Bronchiectasis affects millions globally yet has remained one of respiratory medicine's most inconsistently managed conditions, with treatment approaches varying dramatically between clinicians and countries. This fragmented care has left patients navigating a complex disease that cycles between daily symptoms and acute flare-ups without clear therapeutic direction.
The European Respiratory Society's comprehensive evidence review establishes definitive treatment hierarchies for adult bronchiectasis management. Their analysis of global research data yields strong recommendations for airway clearance techniques as foundational therapy for most patients, alongside pulmonary rehabilitation programs for those experiencing reduced exercise tolerance. The guidelines particularly emphasize long-term macrolide antibiotic therapy for patients at elevated exacerbation risk, representing a shift toward proactive rather than reactive treatment paradigms.
These standardized protocols address a critical gap in respiratory care, where bronchiectasis has historically received less attention than conditions like COPD or asthma despite causing comparable symptom burden. The guidelines' strength lies in their systematic approach to a heterogeneous disease that stems from infectious, immunological, autoimmune, allergic, and genetic origins. By establishing evidence-based treatment sequences, clinicians now have clear frameworks for managing both acute exacerbations and chronic symptom control. However, implementation challenges remain significant given the guidelines must accommodate diverse healthcare systems and resource availability globally. The recommendations represent incremental progress in organizing existing therapies rather than introducing revolutionary treatments, but this systematization could meaningfully improve patient outcomes through more consistent, evidence-driven care approaches.