Bronchiectasis - Treatments

Exercises to make your chest muscles stronger

There's some good evidence that exercising to strengthen your chest muscles can help you breathe more easily.

If you work on the muscles in your chest that help you to breathe in and out, the muscles get stronger. It's the same as exercising your arms and legs to make those muscles stronger.

To train your chest muscles, you breathe in through a device that makes your muscles work harder. You'll be shown how to use the device by a doctor, nurse or other health professional. You'll probably have to train 30 minutes a day, five days a week.

If you have bronchiectasis, making your chest muscles stronger may help you to breathe better.

We found one summary of the evidence about training the chest muscles (a systematic review). It included two studies which looked at 43 people in total.[1]

The studies showed that training the chest muscles for eight weeks:

• Helped people with bronchiectasis to walk further than they could before
• Improved their everyday lives
• Improved their breathing.

Nobody in the studies was harmed by training the chest muscles.

Taking antibiotics every day

If you have bronchiectasis, you're more likely to get chest infections. Chest infections need treatment with antibiotics. To read more, see Treating chest infections.

Some doctors have looked at whether it's better to take antibiotics every day, rather than just taking them when you get an infection. In the research, people took antibiotics every day for several weeks or months. Some people took them for as long as a year. People took their antibiotics as tablets or by breathing them in through an inhaler.

A review of the research looked at about 380 people with bronchiectasis.[2] It found that taking antibiotics every day helped, but only by a small amount.

In some studies, people kept a diary of their symptoms, which was then looked at by a doctor. In other studies, doctors checked on people to see how they were doing. People who took antibiotics were more likely to improve slightly. But antibiotics didn't help people's lungs work any better. And they didn't stop people having periods when their symptoms got worse.

One study looked at people who took antibiotics by breathing them in through an inhaler. People used their inhalers twice a day for six months.[3] People taking antibiotics were less likely to need to go to hospital. The people who did need to go to hospital didn't have to stay for as long.

The research found that antibiotics didn't cause many side effects. People who took antibiotics were no more likely to stop taking them because of side effects than people who took a dummy treatment (a placebo). The side effects you get may depend on which antibiotic you take and the way you take it. One study found that people who took antibiotics using an inhaler were more likely to get:[4]

• Difficulty breathing
• Wheezing
• Chest pain.

Physiotherapy to keep the airways clear

Many doctors recommend that you have physiotherapy and learn exercises to help you get rid of the mucus in your lungs. But we don't know how well this works. There isn't enough evidence to say.

You can learn exercises that will help you to cough up the mucus in your lungs more easily. There are different types of exercise. You'll probably see a physiotherapist to help decide the best type of exercise for you.

Some people find it helpful to blow out into a small device that helps them to loosen the mucus. Other people learn how to loosen the mucus by tapping their chest, or using gravity to help the mucus drain out of their chest.

If your child has bronchiectasis, a physiotherapist can show you how to help them to do this.

There hasn't been enough research to show which exercises are helpful, and good studies are needed. But doctors and physiotherapists usually recommend that you use these exercises. That's because they seem to be very helpful for some people. And they don't seem to cause any harmful effects.

Medicines to open up the airways

You can breathe in medicines with an inhaler to open up your airways, or you can take tablets. But we don't know if either of these will help you.

It may seem strange to take medicines to make your airways wider, when the problem with bronchiectasis is that your airways are already too wide. But bronchiectasis only affects small parts of the lungs. Some people with bronchiectasis also have asthma or chronic obstructive pulmonary disease (COPD). This can make airways in other parts of the lungs too narrow.[5] So taking medicines to open up the airways may help you breathe more easily.

There are several different types of medicine:

• Quick-relief inhalers, such as salbutamol (brand names Ventolin, Salamol, Easi-Breathe, Airomir) and terbutaline (Brycanyl). These work quickly when you inhale them and last for three to four hours.
• Long-acting inhalers, such as salmeterol (Serevent) and formoterol (Foradil, Oxis). These take 15 to 30 minutes to start working, but they last up to 12 hours.
• Ipratropium inhaler (Atrovent) or oxitropium inhaler (Oxivent). These work quickly and last for three to four hours.
• Tiotropium inhaler (Spiriva). This lasts at least 24 hours, so you only need to take it once a day.
• Theophylline tablets (Nuelin SA, Slo-Phyllin, Uniphyllin Continus). You can also get theophylline syrups and injections.

Doctors often prescribe these medicines to people with bronchiectasis. But we couldn't find any high-quality evidence that they are helpful. They are more often used for other lung conditions like asthma.

Medicines that open up the airways do have side effects:

• Quick-relief inhalers and long-acting inhalers can make your hands tremble, especially when you first use them. They may also make your heart beat abnormally.[6] [7]
• Ipratropium, oxitropium and tiotropium may give you a dry mouth. This happens to about 1 in 10 people who take them.[8] [9] [10] [11]
• Theophylline drugs can make you feel sick, give you headaches and give you diarrhoea. Some people also have fits and an abnormal heartbeat. You are more likely to get these side effects if you are older.[12]

Medicines to make your airways less inflamed

You can take medicines called corticosteroids to reduce the swelling in your airways. But we don't know if they will help you very much.

Corticosteroids are different from the drugs called anabolic steroids that some athletes and bodybuilders use. They act on the immune system and calm down inflammation in the body.

Corticosteroids come as:

• Inhaled steroids, such as beclometasone (brand names Beclazone, Qvar), budesonide (Pulmicort) and fluticasone (Flixotide)
• Steroid tablets, such as prednisolone.

There isn't much evidence to show whether these drugs are helpful if you have bronchiectasis. They're more often used for other lung diseases like asthma.

We found one study that looked at 86 people with bronchiectasis. The people in the study who were treated with the inhaled steroid fluticasone coughed up less mucus.[13]

But taking fluticasone didn't affect how well their lungs worked, or how often they had a worsening of their symptoms (an exacerbation).

Another study looked at the evidence from two small trials covering 54 people in total. It looked at the inhaled steroids beclometasone and fluticasone. But it didn't find that they had any effect on coughing, breathing or how much mucus people coughed up. The trials may have been too small to show any effect.[14]

We couldn't find any good quality evidence about taking steroid tablets if you have bronchiectasis.

Corticosteroids do have side effects.

• You may get a yeast infection in your mouth (thrush) if you use inhaled steroids. This happens to about 1 in 10 people.[15]
• Your bones may get weaker if you use corticosteroids for a long time. This is more likely to happen with steroid tablets.[16]
• You have more chance of getting a disease called diabetes if you take steroid tablets for a long time. Diabetes means you can't control the amount of sugar in your bloodstream.[17]

Medicines to break up your mucus or make it less sticky

You can take medicines to break up the mucus in your lungs, or make it less sticky. This may make it easier to cough up. But we don't know how helpful these medicines will be for you.

We've looked at the effectiveness of two types of medicine:

• Bromhexine
• Deoxyribonuclease (rhDNase), also called dornase alfa (Pulmozyme).

There isn't much evidence about either treatment.

We found one study which looked at people whose symptoms had suddenly got worse. Taking bromhexine three times a day for two weeks improved their coughing and reduced the amount of mucus they were bringing up.[18]

We also found two studies of dornase alfa.[18] They showed that taking dornase alfa didn't make much difference. It didn't help the lungs to work better or cut the number of chest infections people got. Some people got flu-like symptoms when they took dornase alfa.

Medicines to make your mucus thinner

You can inhale medicines to make the mucus in your lungs thinner and easier to cough up. But we don't know how well this works.

The most commonly used treatment is a type of salt water, called hypertonic saline. You inhale it through a machine called a nebuliser, which converts the liquid into a fine mist. When you breathe the mist into your lungs, it makes the airways produce more fluid. This dilutes the mucus and makes it thinner.

We couldn't find any evidence about using this type of treatment. But your doctor may suggest it if your mucus is very thick and you are finding it hard to cough it up.

An operation to remove damaged parts of your lung

If parts of your lung are very badly damaged, your surgeon may advise you to have an operation to remove the worst parts. But we don't know how well this operation works. Most people with bronchiectasis won't need this operation.

Your doctor is more likely to suggest surgery if you often cough up a lot of blood and find it very hard to breathe properly.

There haven't been any good studies into this treatment. That's because not many people are suitable for this type of operation. So we don't know how much benefit people get from surgery. It's usually recommended for people with severe damage to one part of their lungs. Surgeons don't advise it for people with bronchiectasis that has spread to large areas of their lungs.