Bronchiectasis 

Bronchiectasis is a chronic condition where the bronchi (the large airways in the lungs) become damaged, widened, and thickened, usually as a result of repeated infections or inflammation. This structural damage makes it hard for mucus to clear from the lungs, creating a cycle of infection and inflammation.

Causes of bronchiectasis

The main causes of bronchiectasis are-

• Repeated lung infections (e.g., pneumonia, tuberculosis)
• Cystic fibrosis (a major cause in children and young adults)
• Immune system disorders
• Autoimmune diseases (e.g., rheumatoid arthritis)
• Inhalation of foreign objects or toxic substances

Symptoms of bronchiectasis

• Chronic productive cough (often with thick, foul-smelling sputum)
• Recurrent chest infections
• Wheezing
• Shortness of breath
• Fatigue
• Hemoptysis (coughing up blood, in severe cases)
• Clubbing of fingers (in long-standing cases)
• Congenital conditions (e.g., primary ciliary dyskinesia)

Diagnosis of bronchiectasis

Bronchiectasis can be diagnosed by-

• High-resolution CT (HRCT) scan of the chest (gold standard)
• Chest X-ray (may suggest but not confirm)
• Sputum culture
• Pulmonary function tests
• Blood tests for underlying causes

 Physiotherapy management of bronchiectasis

Goals 

• Promote effective mucus clearance
• Prevent infections and exacerbations
• Improve exercise tolerance
• Enhance quality of life

Airway Clearance Techniques (ACTs)

These are essential to help remove mucus from the lungs:

1. Active Cycle of Breathing Technique (ACBT)

• Involves a cycle of:
  • Breathing control (gentle breathing)
  • Thoracic expansion exercises (deep breaths)
  • Forced expiration technique (huffing)
• Helps mobilize and clear mucus without causing breathlessness.

2. Postural Drainage

• Uses gravity to assist mucus drainage from specific lung segments.
• Patient lies in different positions depending on which part of the lung is affected.
• Often combined with percussion or vibration.

3. Percussion & Vibration

• Percussion (clapping): Rhythmic tapping on the chest wall to loosen mucus.
• Vibration: Gentle shaking during exhalation to help move mucus upward.

4. Positive Expiratory Pressure (PEP) Therapy for bronchiectasis

• Breathing through a PEP device (e.g., Acapella, Flutter)
• Creates back pressure that helps keep airways open and moves mucus.

5. Autogenic Drainage

• Controlled breathing at different lung volumes to move mucus.
• Requires training and coordination, but very effective when mastered.

 Exercise Training

• Aerobic exercises (e.g., walking, cycling, swimming)
• Breathing exercises (e.g., diaphragmatic breathing)
• Benefits:
  • Improves overall lung function
  • Enhances mucus clearance
  • Boosts immunity and quality of life

 Pulmonary Rehabilitation

• A supervised program combining:
  • Physical training
  • Education
  • Nutritional advice
  • Psychological support