Airway clearance for bronchiectasis

The NHS says a specialist physiotherapist will teach you breathing techniques for clearing phlegm from the lungs and airways, and that you will usually need to do these exercises every day. This helps to control your cough and reduce the risk of chest infections.

Asthma + Lung UK says benefits of airway clearance include reduced breathlessness, fewer flare-ups and lower infection risk. It is used in bronchiectasis, COPD with phlegm and cystic fibrosis.

The active cycle of breathing technique, or ACBT, is a three-stage method of relaxed breathing control, deep breathing and huffing, according to Asthma + Lung UK. Between stages you rest with relaxed breathing so that you do not tire or wheeze.

Asthma + Lung UK explains that a huff is a big breath out through an open mouth instead of a forceful cough. A long huff follows a small-to-medium breath in and a slow squeeze out, like misting up a mirror, whereas a short huff follows a big deep breath in through the nose and a quick breath out.

Asthma + Lung UK describes postural drainage as using changes of position to help phlegm move. Your physiotherapist will check that positions are safe for you, particularly if you have reflux or heart problems.

Hand-held oscillating positive expiratory pressure devices, such as Aerobika, Acapella and Flutter, use a combination of vibrations and air pressure to move phlegm higher up the airways. The NHS also mentions a hand-held vibration device. A physiotherapist chooses and adjusts the device and shows you how to clean it.

Asthma + Lung UK says most people benefit from airway clearance twice a day for 10 to 30 minutes, though this depends on the lung condition, and that more frequent sessions are needed during flare-ups. It suggests staying hydrated to thin phlegm and waiting an hour after eating.

The NHS says if phlegm is difficult to cough up, the care team may recommend a nebuliser with a salt solution before the exercises, and Asthma + Lung UK says to use nebulised saline around 10 minutes beforehand. Mucolytic medicines, including carbocisteine, may also be prescribed.

• Pick consistent times, such as on waking and in the evening.

• Use any prescribed bronchodilator first if you were told to.

• Keep a note of how much phlegm you bring up and its colour.

Asthma + Lung UK says regular physical activity can help manage symptoms like breathlessness and can help clear phlegm from the lungs, and it points to its Keep Active programme and to pulmonary rehabilitation courses.

Pulmonary rehabilitation, described as an education and activity course offering physical and emotional support, is part of bronchiectasis treatment. Many people combine a daily clearance routine with brisk walking or other aerobic activity.

The NHS says patients may be given antibiotics to keep at home as a rescue pack for chest infection symptoms and that if you have more than 3 chest infections a year a specialist may recommend long-term antibiotics. Asthma + Lung UK says a flare-up from bacterial infection is typically treated with antibiotics for 14 days, preferably after a sputum test, and that prophylactic antibiotics may be considered after two or more flare-ups in a year.

A written self-management plan sets out symptoms, treatments and flare-up steps, and Asthma + Lung UK says it helps you recognise early symptoms and treat them quickly.

The NHS advises getting urgent help if your cough is very bad or quickly gets worse, or if you have symptoms of a chest infection such as a high temperature. Asthma + Lung UK advises contacting your healthcare provider for worsening symptoms, blood in sputum or persistent discomfort. Call 999 for severe breathlessness or coughing up a lot of blood.