Acute exacerbation of bronchiectasis

Lucy Morgan
Macquarie University, New South Wales, Australia

Acute exacerbations, defined by a worsening of respiratory symptoms particularly increased cough, sputum volume or purulence, dyspnoea, or systemic symptoms are the key clinical events that significantly impact quality of life, lung function decline, healthcare utilization, and mortality risk.

Exacerbations are frequently triggered by bacterial infections, with Pseudomonas aeruginosa and Haemophilus influenzae being common pathogens, though viral and fungal causes also play a role. Early recognition and prompt treatment are essential to limit disease progression.

Management typically involves antibiotic therapy tailored to prior sputum cultures, airway clearance strategies or hospitalization for severe episodes. Prevention strategies include vaccinations, long-term macrolide therapy in selected patients, pulmonary rehabilitation, and regular airway clearance. Identifying patients at high risk of frequent exacerbations such as those with chronic Pseudomonas colonization, greater radiologic severity, or comorbidities is crucial for guiding individualized treatment plans.

Understanding the underlying drivers of exacerbations and optimizing both acute and preventive strategies are essential to reducing the burden of disease and improving long-term prognosis in bronchiectasis.