Bronchiectasis Treatment

A cough with phlegm, every single day

People with bronchiectasis often describe their mornings the same way: the first half hour goes in coughing up phlegm. Sometimes a cup, sometimes more. Through the day it's better, but it never fully stops. Every few months there's a bad spell with fever, thicker yellow or green sputum, and another course of antibiotics.

Many have been treated for "bronchitis", "TB" or "chest infection" again and again without anyone explaining why it keeps happening.

What bronchiectasis is

In bronchiectasis, some of the airways in the lungs become permanently widened and scarred. Normally, tiny hair-like cilia lining the airways sweep mucus upwards so it can be cleared. In damaged, widened airways, that cleaning system doesn't work well. Mucus pools, bacteria grow in it, the infection causes more inflammation, and the inflammation damages the airways further.

Doctors call this the "vicious cycle" of bronchiectasis. Treatment is all about breaking it.

Causes

In India, the most common causes are:

• Past TB, which can leave behind damaged airways even after successful treatment
• Severe pneumonia or whooping cough in childhood
• Allergic bronchopulmonary aspergillosis (ABPA), an allergic reaction to a fungus, often in people with asthma
• Immune deficiency
• Conditions affecting cilia (primary ciliary dyskinesia) or, rarely, cystic fibrosis
• Rheumatoid arthritis and some other autoimmune diseases
• A blocked airway from an inhaled object or growth
• Sometimes no clear cause is found

Finding the cause matters, because some of them, like ABPA or immune deficiency, have specific treatment.

Symptoms

• Daily cough with sputum, often worse in the morning
• Repeated chest infections
• Breathlessness and wheezing
• Tiredness
• Coughing up blood in some people, usually streaks but occasionally more
• Bad taste in the mouth or bad breath from sputum

Diagnosis

• HRCT chest is the main test. It shows the widened airways clearly.
• Sputum culture to identify the bacteria, which guides the choice of antibiotics during flare-ups
• Spirometry to measure lung function. See PFT test.
• Blood tests to look for causes: immunoglobulins, tests for ABPA (IgE, aspergillus-specific tests), and others as needed
• Bronchoscopy in selected cases. See bronchoscopy.

Treatment

Airway clearance: the daily habit that matters most

Medicines help, but clearing the mucus every day is the foundation. Techniques include:

• Active cycle of breathing: relaxed breathing, then deep breaths, then "huffing" (forced breathing out with an open mouth, like fogging a mirror)
• Postural drainage: lying in certain positions so gravity helps drain mucus from affected parts of the lung
• Devices that create vibration or pressure while you breathe out, helping loosen mucus
• Nebulised saline, sometimes concentrated, to thin the mucus before clearance

We teach you a routine that takes 15 to 30 minutes, once or twice a day, and fits into your life.

Treating flare-ups promptly

During an exacerbation, a course of antibiotics, usually for 14 days, chosen based on your previous sputum results. Having a plan for what to do at the first sign of a flare-up helps catch it early.

Preventing frequent flare-ups

For people who get three or more flare-ups a year despite good airway clearance, long-term options may be considered, such as low-dose macrolide antibiotics or inhaled antibiotics, with monitoring.

Treating the cause and related problems

ABPA needs specific treatment, asthma needs good control, and reflux, sinus disease or immune problems need attention too.

General measures

• Flu vaccine every year and pneumococcal vaccine
• Stopping smoking
• Staying active and doing breathing exercises
• Good nutrition and keeping body weight up
• Pulmonary rehabilitation for those with significant breathlessness

Coughing up blood

Small streaks of blood can happen during infections. If you cough up more than a few spoonfuls, go to an emergency department straight away, as it may need urgent treatment.

Long-term follow-up

Bronchiectasis is a long-term condition, but with regular airway clearance and quick treatment of flare-ups, most people keep it well controlled and lead normal, active lives. Regular follow-up with sputum checks and lung function tests helps keep it that way.

Clinic timings and contact

Dr. Manan Bedi sees patients with bronchiectasis from Panchkula, Chandigarh, Mohali and Zirakpur at Booth 194, Sector 20, Panchkula. OPD: Monday to Saturday 5–7 PM, Sunday 11 AM–2 PM. Bring your CT scan CD and any sputum culture reports. Call +91-99280 14284 or book online.