The European respiratory society guideline for adult bronchiectasis 2025: summary and implementation guide for primary care
ERS · 2026 · Europe
Source and licence
- Authors
- Fiona Mosgrove, Janwillem WH Kocks, Eliza Kompatsiari et al.
- Title
- The European respiratory society guideline for adult bronchiectasis 2025: summary and implementation guide for primary care
- Journal
- NPJ Primary Care Respiratory Medicine, 2026
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC13586304
Licence statement of the original publication
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Introduction
- Bronchiectasis is a highly heterogeneous condition with multiple possible underlying aetiologies, and its management can be complex7. In most countries, management is undertaken by respiratory specialists in secondary or tertiary care centres. However, most healthcare interactions for adult patients with bronchiectasis are with primary care professionals. Patients with bronchiectasis are typically multimorbid with other conditions including cardiovascular disease, depression, osteoporosis, asthma, chronic obstructive pulmonary disease (COPD), and gastro-oesophageal reflux disease (GORD)8. Patient centred management of multi-morbidity often sits best with primary care professionals. In addition, most exacerbations are initially, if not entirely, managed in primary care even for patients under the care of a specialist respiratory physician.
Airway clearance and mucoactive drugs in primary care
- We recommend that patients with bronchiectasis should be taught airway clearance techniquesstrong recommendation, very low certainty of evidence
- We suggest offering mucoactive treatments to patients with bronchiectasis where airway clearance has failed to control symptomsconditional recommendation, very low certainty of evidence
- We suggest not to offer recombinant DNAse to patients with bronchiectasisconditional recommendation, very low certainty of evidence
Pulmonary rehabilitation
- We recommend that patients with breathlessness and/or impaired exercise capacity should be offered pulmonary rehabilitationstrong recommendation, very low certainty of evidence
Long term antibiotic treatments: impacts on primary care
- We recommend offering long term inhaled antibiotics to patients at high risk of exacerbations and chronic infection with Pseudomonas aeruginosaStrong recommendation, moderate certainty of evidence
- We suggest offering long term inhaled antibiotics to patients at high risk of exacerbations and chronic infection with pathogens other than Pseudomonas aeruginosaConditional recommendation, moderate certainty of evidence
- We recommend offering long-term macrolides to patients at high risk of exacerbations despite standard careStrong recommendation, moderate certainty of evidence
- The panel suggests NOT to offer long-term non-macrolide oral antibiotics as a first line treatment to adult patients with bronchiectasis and a high risk of exacerbationsconditional recommendation against the intervention, very low certainty of evidence
Pseudomonas aeruginosa eradication
- We suggest offering eradication treatment to patients with a new isolation of Pseudomonas aeruginosaconditional recommendation, very low certainty of evidence
Inhaled corticosteroids
- We suggest not to offer long term inhaled corticosteroids to patients with bronchiectasis who do not have coexisting COPD or asthmaconditional recommendation, low certainty of evidence
Abstract
Bronchiectasis is a common chronic respiratory disease with rising prevalence, hospitalisation rates, and mortality. It is estimated to affect approximately 1 in 200 adults, imposing a substantial symptom burden and significant healthcare costs, largely driven by exacerbations. Although diagnosis and long-term management are usually led by respiratory specialists, most patient care interactions occur in primary care, including the management of multimorbidity and acute exacerbations. In December 2025, the European Respiratory Society (ERS) published updated global clinical practice guidelines for adult bronchiectasis. This article summarises the 2025 ERS recommendations with a specific focus on their implementation in primary care practice. Key priorities include improving early recognition and reducing diagnostic delay, undertaking standardised investigations to identify underlying causes and treatable traits, and recognising features associated with poor outcomes that warrant specialist referral. The guidance emphasises the importance of sputum microbiology, including testing for non-tuberculous mycobacteria, and targeted blood investigations such as immunoglobulins and allergic bronchopulmonary aspergillosis serology. Core management strategies relevant to primary care are reviewed, including airway clearance techniques, pulmonary rehabilitation, and evidence-based use of inhaled therapies. The article outlines best practice for the management of acute exacerbations, highlights differences from asthma and COPD care, and clarifies the limited role of inhaled corticosteroids in bronchiectasis. The identification and monitoring of patients who may benefit from long-term antibiotic therapy, including those with Pseudomonas aeruginosa infection, are also discussed. By translating specialist guideline recommendations into a primary care context, this summary aims to support timely diagnosis, optimise ongoing management, and improve outcomes for adults with bronchiectasis.
Contents of the original publication
The section headings of the original.
- Introduction
- Underlying causes of bronchiectasis: implications for primary care
- Recommendations
- Diagnosing bronchiectasis
- Aetiological testing
- Managing multimorbidity
- Airway clearance and mucoactive drugs in primary care
- Pulmonary rehabilitation
- Long term antibiotic treatments: impacts on primary care
- Pseudomonas aeruginosa eradication
- Inhaled corticosteroids
- Recognising and managing the deteriorating patient
- Summary
A question about this guideline?
Medelix answers clinical questions from guidelines and studies – every statement with its source.
Are you the rights holder and object to this reproduction? Write to contact@medelix.ai and we will take the page down promptly. Imprint