by Bronchiectasis is a chronic lung condition characterized by irreversible damage and dilation of the bronchial airways. Left untreated, it can cause recurrent infections, shortness of breath, coughing and other associated problems that greatly impact quality of life. While there is no cure for bronchiectasis, appropriate treatment and management with drugs can help control symptoms, prevent exacerbations and slow progression of the disease. Let’s take a closer look at some of the most commonly used bronchiectasis drugs.
Antibiotics
Antibiotics form the mainstay of treatment for bronchiectasis as they help control and prevent infection in the damaged airways. Recurrent infections are a hallmark of this condition and keeping them at bay is crucial for management.
– Oral Antibiotics: Drugs like amoxicillin, doxycycline and ciprofloxacin are generally prescribed for mild to moderate infections. They are usually taken for 2-4 weeks at a time.
– Intravenous Antibiotics: For severe acute exacerbations or when oral antibiotics have failed, intravenous formulations like ceftazidime and meropenem are given. These achieve higher drug levels directly in the bloodstream.
– Long-term Antibiotics: For patients with frequent infections despite oral antibiotics, inhaled or oral macrolide antibiotics like azithromycin are prescribed long-term on a cyclic basis to prevent future flare ups.
Mucolytic Agents
In Bronchiectasis, excess thick and sticky mucus blocks the airways, making it hard to clear out bacteria and debris. Mucolytic or mucus-thinning drugs help loosen and thin out the mucus, improving drainage.
– Dornase Alfa: This recombinant human deoxyribonuclease enzyme breaks down DNA in mucus, reducing its viscosity. It is administered via nebulization.
– Hypertonic Saline: A saline solution higher than normal saline helps hydrate airway secretions, improving its clearance. Used as a nebulized therapy.
– Carbocisteine: An expectorant drug that works by increasing mucus production from submucosal glands in the airways, thinning mucus and facilitating its removal.
Bronchodilators
Bronchoconstriction or narrowing of the bronchial tubes occur in bronchiectasis due to inflammation and excess mucus secretion. Bronchodilator drugs help reverse this bronchoconstriction and dilation of the airways for better airflow.
– Short-acting Beta-2 agonists: Quick relief from bronchoconstriction is provided by short-acting inhalers like salbutamol and terbutaline which work within minutes.
– Long-acting Beta-2 agonists: For round-the-clock protection, long-acting inhalers like salmeterol, formoterol and indacaterol are used which provide bronchodilation for 12 hours or more with single use.
– Anticholinergics: Inhaled tiotropium works through a different mechanism via anticholinergic action, providing 24-hour relief from symptoms.
– Theophylline: This oral bronchodilator works longer for maintenance therapy especially during exacerbations when other agents may not suffice. Requires monitoring of drug levels.
Anti-inflammatory Drugs
Persistent inflammation in bronchiectatic airways leads to structural damage over time. Controlling inflammation is therefore important. Oral and inhaled corticosteroids are used to this effect.
– Inhaled Corticosteroids: Budesonide, beclomethasone, fluticasone given via metered dose inhalers reduce airway inflammation. May be used long-term.
– Oral Corticosteroids: Short bursts of prednisone tablets are used during exacerbations when inflammation increases severely and other agents do not provide relief. Prolonged use requires monitoring for side effects.
– Macrolide Antibiotics: Azithromycin has intrinsic anti-inflammatory properties and can avoid need for regular steroids in selected non-cystic fibrosis bronchiectasis cases.
Surgery
In a minority of advanced bronchiectasis patients where medical therapy repeatedly fails or causes intolerable side effects, surgical options like bronchial artery embolization or lung transplantation may be considered on case by case basis after thorough evaluation.
Bronchiectasis is a lifelong condition but can definitely be managed well with the right treatment approach. Close follow-up under pulmonology guidance and adherence to prescribed drug regimens tailored for each individual case helps control symptoms and associated complications satisfactorily for many patients leading to an acceptable quality of life.
