Non-cystic fibrosis bronchiectasis

Exacerbations of bronchiectasis are common, with European data suggesting that the average patient experiences two exacerbations per year. Exacerbations have been associated with worse QoL, lung function decline and increased mortality. Exacerbations are highly heterogeneous, presenting most frequently with increasing cough and sputum production, but also commonly with breathlessness, wheeze, malaise and systemic features. There is a lack of research into the causes of bronchiectasis exacerbations, but antibiotic therapy is currently recommended for all exacerbations because of the high frequency of bacterial infection in the disease. Exacerbations are the primary end-point for the majority of late-phase bronchiectasis clinical trials, although these have been limited by the lack of a standardised definition. The EMBARC (European Multicentre Bronchiectasis Audit and Research Collaboration) network, in collaboration with colleagues from the USA, Australasia and South Africa, has recently generated a consensus definition of exacerbations, which should help to standardise outcomes. Exacerbations are key events in the natural history of bronchiectasis. There is an urgent need for further research into the causes, optimal management and outcomes of bronchiectasis exacerbations.