Bronchiectasis is when the airway walls, known as bronchi, thicken or enlarge. This is caused by chronic inflammation and/or repeated infections.

In a normal lung, there are little hair-like structures, known as cilia, on the airways. Cilia sweep mucus and particles out of the lungs. But in people with bronchiectasis, cilia are destroyed. Mucus and particles can’t be cleared from the lungs.
As a result, mucus builds up in the lung. This attracts bacteria and microbes that lead to infection. Chronic infections lead to chronic inflammation, and more mucus. Chronic inflammation causes additional thickening and widening of the airways. Over time, it gets harder to breathe.

The Chronic Cycle of Bronchiectasis:

• Mucus builds up. It attracts bacteria and microbes.
• Bacteria multiply. This causes additional lung infections and inflammation.
• New lung infections and inflammation do additional damage to the airways.
• Over time, enlarged and widened airways make it harder and harder to breathe.
• There are repeated infections. The airways can’t clear mucus out of the lungs.

The most common symptoms are:

• coughing up a lot of mucus
• shortness of breath that’s worse during flare-ups
• feeling run-down or tired, especially during flare-ups
• fevers and/or chills, usually during flare-ups
• wheezing or a whistling sound while you breathe
• coughing up blood or mucus mixed with blood, a condition called haemoptysis
• chest pain from increased effort to breathe
• thickening of skin under nails, known as clubbing

HOW PHYSIOTHERAPY WORKS:
ACTIVE CYCLE OF BREATHING TECHNIQUE [ACBT]
Breathing control. Breathing control helps relax the airways....
Chest expansion exercises. Breathe in deeply...
Huffing or huff coughing. Also called forced expiration technique, huff cough at different, controlled lengths to move mucus up to the larger airways...
The ACBT is divided into three parts;
BREATHING CONTROL
This is normal gentle breathing using the lower chest, with relaxation of the upper chest and shoulders. It helps you to relax between the deep breathing and huffing
DEEP BREATHING
These are slow deep breaths in, followed by a three second hold with a relaxed breath out. Three to four deep breaths are enough.
HUFFING
This is a medium sized breath in, followed by a fast breath out through an open mouth, using the muscles of the chest and stomach to force the breath out.
This will move secretions along the airways to a point where you can cough them up.
Huffing is a less tiring way of clearing your secretions than coughing.
COUGHING
This should follow two to three huffs or a deep breath in. Don’t cough unless secretions are ready to be cleared.

BY
DR. NILAYANI.U
CONSULTANT PHYSIOTHERAPIST
WHITEFIELD BRANCH.