CHEST Issues Guidelines for Management of Adult Bronchiectasis

MONDAY, Aug. 10, 2026 (HealthDay News) — New recommendations are presented for the management of adult bronchiectasis in a clinical practice guideline issued by the American College of Chest Physicians and published online July 21 in CHEST.

Rachel Thomson, M.B.B.S., Ph.D., from The University of Queensland in Brisbane, Australia, and colleagues addressed eight questions relating to treatment of bronchiectasis in adults and conducted a systematic review to develop recommendations.

The authors developed 13 conditional evidence-based recommendations addressing key management domains based on 47 studies. These included recommendations for sputum microbiology to guide treatment during exacerbations. Patient symptom response is recommended as a guide for the duration of antibiotic therapy for exacerbations. Recommended options for adults with frequent exacerbations include long-term macrolide antibiotic therapy, inhaled antibiotics, and long-term treatment with brensocatib. For all patients, airway clearance is recommended. Tranexamic acid is suggested as an option to reduce the need for more invasive interventions for patients with bronchiectasis and hemoptysis. The importance of shared decision-making using a multidisciplinary approach is highlighted.

“In the clinical setting, this guideline is not a blanket recommendation for everyone. We work with a heterogeneous population, and each clinician needs to make decisions that are right for their patients,” Thomson said in a statement. “The goal for managing bronchiectasis is to reduce exacerbation frequency, which drives the inflammation and leads to an increase in deterioration and progression of the disease. It is our hope that this guideline helps to break that cycle of exacerbations.”

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