Non-Cystic Fibrosis Bronchiectasis Management

Diagnostic Evaluation

High-resolution CT (HRCT) scanning is the diagnostic procedure of choice to confirm bronchiectasis when suspected, as recommended by the American College of Chest Physicians 3, 4
A comprehensive diagnostic evaluation for underlying disorders causing bronchiectasis should be performed, as identifying and treating these conditions may slow or halt disease progression, according to the American College of Chest Physicians 3, 5

Chest physiotherapy should be used in patients with mucus hypersecretion and difficulty expectorating, with monitoring for symptom improvement, as suggested by the American College of Chest Physicians 4, 6
Manual techniques, such as chest percussion, vibration, and postural drainage, can be used for airway clearance 6

Bronchodilator therapy is recommended for patients with airflow obstruction and/or bronchial hyperreactivity, according to the American College of Chest Physicians 3, 4

Mucoactive treatments (≥3 months) may be offered to patients who have difficulty expectorating sputum and poor quality of life when standard airway clearance techniques have failed, as recommended by the European Respiratory Society 1
Recombinant human DNase (rhDNase) should NOT be used in non-CF bronchiectasis patients, as stated by the European Respiratory Society and the American College of Chest Physicians 1, 4

Selection of agents should be guided by likely pathogens based on previous sputum cultures, according to the American College of Chest Physicians 3, 4
Long-term antibiotic therapy should be considered for patients with ≥3 exacerbations per year, as recommended by the European Respiratory Society 1
Long-term macrolide treatment is recommended for non-Pseudomonas infection, but prior to starting macrolides, active nontuberculous mycobacterial (NTM) infection should be excluded, as stated by the European Respiratory Society and the British Thoracic Society 1, 7

Careful evaluation of each respiratory NTM isolate is necessary in the context of the patient's overall status, according to the American Journal of Respiratory and Critical Care Medicine 8
For patients with confirmed NTM pulmonary disease, treatment should involve collaboration with experts in NTM and bronchiectasis management, as recommended by the British Thoracic Society 7

Surgery to resect bronchiectatic lung should be limited to patients with localized disease who have not responded to medical therapy, according to the American College of Chest Physicians 4, 9

Regular monitoring of sputum pathogens before and after implementation of long-term antibiotics is essential to direct antibiotic choices, monitor resistance patterns, and identify treatment-emergent organisms, as recommended by the European Respiratory Society 1
Drug toxicity monitoring is required, especially with macrolides and inhaled aminoglycosides, according to the European Respiratory Society 1