

Chest physical therapy or physiotherapy (CPT), also known as postural drainage and percussion (PD&P) is performed by your health care provider or care giver.11,18 You’re placed in several different postures or positions to help drain mucus from different parts of your lungs using gravity. Percussion or clapping on your chest wall is done by your care provider to help move the mucus into your larger airways so it can be coughed out. This technique is suitable for infants and small children who are not yet old enough to cooperate with more active techniques. It’s also an option for those unable to use or too fatigued to use independent techniques.18

Self-administered airway clearance techniques include:

  • Autogenic drainage (AD)11,18 

Autogenic drainage uses a cycle of controlled breathing exercises to clear different levels of your lung. This technique moves mucus from the small airways to the medium-sized airways and then to the larger airways to be coughed out.

  • Active cycle of breathing techniques (ACBT)11,18

Active cycle of breathing techniques combines breathing control, deep breathing (thoracic expansion) exercise and huffing (forced expiration technique) performed in a cycle.

  • Oscillating positive expiratory pressure (OPEP) therapy11,18

An OPEP device is a handheld device that combines positive expiratory pressure (PEP) with oscillations (or vibrations) to help clear secretions from your airways. As you exhale through the mouthpiece, positive pressure holds the airways open and allows air to get behind the mucus. Oscillations help to thin, loosen and move the mucus to the larger airways of your lungs where it can be coughed out.

 

woman using aerobika

Managing Mucus Clearance

There are many techniques that can be used to assist with bronchiectasis.

If you are producing excess mucus, different techniques like deep breathing & huff coughing may help you clear the excess mucus.

Devices like the Aerobika* OPEP device are simple hand-held drug free devices, which could help to clear the mucus.4

  • Positive expiratory pressure (PEP) therapy11,18

A PEP device is a handheld device that creates positive pressure when you exhale through the device’s mask or mouthpiece. The positive pressure holds open the airways in your lungs, allowing air to get behind the mucus and loosen it so you can cough it out.

  • High frequency chest wall oscillation (HFCWO) therapy11,18

In this technique external chest wall oscillations are applied to your torso using a fitted vest. The vest produces vibrations to help loosen and thin mucus and separate it from your airway walls so it can be coughed up.

  • Intrapulmonary percussive ventilation (IPV)11,18

This technique uses a pneumatic device to deliver short bursts of air into your lungs at a high rate. These percussive bursts of air are delivered during inhalation and exhalation and help to loosen and mobilize secretions to your upper airways where they can be coughed out.

  • Exercise

Pulmonary rehabilitation exercise and education programs can teach you the skills to help manage your symptoms.19 You should speak with your health care provider about the type and intensity of exercise suitable for you.

  • Nutrition and Diet

Nutrition is important in managing your overall health. People with bronchiectasis may have unintentional weight loss, be underweight and at risk of malnutrition.20 A nutritionist or dietician can help you improve your diet and maintain a healthy weight.7

 

References

1.International Respiratory Coalition. Lung Facts - Diseases - Bronchiectasis. https://international-respiratory-coalition.org/diseases/bronchiectasis/ (Last accessed January 17, 2024).

2. Martina Contarini. Bronchiectasis: a case-based approach to investigation and management. European Respiratory Review 2018;27:180016. https://err.ersjournals.com/content/27/149/180016.

3. Living with Bronchiectasis. British Lung Foundation 2017;BK33 Version 1. https://www.blf.org.uk/sites/default/files/BK33_Bronchiectasis_v1_2017_PDFdownload.pdf (Last accessed January 17, 2024).

4. Alan F Barker. Bronchiectasis. The New England Journal of Medicine 2002.;346:1383-1393. https://www.nejm.org/doi/full/10.1056/NEJMra012519.

5. Bronchiectasis. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/bronchiectasis (Last accessed January 17, 2024).

6. Bronchiectasis Frequently Asked Questions (FAQs). Bronchiectasis and NTM 360°. https://www.bronchiectasisandntminitiative.org/Learn-More/I-am-a-Patient-or-Caregiver/Bronchiectasis-FAQs (Last accessed February 23, 2024). 

7. Doreen Addrizzo-Harris, et al. Living Well With Bronchiectasis Patient Information Guide. CHEST Foundation 2017. https://foundation.chestnet.org/wp-content/uploads/2020/05/Bronchiectasis-Living-Well.pdf (Last accessed January 17, 2024).

8. Bronchiectasis in children. British Lung Foundation. https://www.blf.org.uk/support-for-you/bronchiectasis-in-children/what-is-it (Last accessed January 17, 2024).

9. Galit Livnat, et al. Non-cystic fibrosis bronchiectasis: review and recent advances. F1000 Medicine Reports 2009;1:67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948306/.

10. Jaafer Saadi Imam, Alexander G Duarte. Non-CF bronchiectasis: Orphan disease no longer. Respiratory Medicine. 2020;166:105940. https://www.sciencedirect.com/science/article/pii/S0954611120300809

11. Adam T Hill, et al. British Thoracic Society Guideline for Bronchiectasis in Adults. Thorax 2019;74(1):1-69. http://dx.doi.org/10.1136/thoraxjnl-2018-212463.

12. Bronchiectasis in children. British Lung Foundation. https://www.blf.org.uk/support-for-you/bronchiectasis-in-children/what-is-it (Last accessed January 17, 2024).

13.  MP Murray, et al. Sputum colour: a useful clinical tool in non-cystic fibrosis bronchiectasis. European Respiratory Journal 2009;34(2):361-364. https://erj.ersjournals.com/content/34/2/361.

14. How is bronchiectasis diagnosed? British Lung Foundation. https://www.blf.org.uk/support-for-you/bronchiectasis/diagnosis (Last accessed January 17, 2024).

15. Severity assessment. EMBARC The European Bronchiectasis Registry. https://www.bronchiectasis.eu/severity-assessment (Last accessed January 17, 2024).

16. Bronchiectasis: Symptoms. National Jewish Health. https://www.nationaljewish.org/conditions/bronchiectasis/bronchiectasis-overview/symptoms (Last accessed January 17, 2024).

17. What is the treatment for bronchiectasis? British Lung Foundation. https://www.blf.org.uk/support-for-you/bronchiectasis/treatment (Last accessed January 17, 2024).

18. Annemarie L Lee, et al. Airway-Clearance Techniques in Children and Adolescents with Chronic Suppurative Lung Disease and Bronchiectasis. Frontiers in Pediatrics 2017;5(2):1-8. https://doi.org/10.3389/fped.2017.00002.

19. Eva Polverino, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. European Respiratory Journal 2017;50:1700629. DOI: 10.1183/13993003.00629-2017. https://erj.ersjournals.com/content/50/3/1700629.

20. Bronchiectasis Toolbox. https://bronchiectasis.com.au/bronchiectasis/living-with-bronchiectasis/nutrition (Last accessed January 17, 2024).