This handout is for bronchiectasis (non-cf — chronic + exacerbation). Your care team identified this based on: chronic productive cough >8 weeks ± recurrent lower respiratory tract infection (ers 2025; bts 2019).
Other reasons your team may use this plan: hrct showing bronchoarterial ratio >1 / signet-ring, tram-track, lack of tapering, ballooning (ers 2025 — diagnostic reference standard); acute exacerbation: deterioration in ≥3 of cough/sputum volume/sputum purulence/dyspnea/fatigue/haemoptysis ≥48 h (embarc/ers 2025 exacerbation definition); existing bronchiectasis — annual review, severity re-stratification, or post-exacerbation visit (ers 2025).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| airway clearance technique (ACBT / ELTGOL / oscillatory PEP) | Daily, ≥1-2 sessions/day, taught by respiratory physiotherapy | n/a | daily | ERS 2025 STRONG recommendation — airway clearance for most patients with bronchiectasis (sputum retention drives the vicious vortex); ELTGOL has the best comparative trial evidence |
| nebulised hypertonic saline (6-7% sodium chloride) | 4 mL of 6-7% nebulised (pre-treat with bronchodilator + tolerance test for bronchospasm) | nebulised | BID | Kellett Respir Med 2011 (PMID 22018993) — 7% HS improved FEV1 +15.1% and SGRQ −6.0 vs isotonic, with fewer antibiotic courses (2.4 vs 5.4/pt-yr); ERS 2025 conditional mucoactive recommendation |
| carbocysteine | 750 mg | PO | TID (then taper to 750 mg BID) | Oral mucolytic alternative/adjunct where nebulised hypertonic saline is not tolerated (ERS 2025 conditional mucoactive) |
Plan: ERS 2025 — airway-clearance foundation + phenotype escalation + exacerbation
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Vaccination (influenza, pneumococcal), pulmonary rehabilitation, airway-clearance technique reinforcement + adherence, severity re-stratification (BSI/FACED) at annual review, lung-transplant referral in advanced disease, advance care planning (ERS 2025; BTS 2019)
Guideline: ERS 2025 Clinical Practice Guideline for the management of adult bronchiectasis (Chalmers, Eur Respir J 2025; PMID 41016738; DOI 10.1183/13993003.01126-2025) + BTS 2019 Bronchiectasis Guideline (Hill, Thorax 2019; PMID 30545985; DOI 10.1136/thoraxjnl-2018-212463)