Patient-managed interventions for adults with bronchiectasis: evidence, challenges and prospects

Bronchiectasis is a chronic lung condition which is characterised by recurrent chest infections, chronic
sputum production and cough, and limited exercise tolerance. While bronchiectasis may be caused by
various aetiologies, these features are shared by most patients with bronchiectasis regardless of the cause.
This review consolidates the existing evidence on patient-managed interventions for adults with
bronchiectasis, while also outlining areas for future research. Airway clearance techniques and
hyperosmolar agents are key components of the bronchiectasis management and consistently recommended
for clinical implementation. Questions around their prescription, such as optimal sequence of delivery, are
still to be answered. Pulmonary rehabilitation and exercise are also recommended for patients with
bronchiectasis. Relatively strong evidence underpins this recommendation during a clinically stable stage of
the disease, although the role of pulmonary rehabilitation following an exacerbation is still unclear.
Additionally, self-management programmes feature prominently in bronchiectasis treatment, yet the lack of
consensus regarding their definition and outcomes presents hurdles to establishing a cohesive evidence
base. Moreover, cough, a cardinal symptom of bronchiectasis, warrants closer examination. Although
managing cough in bronchiectasis may initially appear risky, further research is necessary to ascertain
whether strategies employed in other respiratory conditions can be safely and effectively adapted to
bronchiectasis, particularly through identifying patient responder populations and criteria where cough may
not enhance airway clearance efficacy and its control is needed. Overall, there is a growing recognition of
the importance of patient-managed interventions in the bronchiectasis management. Efforts to improve
research methodologies and increase research funding are needed to further advance our understanding of
these interventions, and their role in optimising patient care and outcomes.