Diagnosis
Worsening symptoms that exceeds day-to-day variability and requiring a change in management. Symptoms include cough, sputum volume and/or consistency, sputum purulence, dyspnea and/or exercise tolerance, fatigue and/or malaise, hemoptysis.
Evaluation
Sputum for microbiology at onset of exacerbation before antibiotics started if possible.
Treatment
Antibiotics guided by previous microbiology results, generally 14-day course with shorter course for mild bronchiectasis, rapid clinical response, or pathogens more sensitive to antibiotics.
Airway clearance may need to be adjusted in frequency, intensity, and technique.
Comprehensive reassessment: microbiology including for bacteria, NTM, and fungal; imaging (e.g. CT scan); and review of potential “treatable traits” including comorbidities; airway clearance; mucoactive treatments; long-term (inhaled) antibiotics; anti-inflammatory options; long-term oxygen; pulmonary rehabilitation; and referral to specialty center if not already done.