Aspects of the modern management of bronchiectasis

While bronchiectasis is an old condition, it is only in the last decade that there have been major strides in our understanding of this disease and its treatment. Recent evidence has shown that the "vicious cycle" hypothesis remains valid. This, and the concept of "treatable traits," provide useful frameworks on which to base the management of this condition. In all recently diagnosed patients, a search should be undertaken for specific etiologies. A number of factors, including chronic infection by Pseudomonas aeruginosa, have been shown to be associated with increased morbidity and mortality. While airway clearance strategies remain the mainstay of therapy, other treatments including nebulized hypertonic saline and inhaled antibiotic treatment are discussed. Greater emphasis is being placed on immune‑modulatory therapies, not just long‑term macrolide therapy but other more innovative strategies. The role of surgical lung resection in the management of this condition is also discussed.