Specialist care

What to expect and how to access

Treatment of bronchiectasis is best provided by a team of doctors and other healthcare professionals that are experienced in caring for bronchiectasis.

In many countries there are now specialised clinics which are dedicated to people with bronchiectasis. These clinics will all be slightly different but will include:

  • A doctor, or team of doctors, with a specialist interest and experience in bronchiectasis
  • A physiotherapist, or team of physiotherapists, that can teach chest clearance exercises
  • Nurses or other healthcare professionals that can provide education and support
  • Services to provide inhaled/nebulised antibiotics, other specialised medications and intravenous antibiotics at home.
  • Specialised tests of the immune system or body functions to diagnose the cause of bronchiectasis

Some people with bronchiectasis will regularly attend specialist clinics, while some might be seen in the specialist clinic once, or on a few occasions, and then be transferred back to the care of their regular doctor.

If you think you need to see a specialist, please discuss this with your doctor. There is no directory of bronchiectasis specialists across Europe, but if you have difficulty finding an appropriate specialist please contact European Lung Foundation.

What to expect from your specialist care

Bronchiectasis Patient Checklist

The Bronchiectasis Patient Checklist is based on the European Bronchiectasis Guidelines 2017 and reflect what most patients with bronchiectasis should expect from their care according to these guidelines. Ask your specialist, doctor or nurse to go through the checklist. You can keep track of each recommendation by ticking it off the passport. Find your language below (more languages coming soon):

What are we trying to achieve with treatment?

With good treatment, it is possible for patients with bronchiectasis to remain stable for many years and to have good control of their symptoms. Treatment of bronchiectasis should aim to maximise quality of life, reduce symptoms, prevent exacerbations and prevent any further lung damage from occurring.

The disease progresses through what is called a 'vicious cycle' of infection, inflammation and lung damage. Infections cause the lungs to become inflamed and the inflammation damages the lung. More lung damage makes you more susceptible to infection. We can tackle all three aspects of the cycle as shown in the diagram:

Using inhalers for treatment

What is an inhaler?

Inhalers allow drugs to be delivered directly to your lungs. There are different types including dry powder inhalers (DPI's) and aerosol metered dose inhalers (MDI's).

Inhalers can be divided into those that are designed to give quick relief for symptoms (relievers) and those designed to give a longer lasting relief or prevention of symptoms.

Reliever inhalers open up the lungs to allow more air in and out by relaxing muscles in the lungs. They are best for helping with breathlessness.

Antibiotic treatment

What are antibiotics?

Antibiotics are a group of drugs that fight bacterial infection. They can be given by mouth (oral) as tablets or liquid, or by injection (intravenous, which means directly into the vein). Some antibiotics can be put into a nebuliser (see image) to be taken regularly (inhaled). Different antibiotics work against different bacteria, but many work against multiple bacteria.

Common oral antibiotics that are used in treating bronchiectasis include:

  • Penicillins: these include penicillin, amoxicillin and coamoxiclav
  • Macrolide antibiotics: these include clarithromycin, erythromycin and azithromycin
  • Doxycycline: this is another type of antibiotic taken once a day
  • Quinolones: these include ciprofloxacin, levofloxacin and moxifloxacin

Clearing mucus from the lungs

Things that help with this

Bronchiectasis leads to a build up of mucus which can make infections more likely and also causes worsening symptoms of cough and breathlessness. It is therefore essential that you learn to clear mucus from the airways effectively. This is done by:

  • Performing airway clearance exercises: see What you can do for advice about airway clearance exercises including video demonstrations.
  • Taking medication to help clear the lungs (mucoactive drugs): Some medications are given by a nebuliser or might be given by an inhaler or tablet and are designed to help the mucus come up more easily. For example, inhaling salt water (saline) helps to hydrate mucus making it less thick and therefore easier to cough up. Other drugs which try to do similar things include mannitol (given via an inhaler) and carbocisteine (which is taken as tablets).

These medications should be combined with regular physiotherapy exercises for the best effect.

Drugs in development

Our Drugs in development page has information on clinical trial phases, drugs currently in development and how you can get involved.

Other types of medical treatment