Ways to Breathe Easier With Bronchiectasis

When your chronic cough comes out of nowhere, it can not only be frustrating and disruptive, but frightening and painful. If you are living with bronchiectasis, also known as non-cystic fibrosis bronchiectasis, many irritants can irritate the lungs’ airways and cause a buildup of mucus—making a persistent phlegmy cough a common occurrence and increasing the odds of a bacterial infection.

“Bronchiectasis prevents mucus production that helps keep the lungs healthy,” explains Louis DePalo, M.D., the medical director of the Health Center at Hudson Yards in New York City, an affiliate of the Mount Sinai Health System.

Typically, the mucus that lungs produce to defend against irritants entering the airways is coughed out along with those invaders (or destroyed when it’s swallowed and enters the digestive system). But with bronchiectasis, damage to those airways, due to inflammation and repeated bacterial infection, cause them to eventually thicken and widen such that they can’t effectively clear the mucus as it continues to build up. This results in a chronic cough that slowly expels some of that mucus. The damaged airways also cause the lungs to work less well, which can lead to breathlessness.

“Symptoms can be mild to more severe, ranging from coughing and wheezing to shortness of breath, spitting up blood, and weight loss,” Dr. DePalo says.

Here, our experts share ways to help support your lungs—along with the medications prescribed by your doctor—in order to ease that coughing and other symptoms.

“With bronchiectasis, the lungs tend to hyperinflate in some areas and collapse in others. Facilitating air movement within the lungs helps prevent both of these,” explains Dr. DePalo. He recommends patients practice deep breathing exercises such as “square breathing,” also called “box breathing,” where you inhale, hold, exhale, and hold, all for a count of four. (Bonus: According to the Cleveland Clinic, this type of breathing can help calm the body and mind by engaging the parasympathetic nervous system.)

“Airway movement can also be helpful to maintain lung capacity and improve airway clearance,” says Dr. DePalo. Your doctor can also guide you through other beneficial breathing techniques.

Breathing exercises not only work the diaphragm, the largest muscle of respiration, they also work the muscles in the neck and between the ribs, adds Jamie Garfield, M.D., a professor of thoracic medicine and surgery at the Temple Lung Center at Temple University Hospital in Philadelphia and a volunteer medical spokesperson for the American Lung Association. “While breathing exercises cannot prevent bronchiectasis, they can certainly help minimize symptoms and prevent clinical worsening,” she says.

It makes sense that keeping irritating airborne particles from entering your lungs in the first place can take a load of your airways’ defense system.

“Air filters may help, specifically HEPA (high efficiency particulate air) filters,” says Dr. DePalo. Having a portable air purifier with a HEPA filter that you can keep in your room is a good idea, agrees Dr. Garfield. “These can remove at least 99.97% of airborne particles that are 0.3 microns or larger, including dust, pollen, mold, and bacteria,” she says.

According to the U.S. Environmental Protection Agency (EPA), these pleated mechanical filters should come with a MERV (minimum efficiency reporting values) rating from 1 to 16 that reveals the percentage of particles between 0.3 microns to 10 microns in the air that they remove: A HEPA filter with a MERV rating of 1 removes less than 20% of these particles, whereas a filter with a rating of 16 removes 95% or greater.

On top of that, Dr. DePalo recommends keeping the air in your house neither too humid nor too dry to be optimal for lungs.

Staying inside during bad air quality days can also reduce the symptoms of bronchiectasis. The EPA’s AirNow.gov site provides a user-friendly way to instantly find out your local air quality by entering your zip code, including color-coded categories: good, moderate, unhealthy for sensitive groups, unhealthy, and hazardous.

If you do have to go out, Dr. DePalo recommends masking. Choose an N95 mask, adds Dr. Garfield: They’re not just for filtering viruses but also particulate matter floating in the air that can irritate airways. And both doctors agree: Steer clear of cigarette smoke wherever you go.

For added peace of mind, it’s worth addressing some of the sources of potential irritants that you don’t often think about.

“Make sure your home is assessed for radon, your stove is checked for methane, and that you have working carbon monoxide testers in the home,” says Dr. Garfield. The fewer potential irritants, the less likely you are to exacerbate your symptoms. “For patients with household allergens, I recommend removing carpets and drapes as they tend to hold onto a lot of allergens,” she suggests.

With bronchiectasis, clearing your airways of mucus buildup is essential for helping prevent potential infection and exacerbations, say our experts. And there’s help for making that vital task easier.

“One device that can help to move mucus out of the lungs is an oscillatory vest,” says Dr. DePalo. The inflatable vest is connected by hoses to a small generator; combined, they deliver what’s known as high-frequency chest wall oscillation (HFCWO). According to the Cystic Fibrosis Foundation (CFF), the vest inflates and deflates rapidly to apply pressure “similar to clapping” on the chest. In so doing, it creates vibrations that loosen the mucus from within the airways so that it can more easily be coughed out. Insurance can help cover the cost of the device, per the CFF, so ask your doctor about whether using one is right for you.

Dr. DePalo also recommends using a nebulizer to help deliver medicine directly to the lungs in the form of a mist. According to the American Lung Association, your doctor may prescribe mucus thinning medication to help you cough up mucus and these are often given through a nebulizer. Nebulizers can also be used with just a sterile saline solution to be breathed into the lungs and airways. One recent study in the Journal of Pediatric Pulmonology found that, in a controlled trial, the use of saline nebulization was effective in helping to clear the airways and improve lung volume, with fewer exacerbations seen within the initial two months of use.

Managing your lung health with bronchiectasis takes commitment—but know that you are not in this alone. Along with staying in close contact with your pulmonologist, Dr. Garfield recommends working with a respiratory therapist who can guide you through pulmonary rehabilitation.

“Pulmonary rehab is a comprehensive intervention that includes exercise training, education, and behavior change,” she says. According to a review by the American Thoracic Society, the rehabilitation is typically based at a medical center with supervised exercises and other instruction twice a week for eight weeks or more, but tele-rehabilitation and home-based versions also exist.

Ask your doctor to connect you with a therapist who can address your particular needs. And, while you’re at it, see your primary care doctor about getting all your vaccines for this flu season—including pneumococcal, flu, RSV, and COVID. “Since the most common trigger [for bronchiectasis] is recurrent respiratory infection, keeping the airway clean, keeping vaccines up to date, and avoiding sick people is very helpful,” says Dr. DePalo.

Bottom line: Every step you take to support your lung health, whether big or little, can add up to help you feel more in control of your bronchiectasis—and your days.