New therapies for the prevention and treatment of exacerbations of bronchiectasis

PURPOSE OF REVIEW: Exacerbations of bronchiectasis have a major impact on quality of life, healthcare costs, and long-term risk of complications. Preventing exacerbations is one of the major goals of treatment. Bronchiectasis is increasingly recognized and the impact of bronchiectasis exacerbations on daily clinical practice is also increasing.

RECENT FINDINGS: Preventing bronchiectasis exacerbations are dependent on appropriate risk assessment, identifying the patients at highest risk to rationally target preventive therapies. Inhaled and oral antibiotic treatments can target chronic bacterial infection which is one of the major risk factors for exacerbation. Although the data is weak, airway clearance is an important part of long-term management including in patients with frequent exacerbations. Anti-inflammatory therapies such as inhaled corticosteroids do not currently have a major role outside comorbid chronic obstructive pulmonary disease and asthma, but further studies are required.

SUMMARY: Treatment of acute exacerbations involves prompt administration of antibiotic therapy with usually 14 days of oral, or for severe exacerbations, intravenous antibiotics. The role of corticosteroids is not established and there is little data on the optimal management approach for acute exacerbations. Home intravenous therapy can reduce healthcare costs and improve patient satisfaction with care. A number of large randomized controlled trials are currently enrolling or have recently completed raising the possibility that the treatment paradigm may change in the near future.