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Bronchiectasis frequent exacerbations — SCE Respiratory MCQ

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HardRespiratory InfectionsBronchiectasis frequent exacerbationsSCE Respiratory

A 60-year-old woman with bronchiectasis has four exacerbations in a year despite airway clearance and prompt antibiotics. She is not colonised with Pseudomonas, ECG QTc is normal and NTM cultures are negative. What is the most appropriate management?

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Correct answer: E — Consider long-term macrolide therapy after counselling and monitoring

Long-term macrolide therapy can reduce exacerbations in selected bronchiectasis patients after optimisation, ECG assessment and exclusion of NTM infection. Long-term ciprofloxacin is not preferred because of resistance and toxicity. ICS monotherapy is not bronchiectasis disease-modifying unless there is coexisting asthma or eosinophilic disease.

Reference: BTS Guideline for Bronchiectasis in Adults 2019; BTS long-term macrolide guidance