Management of Non-Cystic Fibrosis Bronchiectasis in Adults

Diagnosis and Initial Evaluation

High-resolution CT (HRCT) scanning is the gold standard for diagnosis, according to the American College of Chest Physicians, and should be used to diagnose non-cystic fibrosis bronchiectasis in adults 1
Testing for allergic bronchopulmonary aspergillosis should be included in the initial diagnostic workup, as recommended by the European Respiratory Society 2

The European Respiratory Society recommends treating exacerbations with 14 days of antibiotics 4
Antibiotic selection should be guided by previous sputum cultures, as recommended by the American College of Chest Physicians 1
Obtain sputum culture prior to initiating antibiotics, as recommended by the British Thoracic Society 3
Consider IV antibiotics for severe exacerbations or treatment failures, as recommended by the British Thoracic Society 3

The European Respiratory Society recommends that all patients with bronchiectasis should participate in airway clearance techniques, which may include active cycle of breathing techniques, postural drainage, manual techniques, or mechanical devices 5
Sessions should last 10-30 minutes until two clear huffs or coughs are completed, as recommended by the British Thoracic Society 6

Patients with impaired exercise capacity should participate in pulmonary rehabilitation, as recommended by the European Respiratory Society, which can improve exercise capacity, reduce cough symptoms, and enhance quality of life 5
Regular exercise should be maintained after formal rehabilitation, as recommended by the European Respiratory Society 5

Consider humidification with sterile water or normal saline to facilitate airway clearance, as recommended by the British Thoracic Society 6
Do not use recombinant human DNase (rhDNase) in non-CF bronchiectasis, as recommended by the British Thoracic Society 6

Consider long-term antibiotics for patients with ≥3 exacerbations per year, as recommended by the British Thoracic Society, which can reduce exacerbation frequency, time to first exacerbation, and improve quality of life 8
First line treatment for chronic P. aeruginosa infection is inhaled colistin, as recommended by the British Thoracic Society 3
First line treatment for non-Pseudomonas infections is macrolides, as recommended by the European Respiratory Society 9

Do not routinely offer inhaled corticosteroids unless comorbid asthma or COPD, as recommended by the British Thoracic Society 6
Do not offer long-term oral corticosteroids, as recommended by the British Thoracic Society 6

Regular monitoring of sputum pathogens before and after implementation of long-term antibiotics is recommended by the American College of Chest Physicians 1
Monitor for drug toxicity, especially with macrolides and inhaled aminoglycosides, as recommended by the American College of Chest Physicians 1
Annual assessment by respiratory physiotherapist to optimize airway clearance regimen is recommended by the British Thoracic Society 6