Table 3 Treatments for acute exacerbations of bronchiectasis
Evidence or studySummary dataLimitations
Antimicrobial agentsSystematic review93Beneficial (see text)
Anti-inflammatories*No data
Mucolytics
    BromhexineCochrane review101High doses of bromhexine with antibiotics eased difficulty in expectoration, reduction in sputum productionNot universally available
    rhDNaseSystematic review101 102No studies in acute phase.101 102 Note increased exacerbation rate when used in non-acute phaseAdverse effects more common in the group receiving rhDNase
Airway clearance
    Chest physiotherapyCochrane review103No data*
    Inhaled hyperosmolar agentsCochrane review104 105One RCT using single mannitol dose in stable bronchiectasis,127 improved airway clearance; one study on 7% HS as adjunct to physiotherapy.105 Sputum weights, ease for expectoration, viscosity better in HS group
Asthma therapies
    Inhaled corticosteroidsNo data during pulmonary exacerbation*See table 2 for other data
    Oral corticosteroidsCochrane review106No RCTsNo other data*
    AnticholinergicsCochrane review107No RCTsNo other data*
    β2 agonistCochrane review108 109No RCTsNo other data*
    LTRACochrane review110No RCTsNo other data*
    MethylxanthinesCochrane review128No RCTsNo other data*
Exercise/physical trainingNo data*
OxygenNo data*Consider data from COPD
SurgeryNo data*
Ventilatory assistance
    BTS guidelines126See text

  • HS, hypertonic saline; LTRA, leucotriene receptor antagonist; RCT, randomised controlled trial; rhDNase, recombinant human deoxyribonuclease.

  • *No other data specific to acute exacerbation management based on single reviewer search (up to March 2006).