Coaching Patients Through Life With Chronic Bronchiectasis Cough

In "Coaching Patients Through Life With Chronic Bronchiectasis Cough," Dr. Sala describes how he sets expectations with patients and tracks their disease at every visit.

Dr. Sala considers setting realistic expectations central to his practice, since bronchiectasis cannot currently be reversed. He tells patients their CT scans will always show bronchiectasis, that inflammation may wax and wane, and that most patients will live with a chronic cough indefinitely, often the very symptom that first brought them to medical attention. Rather than framing cough as a failure to eliminate, Dr. Sala coaches patients to see it as an expected defense mechanism, reframing the goal as minimizing its impact on quality of life, being able to attend the theater, socialize, or go about daily activities without the cough dominating their experience, especially given lingering post-pandemic social sensitivity around coughing in public.

At every appointment, Dr. Sala asks a consistent set of questions: are patients doing their airway clearance, taking prescribed medications, and how many antibiotic courses they've needed recently. Combined with lung function testing, these answers help him judge whether to escalate care, adding azithromycin or brensocatib, or intensifying airway clearance, if a scan shows more mucus or exacerbations are increasing. He describes an ideal visit as one where a patient reports feeling stable for a year, coughing occasionally but functioning well, exercising, socializing, and remaining off antibiotics, signaling good disease control even without aggressive escalation. Dr. Sala frames this recurring question-and-monitor cycle as an ongoing partnership: some patients may need nothing further beyond their current regimen, but all require continued vigilance to catch any meaningful shift in their disease trajectory early, before it becomes a bigger problem.

In "The Future of Bronchiectasis: Prevention, Not Just Treatment," Dr. Sala closes this series with a hopeful look at where bronchiectasis research is headed next.