Management of Adult Bronchiectasis – Consensus-based Guidelines of the German Respiratory Society

Bronchiectasis is a chronic, often progressive respiratory disease characterized by irreversible dilation of the bronchi. It is etiologically heterogeneous and frequently associated with a significant symptom burden, multiple complications, and reduced quality of life. In recent years, the global prevalence of bronchiectasis has increased markedly, placing a substantial economic burden on healthcare systems. These consensus-based guidelines are the first German-language guidelines focused on the management of bronchiectasis in adults. They underscore the critical role of thoracic imaging - particularly computed tomography - in diagnosing and distinguishing bronchiectasis and highlight the importance of identifying the underlying etiology in guiding treatment decisions. The guidelines provide comprehensive recommendations for both pharmacological and non-pharmacological treatment strategies. Non-drug interventions include smoking cessation, physiotherapy, physical training, pulmonary rehabilitation, non-invasive ventilation, thoracic surgery, and lung transplantation. Pharmacological therapies emphasize the long-term use of mucolytics, bronchodilators, anti-inflammatory agents, and antibiotics. In addition, the guidelines address the management of upper airway involvement, common comorbidities, and acute exacerbations. They also cover socio-medical issues, disability rights, and the role of patient education and self-management in optimizing care. Special life stages - such as transition from pediatric to adult care, family planning, pregnancy, parenthood, and palliative care - are also considered. The overarching goal is to promote comprehensive, consensus-driven, and patient-centered care that accounts for individual risks and needs.