European Respiratory Society guidelines for the management of adult bronchiectasis

TLDR

Bronchiectasis in adults is a chronic disorder that impairs quality of life and causes frequent exacerbations, yet no international guidelines existed before this work. The guidelines were developed by a multidisciplinary panel that systematically reviewed the literature and applied the GRADE framework to answer nine key clinical questions. The resulting guideline recommends comprehensive investigation of underlying causes and evidence‑based management of exacerbations, pathogen eradication, long‑term antibiotics, anti‑inflammatories, mucoactive agents, bronchodilators, surgery, and physiotherapy to benchmark and improve care across Europe.

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.