# Treatment options for bronchiectasis
Treatment of bronchiectasis focuses on combating infections, clearing mucus from the airways, and slowing lung damage. Because it is often a long-term condition, daily self-care plays an important role alongside medical treatment. The approach differs per person, depending on the severity, which bacteria are present, and the underlying cause.
Daily airway clearance
**Inhalation of salt water (hypertonic saline)**
ProveniIncluded in official guidelines, or approved by EMA or FDA
This is a basic component of daily care. A nebulizer mists concentrated salt water into the airways, which makes mucus thinner and looser so it can be coughed up more easily. Studies, including the CLEAR trial (2026), show that regular inhalation helps reduce mucus loss and stabilize lung function.
The treatment works in two ways: the salt draws moisture into the mucus, and the mist itself irritates the airways to clean themselves better. Side effects are rare and mild (brief coughing or mild rattling sounds during inhalation).
**Physiotherapy and drainage techniques**
ProveniIncluded in official guidelines, or approved by EMA or FDA
A physiotherapist teaches the patient exercises to loosen mucus and cough it up. This can involve hand or mechanical percussion (chest clapping), breathing techniques, or use of an oscillatory positive expiratory pressure device (so-called 'flutter valve'). Regular practice helps prevent infections and maintain better lung function.
Side effects rarely occur, although some may experience fatigue or mild dizziness with certain positions.
**Mucolytics (mucus-thinning agents)**
ResearchediPositive results in clinical studies, not yet standard treatment
These are inhaled medications that chemically break down mucus so it becomes thinner. They are used alongside salt inhalation, especially if the mucus is very thick and sticky. Positive study associations suggest an additional benefit, but more research into optimal dosing is ongoing.
Side effects can include bronchospasm (brief narrowing of the airways) or cough irritation.
Infection control
**Long-term inhaled antibiotic therapy**
ProveniIncluded in official guidelines, or approved by EMA or FDA
When certain bacteria (especially *Pseudomonas aeruginosa*) establish themselves in the airways, antibiotics are inhaled directly. This delivers high concentrations of the medication directly to the site, with less effect on the rest of the body. This treatment usually continues for months to years to keep the bacteria under control and prevent infections.
Side effects can include cough irritation, bronchospasm, or rarely ear pain. Regular monitoring tests check whether the bacteria are becoming resistant.
**Antibiotics for acute infections**
ProveniIncluded in official guidelines, or approved by EMA or FDA
When an acute infection develops (more mucus, worse cough, fever), the doctor usually prescribes antibiotics that last several weeks. Which antibiotic depends on which bacteria were cultured from the mucus.
Side effects vary by medication and are discussed by the doctor.
**Monitoring for *Pseudomonas* and other bacteria**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Regular sputum cultures help determine which bacteria are present. This determines which antibiotics are most suitable. Recent research (2026) points to more accurate rapid testing methods to detect *Pseudomonas* colonization.
Anti-inflammatory agents and bronchodilators
**Inhaled beta-2 agonists**
ProveniIncluded in official guidelines, or approved by EMA or FDA
These medications relax the muscles around the airways, making them wider and breathing easier. They are usually used before physiotherapy or inhalation with salt solution, so both can work better.
Side effects are usually mild: slight tremors, heart palpitations, or nervousness.
**Inhaled corticosteroids**
ProveniIncluded in official guidelines, or approved by EMA or FDA
These reduce inflammation in the airways. They are particularly prescribed when there is excessive mucus production or when asthma symptoms are present. Because they are inhaled, they work very specifically on the lungs.
Side effects are rare; rinsing the mouth after use prevents thrush.
**Macrolide antibiotics in low doses**
ResearchediPositive results in clinical studies, not yet standard treatment
Certain antibiotics (from the macrolide family) also have anti-inflammatory properties, apart from their antibacterial effect. They are given in low doses for prolonged periods to suppress chronic inflammation.
Side effects can include stomach upset, nausea or change in taste. Long-term use requires regular heart rhythm monitoring.
Experimental Treatments Under Investigation
**Dual-receptor agonists and neutrophil elastase inhibitors**
ExperimentaliOngoing in study setting, outcome still unknown
Various substances are being tested in clinical studies (phase II) to see if they better regulate mucus production or further reduce inflammation. These include ensifentrine, BI 1291583 and GDC-6988. These act on different targets in lung cells than current standard treatments.
To date, they are only available through study participation; effectiveness and side effects are still being determined.
**Inhaled AZD0292 for *Pseudomonas* infection**
ExperimentaliOngoing in study setting, outcome still unknown
This is a targeted antibiotic that is inhaled, specially designed for *Pseudomonas* in non-cystic fibrosis bronchiectasis. It is in clinical trials (2026).
Treatment of underlying causes
**Treatment of immunodeficiencies**
ProveniIncluded in official guidelines, or approved by EMA or FDA
When an underlying immune disorder is identified (for example, common variable immunodeficiency), immunoglobulin replacement can help prevent infections.
**Treatment of allergic reactions**
ProveniIncluded in official guidelines, or approved by EMA or FDA
If allergic bronchopulmonary aspergillosis (infection with *Aspergillus*) is present, corticosteroids and sometimes antifungal agents are given.
**Surgical procedures**
ProveniIncluded in official guidelines, or approved by EMA or FDA
In very severe cases, where one part of the lung is heavily affected and repeatedly causes infections, surgical removal of that lung segment may be considered. This happens only rarely and only after careful consideration.
Supportive measures
**Preventing infection**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Regular hand washing, keeping distance from people with flu or colds, and vaccination against influenza and pneumococci are standard. For some, annual flu vaccination is recommended.
**Physical activity and rehabilitation**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Physiotherapy and gradual muscle exercises improve exercise capacity and psychological well-being. Recent research (2026) shows that psychological factors and physical fitness play important roles in quality of life.
**Improving sleep quality**
ResearchediPositive results in clinical studies, not yet standard treatment
Sleep apnea and sleep disturbance occur more frequently in bronchiectasis and worsen symptoms. Research (2026) suggests that attention to sleep and possibly respiratory support at night for certain patients may be beneficial.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._