Opinion
Video
Current Treatment Options For Bronchiectasis
Dr Metersky provides an overview of current treatment strategies for managing patients diagnosed with bronchiectasis.
This is a video synopsis/summary of an Insights involving Mark Metersky, MD, FCCP, on the diagnosis of bronchiectasis.
The main bronchiectasis management goals are improving quality of life, decreasing cough/sputum burden, reducing exacerbation frequency, and preventing complications like hemoptysis and respiratory failure. Regimens are highly patient-specific depending on disease severity. Patients with mild symptoms may only require airway clearance without extensive treatment burden.
For mild disease, starting with nonpharmacological airway clearance devices alone often helps control symptoms. Handheld oscillatory positive expiratory pressure devices facilitate mucus clearance by loosening and sheer forces during forced exhalation maneuvers. Some patients improve on this alone without progression. If more intensive therapy is warranted/desired, adding inhaled hypertonic saline prior to airway clearance sessions can hydrate airways, further enhancing mucus clearance.
For frequent exacerbators, adding chronic low-dose macrolide antibiotic therapy reduces exacerbations by anti-inflammatory effects. Screening for nontuberculous mycobacterial infection beforehand is mandatory to prevent inducing resistance. Inhaled antibiotics help for chronic gram-negative infections, improving bacterial clearance.
For newly detected Pseudomonas infection, attempting eradication therapy is supported. This entails intensive combination inhaled and oral antibiotic treatment, aiming to definitively clear the organism and prevent chronic infection, which portends worse outcomes. Though evidence quality is modest, eradication can succeed in delaying chronic infection a year or more.
In summary, bronchiectasis management is highly personalized based on disease severity and exacerbation frequency. Mainstays are airway clearance and treating exacerbations. Chronic macrolide therapy, inhaled antibiotics, and attempting Pseudomonas eradication provide further specialized options for more difficult cases.
Video synopsis is AI-generated and reviewed by AJMC editorial staff.
