For years, North American clinicians managing bronchiectasis — a chronic lung condition marked by damaged, widened airways — had no formal guideline to lean on, unlike their European peers who've had one since 2017. That gap is now closed. A panel of 17 experts reviewed 47 studies and developed 13 evidence-based recommendations, published in the journal CHEST, covering everything from antibiotic therapy duration to airway clearance techniques and hemoptysis management.

Lead author Dr. Rachel Thomson highlights that bronchiectasis is more common than many realize, with prevalence rising partly due to increased CT scanning. Management has also evolved — from viewing it purely as an infection-driven disease to recognizing the role of dysregulated inflammation, which has opened the door to targeted anti-inflammatory treatments like azithromycin and the newly FDA-approved brensocatib (Brinsupri).

Key Takeaways:

• Antibiotic course length for exacerbations should be guided by patient response — longer courses (>10 days) are often appropriate and acceptable
• All patients should receive physiotherapy and instruction on airway clearance techniques
• For minor hemoptysis, tranexamic acid (oral or inhaled) is recommended to reduce the need for hospitalization or invasive intervention
• Brensocatib is the only FDA-approved drug specifically for bronchiectasis; azithromycin remains a cornerstone anti-inflammatory therapy

Why it matters: This guideline gives North American clinicians a structured, evidence-based framework for a condition that's often mismanaged or overlooked — potentially improving outcomes for a growing patient population.