Guidelines
Polverino E, Goeminne P, McDonnel M, et al. European respiratory society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50(3):1700629. These guidelines describe appropriate investigation and treatment strategies by posing nine key clinical questions and conducting systematic reviews to answer the questions.
Therapeutics
O’Donnell AE, Barker AF, Ilowite JS, et al. Treatment of idiopathic bronchiectasis with aerosolized recombinant human DNase I. Chest 1998;113:1329-1334. A large multinational trial of patients with idiopathic bronchiectasis found increased exacerbation frequency and a more brisk decrease in FEV1. While noteworthy for its specific findings, this study is widely cited as a reason cystic fibrosis treatment strategies cannot be universally applied to all types of bronchiectasis.
Scheinberg P, Shore E. A pilot study of the safety and efficacy of tobramycin solution for inhalation in patients with severe bronchiectasis. Chest. 2005;127:1420-6. This open label study in 41 patients found significant improvements in pulmonary symptom score and SGRQ. Notably, 9 patients withdrew from the study due to adverse effects likely due to the treatment, primarily cough, wheezing, and dyspnea.
Haworth CS, Foweraker JE, Wilkinson P, et al. Inhaled colistin in patients with bronchiectasis and chronic Pseudomonas aeruginosa infection. Am J Respir Crit Care Med 2014; 189: 975-982. A prospective, randomized, placebo-controlled study comparing colimycin or 0.45% saline nebs twice daily for up to 6 months in 144 patients with non-CF bronchiectasis and chronic P. aeruginosa colonization. Although the primary outcome of time to exacerbation was not significantly different between groups (165 vs 111 days), a subgroup of adherent patients did have significant benefit (168 vs 103 days). Additionally, there were no safety concerns.
The following two trials examined chronic macrolide antibiotic treatment in patients with stable non-cystic fibrosis bronchiectasis. They both found decreased pulmonary exacerbation rate but both also were associated with increased macrolide resistance.
Serisier DJ, Martin ML, McGuckin MA, et al. Effect of long-term, low-dose erythromycin on pulmonary exacerbations among patients with non-cystic fibrosis bronchiectasis: the BLESS randomized controlled trial. JAMA. 2013;309(12):1260-7
Altenburg J, de Graaff CS, Stienstra Y, et al. Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non-cystic fibrosis bronchiectasis: the BAT randomized controlled trial. JAMA. 2013;309:1251-9.
