Preliminary Guidelines for Adult Bronchiectasis

For the first time, we have preliminary North American guidelines for adult bronchiectasis!

But they might not be quite what you expect.

Until a few years ago, I thought guidelines were written by experts sitting around a table, sharing opinions about what they believed worked best. It turns out that is not how it happens at all.

A team of experts is indeed formed, but they must follow a clear, evidence-based process to decide which questions to answer.

This is because they can only make recommendations when there is research to support them, meaning there must be clinical trials to evaluate what is being proposed as a guideline question.

For these new U.S. guidelines, the team focused on eight specific clinical questions. Needless to say, these eight questions do not address everything people with bronchiectasis face in daily life.

Broader topics will likely appear in the upcoming Standards of Care, which are being developed for the Bronchiectasis Care Center Network, a growing collaboration of more than 150 centers across the United States.

Each question in the guidelines is built around the PICO framework, a structured tool that helps researchers ask focused questions and find the best available evidence to guide care.

PICO stands for:

P – Population
I – Intervention
C – Comparison
O – Outcome

Example:
In adults with non-cystic fibrosis bronchiectasis (P), does long-term preventive antibiotic therapy (I), compared with standard symptomatic treatment (C), reduce flare-ups and improve quality of life (O)?

After reviewing all available research, the experts rate the strength of the evidence and prepare their recommendations.

The final version may be released in time for the Second North American Bronchiectasis and NTM Conference at NYU Langone in December.

This is an exciting start. Over time, more questions will be explored, more evidence will be gathered, and the guidelines will continue to evolve. Each update brings us closer to better, more consistent care for everyone living with bronchiectasis.

Warm regards,
Linda Esposito