Bronchiectasis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The medical therapy is divided into medical treatment and physiologic strategies. The medical treatment consists of patient education, treatment of the acute exacerbations, prophylactic treatment, vaccination, and other therapies. The physiotherapy strategies focuses on airway clearance and pulmonary rehabilitation.
Bronchiectasis Medical Therapy
Medical Treatment
Patient Education
- The patients should understand their diagnosis clearly.
- Smoking cessation, regular exercise, and proper nutrition should be advised.
- The patient should know how to self-manage acute exacerbations with a home supply of antibiotics.
Treatment of Acute Exacerbations
- Exacerbations can be defined as patients reporting four or more of the following symptoms: change in sputum production, increased dyspnea, increased cough, fever over 38 °C, increased wheezing, decreased exercise tolerance, fatigue, malaise, lethargy, reduced pulmonary function, changes in chest sounds or radiographic changes consistent with a new infectious process.
- The mainstay of treatment is antibiotic therapy.
- Once the sputum specimen is collected and sent for culture, a targeted antibiotic therapy is recommended.
- Colonization with a particular microorganism is graded as chronic if the same microorganism is detected in three or more consecutive cultures separated by at least 1 month over a period of 6 months.[1]
- Oral antibiotic therapy should be used first line for 10-14 days. Intravenous (IV) antibiotics may be needed if there has been: no response to oral antimicrobials, systemic deterioration or if pathogenic organisms sensitive only to IV agents are cultured. [1]
- Here are suggested antibiotics with specific culture growth
- H. influenza type B
- Amoxicillin 1 g tds × 2/52, Doxycycline 100 mg bd × 2/52
- If β-lactamase-positive strain, Augmentin 625 mg tds × 2/52
- P. aeruginosa
- Ciprofloxacin 750 mg BD × 2/52
- If no response or resistant to above, consider IV alternatives for 2/52: Ceftazidime 2 g tds × 2/52 IV, Tazocin 4.5 g tds IV or Meropenem 1 g tds IV
- S. pneumoniae
- Amoxicillin 1 g tds × 2/52
- M. catarrhalis
- Augmentin 625 mg tds × 2/52 or Ciprofloxacin 500 mg BD × 2/52
- S. aureus
- Flucloxacillin 1 g qds × 2/52
Prophylactic Treatment
- National guidelines recommend that patients suffering from three or more exacerbations per year, should be considered for long-term antibiotics.[1]
Vaccination
- There has been some evidence to support that the yearly influenza vaccine reduces morbidity, mortality, and healthcare costs with high-risk patients.
Other Therapies
- Inhaled mannitol and nebulized hypertonic 7% saline have demonstrated effectiveness in increased airways clearance and sputum yield.[1]
- Inhaled corticosteroids show a significant decrease in sputum production and cough.[1]
- Macrolides exhibit anti-bacterial and immunomodulatory effects.[1]
- The combination of a long-acting beta2-agonists (LABA) with a conventional inhaled corticosteroids (IC) improved the quality of life.
Physiotherapy Strategies=
Airway Clearance
- Postural Drainage
- Autogenic Drainage
- Active Cycle of Breathing Techniques
- Positive Expiratory Pressure (PEP)
- Oscillatory PEP devices
- High-frequency chest wall percussion