Management of Bronchiectasis in Adults

Bronchiectasis is a highly heterogeneous disease in its clinical presentation, severity and treatment response, making the therapeutic approach challenging. The field has benefited greatly from the introduction of evidence-based guidelines, but most recommendations are based on low-quality evidence. The treatment goals in bronchiectasis are to improve airway clearance, prevent or suppress chronic airway infection and reduce airway inflammation. Reducing the airway inflammation might be the ultimate goal of bronchiectasis treatment, avoiding exacerbations and minimizing antibiotic exposure. A deeper understanding of the pathophysiology of bronchiectasis is an unmet need, focusing on the inflammatory pathways, the role of the microbiome and dysfunctional mucociliary clearance. This will allow the identification of disease endo-phenotypes and the development of personalised therapeutic approaches. This review provides an update on the management of bronchiectasis highlighting emerging evidence from recent randomised trials and future perspectives.