February 5, 2018

Bronchiectasis: Mucus clearance techniques

Dr Lucy Burr, Director of Respiratory, Cystic Fibrosis and Sleep Medicine, Mater Health Services, Brisbane

Bronchiectasis is characterised by chronic infection in the small airways, allowing infected mucus to build up causing parts of the lungs to be damaged. This damage results in airway dilatation and increased mucus production leading to a chronic daily cough. Increased mucus means people with bronchiectasis are more likely to be affected by recurrent airway infection and frequent exacerbations (or flare up of symptoms) which often require antibiotics.

The key to treatment and therapy for bronchiectasis is to ensure good general health including a balanced diet, stopping smoking and a particular focus on regular cardiovascular exercise.

One of the most important factors in both controlling symptoms and reducing the opportunity for bacterial infection is keeping the chest free of mucus. Chest clearance can take many forms and many people have no trouble coughing up the mucus and find it easy to clear their lungs in the shower, or whilst out walking. Others find it a little harder and need to utilise a few specialised techniques.

Active Cycle of Breathing (ACBT) is a method used where cycles of controlled breathing are interspersed with deep breathing and huffing. Added to this can be Positive Expiratory Pressure (PEP) where breathing cycles are added to by breathing out against resistance. There are several types of devices that can help with this, find out more from your health professional. Combining these two techniques can help shift the distal mucus that can be difficult to cough up.

There are a few medications that may be useful for people with bronchiectasis, however their use depends to some degree on what bacteria are growing in the lungs. Macrolide antibiotics have been shown to reduce mucus secretion and exacerbations in patients who still have exacerbations despite optimal clearance and exercise. Patients with the Pseudomonas aeruginosa bacteria seem particularly responsive to macrolide, however care must be taken if using these medications when there is co-infection with non-tuberculous mycobacteria (NTM). Other forms of medical treatment may include nebulised antibiotics and nebulised saline to help break up sticky mucus.

For more information, contact Lung Foundation Australia.

Bronchiectasis Action Plan

It is important to understand your bronchiectasis and develop an action plan with your doctor. This should include your symptoms and management strategies for when you are well and for when your symptoms deteriorate. To download the Action Plan, visit: http://bronchiectasis.com.au/wp-content/uploads/2015/09/Bronchiectasis-Action-Plan.pdf or contact us.