We’ve all dealt with having too much mucus before – for example, when you have the flu, a cold, or an allergic reaction that causes sneezing and a runny nose. But for people with bronchiectasis, managing too much mucus and phlegm is a daily battle.

Bronchiectasis is a long-term chronic lung disease that causes permanent airway widening and inability of the lungs to clear phlegm properly. Your airways are the passages that you use to breathe, and they lead from your nose into your lungs. 

Symptoms of bronchiectasis

• Coughing up clear/white phlegm daily, or occasionally green/yellow phlegm, often in large amounts (most common)
• Breathlessness (cannot breathe properly, or feeling like you’re not able to walk as far as before)
• Fatigue       
• Chest pain
• Haemoptysis (coughing up blood) in severe cases  

Coming Soon: Learn how to prevent bronchiectasis 

Living with this condition can be challenging, because it affects one of your most essential body functions – breathing. Let’s look at 7 ways to manage it.

1. Medication

Bronchiectasis can’t be cured, but medications help to prevent infections that can cause further damage to your lungs and reduce symptoms. 

• Antibiotics
  Antibiotics treat infections that cause worsening of your bronchiectasis symptoms. These are called exacerbations, or flares. Take oral antibiotics as prescribed by the doctor. Do not self-medicate or take less than the prescribed amount - it’s very important to finish your dose for the best relief.
  
  
• Mucolytics and expectorants 
  Bronchiectasis causes excess phlegm to build up in your airways. Fortunately, there are ways to get rid of all the excess phlegm so you can breathe better. 
  
  What is phlegm? Phlegm is the mucus produced by your respiratory (breathing) system. It contains white blood cells, bacteria, and viruses.
  
  Phlegm is important because it traps dirt and any bacteria in the air you breathe in, but too much of phlegm will cause coughing and breathing problems. 
  
  What causes phlegm? Your body produces phlegm while fighting off a respiratory infection or inflammation. 
  
  Mucolytics and expectorants (sometimes in the form of syrups or dissolvable tablets) should be taken as your doctor instructs you to. These medications manage excess phlegm by thinning your mucus so that it’s easier to cough out.
  
  
• Bronchodilators 
  Bronchodilators are devices that relax airway muscles and open up the airways for better breathing. They are also used to treat asthma. Your doctor will teach you how to use this device.
  
  
• Oxygen therapy 
  When bronchiectasis is advanced, it can cause your body’s oxygen levels to be low and you may find it hard to breathe. Your doctor will speak to you about long-term oxygen therapy if it is needed.
  
  Oxygen therapy should be administered by a medical professional (doctor or nurse or other trained person) in a hospital, clinic or your home, depending on your lifestyle and schedule. 

2. Airway clearance techniques/chest physiotherapy

Medicine can help you break up thick mucus, but special breathing techniques and exercises, with or without the need for equipment, are also important for clearing your airways. 

Airway clearance techniques are not limited to patients with bronchiectasis and are also effective in patients with other chronic lung diseases such as Chronic Obstructive Pulmonary Disease (COPD).

These exercises are usually taught by a trained physiotherapist.

• ACBT (active cycle of breathing technique) 
  The most common technique is ACBT (Active Cycle of Breathing Technique). Each cycle consists of three stages: 
  
  1. Breathing control, or relaxed breathing, to aid recovery from breathlessness and promote good quality breathing, using the correct muscles.
  
  2. Chest expansion exercises, or deep breathing, to improve airflow through all parts of your airways and loosen the phlegm.
  
  3. Forced expiratory technique, or huff, for moving phlegm from the smaller airways up to the larger airways where it is easier to cough and expel phlegm. 
  
  One cycle takes about 10 to 20 minutes and depending on how much phlegm you produce, the sessions should be conducted once or twice per day. A trained physiotherapist will teach you how to do this, and once you’ve learnt the proper technique, you can do it on your own. 
  
  During a flare or when your symptoms worsen, it is beneficial to increase the number of times you perform ACBT throughout the day.
  
  This is because you have more and/or thicker phlegm that is more difficult to clear. As such, more cycles are needed to expel the phlegm.
  
  
• Postural drainage
  Postural drainage is a special technique that makes it easier to cough out phlegm by changing your body position. (4) Don’t worry about learning how to do this - your physiotherapist will adjust you to lie or sit in the correct way.
  
  
• Percussion/vibration 
  Percussion and vibration use the technique of clapping, tapping, or drumming on your chest to loosen mucus in the airways. It is often used together with postural drainage but can also be performed independently.
  
  
• Airway clearance devices 
  Your doctor or physiotherapist may recommend using airway clearance devices to break up phlegm that is stuck in your airways.
  
  This is called positive expiratory pressure therapy, or PEP therapy, and uses pressure or vibrations to move the phlegm from the smaller airways to the larger airways, making it easier to cough out.
  
  Devices range from commercial handheld devices to simple home-made apparatuses made up of a jug of water and a tube to blow into (bubble PEP). 

3.   Get vaccinated

Bronchiectasis flares happen because of infections, so you must take care not to get any other infections that can make your condition worse. 

Vaccinations protect against respiratory infections, and it is important that you are regularly vaccinated. Some common vaccinations are influenza (seasonal flu), COVID-19, and pneumococcal.

Ask your doctor for more information on suitable vaccines. 

4. Personal hygiene and home remedies

• Hygiene 
  The best way to prevent infections is to have good hygiene. Wash your hands frequently with soap and water. Use surgical masks in crowded public places to avoid getting sick.
  
  
• HEPA air filters 
  Keep your lungs and airways clean. You can try using a HEPA-approved air purifier at home to filter out dust and pollutants from the air you breathe. 
  
  An air filter may help ease bronchiectasis symptoms. Research shows that COPD patients who used HEPA air filters for at least six months had reduced symptoms.

5. Diet

• Drink more water
  Drinking plenty of water thins and loosens phlegm congestion in your airways. Your body also needs enough water for important daily functions that keep you healthy. 
  
  Adults should drink at least 8 glasses of water daily to stay hydrated in Singapore’s hot weather.
  
  
• Choose healthier food
  Healthy eating keeps your body and immune system in the best shape. With a strong immune system, you can fight off infections better. 
  
  Choose foods with the Healthier Choice Symbol (HCS) as they have less sodium, sugar and unhealthy fats. Similarly, limit your consumption of Nutri-Grade C and D drinks, as these contain higher levels of sugar and saturated fats.
  
  
• Eat less processed food
  Eat less processed foods such as canned food, sausages, and potato chips, as these are usually high in refined sugar, salt, and unhealthy fats.
  
  Eating too much processed foods can lead to weight gain, which makes the body work harder when breathing.
  
  
• Avoid food that worsens phlegm
  Limit your consumption of foods that may make your body produce more phlegm, such as spicy food (chilli, curry).
  
  
• Eat foods that contain probiotics
  Your bronchiectasis medicine uses antibiotics to kill bacteria that causes infections in your lungs. But antibiotics can’t tell what’s bad and good, and so it could also kill the good gut bacteria in your digestive system. You need good gut bacteria for a healthy digestive system and body. 
  
  Foods which contain probiotics help replace good gut bacteria. Yoghurt, cheeses, and tempeh are good sources of probiotics.
  
  
• Maintain a healthy weight
  Some people with bronchiectasis be may be underweight or malnourished due to chronic inflammation or infection, as well as the increased effort needed to breathe due to the condition. Nutrient-rich foods containing proteins and healthy fats such as milk, yoghurt or fatty fishes can help to reduce weight loss. 
  
  Being overweight can put more stress on your lungs and heart, as they work harder to supply oxygen to various parts of your body. A healthy diet and exercise can help reduce the increased effort required to breathe for overweight individuals. 
  
  Do consult a qualified dietitian for a personalised nutritional care plan suited to your needs.

6. Get sufficient rest

Your body needs lots of rest and sleep to build a strong immune system and fight infections. Try these tips to help you rest better at night:

• Avoid caffeine at least eight hours before bed.
• Dim the lights an hour before sleeping.
• Take a warm bath to help ease the body for rest.
• Listen to soothing music.  

7. Exercise regularly

Exercise can help improve lung function and reduce phlegm production. Regular exercise can also help increase blood flow and oxygen levels, making it easier to clear the excess phlegm from your lungs and throat.

Bronchiectasis management is important to help you manage symptoms like cough, phlegm, and breathing problems.

Over time, you may also figure out a way to detect signs of flare up and act earlier to avoid it.

It’s best that you follow your doctor/physiotherapist’s instructions and be patient with yourself as you learn how to manage and clear excess phlegm and mucus.

Ref: G25

Related articles:
COPD (Chronic Obstructive Pulmonary Disease): How to Treat

​​Tuberculosis (TB): Treatment and Prevention Tips

Mycoplasma Pneumonia (Walking Pneumonia)​: Causes and Prevention

Phlegm and Mucus: How to Get Rid of It