Treatment of Bronchiectasis at High Risk of Exacerbations Without Chronic Pseudomonas aeruginosa Infection
Patients with bronchiectasis who have experienced frequent or severe exacerbations represent a distinct clinical group requiring a structured, evidence-based treatment approach beyond standard supportive care.
Clinical Scenario
This protocol applies to patients with bronchiectasis who are at high risk of exacerbations — defined as a history of two or more exacerbations in the prior year, at least one severe exacerbation, or one exacerbation combined with severe daily symptoms — and who do not have chronic Pseudomonas aeruginosa infection.
Treatment Approach
Management begins with optimising standard bronchiectasis care across several domains. When that foundation is in place, a specific class of long-term antibiotic therapy is recommended as first-line to reduce exacerbation frequency — but only after a required infection-exclusion step has been completed.
The complete regimen, sequencing, and pre-treatment requirements are detailed in the full protocol.
Treatment Goal
Response is assessed over 12 months, with reduction in exacerbation frequency as the primary measure of success.
References
DOI: 10.1183/13993003.01126-2025
- Patients at high risk of exacerbations include patients with a history of ⩾2 exacerbations in the prior year OR ⩾1 severe exacerbation OR 1 exacerbation plus severe daily symptoms.
- We recommend to offer long-term macrolides to patients at high risk of exacerbations despite standard care.
- For patients without P. aeruginosa infection, macrolides are a clear first-line option (figure 3).
- NTM infection should be excluded before initiating macrolide therapy.
- Has the patient responded to treatment over 12 months?
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