How To Take Care of Yourself During a Bronchiectasis Flare

If you’re living with bronchiectasis, flares are a frustrating part of life. Sometimes, it can take weeks to feel like you’re back to your baseline. And every flare can damage your airways more.

So, is there a way to reduce flares or minimize their impact? We sat down with pulmonary medicine physician Anas Hadeh, MD, to find out.

Why do flares happen?

Bronchiectasis causes what healthcare providers call a “vicious vortex.”

“When your airways are enlarged, you’re more prone to infection, which causes inflammation,” Dr. Hadeh explains. “The inflammation damages your airways more, making you more likely to get infections.” And then, the cycle starts over again.

How to see a flare coming

You probably manage bronchiectasis symptoms on a daily basis. So, how do you know when a flare might be coming? Dr. Hadeh says you should note changes in these six key symptoms:

1. Cough
2. Increased amount of mucus (sputum volume)
3. Thicker, frothy, darker or a different color mucus (sputum purulence)
4. Fatigue
5. Shortness of breath or difficulty doing physical activities
6. Coughing up blood or bloody mucus

“One symptom change doesn’t mean you’re having a flare if you’re otherwise feeling good,” he clarifies. But it’s time to take action if you have three or more of these symptoms for 48 hours.

What to do during a flare

Dr. Hadeh recommends the following if you believe you’re starting a bronchiectasis flare.

Contact your healthcare provider

Even if you’re tempted to tough it out, Dr. Hadeh emphasizes how important it is to let your care team know when you have a flare. “Early action can mean the difference between a mild flare that we can manage with a phone call,” he says, “and a trip to the ER for IV antibiotics.”

And you don’t need to wait for your usual pulmonologist to be available. Getting guidance from anyone on their team can get you the care you need quickly, rather than waiting for your symptoms to get worse. They can also give you advice on what to do if you’re having a flare while traveling.

Test for viruses

The first thing your provider might ask you is if you’ve tested for viral infections, like COVID-19 and the flu. If you’re positive for a virus, early treatment with antivirals might help you avoid a flare and unnecessary antibiotics.

Dr. Hadeh suggests keeping at-home COVID-19 and flu test kits on hand. Many kits now have a single test for both viruses (so you only have to stick a swab up your nose once!).

Increase airway clearance

Mucus’s job is to grab germs and remove them from your body when you cough or sneeze. Airway clearance techniques allow more mucus (and more germs) to get out.

If you feel a flare coming on, Dr. Hadeh says your provider might advise increasing your use of:

• Breathing techniques: Bronchiectasis deep breathing and coughing techniques can help force mucus out of your airways.
• Chest PT: Combining certain positions and clapping or thumping can loosen mucus.
• Hypertonic saline: You use this with a nebulizer to thin mucus so it comes out more easily.
• Positive expiratory pressure (PEP) devices: You might have a hand-held device that helps open your airways (and possibly vibrates) to make it easier to clear mucus.
• Percussive vests: You might use a special vest that vibrates your chest to loosen mucus.

“Sometimes, doing airway clearance more often can prevent a flare from progressing without needing an antibiotic,” he reiterates.

Stay hydrated (really hydrated!)

Dr. Hadeh recommends getting plenty of fluids. Mucus production pulls water out of your body, which can easily lead to dehydration. Taking in plenty of H2O not only keeps you hydrated, but also thins mucus, making it easier to clear out.

You can up your fluid intake by drinking water and broth. Eating water-rich foods, like cucumber and (not surprisingly!) watermelon, is also a tasty way to stay hydrated. And running a humidifier can keep the air around you moist.

Rest up

You feel tired when you’re sick because your body’s trying to save energy. Resting gives your immune system a chance to fight the infection. And resting up early might allow you to recover faster, rather than going until your body forces you to stop.

“Now’s not the time to overdo it,” states Dr. Hadeh.

Take medications as prescribed

If your provider suspects bacteria are causing the flare-up, they’ll prescribe antibiotics. For many people, the same bacteria are the culprits again and again. Your provider can use this information — often from past sputum (saliva and mucus) samples — to get you effective antibiotics right away.

You’ll probably be on the medication for at least two weeks. Make sure to follow your provider’s directions on how to take them and for how long.

Keep track of your flares

“Documenting your flares is crucial. It helps your provider make treatment decisions,” says Dr. Hadeh.

If you have frequent flares, your provider might change up your treatments. You may also be a good candidate for new medications that can reduce your risk of flares.

A final note: Trust your team

When it comes to managing bronchiectasis, work together with your providers to stay healthy.

“Bronchiectasis is a team sport,” encourages Dr. Hadeh. “Keeping your care team in the loop can help you stay on top of symptoms and live your life with fewer interruptions from flares.”