Bronchiectasis is a chronic respiratory disease clinically characterized by recurrent
pulmonary exacerbations, chronic cough, and sputum production, and is associated with an
increase in the airway-artery ratio and permanent airway dilatation. It is recognized as
the third most common chronic respiratory disease after chronic obstructive pulmonary
disease (COPD) and asthma. In the International Classification of Diseases and Related
Health Problems (ICD-10), it has its own diagnostic code (J47.9).
In bronchiectasis, mucociliary clearance is impaired due to bronchial dilatation, and the
insufficient clearance of bacteria and mucus from the respiratory tract leads to
persistent infection, inflammation, and further airway damage. Progressive airway damage
results in impaired lung function, worsening of symptoms, and, ultimately, respiratory
failure and death. It can represent the final pathway of various infectious, allergic,
inflammatory, genetic, and degenerative disorders, making it one of the most complex and
heterogeneous syndromes. Some patients present with daily symptoms, while others remain
asymptomatic except during exacerbations. The most common symptom is chronic cough caused
by purulent or mucopurulent sputum. Other symptoms include dyspnea, pleuritic chest pain,
wheezing, fatigue, and weight loss. Fever, however, is not a common finding and differs
from pneumonia.
The most frequently used classification system categorizes bronchiectasis into varicose,
cylindrical, and saccular (cystic) types. In the most severe form, the saccular type, the
bronchi lose their structural integrity completely, forming cystic structures filled with
secretions. The mildest form is cylindrical, in which the bronchi have thick, straight
walls. In the varicose type, localized narrowings are observed. Diagnosis is made
following history and physical examination, with high-resolution computed tomography
(HRCT) being the most sensitive and specific method, along with sputum culture and chest
radiography.
The goals of bronchiectasis treatment are to manage symptoms, prevent complications, and
improve quality of life. Both pharmacological and patient-managed interventions are
commonly applied. Pharmacological treatments include antibiotics, bronchodilators, and
corticosteroids, which are generally administered via inhalation. Patient-managed
interventions require active participation and behavioral modification. Within published
guidelines, airway clearance techniques are widely described under pulmonary
rehabilitation (PR), but there is no consensus regarding PR itself. For individuals with
reduced exercise tolerance, participation in PR and engagement in physical activity are
recommended. However, research has shown that referral rates to PR are often low, and
exercise and physical activity are not consistently prescribed.
Within PR, techniques such as the active cycle of breathing techniques (ACBT), postural
drainage, thoracic expansion exercises, and various airway clearance methods are applied,
with inspiratory muscle training (IMT) forming an important component. Functional
inspiratory muscle training (FIMT) is an IMT program developed by considering not only
the ventilatory roles of the respiratory muscles but also their non-respiratory
functions. FIMT integrates inspiratory muscle training with core stabilization and
postural control exercises. The rhythmic co-contractions of the muscles in the core
region support trunk stability and provide the basis for movement. In the first stage of
the program, participants receive IMT, and subsequently, core stabilization training and
dynamic trunk activation exercises are incorporated into the intervention.
A review of the literature reveals that no studies have investigated the effectiveness of
FIMT in adults with bronchiectasis. In our study, we aim to evaluate the effects of FIMT,
applied in addition to home-based chest physiotherapy, on pulmonary function, diaphragm
thickness, balance, core stability, functional capacity, physical activity, posture, and
quality of life in adults with bronchiectasis. Furthermore, we aim to compare these
outcomes with those of IMT applied alongside home-based chest physiotherapy. We believe
that this approach will contribute to the development of treatment strategies in clinical
practice and help address existing gaps in the literature.
