European Respiratory Society clinical practice guideline for the management of adult bronchiectasis

Background: Bronchiectasis is a common lung condition associated with wide range of infectious, immunological, autoimmune, allergic and genetic conditions. Exacerbations and daily symptoms have the largest impact on patients and healthcare systems, and they are the key focus of treatments. Current practice is heterogeneous globally, and bronchiectasis has historically been a neglected disease. Here, we present evidence-based international guidelines for the management of adults with bronchiectasis. Methods: A European Respiratory Society (ERS) Task Force, comprising global experts, a methodologist and patient representatives, developed clinical practice guidelines in accordance with ERS methodology and the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. Systematic literature searches, data extraction and meta-analysis were performed to generate evidence tables, and recommendations were formulated using the evidence-to-decision framework. A total of eight PICO (Patients, Intervention, Comparator, Outcomes) questions and three narrative questions were developed. Recommendations: The Task Force recommendations include strong recommendations in favour of airway clearance techniques for most patients with bronchiectasis, and pulmonary rehabilitation for those with impaired exercise capacity. We issue a strong recommendation for the use of long-term macrolide treatment for patients at high risk of exacerbations and a strong recommendation in favour of long-term inhaled antibiotics in patients with chronic Pseudomonas aeruginosa infection at high risk of exacerbation. Conditional recommendations support the use of eradication treatment or mucoactive drugs in specific circumstances. We suggest not to routinely use long-term oral, non-macrolide antibiotic treatment or inhaled corticosteroids. Additional guidance is also provided on testing for underlying causes, managing exacerbations and managing the deteriorating patient. Conclusion: The ERS bronchiectasis guidelines provide an evidence-based framework for optimal management of adults with bronchiectasis and serve as a benchmark for evaluating the quality of care.