Active Ingredients: Doxycycline
Vaccination There have been no specific RCTs on vaccines for patients with bronchiectasis.
However, patients should still be advised to have the influenza vaccine on an annual basis and pneumococcal polysaccharide vaccine PPV-23 if they have not had it previously.
Surgery Patients who demonstrate unilateral localised disease and are not improving with maximal medical therapy should consider resection surgery.
Patients who have massive haemoptysis should also consider surgery.
Currently, bronchial artery embolisation is the first-line treatment and surgery regarded as second line. End-of-life care Long-term oxygen therapy should be considered in bronchiectasis patients who develop respiratory failure. Along with active treatment, it is important to recognise when a patient with end-stage bronchiectasis is approaching end of life.
Future perspective Management of bronchiectasis will benefit from national and international networks and consensus guidelines, such as the recently published European Respiratory Society guidelines on bronchiectasis, and the, soon to be published, updated BTS guidelines.
There have been BTS quality standards in bronchiectasis, which aim to improve care throughout the UK and, if adopted, internationally.
Therefore, it will be interesting whether guidelines, quality standards and self-management plans lead to qualitative or quantitative improvement.
Owing to the difficulties in treating bronchiectasis and the absence of large randomised trials, there is an urgent need for licensed therapies, in particular, long-term antibiotics, long-term anti-inflammatory treatment and muco-active therapies.
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State of the art review: management of bronchiectasis in adults. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from to : a population-based cohort study.
Eur Respir J;47 1:186—193.