Preliminary Guidelines for Adult Bronchiectasis

Thank you, Linda. Can you post these preliminary guidelines?

Because the researchers made it clear that these are preliminary guidelines, I think it is important for us to respect that and wait for the final version.

What I can share is that the team addressed eight key clinical questions covering topics such as airway clearance, prophylactic antibiotic use, treatment for hemoptysis, and when surgery may be recommended. However, there are no specific protocols included yet, and no discussion of sterilization or other day-to-day issues that many of us care about.

This is really just a starting point. Remember, this type of guideline format requires that each recommendation be supported by existing research. So if there is no research, there can be no formal recommendation.

I hope this helps provide some clarity. Warm regards, Linda

@tcd518 I expect the US Guidelines will be similar to the European Guidelines released earlier this summer.

Here is the (very lengthy) article from the ERS Journal:
https://publications.ersnet.org/content/erj/early/2025/09/18/13993003.01126-2025.full.pdf
PICO questions begin on page 21. These lead into the GRADE (Grading of Recommendations,
Assessment, Development and Evaluations) analysis of treatment recommendations.

For those wishing for a list of specific recommendations, you may be disappointed, as these are somewhat different, and leave much of the decision-making to the patient-doctor team. That is fine is you are working with a highly expert pulmonologist, but the language in the tables may lead other doctors (and insurance companies) to balk at some recommendations.

For example, see PQ1, on Airway clearance, under the Summary of Recommendations staring on page 10. An inexperienced doc looking at this may shrug at Airway Clearance, while one who sees the evidence every day knows well its value.

In summary, we will undoubtedly find that what the experts already do is pretty well supported, but the medical community needs to figure out how to communicate this CONCISELY to a broader group of doctors, because not everyone has access to the experts.

Well said, @sueinmn It’s a start, but if they expect any evidence based research to have a real impact on those newly diagnosed or those dealing with Bronchiectasis for years, more concise and direct information needs to reach pulmonologists and family physicians; otherwise it could become a document that might actually mislead some physicians. Hopefully more effort will be placed on the communication piece.

This is the summary recommendations from the European Respiratory Society (ERS) - 2025

“The Task Force recommendations include strong recommendations in favour of airway clearance techniques for most patients with bronchiectasis and pulmonary rehabilitation for those with impaired exercise capacity. We issue a strong recommendation for the use of long-term macrolide treatment for patients at high risk of exacerbations and a strong recommendation in favour of long-term inhaled antibiotics in patients with chronic Pseudomonas aeruginosa infection at high risk of exacerbation. Conditional recommendations support the use of eradication treatment or mucoactive drugs in specific circumstances. We suggest not to routinely use long term oral, non-macrolide antibiotic treatment or inhaled corticosteroids. Additional guidance is also provided on testing for underlying causes, managing exacerbations, and managing the deteriorating patient.”

Thank you @sueinmn and @becleartoday

https://www.chestphysician.org/annual-meeting/news/panel-to-introduce-new-chest-north-american-bronchiectasis-guidelines/
‘Panel to introduce new CHEST North American Bronchiectasis Guidelines. ‘

Hi

I would like some clarification. Are multiple groups creating guidelines?

@becleabecleartoday said this is in progress. Can you clarify at least the group working on this. Is the same group selecting the new Centers?

@jimmy posted a link to CHEST, which is a professional
group of chest physicians. That group held a conference on Oct 21 and introduced guidelines. I was unable to find those guidelines published.

From the posts one group is in process and one group already presented.

Can someone clarify too.

This is a very exciting time for us .

Thanks.

Pat

Yes, I can see where this can be confusing. This is my understanding:

Guidelines already exist from several countries and professional organizations. The first set was developed in 2017 by the European Respiratory Society and has recently been updated. The new U.S. guidelines are being overseen by the American College of Chest Physicians (CHEST).

The Bronchiectasis and NTM Association is a separate organization. It oversees the expansion of the Bronchiectasis Care Center Network and is developing a set of Standards of Care for those centers.

Please let me know if you have any questions,
Linda Esposito

@tcd518 I just googled "North American guidelines for adult bronchiectasis" and pertinent info came up. Does look similar to European guidelines. It's interesting how long-term macrolides are recommended during exasperations. Over the past 4-5 few years (prior to my 2024 NTM diagnosis), I have requested Azithromycin solely for its effectiveness-not knowing anything about bronchiectasis guidelines, only that they got rid of my fatigue and inflammation. I would tell the doctors, nothing else works. Now, I am concerned that following the European and now, NA guidelines could cause NTM to become macrolide resistant. Seems like a catch-22.

@tcd518 this article was posted by a reporter who attended the conference:
https://www.ajmc.com/view/guidelines-for-bronchiectasis-highlight-multiple-treatment-methods