- Bronchodilators: The ERS 2017 guidelines suggest using long-acting bronchodilators on an individual basis for patients with significant breathlessness
- Mucoactive agents: Long-term mucoactive treatment (≥ 3 months) is recommended for adult patients with bronchiectasis who have difficulty in expectorating sputum and poor quality of life, where standard airway clearance techniques have failed to control symptoms
- Inhaled corticosteroids (ICSs): Routine treatment with ICSs is generally avoided in adults with bronchiectasis
Non-pharmacological interventions
- Airway clearance techniques: Patients with chronic productive cough or difficulty expectorating sputum should be referred to a trained respiratory physiotherapist who can teach airway clearance techniques
Long-term management
- Long-term oral antibiotics: For patients with three or more exacerbations per year, long-term macrolide treatment for a minimum of 6 months is recommended to reduce exacerbations. Options include azithromycin 250 mg daily, azithromycin 500 mg thrice weekly, or erythromycin ethylsuccinate 400 mg twice daily
- Long-term inhaled antibiotics: For adults with bronchiectasis and chronic P. aeruginosa infection who have three or more exacerbations per year, long-term treatment with an inhaled antibiotic is suggested
In conclusion, the treatment of a bronchiectasis exacerbation involves a combination of antibiotics, bronchodilators, mucoactive agents, and airway clearance techniques, with long-term management strategies including oral and inhaled antibiotics. The choice of treatment should be individualized based on the patient's specific clinical context and microbiological history.