BRONCHIECTASIS, a chronic lung condition marked by permanent airway dilation and recurrent respiratory symptoms, has historically been a neglected disease with highly variable care worldwide. New international guidelines developed by the European Respiratory Society (ERS) provide evidence-based recommendations for the management of adults with bronchiectasis, aiming to improve patient outcomes and standardise treatment practices globally.
Key interventions for bronchiectasis patients
The ERS guidelines strongly recommend airway clearance techniques for most patients and pulmonary rehabilitation for those with impaired exercise capacity. Long-term macrolide therapy is advised for patients at high risk of exacerbations, while long-term inhaled antibiotics are recommended for patients with chronic Pseudomonas aeruginosa infection and frequent exacerbations. Conditional recommendations support eradication therapy or mucoactive drugs in select situations. The guidelines advise against routine use of long-term oral non-macrolide antibiotics or inhaled corticosteroids.
Additional guidance covers testing for underlying causes, managing acute exacerbations, and responding to deteriorating patients. By offering a structured framework for these interventions, the guidelines aim to reduce the heterogeneity of care and ensure patients receive therapies with proven benefit.
Implementing the bronchiectasis guidelines
The ERS Task Force followed rigorous methodology, including systematic literature reviews, meta-analyses, and formulation of evidence-based recommendations using the GRADE framework. Eight patient-intervention-comparator-outcome (PICO) questions and three narrative questions were addressed to provide comprehensive guidance for clinical decision-making. The guidelines are intended for all healthcare professionals involved in adult bronchiectasis care, as well as policymakers and regulatory authorities, serving as a benchmark to evaluate and improve care quality.
Limitations and context
While these guidelines offer a robust evidence-based framework, bronchiectasis is a heterogeneous condition, and no guideline can replace clinical judgement. Recommendations should be interpreted in the context of individual patients, especially for associated conditions such as cystic fibrosis, primary ciliary dyskinesia, allergic bronchopulmonary aspergillosis, and non-tuberculous mycobacterial infections, which have separate syndrome-specific guidance. The guidelines focus on adults, with separate recommendations available for paediatric care.
Reference
Chalmers JD et al. European Respiratory Society clinical practice guideline for the management of adult bronchiectasis. Eur Respir J. 2025; DOI:10.1183/13993003.01126-2025.
