What a Perfect NCFBE Patient Looks Like… And Why It’s a Problem


Woody was diagnosed with bronchiectasis in 1996 after the death of his wife. He struggled with fevers, infections, and just trying to get around. Although looking at him now at 80 years old, it is kind of hard to imagine that used to be the case. 

“Since I got the bronchiectasis under control, I was a hospice volunteer, I taught English to immigrants, I was appointed to the State Board of Education in Connecticut,” Woody’s smile was beaming as he spoke to a room full of clinicians. Despite being retired, he described how he kept himself busy with his extensive activities in education, scholarship, community service, and book writing. But he has another full-time job that he forgot to mention: managing his bronchiectasis.  

Woody begins his day with a vibrating vest and nebulizer. He then uses his 2 inhalers and takes his oral pills. After this, he takes oxygen while he does his 40-minute walk on the treadmill (with a steep incline). He then does weight-bearing resistance exercises and Pilates.  

“And then it’s time for lunch,” he chuckled.  

He then repeats the vibrating vest, nebulizer, and inhalers in the later part of the afternoon. Then, 3 times a week he goes to the hospital for pulmonary rehabilitation. Finally, when he is about to lay down to sleep at night, he uses his CPAP machine for oxygen.  

“He’s the perfect patient,” his pulmonologist Dr. Metersky remarked. 

Managing non-cystic fibrosis bronchiectasis (NCFBE) is a full-time job and compliance can be a big problem for patients.  

“Beginning airway clearance is the hardest part for patients,” Molly Mailes, MSN, RN, MEDSURG-BC comments. In her patient education, Molly tries to identify exactly what it is that patients are concerned about when it comes to airway clearance, and then she tailors her consultation to address those barriers to figure out a way to better integrate the new regimen into the patient’s life.  

Dr. Johnson acknowledges the difference working with a nurse has made in her patients. Before working with a nurse to individualize education, “patients were unclear about how to use a nebulizer, where to get a nebulizer, how to clean it, what medications to use,” she says. “Me introducing the concept to them in the office and then them following up with Molly for a very detailed, patient-centric, one-on-one discussion about all this… this teamwork has really made incorporation of bronchial hygiene much more effective in our practice. It’s been great.”  

To learn more about how Dr. Johnson and Molly work together to educate their patients about NCFBE and airway clearance, click here. 

Managing NCFBE is also a challenge for clinicians due to the lack of effective treatment options. Recognizing this challenge, Dr. Metersky, Dr. Johnson, and Molly demonstrate how they approach NCFBE diagnosis and treatment here and here within the context of current limitations. If you are interested in how well you can manage a patient with NCFBE, you can try your hand at it in this quick and fun virtual escape room! 

Currently, NCFBE is managed symptomatically with airway clearance, exercise, pulmonary rehabilitation, and macrolides. While Woody is proof that staying on top of a rigorous exercise, rehab, and airway clearance regimen helps overcome the limitations of NCFBE, it can take until lunch time to complete…and that is a problem.  

“I don’t schedule any early appointments because of it,” Woody explains. Luckily, a new era is upon NCFBE as emerging agents are finally addressing the underlying pathophysiology of the disease. To learn more about these new agents, how they work, and how far along they are developmentally, click here. 

For more, check out the following CE activities below, expiring soon!

New Insights into the Pathophysiology and Treatment of Non-Cystic Fibrosis Bronchiectasis
Patient Case Module 1: Reducing the Burden and Improving QoL in Non-Cystic Fibrosis Bronchiectasis: A Team-Based Approach to Challenging Cases
Patient Case Module 2: Reducing the Burden and Improving QoL in Non-Cystic Fibrosis Bronchiectasis: Insights on Challenging Cases
Halting the Vicious Vortex: Case-based Discussions in Non-Cystic Fibrosis Bronchiectasis

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*Earn Pulmonology Continuing Medical Education Credit(s) by clicking the activity Learn More button.

New Insights into the Pathophysiology and Treatment of Non-Cystic Fibrosis Bronchiectasis