European Respiratory Society guidelines for the management of adult bronchiectasis

Abstract

Bronchiectasis in adults is a chronic disorder associated with poor quality of life and frequent exacerbations in many patients. There have been no previous international guidelines.The European Respiratory Society guidelines for the management of adult bronchiectasis describe the appropriate investigation and treatment strategies determined by a systematic review of the literature.A multidisciplinary group representing respiratory medicine, microbiology, physiotherapy, thoracic surgery, primary care, methodology and patients considered the most relevant clinical questions (for both clinicians and patients) related to management of bronchiectasis. Nine key clinical questions were generated and a systematic review was conducted to identify published systematic reviews, randomised clinical trials and observational studies that answered these questions. We used the GRADE approach to define the quality of the evidence and the level of recommendations. The resulting guideline addresses the investigation of underlying causes of bronchiectasis, treatment of exacerbations, pathogen eradication, long term antibiotic treatment, anti-inflammatories, mucoactive drugs, bronchodilators, surgical treatment and respiratory physiotherapy.These recommendations can be used to benchmark quality of care for people with bronchiectasis across Europe and to improve outcomes.

Effect of Air Pollution on Exacerbations of Bronchiectasis in Badalona, Spain, 2008–2016

“…On the contrary, Li et al [27] did not found any obvious inflammatory response in rat lungs exposed to SO 2 . Given the fact that the key components of the disease are chronic bronchial infection, inflammation, impaired mucociliary clearance, and structural lung damage [1], air pollution could play a role in exacerbations in patients without clear signs of bronchial infection.…”

“…Many of the patients with bronchiectasis have frequent exacerbations [1], which is associated with a decline in lung function [2] and increased mortality [3, 4]. …”

Nebulized Antibiotics in Acute Exacerbation of Non-Cystic Fibrosis Bronchiectasis: Shifting the Goal Posts or a Post Too Far?

“…The use of IA would be justified for a reduction in exacerbations, hospitalisations, or mortality, but not for microbiological clearance alone [4, 6]. This is especially true if clearance is defined by a single negative culture and not by at least 2 consecutive negative cultures 1 month apart [1].…”

“…Current guidelines recommend IA for NCFB in two situations: stable NCFB with Pseudomonas colonization and frequent exacerbations and as a consolidation therapy along with or after parenteral therapy for severe AE-NCFB for a total duration of 3 months [4]. A previous trial of nebulized preservative-free tobramycin compared to placebo in addition to oral ciprofloxacin during AE-NCFB showed greater microbiological response but poor clinical response due to frequent bronchospasm (50%) induced by tobramycin [5].…”

Inhaled Treatments and the Future of Respiratory Diseases: Holding Our Breath

“…Recently, Regan and Hill [3] reviewed the available studies regarding long-term inhaled antimicrobial therapy in BE finding only little evidence of emerging bacterial resistance and treatment-emergent pathogens. Despite limitations, European guidelines suggest inhaled antibiotics for eradication or long-term therapy for PA [4]. …”