The management of bronchiectasis is long-term and is directed at:

• Improving the clearance of sputum, also called bronchopulmonary hygiene,
• Controlling infection (both prevention and treatment),
• Identifying and treating co-morbid conditions often seen with bronchiectasis (such as GERD and chronic sinusitis),
• Improving muscle strength and endurance through pulmonary rehabilitation and
• Identifying the need for surgical resection of affected segments or lobes of the lung.

Your health care provider will evaluate your history and recommend the best management plan for you.

Bronchopulmonary Hygiene Therapy
Improved clearance of mucus is the cornerstone of the management of bronchiectasis and includes several components. They include:

• Inhaled medication (bronchodilator and/or inhaled steroid) and
• Airway clearance measures (oscillating positive expiratory pressure device, high-frequency chest wall oscillation vest).

Your health care provider may recommend one or more of them depending on your individual needs.

Inhaled Medication
Inhaled Bronchodilators - An inhaled bronchodilator medication opens the airways by relaxing the smooth muscles around the airways.  This type of medication is available in a number of inhaled forms.  Commonly used inhaled short-acting bronchodilators include:

• ProAir®, Proventil® HFA, Ventolin® HFA (albuterol)
• Xopenex® (levalbuterol)
• Maxair® (pirbuterol)

Inhaled long-acting bronchodilators may also be used.  They include:

• Serevent® (salmeterol)
• Foradil® (formoterol)
• Spiriva® (tiotropium)

Inhaled Steroids - Inhaled steroids reduce and prevent swelling inside the airways. Common inhaled steroids include:

• Flovent® (fluticasone)
• Pulmicort® (budesonide)
• QVAR® (becolmethasone)
• Asmanex® (mometasone)
• Azmacort® (triamcinolone)
• Aerobid® (flunisolide)

Inhaled Steroid and Long-Acting Bronchodilator Combinations

Common combinations of inhaled steroid and long-acting bronchodilator include:

• Advair® (Flovent® and Serevent®)
• Symbicort® (Pulmicort® and Foradil®)

Airway Clearance Measures
If you produce a large amount of mucusyour health care provider may recommend techniques to help clear the mucus.

• Oscillating positive expiratory pressure devices (OPEPD): These include devices such as the Acapella® or the Flutter Valve® that help clear mucus from your lungs. These are small devices you exhale into.

• 

  Acapella® Valve

  High-frequency chest wall oscillation vests: These include The Vest™ and the SmartVest® and are inflatable vests that you put on. The vest shakes your chest to help dislodge the mucus from the airway walls. Sometimes the Acapella® or the Flutter Valve® is used after the inflatable vest. Once the mucus is dislodged, the Acapella® or the Flutter Valve® can help clear the mucus.
• Postural drainage and clapping use gravity to promote drainage of mucus from the lungs.

Each technique can be prescribed by your health care provider. Correct technique using these devices is very important.  Make sure a health care provider experienced in the use of the device shows you how to use it.  It is also important to have your technique checked periodically to make sure you continue to use it correctly to obtain the most benefit.

Treatment of Infections: 
If a specific infection, such as Pseudomonas aeruginosa, is found to be the cause of the bronchiectasis, then antibiotics are tailored to the underlying cause.  Rotating antibiotics are not encouraged because this promotes the development of drug-resistant organisms.  Therefore, your health care provider will prescribe an antibiotic based on your signs, symptoms and the results of appropriate sputum cultures.  For example, you may need an antibiotic only when you experience increased shortness of breath, cough, blood in the mucus or an increase in the amount and thickness of the mucus.

Treatment of co-morbid conditions such as gastroesophageal reflux and chronic sinusitis is important.

Pulmonary Rehabilitation:
Pulmonary rehabilitation may improve your overall health. A well-rounded rehabilitation program includes education, exercise and eating well and can help you stay healthy and feel good.

Resective Surgery
Resective surgery is occasionally indicated - usually only if bronchiectasis is very localized in the lung and medical treatment and other therapies are not effective.