The American College of Chest Physicians (CHEST) recently released a clinical practice guideline regarding bronchiectasis management in adults. The Management of Adult Bronchiectasis guideline covers antibiotic treatment for acute exacerbations, route and duration of antibiotic therapy, airway clearance strategies, and more. CHEST specifies that the recommendations included in the guideline are for adults with non-cystic fibrosis bronchiectasis.

The guideline contains 13 recommendations, which we’ve outlined below. All are indicated as “conditional” strength recommendations. A single recommendation was excluded from the 13. It sought to answer the question of if eradication therapy should be attempted in patients with bronchiectasis and a first isolate of Pseudomonas aeruginosa. There was insufficient evidence, and the potential 14th recommendation was labeled as such. For the most complete look at the following recommendations, along with their rationale, view the full-text version.

Recommendations of the 2026 Guideline:
  • For the management of acute exacerbations of bronchiectasis, we suggest targeted antibiotic therapy based on microbiological culture results.
  • For the treatment of acute exacerbations of bronchiectasis, we suggest either longer duration antibiotic therapy (i.e., >10 days) or shorter duration antibiotic therapy (i.e., <10 days) depending on clinical response.
  • For patients with bronchiectasis experiencing frequent exacerbations (i.e., 2+ per year), we suggest long-term (3+ months) inhaled antibiotic therapy over no long-term inhaled antibiotic therapy.
  • For adults with frequent exacerbations of bronchiectasis, we suggest long-term macrolide antibiotic therapy.
  • For adults with frequent exacerbations of bronchiectasis, we suggest long-term brensocatib therapy.
  • For adults with frequent exacerbation of bronchiectasis, we suggest against long-term atorvastatin therapy.
  • For patients with bronchiectasis and hemoptysis, we suggest tranexamic acid.
  • For patients with bronchiectasis, we suggest against the use of rhDNase for airway clearance.
  • For patients with bronchiectasis, we suggest the use of nebulized hypertonic saline for airway clearance.
  • For patients with bronchiectasis, we suggest the use of breathing techniques (ELTGOL or active cycle of breathing) for airway clearance.
  • For patients with bronchiectasis, we suggest the use of positive expiratory pressure for airway clearance.
  • For patients with bronchiectasis, we suggest the use of high frequency chest wall oscillation for airway clearance.
  • For patients with bronchiectasis and localized disease with refractory symptoms despite optimized medical management, we suggest surgical resection be considered in appropriate surgical candidates.

And the statement regarding eradication therapy: For patients with bronchiectasis and a first isolate of P. aeruginosa, we make no specific recommendation for or against eradication therapy compared to no eradication therapy.

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