What are the recommended management strategies for a patient with bronchiectasis experiencing frequent exacerbations?

Recommended management strategies for a patient with bronchiectasis experiencing frequent exacerbations include:

• Referral to a respiratory specialist: Patients with three or more infective exacerbations per year or fewer exacerbations causing significant morbidity should be referred to a respiratory specialist for further assessment and management ¹.
• Long-term prophylactic antibiotic therapy: Consideration of long-term antibiotic prophylaxis, such as oral macrolides, should be made on specialist advice for patients with frequent exacerbations ¹.
• Antibiotic treatment during exacerbations: Prescribe antibiotics for 7–14 days based on sputum culture and sensitivity; if the patient is on long-term antibiotics, switch to a different antibiotic class during exacerbations ¹.
• Airway clearance techniques: Ensure the patient uses an appropriate airway clearance technique taught by a respiratory physiotherapist, with urgent referral if not already trained or unable to manage independently ¹.
• Monitoring and assessment: Regular clinical review tailored to disease severity, including spirometry, oxygen saturation, and assessment of sputum clearance compliance, is recommended ¹.
• Management of chronic infections: Specialist follow-up is required for patients with chronic colonization by Pseudomonas aeruginosa, MRSA, or non-tuberculous mycobacteria ¹.
• Smoking cessation and immunization: Offer smoking cessation support and immunizations against Streptococcus pneumoniae and seasonal influenza ¹.
• Consider inhaled antibiotics or macrolides: For patients with chronic Pseudomonas aeruginosa infection and frequent exacerbations, inhaled antibiotics or long-term macrolides may be used based on specialist advice ¹.
• Patient education: Ensure patients understand their condition, recognize exacerbations, and know when and how to seek treatment ¹.