Clinical Scenario

In patients with bronchiectasis whose respiratory symptoms remain inadequately managed despite standard airway clearance techniques, an additional treatment step is warranted. This protocol addresses the next structured intervention for that population.

Treatment Approach

When airway clearance alone has not achieved adequate symptom control, a class of mucoactive agents — available in both oral and inhaled forms — may be added. Notably, one specific mucoactive agent is recommended against in this setting. The full selection criteria, specific agents, and sequencing are detailed in the complete protocol.

Treatment Goals

The aim is meaningful improvement in respiratory symptoms and quality of life. If no clinical benefit is evident after a reasonable trial period (e.g. 3 months), treatment should be discontinued.

References

DOI: 10.1183/13993003.01126-2025

We suggest to offer mucoactive treatments to patients with bronchiectasis where airway clearance has failed to control symptoms.
Oral mucoactive agents, such as carbocisteine or N-acetylcysteine, reduce mucus viscosity, although evidence is limited.
Nebulised hypertonic saline and inhaled mannitol hydrate mucus and stimulate cough to facilitate clearance.
We suggest not to offer recombinant DNase to patients with bronchiectasis.
If no clinical benefit is evident after a reasonable trial period (e.g. 3 months), treatment should be discontinued.

View source ↗

Bronchiectasis: What to Do When Airway Clearance Fails to Control Symptoms

Clinical Scenario

Treatment Approach

Treatment Goals

References