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Bronchiectasis - Management
Basis for recommendation

Sputum culture

  • Experts recommend that samples should be collected even in people taking long-term antibiotics, as the antibiotic doses used are low and have little effect on actual pathogens isolated [McLean, 2008].

Antibiotics

  • Recommendations on the use of antibiotics are based on the expert opinion of the British Thoracic Society [British Thoracic Society, 2010] and the opinions of CKS expert reviewers, who also recommend some flexibility in the duration of antibiotic treatment. Not all people may require the full 14 days. Clinical judgement is advised due to the weakness of the evidence base.
  • The recommendation to not switch antibiotic on the basis of culture results unless there also is a lack of clinical response is based on expert opinion. This is because some people may respond to antibiotic treatment despite resistance to that drug in vitro [Murray and Hill, 2009; British Thoracic Society, 2010].

Inhaled short-acting beta2-agonist

  • CKS expert reviewers advise that while a short-acting beta2-agonist may be prescribed for acute symptoms, longer-term use should prompt secondary care referral for review.

Corticosteroids

  • CKS expert reviewers advised that inhaled or oral corticosteroids have no routine role for the treatment of isolated bronchiectasis; but they may be of value for the treatment of coexisting conditions such as asthma.

Physiotherapy

  • It is not possible, from the limited available evidence, to assess the effectiveness of physiotherapy for people with bronchiectasis.
  • It is widely believed by experts that airway clearance techniques are an important component of managing bronchiectasis [British Thoracic Society, 2010].

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