Cardiothoracic Services (Heart and Lung)

Bronchiectasis - adult

Introduction

Bronchiectasis is caused by an abnormal widening of one or more airways in the lungs, and can occur for a number of reasons. Problems are caused when extra mucus develops in the abnormal airways, making them prone to infection (infections are often caused by bacteria (germs)).

This page gives you information about the treatment you may be prescribed if you suffer from bronchiectasis.

You can find out more about the bronchiectasis service we provide.

You can also download and print a PDF document of our Brochiectasis top tips.


Treatment targets

The aims of management of bronchiectasis are to reduce the symptoms, reduce the severity and frequency of flare ups, to preserve lung function and improve health-related quality of life.

We believe that there are three main components to bronchiectasis, and that these drive each other. All three components have treatment options, which are:

  • Infections
  • Airway inflammation
  • Mucous Retention

It is important that we treat all three components to maximise the chances of improving health. We will do this in partnership with the patient to support a holistic (whole body) approach to care.

Flare-ups

Bronchiectasis patients may experience flare-ups, which occur when a chest infection happens. This may be associated with the following symptoms for more than 48 hours:

  • You feel unwell
  • You are coughing more sputum
  • There is a change in sputum colour
  • You have chest pain breathing-in for more than 48 hours.

What should I do?

If you are having a flare-up, you should:

  • Send a sputum sample to GP or hospital
  • Start emergency pack of antibiotics for 14 days
  • Let your GP know you’re unwell if you haven’t already.

Physiotherapy

Our physiotherapy staff will show you how to move mucus or phlegm from your chest to help you breathe more easily.

Pulmonary rehabilitation

Pulmonary rehabilitation (PR) is a structured programme of exercise and education for people with chronic chest conditions, including Bronchiectasis.

PR is designed to improve your level of fitness and quality of life, and can help you learn to cope, and live with your condition.

We have two PR centres: one at the Freeman Hospital and another at the RVI (please note, these links open up PDF documents which may take a little while to download).

Pulmonary rehab is the best treatment for breathlessness - it is recommended in national bronchiectasis guidelines.

Chest physiotherapy to aid mucus clearance

Active Cycle of Breathing Techniques (ACBT) is a breathing technique taught by physiotherapists to help patients manage their own condition by:

  • loosening and clearing secretions
  • improving ventilation in the lungs
  • improving the efficiency of your cough

Nutrition

If you have bronchiectasis, you need to be aware that your lifestyle, including your diet can affect your health. Eating a good diet can help your body fight infections, or reduce the risk of infections.

You may be surprised to learn that food affects your breathing. Food is the fuel used by your body for all of its activities including breathing. The process of changing food to fuel (or energy) is part of a process called metabolism.

Oxygen and food are the raw materials of this process, and energy and carbon dioxide are the end products. Carbon dioxide is the waste product and is exhaled by your lungs. Your body uses this energy for all of its functions. The right mix of nutrients in your diet can help you breathe easier. Carbohydrates, protein and fat all provide energy.

Carbohydrates are the major source of energy for the body. These include sugary foods eg cakes, sweets and starchy foods (eg bread, potatoes, rice, pasta and cereals).

Protein foods include meat, fish, eggs, cheese, milk, nuts and beans. Muscle and other body tissues are composed of protein. There is evidence to suggest the need for protein increases with age. To help maintain strong respiratory muscle, you should have a good source of protein at least twice a day.

Fat is a concentrated source of energy. Sources include butter, margarine, and vegetable oils.  Metabolism of fat provides the least carbon dioxide (waste product). If you are trying to gain weight, you should include more high fat foods in your diet. 

Weight

You should get into the habit of checking your weight and observing any changes to your weight.

Overweight

If you become overweight, your heart and lungs have to work harder, to supply oxygen to your body.

Losing weight through a healthy diet and exercise will make breathing easier. You should try to reduce portion sizes, cut down on snacking and reduce intake of foods high in sugar and fat content.

Underweight

You may find that you are losing weight without trying.

Your breathing may be using more calories compared to a healthy person. Infections also increase your body’s energy requirements.

You may also find that you lose your appetite. If you are more breathless, this in turn can make eating more difficult. You should try to eat four to six small nutrient dense meals a day. Try nibbling on high calorie snacks throughout the day.

It is important that you prevent becoming underweight as this will lead to a loss of muscle mass and the muscles may become weakened. If your body is well nourished, it is more able to fight infection.  If you have a flare up it may help you respond better to treatment.

Nutritional supplements

You may find it difficult to meet your calorie (energy) needs from the food you are eating. You may find that you tire easily and cooking and eating becomes more difficult.

Your Dietitian may recommend special nutritional products that provide extra calories and nutrients. These should be take in addition to the food you are eating.

Fluids

It is important to keep secretions in your lungs thin and easy to cough up. If you don’t drink enough fluids, your secretions may become thick and sticky and may increase your risk of an infection.

You should have at least 8 cups of non-alcoholic fluid per day. Limit your alcohol intake as alcohol causes dehydration. If you feel too full to drink fluids with meals, then only take small amounts of fluid with your food. Try instead to drink an hour after eating. 

A dietitian can discuss any concerns you may have with your diet, and give you more detailed advice.

Antibiotics

Antibiotics are a group of drugs that fight bacterial infections. You will need an antibiotic if you have worsening symptoms, with increased sputum and or a change in colour (eg darker).

It is important to take a sputum sample to your GP when you first notice a change in your symptoms so that you can begin taking antibiotics straightaway. This will make sure you are getting the correct antibiotic to treat the bacteria that are growing in your lungs. Over a period of time your sputum results may show your doctor which antibiotics you have needed in the past and this treatment can be started immediately.

This is very important in preventing delay in your treatment and may avoid a flare-up.

When you have a flare-up you will be prescribed a course of antibiotics. It is important to be aware the national guidelines recommend this should be for 14 days. Sometimes you may need antibiotics for a longer period.

There are different ways to take antibiotics:

  • Orally as tablets or liquids
  • Intra-venously (IV) through a vein
  • Nebulised: inhaled in a fine mist using a special machine called a nebuliser

All drugs can cause side effects and antibiotics are no exception. There is always information about potential side effects in the leaflet accompanying the antibiotics. If you are worried about side effects, talk it over with your health care professional

Oral antibiotics

Oral antibiotics can be in the form of tablets or liquids. These should be taken as recommended by the chemist on the label (eg with or without food or with milk) and you should always take the full course of your antibiotics as prescribed. If you feel you are not improving by the third or fourth day or you are feeling worse, do not stop taking your antibiotics but contact your doctor. If you have submitted a sputum tests the results might be ready and it might be necessary to change to a different antibiotic.

Intravenous (IV) antibiotics

You may need IV antibiotics if you are very unwell during a flare-up or if your infection does not respond, or is resistant, to oral antibiotics.

Depending on your individual situation there are different ways IV antibiotics can be given, and you may need a stay in hospital to receive IV antibiotics. There are three ways of receiving IV antibiotics:

  • Cannula: This involves a cannula (a small tube) being inserted into a vein (usually in your arm). The antibiotics are given directly into the cannula.
  • Midline catheter: A midline catheter is a very fine/thin intravenous tube - about 20cm long - that is inserted into a vein in the inside of the elbow and extends into the vein of the upper arm. The benefit of a midline is that it can stay in the arm for the duration of the treatment (ie 14 days), which will preserve other veins, and removes the need for replacing cannula every three days.
  • Implanted port (Portacath): A small device which is inserted under the skin, with a catheter attached which connects the port (opening) to a vein. The port has a septum (seal) through which the antibiotics are injected. The port is inserted in theatre under a local or general anaesthetic. To access the port, a needle with a line attached is pushed into the port and secured with a dressing. This is removed when the treatment is finished. The port can stay in place for many years and is suitable for patients who are on very regular antibiotics.

You may be able to have IV antibiotics at home (home IV therapy), and you or a family member can be trained to administer your IV antibiotics. This is very popular with patients as it means they can return home early and avoids lengthy hospital admissions, improving their quality of life. We would have to ensure that you had the right training to be safe to do this. We also give you some written instructions on home IV therapy (please note, this links to a PDF document which may take some time to download). 

We provide patients with a personalised guide to antibiotics. We provide these to patients on request.

Nebulised (inhaled antibiotics)

Nebulised antibiotics involves taking a solution of antibiotics and turning it into a very fine mist that can be breathed in. Nebulised antibiotics are a ‘maintenance’ treatment and are meant to reduce the number of flare-ups per year. They are not intended to treat individual flare-ups and don’t replace oral or IV antibiotics needed for flare-ups.

Nebulised treatment may be recommended by a respiratory specialist if you are having three or more chest infections which require antibiotics in any one year. We will use nebulised antibiotics to try and improve your symptoms and reduce the frequency of chest infections.

Patient guides

You can read our patient guides and watch videos about the use of nebulised antibiotics (please note, these links open PDF documents):

Other nebulised treatments

Inhaled hypertonic saline is a strong salty water solution which is inhaled and can make your phlegm easier to cough up and may reduce symptoms and infections:

Inhaler guides

There is a range of online advice to help you use your inhaler to treat bronhciectasis more effectively:

Problems with continence

We know that up to half of the patients attending our service can have some problems with urinary incontinence - many people describe ‘leaking’ particularly when they cough. This can have a negative impact on their quality of life, particularly if they feel that they cannot cough and clear their chest because of this problem.

Please speak to your health care professional about this. Alternatively you can ask your GP or contact the community continence service.

Contacts

You can get more information about our bronchiectasis service by contacting:

  • Dr A De Soyza, Consultant Respiratory Physician, tel: 0191 213 7468
  • John Davison, Specialist Nurse - Complex Lung Disease, tel: 0191 213 9114; email: john.davison2@nuth.nhs.uk 
  • Helen Groves, Advice and Support for nebulised treatments, tel 0191 213 8729
  • Jacqueline Smith, Patient Pharmacy Support, tel: 0191 244 8937
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