Treatment to prevent exacerbations in bronchiectasis: macrolides as first line?

Bronchiectasis exacerbations are defined by an increase in daily respiratory symptoms such as cough, sputum production, malaise, fatigue and breathlessness [1–3]. Symptoms accumulate over several days and can take weeks to resolve, with many patients never fully returning to baseline after therapy [4]. Patients with frequent exacerbations experience poorer quality of life and a markedly increased mortality [5–7]. Patients tend to continue to have frequent exacerbations over time unless therapy is initiated to prevent them [5]. Bronchiectasis guidelines such as those recently issued from the European Respiratory Society (ERS) and British Thoracic Society therefore rightly prioritise exacerbation prevention as perhaps the key objective of therapy, alongside improvement of patients' symptoms and quality of life [8–10]. Macrolides appear to be superior to inhaled corticosteroids for exacerbation prevention in bronchiectasis patients <http://bit.ly/2Je3BY6>