Bronchiectasis with Increasing Exacerbation Frequency and Worsening Lung Function

This protocol addresses patients with bronchiectasis who are experiencing clinical deterioration — a pattern characterised by more frequent or more severe exacerbations, progressive worsening of respiratory symptoms, and rapid decline in lung function.

Clinical Scenario

Clinical deterioration — including increasing exacerbation frequency and/or severity, worsening of symptoms, and rapid decline in lung function — warrants a comprehensive re-evaluation of the patient and their current treatment plan.

Approach (partial overview)

In this setting, the management approach may involve advanced surgical evaluation for carefully selected patients, as well as interventions targeting specific acute complications. Respiratory support options are also considered where indicated.

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References

DOI: 10.1183/13993003.01126-2025

Clinical deterioration, including increasing exacerbation frequency and/or severity, worsening of symptoms and/or rapid decline in lung function, should result in a comprehensive re-evaluation of the patients and their treatment.
Lung resection may be considered in highly selected patients with localised disease whose symptoms are not controlled by medical treatment optimised by a bronchiectasis specialist.
Early referral for lung transplantation is essential in patients with progressive disease despite optimal medical management.
This may include rapidly declining FEV1 or FEV1 <30% predicted and/or arterial carbon dioxide tension (PaCO2) >50 mmHg.
Haemoptysis: bronchial artery embolisation or surgical resection in selected cases, following multidisciplinary discussion with a thoracic surgeon experienced in bronchiectasis.
Respiratory failure: supplemental oxygen; non-invasive ventilation; referral for lung transplantation.

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