Bronchiectasis: Management

Key points

• Bronchiectasis: permanent dilatation of the airways from chronic infection or inflammation; first assess for treatable causes (e.g. immune deficiency, ABPA).
• Airway-clearance physiotherapy (including inspiratory muscle training) has a good evidence base in non-CF bronchiectasis; postural drainage.
• Treat exacerbations with antibiotics guided by sputum culture; long-term (rotating, or a macrolide such as azithromycin) antibiotics reduce exacerbations in frequent exacerbators.
• Eradicate Pseudomonas aeruginosa on first isolation; bronchodilators in selected patients; annual influenza and pneumococcal vaccination.
• Surgery (resection) is occasionally considered for localised disease; consider lung transplantation in advanced disease.