A comprehensive approach to the management of<unk>  is recommended. It is important to establish whether an underlying modifiable cause, such as immunoglobulin deficiency or alpha-1 antitrypsin deficiency is present. The next steps include controlling infections and bronchial secretions, relieving airway obstructions, removing affected portions of lung by surgery, and preventing complications. Airway clearance The goal of airway clearance therapy is to loosen secretions and interrupt the cycle of inflammation and infection. Airway clearance techniques improve difficulty breathing, cough, and help patients cough up phlegm and mucus plugs. Airway clearance usually uses an inhaled agent (hypertonic saline) with chest physiotherapy, such as high-frequency chest wall oscillation. Many airway clearance techniques and devices exist. The choice of a technique or device is based on the frequency and tenacity of phlegm, patient comfort, cost, and the patient's ability to use the technique or device with minimal interference to their lifestyle. The active cycle of breathing technique (ACBT), which can be employed with or without a flutter device, is beneficial in treating those with<unk> . Mucolytic agents such as dornase alfa are not recommended for individuals with non-CF<unk> . Mannitol is a hyperosmolar agent that is thought to hydrate airway secretions, however, clinical trials with it have not demonstrated efficacy. Anti-inflammatories The two most commonly used classes of anti-inflammatory therapies are macrolides and corticosteroids. Despite also being antibiotics, macrolides exert immunomodulatory effects on the host inflammatory response without systemic suppression of the immune system. These effects include modifying mucus production, inhibition of biofilm production, and suppression of inflammatory mediators. Three large multicenter, randomized trials have shown reduced rates of exacerbations and improved cough and dyspnea with use of macrolide therapy. The impact of adverse effects of macrolides such as gastrointestinal symptoms, hepatotoxicity, and increased antimicrobial resistance needs ongoing review and study. Inhaled corticosteroid therapy can reduce sputum production and decrease airway constriction over a period of time, helping prevent progression of<unk> . Long term use of high-dose inhaled corticosteroids can lead to adverse consequences such as cataracts and osteoporosis. It is not recommended for routine use in children. One commonly used therapy is beclometasone dipropionate. Antibiotics Azithromycin is a macrolide commonly used in<unk> . Antibiotics are used in<unk>  to eradicate P. aeruginosa or MRSA, to suppress the burden of chronic bacterial colonization, and to treat exacerbations. The use of daily oral non-macrolide antibiotic treatment has been studied in small case series, but not in randomized trials. The role of inhaled antibiotics in non-CF<unk>  has recently evolved with two society guidelines and a systematic review suggesting a therapeutic trial of inhaled antibiotics in patients with three or more exacerbations per year and P. aeruginosa in their sputum. Options for inhaled antibiotics include aerosolized tobramycin, inhaled ciprofloxacin, aerosolized aztreonam, and aerosolized colistin. Bronchodilators Some clinical trials have shown a benefit with inhaled bronchodilators in certain people with<unk> . In people with demonstrated bronchodilator reversibility on spirometry, the use of inhaled bronchodilators resulted in improved dyspnea, cough, and quality of life without any increase in adverse events. However, overall there is a lack of data to recommend use of bronchodilators in all patients with<unk> . Surgery The primary role of surgery in the management of<unk>  is in localized disease to remove segments of the lung or to control massive hemoptysis. Additionally, surgery is used to remove an airway obstruction that is contributing to<unk> . The goals are conservative, aiming to control specific disease manifestations rather than cure or eliminate all areas of<unk> . Surgical case series have shown low operative mortality rate (less than 2%) and improvement of symptoms in the majority of patients selected to receive surgery. However, no randomized clinical trials have been performed evaluating the efficacy of surgery in<unk> . Clinical trials Results from a phase 2 clinical trial have recently been published. In a placebo-controlled, double-blind study conducted in 256 patients worldwide, patients who received Brensocatib reported prolonged time to the first exacerbation and also reduced rate of yearly exacerbation.
Bronchiectasis
Chronic obstructive pulmonary disease
Plastic bronchitis
Tracheobronchomalacia
Bronchitis kettle
Asbestosis
Acute bronchitis
Dust pneumonia