Bronchiectasis Guidelines

Updated: Jul 23, 2019
  • Author: Ethan E Emmons, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Guidelines

Guidelines Summary

Guidelines on adult bronchiectasis by the European Respiratory Society  [125]

The minimum set of etiological tests suggested for adults with a new diagnosis of bronchiectasis is as follows:

  • Differential blood cell count
  • Serum immunoglobulins (total IgG, IgA, and IgM)
  • Testing for allergic bronchopulmonary aspergillosis (ABPA)

Treat acute exacerbations of bronchiectasis with a 14-day course of antibiotics.

Adults with bronchiectasis with a new isolation of P aeruginosa infection should be offered eradication antibiotic treatment. Eradication antibiotic treatment is not suggested for adults with bronchiectasis following a new isolation of pathogens other than P aeruginosa.

Treatment with inhaled corticosteroids is not suggested for adults with bronchiectasis. However, it is suggested that the diagnosis of bronchiectasis should not affect the use of inhaled corticosteroids in patients with comorbid asthma or COPD.

Statins are not recommended for the treatment of bronchiectasis.

Offer long-term antibiotic treatment for adults with bronchiectasis who have three or more exacerbations per year, as follows:

  • Long-term treatment with inhaled antibiotic for adults with bronchiectasis and chronic P aeruginosa infection
  • Long-term treatment with macrolides (azithromycin, erythromycin) for adults with bronchiectasis and chronic P aeruginosa infection in whom inhaled antibiotic is contraindicated, not tolerated, or not feasible
  • Long-term treatment with macrolides (azithromycin, erythromycin) in addition to, or in place of, inhaled antibiotic for adults with bronchiectasis and chronic P aeruginosa infection who have a high exacerbation frequency despite taking inhaled antibiotic
  • Long-term treatment with macrolides (azithromycin, erythromycin) for adults with bronchiectasis not infected with P aeruginosa
  • Long-term treatment with oral antibiotic (selection based on antibiotic susceptibility and patient tolerance) for adults with bronchiectasis not infected with P aeruginosa in whom macrolides are contraindicated, not tolerated, or ineffective
  • Long-term treatment with inhaled antibiotic for adults with bronchiectasis not infected with P aeruginosa in whom oral antibiotic prophylaxis is contraindicated, not tolerated, or ineffective

Long-term mucoactive treatment (≥3 mo) is suggested in adult patients with bronchiectasis (1) who have difficulty in expectorating sputum and have a poor quality of life and (2) where standard airway clearance techniques have failed to control symptoms. Recombinant human DNase is not recommended in adult patients with bronchiectasis.

Routinely offering long-acting bronchodilators is not suggested for adult patients with bronchiectasis. Offer long-acting bronchodilators for patients with significant breathlessness on an individual basis. Use of bronchodilators is suggested (1) before physiotherapy, (2) before inhaled mucoactive drugs, and (3) before inhaled antibiotics, in order to increase tolerability and optimize pulmonary deposition in diseased areas of the lungs. Again, however, it is suggested that the diagnosis of bronchiectasis should not affect the use of long-acting bronchodilators in patients with comorbid asthma or COPD.

Surgical treatments are not suggested for adult patients with bronchiectasis, except for those with localized disease and a high exacerbation frequency despite optimization of all other aspects bronchiectasis management.

Patients with a chronic productive cough or difficulty expectorating sputum should be taught an airway clearance technique by a trained respiratory physiotherapist, and it should be performed once or twice daily.

It is recommended that adult patients with bronchiectasis and impaired exercise capacity participate in a pulmonary rehabilitation program, and they should exercise regularly. All interventions should be tailored to the patient's symptoms, physical capability, and disease characteristics.