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.

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Conflict of interest: A. Spinou reports a leadership role with the EMBARC committee. A.L. Lee, B. O'Neil and A. Oliveira have nothing to disclose. M. Shteinberg reports grants from GSK, Trudell medical international and Tel Aviv league for lung diseases, consultancy fees from AstraZeneca, Boehringer Ingelheim, Dexcel, Kamada, Synchrony medical, Trumed, Vertex and Zambon, payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, GSK, Kamada, Sanofi and Insmed, support for attending meetings from Boehringer Ingelheim Israel, AstraZeneca Israel, Kamada, Rafa, and GSK Israel, participation on a data safety monitoring board or advisory board with Bonus Biotherapeutics, Boehringer Ingelheim, and AstraZeneca, leadership role with AJRCCM (Associate Editor), Israeli Pulmonology society (Management board member), Israeli society for Tuberculosis and mycobacterial diseases (Management board member), EMBARC (Management board member), ERJ (Editorial board member), Chest (Editorial board member) and ERJ Task Force for bronchiectasis guidelines, and receipt of equipment, materials, drugs, medical writing, gifts or other services from Trudell medical international. B. Herrero-Cortina reports payment or honoraria for lectures, presentations, manuscript writing or educational events from SEPAR (Spanish Respiratory Society), and a leadership role with SEPAR (Spanish Respiratory Society).