Treatment of Bronchiectasis Exacerbation: Worsening Cough, Sputum, Dyspnoea, or Haemoptysis
A bronchiectasis exacerbation is a clinically meaningful worsening of symptoms that exceeds day-to-day variability and requires a change in management. Structured, evidence-based treatment aims for a rapid return to the patient's baseline.
Clinical Presentation
- Worsening cough or change in sputum volume and/or consistency
- Increased sputum purulence
- Dyspnoea and/or reduced exercise tolerance
- Fatigue or malaise
- Haemoptysis
Treatment Approach
The cornerstone of management is targeted oral antibiotic therapy, with agent selection informed by prior microbiology results and local susceptibility patterns. Course duration is individualised according to clinical severity and the patient's trajectory during treatment.
Goal: Rapid return to baseline symptoms
References
DOI: 10.1183/13993003.01126-2025
- An exacerbation is defined as a worsening of symptoms that exceeds day-to-day variability and requires a change in management.
- Core symptoms of exacerbation include a change in cough, sputum volume and/or consistency, sputum purulence, dyspnoea and/or exercise intolerance, fatigue or malaise, and haemoptysis.
- Antibiotics should be prescribed for an exacerbation, guided by previous microbiology results, local susceptibility patterns and clinical severity.
- In general, a 14-day antibiotic course is considered standard, especially in severe exacerbations or in patients with P. aeruginosa infection.
- Shorter courses may be appropriate in patients with mild bronchiectasis, those with infection due to pathogens more sensitive to antibiotics (e.g. Streptococcus pneumoniae) or patients with a rapid return to baseline symptoms during treatment.
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