Treatment of Bronchiectasis and Nontuberculous Mycobacterial Lung Disease

The treatment goals for people with bronchiectasis and/or nontuberculous mycobacterial lung disease (NTM lung disease) are similar. The goals for both conditions are to reduce exacerbations (x saa cer bay shuns) or flare-ups. This is done by keeping the airways clear of mucus and maintaining lung function which will improve patients’ quality of life.¹ People with NTM lung disease can develop bronchiectasis because of the repeated infections which can cause permanent inflammation and scarring of the airways. Likewise, people with bronchiectasis are at risk of getting infections like NTM and Pseudomonas Aeruginosa, (soo-duh-mo-nuhs air-o-gin-osa) as well as many other lung infections.

Treatment plans for these two conditions will vary because of:

• symptom burden
• how often exacerbations or flare-ups occur
• specific germ(s) (or history of in sputum or spit
• lung function
• having another respiratory condition (e.g., chronic obstructive pulmonary disease (COPD), asthma etc.)
• disease problems (e.g., weak immune system, weight loss, fatigue).¹

Specific treatment plans will vary by patient. However, there are some ideas about how to manage the disease that are useful to all patients. These ideas or guidelines are useful to patients who have bronchiectasis, NTM lung disease or both. These disease guidelines include:

• being educated about your disease(s), including how to recognize an exacerbation or flare-up;
• knowing how to cough up mucus and clear your airways.
• watching for changes in the color, amount, and feel of your spit or sputum. (Your doctor may order sputum cultures;
• getting the flu and pneumonia vaccines each year;
• doing daily or routine exercise (If you feel breathless, consider pulmonary rehabilitation);
• stopping smoking.¹

Based on your specific medical history and needs, your doctor will put together a plan that may or may not include the following:

Antibiotics – Antibiotics (anty bye ahh ticks) are a group of drugs that fight infections. These drugs are the main treatment for lung infections caused by bronchiectasis.² Some antibiotics are used to target specific germs. Others are used to target many types of germs. In some cases, for the treatment of an active, hard-to-treat infection, your doctor may need to prescribe single or multiple oral and / or IV (intravenous) antibiotics.² Your doctor may ask you to collect a sputum sample. This sample will be tested to help know which drug is best for treating the germ(s) in your lungs.

Mucus-thinning Medicines – Clearing mucus from your lungs is one of the most important parts of a treatment plan for bronchiectasis and NTM lung disease.³ Your doctor may prescribe for you drugs that help to thin your mucus. This will make it easier to cough up sputum that is in the airways of your lungs. These drugs, along with drinking lots of water, can be a helpful way to reduce mucus pooling. This will reduce the chance of an exacerbation. For more information on drugs for clearing the airways, click here.

Airway clearance – There are non-medicine therapies that help those with bronchiectasis and NTM to clear mucus from the airways. Techniques for clearing the lungs airways are tailored to the individual patient with the help of a lung specialist. These techniques may vary from person to person. Deciding which method to used is based on the how much mucus is pooling in the lungs, how well you can tolerate the therapy, and how useful the therapy is for you. To learn more about the ways to clear your airways and the devices that can help, click here. Not all methods will work for everyone. So, each person must work with their doctor and health care team to decide what is best for them.

Bronchodilators – There is limited proof that the drugs called bronchodilators (brawn-coe die lay tores) will improve symptoms for patients with bronchiectasis and NTM lung disease. However, if you have shortness of breath, your doctor may prescribe a short-acting and long-acting bronchodilator to lessen the shortness of breath.¹ These drugs may, in some cases, help with the clearing of mucus. For more information on how to take these types of inhaled drugs, click here.

Surgery – Your doctor may suggestremoving a part of your lung if your disease is in just in one part of the lungs and your symptoms are not getting better.¹ Removing the affected area of the lungs can result in a significant decrease of bronchiectasis symptoms and an improved quality of life.^1,4

Pulmonary Rehabilitation (pulmonary rehab) –If you have shortness of breath that keeps you from doing your normal daily activities or is affecting your quality of life, you may want to consider pulmonary rehab.⁵ Pulmonary rehab includes exercise, education, and support from trained health care professionals. To learn more about pulmonary rehab and how it can help you, click here.

Anti-inflammatory medicines – Inhaled and oral corticosteroids (core ti coe stair royds) are not usually prescribed to patients with bronchiectasis or NTM lung. However, these drugs may be given to you if you also asthma or COPD or conditions like allergic bronchopulmonary aspergillosis (ABPA). These conditions all respond well to corticosteroids. There is no proof that these drugs help lung function or reduce the number of exacerbations or flare-ups in patients with bronchiectasis and NTM lung disease.¹ There are drugs, such as macrolides (maa crow liedz) that may help with bronchiectasis because they help reduce inflammation. Azithromycin (uh zi throw my sin) is an example of this type of drug. Before taking this type of drug, you would need your lung disease doctor would need to decide if it were the right drug for you and would create drug-resistant lung infections.

References:

¹Chalmers JD, Sethi S. Raising awareness of bronchiectasis in primary care: overview of diagnosis and management strategies in adults. NPJ Prim Care Respir Med. 2017;27(1):18. doi: https://doi.org/10.1038/s41533-017-0019-9
²National Heart, Lung, and Blood Institute (NHLBI). Bronchiectasis. NHLBI website. Accessed June 9, 2021. https://www.nhlbi.nih.gov/health-topics/bronchiectasis.
³Lesan A, Lamle AE. Short review on the diagnosis and treatment of bronchiectasis. Med Pharm Rep. 2019;92(2):111-116. doi: https://doi.org/10.15386/cjmed-1060
⁴Coutinho D, Fernandes P, Guerra M, Miranda J, Vouga L. Surgical treatment of bronchiectasis: a review of 20 years of experience. Rev Port Pneumol. 2016 ;22(2):82-85. doi: https://doi.org/10.1016/j.rppnen.2015.09.007.
⁵Pasteur M, Bilton D, Hill A, et al. British Thoracic Society guidelines for non-CF bronchiectasis. Thorax. 2010;65:i1–i58. doi: https://doi.org/10.1136/thx.2010.136119.