Bronchiectasis
Guidelines on adult bronchiectasis by the European Respiratory Society[22]
Suggest the minimum bundle of etiological tests in adults with a new diagnosis of bronchiectasis: (1) differential blood count; (2) serum immunoglobulins (total IgG, IgA, and IgM); and (3) testing for allergic bronchopulmonary aspergillosis (ABPA).
Acute exacerbations of bronchiectasis should be treated with 14 days of antibiotics.
Adults with bronchiectasis with a new isolation of P. aeruginosa should be offered eradication antibiotic treatment.
Suggest not offering eradication antibiotic treatment to adults with bronchiectasis following new isolation of pathogens other than P. aeruginosa.
Suggest not offering treatment with inhaled corticosteroids to adults with bronchiectasis.
Recommend not offering statins for the treatment of bronchiectasis.
Suggest that the diagnosis of bronchiectasis should not affect the use of inhaled corticosteroids in patients with comorbid asthma or COPD.
Offer long-term antibiotic treatment for adults with bronchiectasis who have 3 or more exacerbations per year.
Long-term treatment with an inhaled antibiotic for adults with bronchiectasis and chronic P. aeruginosa infection.
Long-term treatment with macrolides (azithromycin, erythromycin) for adults with bronchiectasis and chronic P. aeruginosa infection in whom an inhaled antibiotic is contraindicated, not tolerated, or not feasible.
Long-term treatment with macrolides (azithromycin, erythromycin) in addition to or in place of an inhaled antibiotic for adults with bronchiectasis and chronic P. aeruginosa infection who have a high exacerbation frequency despite taking an inhaled antibiotic.
Long-term treatment with macrolides (azithromycin, erythromycin) for adults with bronchiectasis not infected with P. aeruginosa.
Long-term treatment with an oral antibiotic (choice based on antibiotic susceptibility and patient tolerance) for adults with bronchiectasis not infected with P. aeruginosa in whom macrolides are contraindicated, not tolerated, or ineffective.
Long-term treatment with an inhaled antibiotic for adults with bronchiectasis not infected with P. aeruginosa in whom oral antibiotic prophylaxis is contraindicated, not tolerated, or ineffective.
Long-term mucoactive treatment (≥3 months) in adult patients with bronchiectasis who have difficulty in expectorating sputum and poor quality of life and where standard airway clearance techniques have failed to control symptoms.
Recommend not to offer recombinant human DNase to adult patients with bronchiectasis.
Suggest not routinely offering long-acting bronchodilators for adult patients with bronchiectasis.
Offer long-acting bronchodilators for patients with significant breathlessness on an individual basis.
Use bronchodilators before physiotherapy, before inhaled mucoactive drugs, and before inhaled antibiotics in order to increase tolerability and optimize pulmonary deposition in diseased areas of the lungs.
Suggest that the diagnosis of bronchiectasis should not affect the use of long-acting bronchodilators in patients with comorbid asthma or COPD.
Suggest not offering surgical treatments for adult patients with bronchiectasis with the exception of patients with localized disease and a high exacerbation frequency despite optimization of all other aspects of their bronchiectasis management.
Suggest that patients with chronic productive cough or difficulty to expectorate sputum should be taught an airway clearance technique (ACT) by a trained respiratory physiotherapist to perform once or twice daily.
Recommend that adult patients with bronchiectasis and impaired exercise capacity should participate in a pulmonary rehabilitation program and take regular exercise. All interventions should be tailored to the patient's symptoms, physical capability, and disease characteristics.
See Bronchiectasis
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. New Clinical Practice Guidelines, October 2017 - Medscape - Oct 06, 2017.
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