An expert panel evaluated 8 PICO questions on adult bronchiectasis management — covering antibiotic therapy for acute exacerbations, long-term suppressive antibiotics, anti-inflammatory therapies, airway clearance, hemoptysis management, and surgical resection — using a systematic review of 47 studies and the GRADE approach.
Thirteen evidence-based recommendations were produced across all key management domains; all 13 are conditional recommendations based primarily on low-certainty evidence.
All recommendations are conditional and based on low-certainty evidence, limiting the strength of guidance. Accurate phenotyping and endotyping to guide treatment decisions remain underdeveloped. Variability in clinical practice and research gaps persist across most PICO domains.
Clinicians should apply shared decision-making and a multidisciplinary approach when managing bronchiectasis, as no recommendation carries high-certainty backing. Treatment burden — including cost and quality-of-life impact — must be weighed in every therapeutic decision.
