For those living with bronchiectasis, the disease has long been a spiral without a shared map — airways damaged, infections recurring, care varying from one clinic to the next. The American College of Chest Physicians has now offered that map: thirteen evidence-based recommendations published in CHEST, designed to bring consistency to a condition that has too often been managed by instinct alone. It is not a final answer, but a common language — a foundation from which clinicians and patients can begin to navigate together.
CHEST releases 13 evidence-based recommendations for managing adult bronchiectasis
Bronchiectasis patients face reduced quality of life, declining lung function, and increased mortality risk without appropriate management.
Break the cycle of exacerbations that drives the disease forward
Mark
Why does bronchiectasis need its own guideline? Isn't it just another chronic lung disease?
Mimi
It's chronic, yes, but it's also a trap. The disease feeds itself—damage causes infection, infection causes inflammation, inflammation causes more damage. Without the right interventions, patients spiral. There's been no consensus on how to interrupt that cycle, so treatment has been all over the place.
Mark
What makes these 13 recommendations different from what doctors were already doing?
Mimi
They're evidence-based and published together. Before, a doctor in one hospital might use macrolides, another might use inhaled antibiotics, another might try something else. Now there's a shared language, a framework for thinking through the choices.
Mark
The guideline says the evidence certainty is low. Doesn't that undermine the recommendations?
Mimi
Not really. It's honest. Bronchiectasis is relatively rare, so large trials are hard to run. Low certainty doesn't mean the recommendations are wrong—it means we're working with the best evidence we have and acknowledging the limits. It actually makes the shared decision-making piece more important.
Mark
What does "shared decision-making" mean in practice?
Mimi
It means the doctor doesn't just prescribe. They talk with the patient about what the options are, what the trade-offs are, what matters most to that person's life. A patient who coughs up blood might prioritize stopping that over other concerns. Another might prioritize avoiding long-term antibiotics. The guideline creates space for that conversation.
Mark
Is this guideline going to change how patients feel?
Mimi
Potentially, yes. If it leads to more consistent, thoughtful treatment that actually reduces exacerbations, patients will feel the difference—fewer infections, less decline, better quality of life. But that only happens if clinicians actually use it.
Il Polso
- Bronchiectasis traps patients in a worsening cycle of infection, inflammation, and lung damage that, without coordinated care, accelerates toward serious decline and death.
- Inconsistent treatment across healthcare settings has meant that where a patient lives has shaped how — and how well — they are treated, a disparity the new guidelines directly confront.
- Thirteen evidence-based recommendations now give clinicians a shared framework: sputum testing to guide antibiotics, symptom-driven treatment duration, airway clearance for all, and targeted therapies for those with frequent exacerbations.
- Because the evidence base remains uncertain and patients vary widely, the guidelines are conditional — designed to inform judgment, not replace it, with shared decision-making at the center.
- The release marks a turning point for a chronic condition long underserved by consensus, signaling that the medical community is mobilizing around the burden bronchiectasis places on patients' lives.
For those living with bronchiectasis, the disease has long been a spiral without a shared map — airways damaged, infections recurring, care varying from one clinic to the next. The American College of Chest Physicians has now offered that map: thirteen evidence-based recommendations published in CHEST, designed to bring consistency to a condition that has too often been managed by instinct alone. It is not a final answer, but a common language — a foundation from which clinicians and patients can begin to navigate together.
Bronchiectasis is a disease that compounds itself. Damaged airways trap mucus, infections take hold, inflammation spreads, and the harm deepens — pulling patients into a cycle of persistent cough, breathlessness, and declining lung function. Without proper management, exacerbations multiply, quality of life erodes, and mortality risk rises. For years, no clear consensus existed on how to interrupt that cycle, leaving clinicians to make different choices in different places and patients to receive inconsistent care.
The American College of Chest Physicians has now stepped into that gap. A new clinical guideline, published in the journal CHEST, offers thirteen evidence-based recommendations for managing adult bronchiectasis — a shared framework intended to standardize care across healthcare settings. Lead author Rachel Thomson was careful to frame the document not as a mandate but as guidance: the recommendations are conditional, the evidence still evolving, and the patient population too varied for rigid rules.
The recommendations address several critical areas: sputum microbiology testing to guide antibiotic selection during exacerbations, symptom-based rather than schedule-based antibiotic duration, and — for patients with frequent exacerbations — options including long-term macrolide antibiotics, inhaled antibiotics, or brensocatib therapy. Airway clearance techniques are recommended universally, and tranexamic acid is suggested for patients who experience hemoptysis, reducing the need for more invasive intervention.
Running beneath all of it is an emphasis on shared decision-making — clinicians collaborating across specialties and, crucially, in genuine partnership with patients. For those living with bronchiectasis, the guidelines represent something meaningful: evidence that the medical community is working, together, to lighten the weight of a condition that has long been carried without enough support.
Bronchiectasis is a disease that spirals. The airways become damaged, mucus accumulates, infections take hold, inflammation spreads, and the damage deepens. Patients cough persistently, produce sputum, struggle for breath, and tire easily. Without the right treatment, the cycle accelerates—more exacerbations, steeper decline in lung function, worse quality of life, higher risk of death. Yet until recently, there was no clear consensus on how to treat it. Doctors made different choices in different places, and patients received inconsistent care.
The American College of Chest Physicians has now released a new clinical guideline aimed at changing that. Published in the journal CHEST, the document contains 13 evidence-based recommendations designed to standardize how adult bronchiectasis is managed across healthcare settings. The goal is straightforward: break the cycle of exacerbations that drives the disease forward.
Rachel Thomson, the lead author and a physician at the college, emphasized that the guideline is not a one-size-fits-all mandate. "We work with a heterogeneous population, and each clinician needs to make decisions that are right for their patients," she said. The recommendations are conditional, meaning they offer guidance rather than rigid rules. They carry a low level of certainty of evidence, which reflects the reality that bronchiectasis research is still evolving. What matters is that clinicians now have a shared framework for thinking through treatment choices.
The recommendations cover several key areas. Doctors should use sputum microbiology testing to guide antibiotic selection during exacerbations when possible. The duration of antibiotic therapy should be determined by how the patient responds symptomatically, not by a fixed schedule. For patients experiencing frequent exacerbations, the guideline suggests three main options: long-term macrolide antibiotics, inhaled antibiotics, or long-term brensocatib therapy. Airway clearance techniques are recommended for all patients, and the guideline provides detailed review of different approaches. For those with bronchiectasis who experience hemoptysis—coughing up blood—tranexamic acid is suggested as a way to reduce the need for more invasive procedures.
Beyond these specific recommendations, the guideline emphasizes something equally important: shared decision-making with patients using a multidisciplinary team approach. Bronchiectasis management is not something a single doctor decides in isolation. It requires conversation, collaboration across specialties, and genuine partnership with the patient about what matters most to them.
The full guideline is available through the CHEST journal website. For clinicians treating bronchiectasis, it represents a turning point—not a final answer, but a foundation for more consistent, thoughtful care. For patients living with this chronic condition, it signals that the medical community is working to reduce the burden they carry.
Citazioni salienti
Each clinician needs to make decisions that are right for their patients. The goal is to reduce exacerbation frequency, which drives the inflammation and leads to deterioration and progression of the disease.— Rachel Thomson, lead author of the guideline
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