Management and Treatment of Bronchiectasis

Bronchiectasis is characterised by irreversible dilatation of the bronchi, chronic sputum production and recurrent exacerbations that drive progressive lung damage. Management aims to break the cycle of infection and inflammation, preserve lung function and improve quality of life. Core strategies encompass accurate diagnosis by high-resolution computed tomography, identification of underlying aetiology, and individualised treatment plans integrating airway clearance techniques, targeted antimicrobial therapy and adjunctive measures such as bronchodilators or anti-inflammatory agents. Multidisciplinary care, often delivered through specialist clinics or pulmonary rehabilitation programmes, is essential to optimise airway clearance, exercise capacity and self-management skills. Prognostic tools such as the Bronchiectasis Severity Index facilitate risk stratification and guide intensity of follow-up. Emerging therapies under investigation include inhibitors of neutrophil elastase and novel inhaled antibiotics intended to suppress key pathogens such as Pseudomonas aeruginosa. Ongoing research highlights the importance of the airway microbiome in shaping disease trajectories and suggests a move towards microbiome-guided antimicrobial selection. International guidelines emphasise personalised care plans, regular monitoring of exacerbation frequency, sputum microbiology and lung function, and integration of vaccination and comorbidity management to reduce overall disease burden.

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Management and Treatment of Bronchiectasis publication trend

The graph below shows the total number of articles in management and treatment of bronchiectasis across all publications each year (not limited to Nature Index journals).

Technical terms

Bronchiectasis Severity Index (BSI): composite score to predict mortality, exacerbations and hospital admissions.

High-Resolution Computed Tomography (HRCT): imaging technique to visualise and quantify bronchial dilatation and structural changes.

Airway Clearance Techniques (ACT): physical and mechanical methods designed to mobilise and expectorate retained secretions.

Microbiome: the community of bacteria, viruses and fungi residing in the lower airways, influencing inflammation and infection dynamics.

References

1. Bronchiectasis in Europe: data on disease characteristics from the European Bronchiectasis registry (EMBARC). The Lancet Respiratory Medicine (2023).
2. Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis. BMC Pulmonary Medicine (2018).
3. Longitudinal assessment of sputum microbiome by sequencing of the 16S rRNA gene in non-cystic fibrosis bronchiectasis patients. PLOS ONE (2017).
4. The short and long term effects of exercise training in non-cystic fibrosis bronchiectasis – a randomised controlled trial. Respiratory Research (2014).
5. Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts. Thorax (2016).
6. Neutrophil elastase in bronchiectasis. Respiratory Research (2017).