Bronchiectasis can lead to persistent cough, fatigue, breathlessness, and recurrent chest infections, which can notably impact a patient's quality of life. The American College of Chest Physicians (CHEST) and the European Respiratory Society (ERS) have published clinical practice guidelines within the past year outlining management recommendations for adults living with the chronic lung condition. Today, we're comparing key sections of those guidelines side by side.
The following side-by-side comparison represents just a portion of the complete guidelines, specifically recommendations focusing on the management of exacerbations and airway clearance strategies in adults with non-cystic fibrosis bronchiectasis. View the full-text links in the table below for the complete look at the ACCP and ERS guidelines. Throughout its guideline, the ERS endorsed several recommendations from other clinical guidelines and statements. These are indicated as an "endorsed recommendation" where appropriate.
Guidelines for Comparison
| Item | Management of Adult Bronchiectasis | Management of Adult Bronchiectasis |
|---|---|---|
| Authoring Organization: | American College of Chest Physicians (CHEST) | European Respiratory Society (ERS) |
| Publication Date: | June 2026 | September 2025 |
| Links | Overview / Full Text | Summary / Full Text |
Management of Exacerbations
| Topic | CHEST | ERS |
|---|---|---|
| Long-Term Inhaled Antibiotics | Recommended | Recommended |
| Antibiotic Course Duration | Flexible, as appropriate. Supports ≥10 day courses, or >10 day courses based on clinical response. | 14-day antibiotic course. Shorter courses may be appropriate in certain patient populations (endorsed recommendation). |
| Long-Term Macrolides | Recommended | Recommended |
| Long-Term Non-Macrolide Oral Antibiotics | No recommendation | Recommends AGAINST |
| Long-Term Inhaled Corticosteroids | No recommendation | Recommends AGAINST |
| Long-Term Brensocatib Therapy | Recommended | No recommendation |
| Long-Term Atorvastatin Therapy | Recommends AGAINST | No recommendation |
Airway Clearance Strategies
| Topic | CHEST | ERS |
|---|---|---|
| DNase | Recommends AGAINST | Recommends AGAINST |
| Mucoactive Treatments | Recommended (nebulized hypertonic saline, specifically) | Recommended |
| Breathing/Clearance Techniques | Recommended | Recommended |
| Positive Expiratory Pressure | Recommended | No recommendation |
| High-Frequency Chest Wall Oscillation | Recommended | No recommendation |
Additional Comparison Points:
ACCP recommends surgical resection when appropriate. ACCP states that surgical resection should be performed at a high-volume thoracic center that can provide pulmonary rehabilitation following resection. ERS recommends that pulmonary rehabilitation should be available to certain patient populations and also provides an endorsed recommendation that states lung resection may be considered in certain highly selected patients.
Both guidelines discuss P. aeruginosa eradication. ACCP makes no recommendation for or against eradication. ERS suggests offering eradication treatment to patients with a new isolation of P. aeruginosa.
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