Towards development of evidence to inform recommendations for the evaluation and management of bronchiectasis

Bronchiectasis (BE) is a chronic condition characterized by airway dilation as a consequence of a variety of pathogenic processes. It is often associated with persistent airway infection and an inflammatory response resulting in cough productive of purulent sputum, which has an adverse impact on quality of life. The prevalence of BE is increasing worldwide. Treatment guidelines exist for managing BE, but they are generally informed by a paucity of high-quality evidence. This review presents the findings of a scientific advisory board of experts held in the United States in November 2020. The main focus of the meeting was to identify unmet needs in BE and propose ways to identify research priorities for the management of BE, with a view to developing evidence-based treatment recommendations. Key issues identified include diagnosis, patient evaluation, promoting airway clearance and appropriate use of antimicrobials. Unmet needs include effective pharmacological agents to promote airway clearance and reduce inflammation, control of chronic infection, clinical endpoints to be used in the design of BE clinical trials, and more accurate classification of patients using phenotypes and endotypes to better guide treatment decisions and improve outcomes. •Bronchiectasis (BE) is increasing in prevalence but clinical guidelines are limited.•Few established standards of care exist for BE based on high-quality evidence.•Guidance for airway clearance and appropriate antimicrobial use is lacking.•Clinical trials with more accurate inclusion criteria and relevant endpoints are needed for improved BE management.•New assessment frameworks/evidence-based treatment recommendations are required.