Bronchiectasis treatment centers on keeping your airways clear of mucus, preventing infections, and reducing inflammation. There is no cure for the condition, but a combination of daily airway clearance, targeted medications, exercise, and vaccinations can slow its progression and significantly improve quality of life. The European Respiratory Society’s latest clinical guidelines emphasize that treatment should be tailored to your specific situation, including what’s causing the bronchiectasis, which bacteria are present in your lungs, and how frequently you experience flare-ups.
Airway Clearance: The Daily Foundation
Clearing mucus from your airways is the single most important thing you can do every day. The European Respiratory Society strongly recommends airway clearance techniques for most people with bronchiectasis, regardless of severity. Mucus that sits in damaged airways becomes a breeding ground for bacteria, so getting it out regularly helps prevent infections and reduces coughing.
The most commonly used methods fall into two categories: device-based and manual techniques. Oscillating positive expiratory pressure (PEP) devices are the most popular option. These small handheld tools (brands like Acapella, Flutter, and Aerobika) create vibrations and back-pressure as you exhale into them, loosening mucus deep in the airways so you can cough it up more easily. In one U.S. study, 47% of patients used an oscillating PEP device as their primary clearance method.
Manual techniques include postural drainage (positioning your body so gravity helps mucus drain from specific lung segments), chest percussion (rhythmic clapping on the chest wall), and the active cycle of breathing technique, which alternates relaxed breathing with deep breaths and forced exhalations called “huffs.” Many people combine multiple methods. In registry data, 46% of patients used more than one technique at baseline. A respiratory physiotherapist can teach you which combination works best for your pattern of disease and help you build a routine that takes 15 to 30 minutes once or twice a day.
Inhaled Treatments to Loosen Mucus
If airway clearance alone isn’t enough, nebulized hypertonic saline can help. Breathing in a concentrated salt solution draws water into your airways, thinning the mucus so it’s easier to move. Most clinical trials have tested 6% or 7% saline solutions, inhaled twice daily via a nebulizer before airway clearance sessions. Studies show a clear dose-response relationship: higher concentrations move more mucus. However, solutions above 7% tend to irritate the upper airways, so 7% is the practical ceiling for most people.
Your doctor will typically have you try your first dose under supervision, because hypertonic saline can trigger airway narrowing in some patients. Using a bronchodilator inhaler beforehand reduces this risk. The European Respiratory Society conditionally recommends mucoactive drugs like hypertonic saline in specific circumstances rather than as a blanket treatment for everyone.
Long-Term Antibiotics to Prevent Flare-Ups
If you’re experiencing frequent exacerbations (typically three or more per year), long-term antibiotic therapy can reduce how often they happen. The strongest evidence supports macrolide antibiotics taken continuously for at least 12 months. The British Thoracic Society identifies three well-studied regimens: azithromycin 500 mg three times a week, azithromycin 250 mg daily, or erythromycin 400 mg twice daily. Many doctors start with the lowest effective dose (azithromycin 250 mg three times a week) to minimize side effects like nausea and hearing changes, then adjust based on your response.
For people with chronic Pseudomonas aeruginosa infection who also have frequent flare-ups, the European Respiratory Society strongly recommends long-term inhaled antibiotics. These are delivered directly to the lungs via a nebulizer, which concentrates the drug where it’s needed while limiting side effects elsewhere in the body. When Pseudomonas is first detected in sputum cultures, eradication treatment is conditionally recommended to try to clear the bacteria before it becomes established.
Routine use of long-term oral antibiotics other than macrolides is not recommended, and inhaled corticosteroids (steroid inhalers) should not be used routinely for bronchiectasis unless you also have asthma or another condition that requires them.
Treating Acute Flare-Ups
An exacerbation typically means worsening cough, increased mucus production, changes in mucus color, increased breathlessness, or new fatigue. When this happens, antibiotic treatment is the standard response. European Respiratory Society guidelines recommend a 14-day course of antibiotics, chosen based on your most recent sputum culture results. For people with Pseudomonas, 14 days is the standard. For milder cases without Pseudomonas, shorter courses may be appropriate.
Severe exacerbations requiring hospitalization or intravenous antibiotics are particularly damaging to the lungs, so the overall treatment strategy aims to prevent them. Keeping a sputum sample kit at home and having a plan in place with your doctor to start antibiotics quickly at the first signs of a flare-up can shorten the duration and severity.
Exercise and Pulmonary Rehabilitation
The European Respiratory Society strongly recommends pulmonary rehabilitation for people with bronchiectasis whose ability to exercise has declined. These structured programs run six to 12 weeks, with supervised exercise sessions two to three days per week. A team of providers designs activities around your tolerance level, combining aerobic exercise (like walking or cycling) with strength training.
Even outside a formal program, regular physical activity helps. Exercise naturally shakes mucus loose from the airway walls, makes coughing more productive, and builds the cardiovascular fitness that protects you during flare-ups. Aim for whatever level of activity you can sustain consistently, and increase gradually.
Staying Hydrated
Drinking enough water helps keep mucus thin and easier to clear. NYU Langone Health recommends eight to ten 8-ounce glasses of water per day for people with bronchiectasis. This is a simple step, but it makes a noticeable difference in how productive your airway clearance sessions feel, especially in dry or air-conditioned environments.
Vaccinations That Reduce Risk
Infections that might cause a few days of misery for a healthy person can trigger serious exacerbations in bronchiectasis. Staying current on vaccines is a straightforward way to lower that risk.
- Influenza: one dose annually.
- Pneumococcal: if you haven’t previously been vaccinated, one dose of a newer pneumococcal conjugate vaccine is recommended. If you receive PCV15 specifically, a follow-up dose of PPSV23 is given at least one year later.
- COVID-19: follow the current seasonal schedule, with adults 65 and older receiving an additional dose six months after the first seasonal dose.
- RSV: for adults aged 50 to 74 with chronic lung disease, a single dose of RSV vaccine is now recommended. No additional doses are currently advised.
Identifying and Treating the Underlying Cause
Bronchiectasis is often the result of another condition, and finding that cause can open up additional treatment options. The European Respiratory Society recommends standardized testing for underlying causes because it frequently reveals treatable problems. Immunodeficiency (where the immune system doesn’t fight infections effectively), allergic bronchopulmonary aspergillosis (a fungal allergy that damages airways), nontuberculous mycobacterial infections, and cystic fibrosis are among the most important to identify. Treating immunodeficiency with immunoglobulin replacement, for example, can dramatically reduce infection frequency and slow airway damage.
When Surgery Becomes an Option
Surgery is reserved for a small number of people whose disease keeps progressing despite optimal medical treatment, or who can’t tolerate their medications. The ideal surgical candidate has truly localized disease, meaning the damage is confined to one area of lung that can be removed while leaving enough healthy tissue behind. People with recurrent significant bleeding (hemoptysis) or cavities in the lung may also benefit from resection.
When bleeding is the primary problem, bronchial artery embolization is often tried first. This is a minimally invasive procedure where a radiologist blocks the blood vessel responsible for the bleeding. For people with diffuse bronchiectasis affecting both lungs, the only surgical option is bilateral lung transplantation, which is primarily used in cystic fibrosis-related disease. Recurrent bleeding that can’t be controlled by embolization is one of the criteria for referral to a transplant center.