The European Respiratory Society guideline for management of adult bronchiectasis: clinical summary

This review provides an overview of the 2025 European Respiratory Society guidelines for adult bronchiectasis. We cover the initial assessment of patients with bronchiectasis to identify the underlying cause, pharmacotherapy including long-term oral and inhaled antibiotic treatment, anti-inflammatory treatments and mucoactive drugs, and non-pharmacological treatments including airway clearance and pulmonary rehabilitation. We provide examples of how to implement the guideline algorithms in practice including how to manage patients during an acute exacerbation and the deteriorating patient. An important component of the new guideline is assessing patients' future risk of exacerbation, which takes into account not just prior history of exacerbations, but also severity of baseline symptoms and additional risk factors such as the underlying cause of bronchiectasis and infection with pathogens like Pseudomonas aeruginosa. The guideline provides an evidence-based framework for identifying the appropriate treatments for individual patients taking into account the heterogeneity and complexity of bronchiectasis.