In a world with perfect airway clearance antibiotics would be rarely needed. We all know how challenging clearance is -- the learning, the timing, the maneuvering, the equipment, the energy, et al. So many variables, which often result in less than perfect airway clearance. Many of us are colonized with some bacteria, which means it's established in our lungs but we don't get sick from it. That's where the clearance comes in -- to keep the colony down so that we don't get sick.

If exacerbations/infections are not properly treated with antibiotics the bronchiectasis gets worse. It's very specific to each person -- the extent of the disease, how effective airway clearance is, age, activity, comorbidities...

I don't have a good feel for whether antibiotics are appropriate for an exacerbation when there are no symptoms of an infection. I'm hoping the CT scan, which has not been scheduled yet, gives some clues as to what is going on. It's disheartening to have increased symptoms and not know why. Maybe Scoop is right about airway clearance because I have been tackling it more hurriedly because it's bicycling and gardening season. Oops!