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Bronchiectasis - Management
Basis for recommendation
Physiotherapy
- It is not possible, from the limited available evidence, to assess the effectiveness of physiotherapy for people with bronchiectasis.
- It is widely believed by experts that airway clearance techniques are an important component of managing bronchiectasis [British Thoracic Society, 2010].
Pulmonary rehabilitation
- UK Guidelines recommend a number of techniques; such as postural drainage and pelvic floor muscle training [Bott et al, 2009].
- Pulmonary rehabilitation is recommended in individuals with bronchiectasis who are breathless during activities of daily living; based on limited evidence summarized by the British Thoracic Society [British Thoracic Society, 2010].
- A Cochrane systematic review showed that inspiratory muscle training improved exercise endurance and health-related quality of life [Bradley et al, 2002].
- Further evidence was provided from a randomized controlled trial that compared exercise capacity in three groups of people. The first group received 8 weeks of a high intensity pulmonary rehabilitation programme with inspiratory muscle training; the second group received pulmonary rehabilitation with sham inspiratory muscle training; and a control group received no rehabilitation.
- There was a statistically significant improvement in exercise capacity in both groups receiving pulmonary rehabilitation.
- This improvement was maintained in the group receiving additional inspiratory muscle training but not in the group that received sham inspiratory muscle training.
Prophylactic antibiotics
- Limited evidence from studies of long-term antibiotics suggest small clinical benefits, and no benefit in terms of exacerbation rate or lung function.
- Information on who should receive long-term antibiotics are based on the expert opinion of the British Thoracic Society [British Thoracic Society, 2010].
Bronchodilators
- Information on the use of bronchodilators are based on the expert opinion of the British Thoracic Society [British Thoracic Society, 2010].
- It is unclear from the limited available evidence whether bronchodilators are beneficial in bronchiectasis.
Lung resection surgery
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