The Vicious Cycle of Bronchiectasis

The definition of insanity is doing the same thing over and over expecting different results. According to a recent paper, bronchiectasis falls into this category of insanity due to its’ patient variability and being a heterogeneous disease with numerous, different underlying etiologies and presentations.¹

Bronchiectasis is a condition affecting the airways in the lungs that causes cough, increased mucus production, and recurrent lung infections. The symptoms are caused by abnormal widening of the airways of the lung, also known as bronchi. The cells lining the airways become inflamed and swollen. These damaged airways can no longer effectively clear mucus and bacteria from the lung. This cycle can lead to flare-ups of cough, mucus production, shortness of breath and lung infections. Each lung infection can make the bronchiectasis worse. Untreated, this vicious cycle of infection, inflammation and injury often results in progressive symptoms and loss of lung function, activities of daily living and quality of life. Therefore, early diagnosis and treatment of bronchiectasis is very important. It’s time to promote the importance of bronchial hygiene for at-risk respiratory patients so they can be in the best health possible today and in the future.

Bronchiectasis Population

According to the American Lung Association, bronchiectasis affects 350,000 – 500,000 people in the United States². Studies show almost 50% of COPD patients may have bronchiectasis with 70,000 new patients each year.³’⁴

Signs & Symptoms of Bronchiectasis

Bronchicectasis population

Often developing gradually, symptoms of bronchiectasis may not appear for months or even years after the pre-disposing event or events. Some of the signs and symptoms of a bronchiectasis exacerbation are the same as those of acute Bronchitis and COPD making them hard to differentiate.

Bronchiectasis can be tricky because it often presents like Chronic Obstructive Pulmonary Disease (COPD), but won’t respond to COPD therapy. In fact, studies show it’s much more prevalent than what’s being diagnosed.

Patients suffering from:

  • Long-term productive cough
  • Recurring chest infections
  • Frequent exacerbations requiring antibiotics, i.e., recurring pneumonia
  • Frequent hospitalizations

…should be screened for bronchiectasis.

Managing Symptoms of Bronchiectasis

The goals of treatment in bronchiectasis are to facilitate airway clearance, suppress bacterial infection and prevent exacerbations.⁵ A well-rounded treatment plan incorporating antibiotics, periodic testing and airway clearance helps manage the symptoms of this chronic disease.

Airway Clearance Therapy is considered the cornerstone therapy aimed at minimizing the effects of airway obstruction, infection, and inflammation in lung diseases such as bronchiectasis.  Airway Clearance Therapy is the best solution for at-risk pulmonary patients because it provides a preventative treatment option that results in reduced, recurring hospitalizations and better overall health.⁶’⁷

High Frequency Chest Wall Oscillation (HFCWO) is an airway clearance therapy that can help mobilize and loosen secretions in the lungs, which may help reduce exacerbations, hospitalizations, and antibiotic use.

What is the potential impact of breaking the vicious cycle?

Breaking the cycle allows clearance of mucus and bacteria from the lungs keeping patients healthier

Bronchiectasis patients averaged $5,681 higher medical care expenditures with averages of : 8,9,10

Benefits of HFCWO Therapy for Bronchiectasis

One of the most effective airway clearance therapies available today for bronchiectasis patients is the mobile high frequency chest wall oscillation (HFCWO) therapy vest, which produce vibrations at various frequencies and pulse intensities, thinning mucus and loosening it from the airways of the lungs. Mobile HFCWO vest therapy is a safe way to clear excess mucus from the lungs and their airways, as well as provide relief from coughing and bacterial infections. Clinical studies show most patients using mobile HFCWO airway clearance vests report relief of symptoms and improved pulmonary function. The main goal of HFCWO vest treatment is to keep infections and bronchial secretions under control. It’s also critical to prevent further obstructions of the airways and minimize lung damage.

Other potential benefits of using the HFCWO respiratory vest may include:

  • Better overall respiratory health¹¹
  • Decreased pulmonary exacerbations¹¹
  • Reduced hospitalizations for respiratory causes¹¹
  • Safely loosening and thinning mucus so that lungs become less susceptible to respiratory infections
  • Ease of use for patient

AffloVest Mobile HFCWO therapy is specifically engineered to mimic anatomically targeted manual chest physical therapy, the gold standard of airway clearance therapy. It can be an effective therapy for bronchiectasis patients by improving bronchial drainage through the mobilization of secretions.  In a recent study, published in RT Magazine, AffloVest therapy showed a significant reduction in antibiotic usage, emergency visits and overall hospitalization comparing patients prior to using AffloVest and, on average, 6 months after utilizing the therapy.¹²

AffloVest is the first battery-operated, mobile during use, HFCWO therapy that allows patients to receive state-of-the-art airway clearance therapy on the go.


  1. Metersky, M., Chalmers, J. Bronchiectasis Insanity: Doing the Same Thing Over and Over Again and Expecting Different Results? F1000 Research. March 2019. 8(F1000 Faculty Rev):293.
  2. American Lung Association. Learn About Bronchiectasis.
  3. Kosmas E, et al., Bronchiectasis in Patients with COPD: An Irrelevant Imaging Finding or a Clinically Important Phenotype? CHEST 2016;150(4):894A.
  4. Weycker D, et al., Prevalence and Incidence of Non-cystic Fibrosis BE Among US Adults in 2013. Chron Respir Dis 2017. Nov;14(4): 377-384.
  5. Chalmers, J. et al. Management of Bronchiectasis in Adults. European Respiratory Journal. 2015. May;45(5):1446-62.
  6. O’Neill, K. et al. Airway Clearance, Mucoactive Therapies and Pulmonary Rehabilitation in Bronchiectasis. Respirology. 2019; 24(3):227-237.
  7. McShane, P et al. Concise Clinical Review: Non-Cystic Fibrosis Bronchiectasis. Am J Respir Crit Care Med 2013; 188(6):647-656.
  8. Ford ES, Murphy LB, Khavjou O, Holt JB, Croft JB., Total and State-Specific Medical and Absenteeism Costs of COPD Among Adults Aged 18 Years in the United States for 2010 and Projections Through 2020; CHEST American College of Chest Physicians; CDC; 2014
  9. Weycker D, et al., Prevalence and Economic Burden of Bronchiectasis. CLIN PULM MED 2005;12:205.
  10. McShane, P et al. Concise Clinical Review Non-Cystic Fibrosis Bronchiectasis; University of Chicago Medicine, Chicago, Illinois; University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; Am J Respir Crit Care Med Vol 188, Iss. 6, pp 647–656, Sep 15, 2013 Copyright ª 2013 by the American Thoracic Society  Originally Published in Press as DOI: 10.1164/rccm.201303-0411CI on July 30, 2013
  11. Susman, E. Oscillating Vest Keeps COPD Patients Out of Hospital. MedPage Today. October 23, 2019.
  12. Foley, B. et al. Reduction in Antibiotic Use, Emergency Visits and Hospitalizations in COPD and Bronchiectasis Patients after Initiating AffloVest HFCWO Therapy. RT Magazine. January/February 2021.