CHEST releases guideline on managing adult bronchiectasis

The American College of Chest Physicians (CHEST) recently released a new clinical guideline on the management of adult bronchiectasis. Published in the journal CHEST®, the guideline contains 13 evidence-based recommendations that will create standardization in the management of bronchiectasis.

Bronchiectasis is a chronic respiratory condition involving a cycle of impaired mucociliary clearance, chronic infections, inflammation, and progressive airway destruction, leading to persistent cough, with sputum production, dyspnea, and fatigue. Without appropriate management, patients can experience increased exacerbations, reduced quality of life, declining lung function, and increased mortality risk. There is variability in clinical practice regarding treatment selection, highlighting the need for evidence-based guidance to optimize patient outcomes and standardize care delivery across healthcare settings.

“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,” said Rachel Thomson, MBBS, FCCP, lead author of the guideline. “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.”

Thirteen conditional recommendations are made with a low level of certainty of evidence. Highlights include:

• Recommendations for sputum microbiology to guide therapy during exacerbations if possible.
• Duration of antibiotic therapy for exacerbations should be guided by patient symptom response.
• For adults with frequent exacerbations of bronchiectasis, recommended options include long-term macrolide antibiotic therapy, inhaled antibiotics, and long-term brensocatib therapy.
• Airway clearance is recommended for all patients, and we provide a detailed review of different techniques.
• For patients with bronchiectasis and hemoptysis, we suggest tranexamic acid as an option to reduce the need for more invasive interventions.

Beyond the 13 recommendations, the guideline stresses that shared decision-making with patients using a multidisciplinary approach is paramount.

The entire list of recommendations included in the new guideline can be accessed through the CHEST journal website in the article titled, “Management of Adult Bronchiectasis: An American College of Chest Physicians Clinical Practice Guideline.”

Reference:

Rachel Thomson, Christina Thornton, Management of Adult Bronchiectasis: An American College of Chest Physicians Clinical Practice Guideline, CHEST Journal, DOI:10.1016/j.chest.2026.06.057