MANAGEMENT OF BRONCHIECTASIS

Bronchiectasis_NHLBI

Principles of Treatment

The anatomical picture makes very little difference to the treatment of the disease.

• Relieve the obstruction before permanent damage occurs (recognition of either localised obstruction or appropriate treatment for whooping cough or measles).
• Control infection. Antibiotics are given prophylactically in all but very mild cases. The dosage of the antibiotics should be altered if an acute infection occurs. Intravenous treatment is indicated for severe infections (Currie 1997). Inhaled (delivered by a nebuliser) or continuous oral therapy may be used for chronic sepsis and more resistant pathogens (e.g. Staph. aureus and P. aeruginosa).
• Promote good health with a good diet and fresh air.
• Maintain and improve exercise tolerance as some patients with bronchiectasis become deconditioned owing to fatigue and shortness of breath.
• Inhaled steroids may be used in order to reduce inflammation and reduce the volume of sputum
produced (Elborn et al. 1992).
• Surgery to remove the area of affected lung may be indicated in young patients with localised disease, although there is conflicting evidence regarding the efficacy of surgery when compared to conservative treatment (Corless and Warburton 2000).

Physiotherapy Aims of treatment

The principal aims of physiotherapy in bronchiectasis
are:
• to remove secretions and clear lung fields
• to teach an appropriate sputum clearance regimen
• to educate the patient in the pathology and management of the condition
• to promote good general health and maintain or improve exercise tolerance
• to teach the patient how to fit in home treatment within his or her lifestyle.

Clearing secretions

Postural drainage may be indicated, if tolerated for patients with excessive bronchial secretions. The position must be accurate for the areas of lung affected. Accuracy is judged by production of sputum and by identification of the affected areas on a chest radiograph. This minimises the danger of secretion overspill into the least affected side, which could cause spread of the disease or pneumonia. Percussion, shaking and vibrations with the active cycle of breathing technique (ACBT) are also necessary and must be accurately applied over the affected area of the lungs.
The patient may be taught the forced expiration technique (FET). A flutter or positive expiratory pressure (PEP) valve may be used to facilitate the move ment of peripheral mucus plugs and pus into the trachea from where they are cleared by coughing. The patient must perform a combination of these treatments 2-3 times daily. It is important to ensure that the patient has disposable sputum pots and polythene or paper bags to dispose of the infected sputum without the risk of reinfection or endangering other members of the family. Should the patient develop a cold or influenza, antibiotics must be readily available together with physiotherapy so that infection and secretions can be cleared promptly.

Maintaining exercise tolerance

Mobility of the thorax, good posture and good general health are achieved by the patient performing a daily exercise programme. This comprises general deep breathing, attention to maintaining a good posture and some aerobic exercise such as brisk walking. The patient may also attend a pulmonary rehabilitation programme if exercise intolerance is impairing mobility and quality of life. The patient should also be encouraged to partake in sports, such as jogging, walk ng, cycling, tennis or swimming.

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