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Treatment of Bronchiectasis

 Identify and treat underlying causes.
 Airway clearance techniques typically performed 1-2 times daily for
20-30 minutes and may include:
 Postural drainage.
 Forced expiration technique.
 Positive expiratory pressure device.
 Addition of noninvasive ventilation or intermittent positive pressure
breathing.
 Offer manual chest percussion airway clearance techniques to patients
having acute exacerbations or if patient is very fatigued.
 Airway oscillatory device might improve quality of life in adults with
bronchiectasis.
 Antibiotics may be indicated for adults and children with
exacerbations and acute deterioration with worsening local
symptoms and/or systemic systems:
 Obtain sputum sample prior to starting antibiotics.
 Selected dosing for first-line treatment in adults includes for patients
with no previous bacteriology available:
 Amoxicillin 500 mg twice daily for 14 days.
 Clarithromycin 500 mg twice daily for 14 days for patients allergic to
penicillin.
 Pathogen-specific antibiotic regimens vary for adults and children.
 Prolonged use of antibiotics associated with improved response rates
in patients with bronchiectasis.
 Use of macrolides for ≥ 2 months decreases risk of exacerbations in
adults with noncystic fibrosis bronchiectasis and may decrease risk in
children.
 Long-term oral or nebulized antibiotics may be necessary for patients
having recurrent exacerbations
 Offer pulmonary rehabilitation to patients with breathlessness
affecting quality of life.
 Inspiratory muscle training may improve exercise capacity and quality of
life in patients with bronchiectasis.
 Pulmonary rehabilitation plus inspiratory muscle training associated with
improved exercise tolerance in patients with idiopathic bronchiectasis.
 Noninvasive ventilation may be considered for patients with
chronic respiratory failure to improve quality of life and reduce
number of hospitalizations.
 Surgical options include
 Lung resection in patients with localized disease and symptoms
refractory to medical treatment
 Bronchial artery embolization or surgery for patients with massive
hemoptysis.