Bronchiectasis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
Along with treatment of bronchiectasis, it is important to treat the underlying condition if one is present. The medical therapy is divided into medical treatment and physiotherapy 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
- The mainstay of treatment is antibiotic therapy
- Once the sputum specimen is collected and sent for culture, a targeted antibiotic therapy is recommended
- It is considered 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]
- Intravenous (IV) antibiotics may be needed if there has been: no response to oral antibiotics, systemic deterioration, or if the organism is sensitive only to IV agents[1]
- Allergic bronchopulmonary aspergillosis (ABPA)
- Oral prednisone 0.5 to 1 mg/kg per day for two weeks followed by alternate day therapy tapered over three to six months
- A 16 week course of an antifungal agent, such as itraconazole or voriconazole, may be added in patients who require large doses of glucocorticoids
| Culture Growth | Antibiotics | Dosage |
|---|---|---|
| Haemophilus influenzae type B | Amoxicillin | 1 g three times daily for two weeks |
| Haemophilus influenzae type B | Doxycycline | 100 mg twice daily for two weeks |
| Haemophilus influenzae type B (β-lactamase-positive strain) | Augmentin | 625 mg three times daily for two weeks |
| Pseudomonas aeruginosa | Ciprofloxacin | 500-750 mg twice daily for two weeks |
| If resistant to Pseudomonas aeruginosa | Ceftazidime | 2 g three times daily for two weeks (IV) |
| If resistant to Pseudomonas aeruginosa | Tazocin | 4.5 g three times daily IV |
| If resistant to Pseudomonas aeruginosa | Meropenem | 1 g three times daily IV |
| Streptococcus pneumoniae | Amoxicillin | 1 g threes times daily for two weeks |
| Moraxella catarrhalis | Augmentin | 625 mg three times daily for two weeks |
| Moraxella catarrhalis | Ciprofloxacin | 500 mg twice daily for two weeks |
| Staphylococcus aureus | Flucloxacillin | 1 g once a day for two weeks |
Other Therapies
- Inhaled mannitol and nebulized hypertonic 7% saline for increased airways clearance and sputum yield[1]
- Inhaled corticosteroids show a significant decrease in sputum production and cough[1]
- The combination of a long-acting beta2-agonists (LABA) with a conventional inhaled corticosteroids can improve 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
Pulmonary Rehabilitation
- Exercise training
- Nutritional counseling
- Education of the patient's disease and how to manage it
- Techniques on how to conserve energy
- Strategies on breathing
- Psychological counseling
References
- ↑ 1.0 1.1 1.2 1.3 McDonnell MJ, Ward C, Lordan JL, Rutherford RM (2013). "Non-cystic fibrosis bronchiectasis". QJM. 106 (8): 709–15. doi:10.1093/qjmed/hct109. PMID 23728208.