Managing exacerbations

All patients should have a written bronchiectasis action plan that outlines usual treatment, how to recognise worsening of symptoms, and how to adjust treatment in response to deterioration. Templates are available for download from the Lung Foundation Australia website.

Patients with severe exacerbation of bronchiectasis need close clinical review and usually require hospital admission; see Clinical features of an exacerbation of bronchiectasis in adults that may benefit from antibiotic therapy for clinical features of severe exacerbations.

Antibiotic therapy should only be used for exacerbations of bronchiectasis if the patient has all three of the following clinical features suggestive of bacterial infection:

• increased sputum volume or change in sputum viscosity
• increased sputum purulence
• increased cough, which may be associated with wheeze, breathlessness or haemoptysis.

For assessment and antibiotic management of exacerbations of bronchiectasis, see Antibiotic management of bronchiectasis.

Long-term oral or inhaled antibiotic therapy (eg low-dose macrolides) may be used by specialists to reduce the frequency of exacerbations in patients with bronchiectasis. Long-term antibiotic therapy is only appropriate for patients with bronchiectasis who have more than three exacerbations per year when other aspects of management (eg airway clearance, exercise, treatment of causes) are optimised. The reduction in exacerbation frequency may be due in part to the anti-inflammatory effect of macrolides. For more information, see The role of long-term antibiotic therapy for bronchiectasis.