Bronchiectasis Patient Conference 2026

Q: I take enerzair and berotec but this seems not to be sufficient. What other medication could be added?  

A: You are already on a very strong inhaled combination with Enerzair, so if symptoms are not well controlled, the issue is often not just “adding another inhaler.” In my experience, especially in patients with asthma or bronchiectasis, we first need to check inhaler technique, and a regular use. If everything is optimized, one option is adding other medications. In patients with more severe or persistent symptoms, we may consider biologic therapies, which target specific types of airway inflammation. If you are using Berotec frequently, that could be a sign your disease is not well controlled and needs a structured reassessment. I would strongly recommend discussing this with your specialist to tailor the next step based on your specific disease pattern. 

Q: Is it possible to have an exacerbation and not need antibiotics?  I’m thinking viruses 

A: Yes, some people find they can manage an increase in symptoms just by increasing airway clearance and things settle. It is hard to know for certain when its a virus and not and so in most cases particularly if the sputum is coloured we would recommend an antibiotic 

Q: I am on a long-term course of Azithromycin 250 mg three time a week. 
I have the following questions:
1.  How detrimental is the above medication to my liver and kidneys etc?
2.  I no longer have infection but I have bouts of daily cough and I empty 
     my lungs using physio.  Is it advisable to stop the above medication? 

A: Azithromycin 250 mg three times weekly is widely used in bronchiectasis to reduce inflammation and prevent exacerbations, not to treat active infection. In general it is well tolerated, but we routinely monitor safety with periodic liver tests, an ECG (because of possible QT prolongation), and attention to any hearing changes over time. An important point before and during treatment is to check sputum for non-tuberculous mycobacteria (NTM), as macrolides can create resistance if NTM is present. Even if you currently feel “infection-free,” the benefit of azithromycin is preventive, helping to reduce future flare-ups. If you have been stable for a long period with good airway clearance, a supervised trial of stopping can be considered, but not on your own.
I recommend discussing this with your specialist so you can plan monitoring (symptoms, sputum, lung function) and restart promptly if needed. 

Q: Any news regarding the commercialization of Brensocatib in Italy? 

A: Brensocatib (Brinsupri) has been approved at European level in 2025, so from a regulatory standpoint it is now an authorized therapy in the EU. In Italy access depends on AIFA national decisions (pricing and reimbursement). The key update is that AIFA issued a formal classification in February 2026, which means the drug has officially entered the Italian regulatory pathway. What this means in practical terms (based on how these processes usually evolve):
– the drug is not yet widely available in routine clinical practice
– availability will depend on reimbursement decisions and regional implementation 

Q: I have NTM and bronchiectasis. I’m not able to take the antibiotics. Is there an alternative to take? 

A: Speak to your doctor about alternative antibiotics. There are a number of other options if the first line treatment was hard to take. It is a common problem. 

Q: What can someone take as a regular antibiotic, if they can’t take Azithromycin, Doxycycline, Co-Trimozazole, Ciprofloxacin? Are there other options or treatments people can use? 

A: The ERS guidelines suggest considering antibiotics in a nebulizer in this situation but there are other oral medications depending on the bugs in the sputum 

Q: Will Brensocatib replace the therapy with Azithromycin or will it be in addition to Macrolides? 

A: This is one of the key questions we are all discussing right now in bronchiectasis. Brensocatib works very differently from azithromycin. Based on current evidence, it is not expected to replace macrolides. Whether combination therapy will be beneficial is still being studied, and we don’t yet have definitive guidance. For now, the choice will be individualized in specialist centres, based on exacerbation history, microbiology (including NTM), and overall risk–benefit balance. 

Q: Do bronchodilators like Terbasmin or Ventolin used daily before aerosols and airway clearance cause nervous tics? 

A: Short-acting bronchodilators like Ventolin or Terbasmin can stimulate the nervous system, so side effects like tremor, restlessness, or a “jittery” feeling are quite common. In some patients—especially children or with frequent daily use—this can occasionally be perceived as small involuntary movements. It is not dangerous, but it usually means the dose or frequency may be a bit too high for that individual. Using them before airway clearance is often helpful, but the lowest effective dose should be used. If these symptoms are noticeable or bothersome, it’s worth discussing alternatives or dose adjustment with your doctor. In my experience, with a small adjustment, these effects can usually be minimized quite easily. 

Q: Do researchers show the effectivity of taking antibiotic on a regular base? 

A: There is good evidence that long-term antibiotics can be effective in bronchiectasis, but only in selected patients. The strongest data are for macrolides (like azithromycin), which can reduce exacerbations and improve symptoms when taken regularly. However, they are used mainly in patients with frequent flare-ups, not in everyone. There are also risks, including antibiotic resistance, hearing effects, and cardiac issues, so careful selection and monitoring are essential. Importantly, we always check for infections like NTM before starting, because macrolides can create resistance if these are present. So yes, they work—but they should be used in a targeted, supervised way, not routinely for all patients. 

Q: Does the treatment differ if the issue is localized in one lung vs a systemic airway issue? 

A: Yes, this is a very important distinction, and it can significantly influence management. If bronchiectasis is localized to one area, we first look for a specific cause (for example prior infection, obstruction, or a focal problem), and in selected cases even surgical resection can be considered. In contrast, when disease is diffuse or systemic, treatment focuses on long-term medical management—airway clearance, prevention of infections, and controlling inflammation.  That said, most of the treatments (like physiotherapy and infection control) are shared between both forms. 

Q: What are the new drugs to treat bronchiectasis? 

A: I think you are referring to brensocatib which is an oral drug that targets neutrophilic inflammation by blocking DPP-1, reducing the activity of enzymes that damage the airways.
In large phase 3 trials (ASPEN), it showed a  reduction in exacerbations, delayed time to first flare, and slower decline in lung function compared with placebo. It also improved symptoms and quality of life, which is clinically meaningful for patients. From a specialist perspective, this is not a “cure” and it does not reverse bronchiectasis, but could be a drug that modifies the disease course, not just symptoms. 

Q: I am interested in knowing if there are alternatives to long term azithromycin (from an inflammatory perspective) as I would appear to be allergic (at present I am having to use lots of steroid cream/tacrolimus and antihistamines to manage rashes). 

A: This is a very relevant issue, and macrolide intolerance is something we do see in practice sometimes. If azithromycin is not tolerated, there might be alternative strategies targeting inflammation, but the choice depends on your specific disease pattern. One option if you live in the US is brensocatib, which directly targets neutrophilic inflammation and may become a key alternative in appropriate patients. In some cases, we consider inhaled antibiotics alone (especially with Pseudomonas) or other oral options, though they don’t have the same anti-inflammatory effect as macrolides.  I would recommend a specialist review and select the most effective alternative. 

Q: Does the treatment differ depending on whether the bronchiectasis is localized or diffuse, and is there a way to target treatment to the specific affected areas? 

A: If bronchiectasis is localized, we look carefully for a specific cause (e.g. obstruction), and in selected cases even targeted approaches or surgery can be considered. When it is diffuse, management is mainly medical and long-term—airway clearance, infection control, and anti-inflammatory strategies. Most treatments act on the whole lung, but we can partly target affected areas through physiotherapy (postural drainage) and positioning techniques. Imaging helps guide this, so airway clearance can be focused on the most involved regions. Treatment is always individualized, but the localized vs diffuse pattern is a key element in that decision. 

Q: I had one positive NTM result and then a lot of negative ones. How long after the first positive result should I try azithromycin 3 times per week? My bronchiectasis is severe enough to suggest starting azithromycin. 

A: This is a very important point, because NTM status directly affects the safety of azithromycin. A single positive NTM culture followed by multiple negatives does not confirm active NTM disease, but it does require caution. Before starting long-term azithromycin, we need to be reasonably confident that NTM is not present, otherwise there is a real risk of inducing macrolide resistance. In practice, we usually confirm with bronchoscopy and repeated negative sputum cultures (often over several months) and stable clinical/radiological findings. If NTM is excluded and your bronchiectasis has frequent exacerbations, azithromycin can then be appropriate, if no other long-term interventions are adequate (in my opinion). This decision should be made with a specialist, balancing exacerbation risk against the microbiology history and ideally with ongoing sputum monitoring. 

Q: I had great results in my pseudomonas and no side effects after starting inhaled tobramycin. Then after some months its efficacy started dropping and I started it again after one year’s break. Sadly, this time, even though it helped with pseudomonas, it made me feel awful, with a lot of dyspnoea. Is this common? Does it mean I can no longer try it again? 

A: What you describe is something we sometimes see with inhaled tobramycin. Some patients develop bronchospasm or airway irritation over time, leading to breathlessness, even if the drug is still effective against Pseudomonas. It does not necessarily mean you can never use it again, but it does suggest your airways are reacting to it and caution is needed. In practice, we sometimes try pre-treatment with a bronchodilator, dose adjustment, or a supervised rechallenge to see if tolerance improves. If symptoms are significant, we usually consider alternative inhaled antibiotics (e.g. colistin), which might be better tolerated. I would strongly recommend discussing this with your specialist before restarting, so the next step is both safe and effective. 

Q: What are the best mucolytics for bronchiectasis?

A: There is no single “best” mucolytic in bronchiectasis, and overall evidence is scarce and mixed. Mucolytics can help some patients, but their benefit is variable. Different options: hypertonic saline (inhaled), carbocisteine (oral), mannitol or N-acetylcysteine. Importantly, dornase alfa (DNase) should be avoided in non-CF bronchiectasis. Mucolytics work best  and should be prescribed as adjuncts to airway clearance, not as standalone treatments, in patients where physio is not able to control symptoms alone. In practice, treatment is individualized, often using a trial-and-response approach. 

Q: Is the eradication of common bacteria with inhaled antibiotics recommended and under which conditions? 

A: No, we don’t recommend trying to eradicate haemophilus influenzae with inhaled antibiotics. Inhaled antibiotics are only occasionally used for haemophilus as it usually responds to oral (tablet) antibiotics. 

Q: I can’t tolerate inhaled antibiotics so what’s the best next options? 

A: It depends on the clinical situations and reasons why you got inhlaed antibiotics. I cannot give you more precise indications without more informatiuons. Generally speaking, one option is long-term oral antibiotics (e.g. macrolides like azithromycin, if tolerated and NTM is excluded), mainly for their anti-inflammatory effect. If macrolides are not suitable, some patients use alternative oral regimens (e.g. doxycycline), although evidence is more limited. Another key strategy is to optimize airway clearance. Newer approaches like brensocatib in the USA target inflammation and may be particularly relevant in patients with frequent exacerbations. The best choice depends on your microbiology, exacerbation pattern, and tolerance, so this should be individualized in a specialist centre. 

Q: Is treating NTM without starting all 4 antibiotics at once, but adding them in a while if seems necessary, an option? (Azithromycin, dexambntol, rifampicin, amikacin). 

A: In general, starting NTM treatment step-by-step is not recommended in routine practice. The standard approach is to begin a full multidrug regimen together, because using one or two drugs alone risks inducing antibiotic resistance, especially to macrolides. 

Q: Is NTM treatment beneficial, even if it does not eradicate it? 

A: Yes, even if eradication is not the main goal/cannot be obtained, antimicrobial therapy may result improvement in symptoms, stabilization of radiological findings, prevent disease progression and bacterial load suppression. 

Q: When/how often should we be tested for NTM and aspergillus? Is this a separate test than other bacteria, as e.g. pseudemonas? 

A: This depends on the severity of the disease. Many people test every year for NTM, others only when symptoms change or deteriorate. it is a different test to the standard sputum test so the doctor has to specifically request it 

Q: Can Azithromycin cause tinnitus? What would be the signs your hearing is being impacted? What is the prevalence of long QT with Azithromycin? 

A: Yes, Tinnitus is a relatively common side effect and we usually advise to stop the medication if you get tinnitus as it can cause permanent hearing loss if continued. The tinnitus is usually reversible if the medication is stopped early enough. Prolonged QT is rare with azithromycin alone but is a risk in combination with other drugs that prolong the QT. Many clinicians will do an ECG to make sure this is not a problem. 

Q: Should all patients take Azithromycin? 

A: Not everyone- but patients with severe symptoms or frequent exacerbations despite airway clearance could benefit. The guidelines suggest a lot more people should try it than currently do 

Q: What are the side-effects of the 3-times per week azithromycin pills? Are they recommended for teenagers or young adults? 

A: The main side effects are diarrhoea and other abdominal symptoms (up to 1 in 5 people). Tinnitus and hearing loss occurs (probably 1 in 50 to 1in 100 people) and prolonged QT interval or interaction with other medicines. Drugs can have other side effects which are not listed here. It can be used in children and trials in children and young adults show it is highly effective. 

Q: I read Tiprelestat was meant to be very helpful with inflammation reduction, it was initially used with Covid patients, with very little side effects. Are there any trials going on regarding this drug? 

A: There are no planned trials in bronchiectasis- it targets very similar pathways to the DPP1 inhibitors and so it may not be developed as there is already a solution to that pathway. 

Q: Can you get on a trial with Traction Bronchiectasis and typical BE? I keep being told I can’t go on any trials? 

A: As long as you have conventional BE in at least one lobe you can be enrolled in almost all trials. 

Q: Is early access available for Brensocatib? I took part in the Aspen trial. 

A: There was a post-trial access programme so some people after the trial have continued to take it. Unfortunately there is no other access programme at the moment. 

Q: What alternatives are there to azithromycin ? I’m one who can’t have it. 

A: If azithromycin is not suitable, there are other antibiotic or non-antibiotic options depending on your condition. The choice depends on your symptoms, infections, and medical history. Airway clearance techniques are also very important. Your specialist can tailor the best alternative for you. 

Q: What treatment options are available if standard anti-Aspergillus therapy with tablets cannot be used because the patient is taking heart medication that is incompatible with it? Endobronchial administration of Amphotericin B was ineffective. 

A: There are a whole family of drugs called azoles which are generally used but often have interactions. It depends what type of aspergillus lung disease you have as if its ABPA, then steroids alone can sometimes be enough. It sounds like you are already well down the complex aspergillus treatment pathway with Amphoteracin B so would advise discussing with your medical team. 

Q: Should bronchiectasis patients with a penicillin allergy seek to be tested to confirm? 

A: I would say yes. It is often very useful to confirm a penicillin allergy with proper testing by a specialist. Many people labelled as allergic are actually not, which can unnecessarily limit treatment options. Testing is generally safe and can help doctors choose the best antibiotics. 

Q: Ciproxin is my rescue antibiotics. What if I start azithromycin? 

A: Ask your own doctor but it might make sense you have a period off azithromycin when taking the Ciprofloxacin (due to effects on ECG and QT intervals). 

Q: My consultant is holding back on Azithromycin in case it has to be used for NTM. And it is a macrolide so could it add to MDROs? 

A: Your doctor is being cautious because using azithromycin alone can lead to resistance if NTM infection is present. Macrolides can also contribute to antibiotic resistance over time. This is why we all carefully evaluate before prescribing macrolide long-term treatment. It is always a question of balance between benefits and risks. 

Q: I’d also like to know about the medicines used for Pseudomonas aeruginosa. 

A: Pseudomonas aeruginosa in bronchiectasis can be treated in various ways, depending on the situation (primary infection, chronic infection, or exacerbation). In chronic cases, the mainstay of treatment is often inhaled antibiotics (such as tobramycin, colistin or gentamicin). During exacerbations, however, oral or intravenous antibiotics are used, selected on the basis of the antibiotic susceptibility test. In selected cases, repeated courses or eradication strategies are employed in the early stages. It is essential to perform regular sputum cultures to guide drug selection and prevent resistance. Management must always be personalised in a specialist centre, as Pseudomonas requires a structured and ongoing approach. 

Q: Can Brensocatib reverse or slow down lung damage 

A: Yes, the phase 3 trial showed that patients with bronchiectasis taking brensocatib progressed more slowly measured by lung function and on CT scan 

Q: I am allergic to anti inflammatories so would I therefore be unable to take brensocatib? 

A: No, it has a unique mechanism of action so allergy to other medicines would not affect it 

Q: With the FDA approval of Brensocatib (BRINSUPRI), does this therapy effectively repair or improve existing lung damage and bronchiectasis symptoms, or is its clinical primary function to halt further progression by reducing neutrophil-mediated inflammation and the frequency of exacerbations? 

A: I think the consensus would be that it slows down or stops the progression of the disease rather than reversing things in most cases but we are still learning as data accumulates particularly beyond 1 year 

Q: How can patients tell if Brensocatib is working? 

A: Evidence suggests that, particularly at the 25mg dose, symptoms get better around 4 weeks and then the number of exacerbations should reduce 

Q: I am very allergic to doxycycline (more so than azithromycin)! I am in UK so guess brensocatib will not be available on NHS? 

A: There are a few other alternatives so discuss with your doctor (i use co-trimoxazole in some patients for example). Brensocatib may be available in the UK in the future but you could also consider access to a DPP1 through a clinical trial 

Q: What are the specific clinical benchmarks for transitioning from oral/systemic antibiotics to chronic maintenance inhaled therapy (e.g., Colistin or Tobramycin), and is there a role for using these as a preventative measure against environmental triggers like air conditioning, rather than only during active flare-ups? 

A: Yes, the ERS guidelines suggest using inhaled antibiotics if you are at high risk of exacerbation and have pseudomonas infection in the lungs or very occasionally with other bacteria. 

Q: What other medications are there re appetite? I only ask so I can discuss with medical team 

A: Some drugs can indeed enhance appetite; however not a lot of evidence exists that it is very effective; studies are ongoing. Personally I do not recommend steroids; cyproheptadine is sometimes being used. This can be discussed with your medical team

Q: What are the most effective clinical protocols for shortening the recovery phase after antibiotics—specifically for clearing residual clear mucus and resolving pleuritic chest pain 

A: Two things- one is that it is often necessary to increase airway clearance after an infection as things resolve. Second is to ensure symptoms have settled as it is not uncommon that a second course of antibiotics is needed if things like chest pain persist.  

Q: Should a regular sputum sample be part of ongoing care?  My GP said my sputum will always have bacteria in it and so discourages that practice 

A: Guidelines recommend that we send sputum once a year at least, when patients are stable, to assess microbiology.  Also before starting antibiotic treatment for a flare up or exacerbation. 

Q: I have chronic sinusitis, often with infected mucus, despite daily nasal clearance with saline solution. I have Pseudomonas contracted after bronchiectasis. I do have inhaled antibiotics for this but I am worried as I have continual congestion in lungs and sinus and wonder if something else is happening in my lungs. 

A: This is a situation we see quite often. Chronic sinusitis and bronchiectasis are closely linked, and the sinuses can act as a reservoir for bacteria, potentially contributing to ongoing symptoms in the lungs. Persistent congestion despite treatment does not necessarily mean something “new” is happening, but it does suggest that the current strategy may need to be reassessed and better integrated between ENT and respiratory care. We would review sputum cultures, consider sinus cultures, and sometimes optimize treatment. It is also important to rule out complications. I would strongly recommend a coordinated evaluation in a specialist centre, where both sinus and lung disease can be managed together in a structured way. 

Q: How do we break the cycle of recurring infections despite treatment (antibiotics), mucus clearance, and physiotherapy? 

A: We need to go beyond individual treatments and optimize all components together, making sure airway clearance is truly effective, not just performed. A key step is targeting infection properly: repeated sputum cultures, checking for resistance, and considering long-term strategies (inhaled antibiotics or macrolides, if appropriate). At the same time, we should address inflammation and underlying drivers (sinus disease, reflux), because untreated contributors will keep the cycle going. In some patients, newer approaches like brensocatib or tailored anti-inflammatory strategies may help reduce recurrence. In practice, breaking the cycle requires a personalized, multidisciplinary plan, often best coordinated in a specialist centre. 

Q: Is losing weight a main symptom of NTM? 

A: Weight loss can occur in NTM pulmonary disease, but it is not specific and not always present.
When it happens, it is usually related to chronic infection, inflammation, reduced appetite, and increased energy expenditure. It is therefore considered a possible associated feature, not a defining symptom. If weight loss is ongoing or significant, it should always be evaluated, as it may reflect disease activity or other contributing factors. 

Q: What are the latest 2026 treatments and research-backed protocols to eradicate Pseudomonas and prevent it from becoming a chronic colonization? 

A: Generally, the recommended regimen is 2 weeks of oral ciprofoxacin followed by 3 months of nebulized colistin. This is usually recommended on first isolation. 

Q: Can you be colonised with Proteus? 

A: I think you can be colonised with Proteus species in bronchiectasis, but it is uncommon compared to organisms like Pseudomonas or Haemophilus. 

Q: What is the volume of sputum needed for sputum culture? 

A: For a sputum culture, you don’t need a large amount—about 1–2 mL (roughly a teaspoon) is usually sufficient. More important than volume is quality as I said in my presentation: it should come from the chest (lower airways), not just saliva. A thick, mucoid or purulent sample is ideal for accurate microbiological analysis. Even smaller amounts can sometimes be processed if the sample is good quality. So focus on getting a true chest sample, rather than worrying about volume alone. 

Q: Could my Gram-negative bacteria (Pseudomonas/Klebsiella) be masking an underlying NTM or fungal infection? Can we run specific 3-day NTM and fungal cultures to be sure? 

A: This is a very thoughtful question, and the short answer is: they don’t truly “mask” each other, but they can complicate detection and interpretation. Pseudomonas or Klebsiella do not prevent NTM or fungi from being present, but they can dominate cultures and sometimes make it harder to isolate other organisms. For this reason, we use specific, separate cultures: NTM requires dedicated mycobacterial cultures (which take weeks, not days), and fungi also need targeted processing. A “3-day culture” is not sufficient for NTM—standard protocols involve prolonged incubation (often up to 8 weeks). If there is clinical suspicion (e.g. worsening despite treatment, suggestive CT findings), it is absolutely appropriate to request targeted NTM and fungal testing. 

Q: Is Pseudomonas Forever? 

A: Not necessarily—but it can be persistent and difficult to clear once established. In early stages (first isolation), we often try eradication treatment, and in some patients this is successful for a certain period. However, if Pseudomonas becomes chronic (repeatedly present over time), it tends to persist in the airways. Even then, the goal is not “giving up,” but controlling it—reducing bacterial load, preventing exacerbations, and protecting lung function. Many patients live for years with well-controlled Pseudomonas using inhaled antibiotics and structured care. So it’s not always “forever,” but when chronic, it becomes a condition to manage rather than eliminate. 

Q: Can candida cause problems if repeatedly showing up & what can microbiologist examination show? 

A: Candida in sputum is quite common and usually represents colonization, not a true lung infection—especially in bronchiectasis (in the immunocompetent people). In most cases, it does not require treatment outside immunocompromised patients. However, repeated isolation can reflect altered airway microbiology, often after antibiotics or inhaled steroids.
I treat Candida only if there is clear evidence it is contributing to symptoms, not just because it appears in cultures. 

Q: Can pseudomonas cause cavities in the lungs? 

A: Pseudomonas can contribute to lung damage, but it does not typically cause true cavities on its own. In bronchiectasis, it is associated with chronic infection, inflammation, and progressive airway damage, rather than cavitation. Lung cavities are more commonly seen with conditions like NTM (non-tuberculous mycobacteria), tuberculosis, or certain fungal infections. That said, severe or advanced infection can sometimes produce complex changes that may look atypical on imaging. If cavities are reported on a CT scan, we usually actively investigate for other causes, especially NTM or fungi. 

Q: Eradication of pseudomonas can take place only in the beginning after colonalisation or is this just more easy to happen at that point? 

A: It has the best chance of eradication the earlier you get it (i.e. on first isolation) however this varies by individual. It is less likely it is eradicated If it has been there for prolonged periods and the aim of antimicrobial therapy in this case is to “control” rather than “eradicate” it. 

Q: When/how often should we be tested for NTM and aspergillus? Is this a separate test than other bacteria, as e.g. pseudemonas? 

A: Guidelines recommend to perform a mycobacterial culture (to detect NTM) at least annually and at an exacerbation (definitely when not responding to classic antibiotics), or when radiological  imaging suggests new findings compatible with NTM infection in patients at risk. Mycobacterial culture is to be specifically requested by the treating physician; it is not routinely done by the lab. Fungal cultures (to detect Aspergillus) are commonly done together with bacteriological culture (at least in my setting), so no specific request. Aspergillus is commonly found in sputum; very often considered a contaminant (present in mouth). 

Q: What is the difference between Pseudomonas and NTM? 

A: Pseudomonas is a bacteria which infects the airways of some patients and can be very difficult to treat.  non-tuberculous mycobacteria are a group of bugs that don’t cause infections in healthy airways but can do in the airways of patients with respiratory illnesses. They grow slowly and are difficult to treat requiring longer courses of combinations of antibiotics – often a year or more. 

Q: I grew pseudomonas putida- low number. I opted to watch and wait to treat. Should I opt to treat? 

A: This is a clinical question unique to your situation- I would advise you speak with your physician. This depends on the burden, form and type of Pseudomonas and other health indices. 

Q: Pseudomonas – At what point is it considered chronic colonization rather than a sporadic isolation? Is a one-year interval considered ‘long-term,’ and is there still a window for successful eradication, or is it becoming irreversible?” 

A: It is usually considered chronic when it is isolated several times (people often say 3) and if it has not cleared away with antibiotics. We don’t know the window on eradication – we think the longer it has been there the harder it is to get rid of, but hard doesn’t mean it is impossible! 

Q: Do other bacteria which form biofilms cause similar problems (e.g. Serratia)? 

A: Yes—other bacteria that form biofilms, such as Serratia, Stenotrophomonas, or even Haemophilus, can cause similar problems, although usually less aggressively than Pseudomonas. Biofilms allow bacteria to persist in the airways, resist antibiotics, and evade the immune system. This leads to chronic infection, ongoing inflammation, and recurrent exacerbations, much like what we see with Pseudomonas. However, Pseudomonas remains the most effective “biofilm former” and is typically associated with more severe disease. The clinical impact of other organisms depends on how often they are isolated and whether they correlate with symptoms. I tend to interpret these findings case by case, focusing on repeated cultures and clinical relevance rather than a single result. 

Q: How long does it take for pseudomonas to grow on a sputum sample 

A: Pseudomonas usually grows quite quickly in standard sputum cultures. In most cases, it can be detected within 24–48 hours in the laboratory. A preliminary result is often available at that stage, with confirmation and antibiotic sensitivities following over the next 2–3 days. 

Q: Is there a risk of infection with pseudomonas – can the bacteria be transmitted particularly to those with compromised immune systems?  

A: Pseudomonas can be transmitted, but the risk in everyday settings is generally low. It is mainly a concern for highly vulnerable individuals (e.g. on chemotherapy, transplant patients, immunosuppressed in general), especially in close or healthcare environments. Good precautions are hand hygiene, covering coughs, not sharing nebulizers or equipment, and cleaning respiratory devices carefully, wearing masks. It’s sensible to avoid close contact during exacerbations or if you are producing a lot of sputum. In settings like exercise classes, the risk is low if you are stable, but maintaining distance, hygiene, and avoiding shared equipment is advisable. In practice, we do not isolate patients, but we recommend common-sense precautions to protect more vulnerable individuals. 

Q: Would you address the various strains of pseudomonas and do all need treatment? Which ones are most concerning? We all know aeruginosa is serious, but are most of them? Putida? 

A: Not all Pseudomonas species behave the same. Pseudomonas aeruginosa is by far the most clinically important and it is strongly associated with chronic infection, biofilm formation, more exacerbations, and faster lung decline. Other species, such as Pseudomonas putida, seem to be less aggressive. I tend to focus on clinical relevance over the name of the organism. 

Q: My NTM (micobacteria Chimaera) was identified by whole genome sequencing, does that confirm I’ll need treatment? 

A: WGS is usually done on culture – so after the bug has grown – to identify the species (the type of NTM). The identification of the species (Mycobacterium chimaera in your case) is important for the treating physician to judge clinical relevance and choice of antibiotics but it does not necessarily confirm the need for treatment. This is based on an assessment of microbiology, clinical and radiological findings, very often over time. 

Q: About NTM microbiology testing: is positive/negative result enough (this is what I normally get in turn of my sputum tests), or wouldn’t  it be more significant an assessment of bacterial load, too, to monitor a trend (bettering/worsening)? 

A: Microbiology for NTM includes mycobacterial culture. It gives growth or no growth. If growth of mycobacteria, they will be typed (which species is present), time to growth and the bacterial load is also usually reported. Your treating physician will deal with this. 

Q: When someone has both pseudomonas and NTM, how do you know which bacterium causes symptoms? 

A: This is a great question and in my experience we can’t be sure. A common approach is to tackle the Pseudomonas and if ongoing symptoms then NTM treatment can come into focus. 

Q: What is the pathological score of M. kansasii vs say MAC? 

A: Pathogenicity may vary : by geographic region, by subtype. There is nothing like a uniform score of pathogenicity (=disease causing). However, M. kansasii is usually clinically relevant but again this also depends on the clinical presentation. To decide on disease-causing potential just on the species cannot be done.  

Q: In a patient with recurrent Gram-negative bacteria (like Pseudomonas or Klebsiella), what are the clinical criteria for expanding the workup to include NTM and fungal (Aspergillus) testing, and is it possible for these fast-growing bacteria to mask a co-infection on standard sputum cultures? 

A: Exacerbation criteria not dependent on the species. 

Q: I have two questions:
1- Brensocatib or Verducatib, which is in the third phase of the clinical trial, do they positively affect cortisol balance and have a positive impact on EV1?
2- The CLEAR Bronchiectasis & Pseudomonas Phase II AZD0292 clinical trial, which primarily targets Pseudomonas, is underway. Will treatments with Brensocatib and AZD0292 be compatible in the future? 

A: 1- there is no data on cortisol. If you mean FEV1 for lung function then both medications seem likely to slow down decline in FEV1

2- Yes, they work differently so could potentially be combined in future 

Q: Is cyclical treatment of Fluimucil (NAC) advisable for NCFB? 

A: There is one small trial showing long term use of NAC can reduce exacerbations and improve symptoms. It is used a lot in some countries like the UK but is not suitable for everyone. Our guidelines suggest to consider it if there are difficult mucus symptoms despite doing good airway clearance. 

Q: Viral triggers to exacerbations seem to much harder to recover from post covid.  It used to be a couple of weeks and done and dusted, the last one was 3 months with 7 weeks unable to do anything much (inc eat).   Is this universal or just me ? 

A: This is not something that has been reported more widely to my knowledge 

Q: Is pulmozyne helpful  for non cf patients or is it harmful 

A: Pulmozyme (DNase) is effective in cystic fibrosis (CF) but not in non-CF bronchiectasis. Studies have not shown benefit and in some cases showed worse outcomes. For this reason, guidelines not recommended outside CF. 

Q: In the UK, if I take a sputum sample to my GP, what bacteria will be tested for? Is that the same for the Respiratory dept at my local hospital? 

A: It will usually be the same between hospital and GP. The lab will grow the sample in a way that is likely to show up the common respiratory bacteria.  If we specifically ask them to check for NTM, they will but it’s not a standard part of the sputum test usually. 

Q: Good morning, I’d like to ask about non-tuberculous mycobacteria: if the sputum test has been positive for 4 years, should it be treated? Thank you all ❤️ 

A: A positive sputum test does not automatically mean that treatment is required. To initiate treatment for non-tuberculous mycobacteria (NTM), three factors must be present: compatible symptoms (cough, sputum, worsening of symptoms), radiological abnormalities on CT scan, and repeated microbiological confirmation. There are patients who remain positive for years but are stable, with no progression: in these cases, it is often preferable to observe and monitor rather than treat immediately. Treatment is, in fact, long, demanding and associated with possible side effects, so it should be reserved for those with active, progressive disease. If, however, there is clinical deterioration, an increase in exacerbations or progression on CT, then treatment becomes indicated. The recommendation is to undergo assessment at a specialist centre, to integrate symptoms, CT scans and microbiology findings and decide on the right time to start treatment.

Q: How often should controlled breath be used during airway clearance? 

A: You use controlled breathing as your “breaks” from other parts. If you feel tired, breathless or need to concentrate, you add more controlled breathing in airway clearance. 

Q: Can aggressive coughing or using an Aerobika actually cause airways to collapse further for patients with Mounier-Kuhn? How can lungs be cleared safely without squashing windpipe? 

A: That’s a very relevant question in Mounier-Kuhn, where the airways are already enlarged but structurally weak and prone to dynamic collapse. In general, aggressive coughing or excessive expiratory pressure (including over-vigorous use of devices like Aerobika) can indeed promote airway collapse, especially during forced exhalation. The goal is not to “push harder,” but to clear mucus using controlled, low-pressure techniques such as huff coughing (forced expiration with an open glottis) rather than explosive coughing. In some cases, strategies like positive pressure support (e.g., PEP masks or even NIV in selected patients) help keep the airways open during clearance. I would strongly recommend a personalized airway clearance plan with a specialist team and a respiratory physiotherapy, because in Mounier-Kuhn technique matters much more than intensity. 

Q: How can you do a sputum test if you don’t have much mucus coming up? 

A: I would try to collect after airway clearance or inhalation (e.g. saline), when mucus is more likely to mobilize. Doing the sample in the morning, after hydration and a few deep breaths/huff coughs, can also help. In selected cases, especially if results are important, a bronchoscopy sample may be considered. 

Q: Is it recommended to use bronchiodialating sprays every day to improve airway clearance, or rather when you experience an exercerbation?  

A: Bronchodilators use depends on your individual pattern. In many patients, using a bronchodilator before airway clearance (even daily) improves mucus mobilization and makes physiotherapy more effective. This is especially useful if you have airflow limitation, wheeze, or coexisting asthma/COPD. However, not everyone needs them every day. The best approach is individualized. 

Q: What nasal sprays can be used?  

A: Simple saline sprays have antiviral properties and there is evidence that they reduces days of illness from viruses, if taken at the first signs of illness.  While there isn’t specific evidence looking at if they prevent viruses from gaining hold, many patients find them very useful to use during travel. 

Q: Which nebuliser do you use now promixin is no longer available 

A: Unfortunately Ineb has been discontinued and we are waiting for a replacement mesh nebulizer. There are various kinds (we don’t recommend one specific type). 

Q: What support is available for those with other complex conditions limiting typical  BE management strategies, for example if exercise can’t be done? 

A: This is a very important point, because bronchiectasis care really needs to be adapted when other conditions limit what you can do. If standard exercise is not possible, we usually work with a respiratory physiotherapist to design a tailored, low-intensity or modified program (even chair-based or breathing-focused), rather than stopping activity altogether.
Airway clearance can also be adapted with gentler techniques, devices, or sometimes supported approaches like PEP. Equally important is optimizing everything else: vaccinations, nutrition, infection prevention, and the right medications to reduce exacerbations. Some centres offer multidisciplinary support (physio, nutrition, psychology), which is particularly valuable in complex patients. If access is limited locally, I would suggest asking for referral to a specialist centre or exploring tele-rehabilitation programs, which are increasingly available and effective. 

Q: Are Massage guns useful for airway clearance, maybe as an alternative to the costly Percussion Vest? 

A: In theory, vibration helps loosen mucus, and that’s what chest physiotherapy or devices like the Vest are designed to do. However, a massage gun is not designed for airway clearance, and there is no clinical evidence supporting its use in bronchiectasis. The key difference is that medical devices deliver controlled, specific frequencies and pressures, whereas massage guns are more aggressive and not calibrated for the lungs. Used incorrectly, a massage gun could cause discomfort, worsen pain, or even be counterproductive (especially over ribs or fragile areas). If cost is an issue, there are much more effective and validated alternatives—like PEP devices, flutter valves, or guided physiotherapy—which have solid evidence for improving mucus clearance. In practice, I would not recommend a massage gun as a substitute, but if you’re struggling with current techniques, it’s worth tailoring a simpler, effective, and safer airway clearance strategy with a physiotherapist. 

Q: After doing airway clearing techniques, is coughing strongly the only way to expel the mucus, or are strong hubs enough? 

A: The best way is to start with a technique/device and then huffs and cough at the end. If you cough strongly only, you do not clear the more distant parts of your airways. 

Q: If you don’t really cough a lot or have a lot of mucus on a daily basis, is it still necessary to do airway clearance daily? 

A: Not if you do not have mucus to clear. But you need to know that there is no mucus, so no symptoms, no mucus on imaging and good management overall. This means you have mild bronchiectasis. Then you practice airway clearance as required (exacerbations) and keep some practice to maintain the technique. 

Q: If patients do not use airway clearance techniques, what other methods do they use? 

A: In practice, very few patients truly do “nothing”—they often use simpler or more natural ways of clearing mucus without formal techniques. The most common is just spontaneous coughing, sometimes combined with deep breathing, although this is often less efficient and more tiring. Some rely on physical activity or movement (even light walking or daily tasks), which can help mobilize secretions. Others use basic strategies like good hydration. However, these approaches are usually less effective than structured airway clearance, especially in patients with daily sputum. If standard techniques are difficult, we usually try to simplify and adapt them rather than abandon airway clearance altogether. 

Q: I know examples where patients have done ACBT for years, but later found that autogenic drainage was more effective. I would like to learn all the different techniques from one specialized pulmonary physiotherapist and not have to travel all over Germany and lose years and years in the process. Home visit may be fine in the larger cities but what if you do not live in a major city? 

A: Different techniques work differently for each patient, and finding the right one can take time.
Ideally, you should learn about the different techniques from one experienced respiratory physiotherapist, but access can be challenging outside major cities / areas. In practice, a very effective solution is to arrange one or two intensive sessions in a specialist centre, then continue locally with guidance. Many centres and physiotherapists now also offer tele-rehabilitation or video sessions, which can be extremely useful for follow-up and refinement. Another option is to look for physiotherapists with experience in cystic fibrosis or COPD, as they are often trained in advanced airway clearance. The key is not traveling everywhere, but finding one expert who can teach and then support you over time, even remotely. 

Q: Why is early morning sputum better? Even though I produce a lot of sputum, I always find it difficult to get it out in the morning 

A: Early morning sputum is preferred because mucus accumulates overnight, making it more representative for cultures and analysis. During sleep, clearance mechanisms slow down, so bacteria and secretions tend to pool in the airways. That said, many patients find it harder to bring it up in the morning, because mucus is often thicker and more dehydrated after the night. This is very common and does not mean you are doing anything wrong. In practice, it helps to hydrate, use inhalation (e.g. saline), and perform airway clearance before trying to expectorate. A short routine in the morning can make sputum easier to mobilize and collect effectively. 

Q: What if an emergency department has never heard of BE?  

A: This does sometimes happen- there is a lack of knowledge about bronchiectasis.  If you find this frequently it can be helpful to get your doctor to print off one of your letters so you can show people what you have (or even have a management plan showing what should be done when you have an exacerbation). 

Q: Can those who have occasionally had + cultures for MAC still take azithromycin 3/wk? 

A: Preferably macrolides (azithromycine/clarithromycin) are interrupted when MAC is cultured – at least until active NTM-PD is excluded – to avoid monotherapy to result in macrolide-resistance. It is not always easy this decision, particularly in patients with bronchiectasis and frequent exacerbations. Sometimes the drug is interrupted temporarily; sometimes alternative measures are being considered. 

Q: If inhaled steroids are not recommended as a treatment for bronchiectasis, why would a reduction in the strength of an inhaled steroid cause an exacerbation of bronchiectasis? 

A: Inhaled steroids are not indicated for bronchiectasis alone, but are used if there is associated asthma or a particular type of inflammation. So if someone finds they feel worse when steroids are reduced it might indicate they have asthma or a steroid responsive type of inflammation 

Q: On my son’s CT scan, 2 years ago, the term “small bronchiolectasis in LII” appeared. What is the difference with bronchiectasis? Should it be treated the same way as bronchiectasis? 

A: “Bronchiolectasis” refers to dilation of the smaller airways (bronchioles), whereas bronchiectasis involves the larger, more proximal bronchi. When described as “small” and localized (like in one lobe), it can sometimes be a mild or early finding, or even related to an acute infection rather than established disease. It does not automatically mean your son has clinically significant bronchiectasis or needs the same long-term treatment. Management depends much more on symptoms: if he is well, with no chronic cough, sputum, or recurrent infections, we usually just monitor rather than treat aggressively. I would suggest follow-up with a specialist to interpret the scan in context and decide if any monitoring or further evaluation is needed. 

Q: How regularly should we have a lung function test and ct scan for it to be considered good practice? 

A: In bronchiectasis, follow-up is guided more by clinical stability and disease activity than by fixed rigid schedules. In general, lung function (spirometry) is done at least once a year or often every 4- 6 months in patients with more severe or unstable disease. CT scans are different: we do not repeat them routinely, because of radiation exposure, but only if there is a clinical reason (worsening symptoms, frequent exacerbations, or unclear changes). In stable patients, it is quite common not to repeat a CT for some years. What matters most in day-to-day practice is regular clinical review, sputum microbiology, and tracking exacerbations. So, good practice is frequent clinical monitoring, periodic lung function, and selective—not routine—CT imaging. 

Q: Is FEV1 reversible in bronchiectasis? I ‘m 40 years old and have around 50 FEV1. I don’t have asthma or any other lung condition. I get very anxious every time it gets worse than 50. I know from people with CF that if it goes below 30 a transplantation might need to take place. Is it the same for bronchiectasis? 

A: There can be improvement in lung function with some treatments like bronchodilator inhalers, some anti-inflammatory treatments and physio. Improvements are often modest (a few hundred mls) and so currently not fully reversible in most cases. 

Q: My 20-year-old son was diagnosed with bronchiectasis a few months ago. He is unable to cough up phlegm. He has a mild cough after meals. What could very high IgE levels (350) mean? And what should we do in his case, given he isn’t coughing up phlegm?  

A: Bronchiectasis in a young boy, especially if accompanied by a cough after meals and without sputum, must be assessed very carefully as it is often an early or mild form. Elevated IgE levels (350) suggest an allergic component: this may be allergic asthma, rhinitis, or, more rarely, conditions such as sensitisation to Aspergillus (to be assessed with specific tests). Postprandial cough also suggests possible gastro-oesophageal reflux, which may contribute to respiratory symptoms. The fact that he does not cough up sputum is quite common: it does not mean there are no secretions, but that they are few or difficult to mobilise. In such cases, gentle, preventive strategies are employed: light respiratory physiotherapy, hydration, and, if necessary, saline aerosol therapy to facilitate clearance. The most important step is a multidisciplinary specialist assessment (pulmonologist + allergist + gastroenterologist) to fully characterise the condition and establish a targeted management plan. 

Q: How different is mannitol test vs methocholine? 

A: Methacholine is a direct test, mannitol is an indirect test (mannitol is therefore more like what happens in the real world). Both test how twitchy your airways . Usually a drop of 20% is positive so your test is positive suggesting you may have asthma or bronchial hyperresponsiveness. You should discuss this with your doctor but it might mean you could benefit from inhaled treatment. 

Q: How often for CT scans and Lung function testing? 

A: In good clinical practice, we try to balance careful monitoring with avoiding unnecessary tests.
Lung function (spirometry) is usually done once a year, and every 4-6 months if the disease is more severe, unstable, or changing. CT scans are not done routinely: after the initial diagnosis, we repeat them only if there is a clear clinical reason (worsening symptoms, frequent exacerbations, or unexpected changes). In stable patients, it’s common not to repeat a CT for some years. The day-to-day follow-up relies much more on symptoms, exacerbations, and sputum results than on repeated imaging. 

Q: Should HR CT scans be repeated at perhaps 5 year intervals or similar to see if lungs have detriorated and alternative treatment considered 

A: In general, we do not repeat HRCT scans at fixed intervals (such as every 5 years) just to “check progression.” CT is mainly used at diagnosis and then only if there is a clinical reason—for example worsening symptoms, more frequent exacerbations, or unclear changes. This is because of radiation exposure and because CT findings alone rarely change management in a stable patient. Instead, we follow the disease with symptoms, exacerbation history, lung function, and sputum results. If these suggest deterioration, then repeating a CT becomes appropriate. So the approach is clinical-driven imaging, not routine interval scanning. 

Q: I am struggling to get an accurate diagnosis. It has been diagnosed as Pneumonia via a CT scan seen by 3 radiologist.  

A: This situation is unfortunately not uncommon. A CT report alone is not enough—the diagnosis of bronchiectasis must be made by integrating imaging with symptoms and history. Differences between radiologists can occur, especially in early or mild disease, where findings may be subtle or borderline. The most effective next step is to have your case reviewed in a specialist respiratory centre, where clinicians and radiologists work together in a multidisciplinary way. Bringing all previous scans, reports, and a clear clinical timeline can make a big difference in reaching a consistent conclusion. In my experience, a focused expert review often clarifies the diagnosis and avoids both over- and under-treatment. 

Q: What can you tell me about ‘dry’ bronchiectasis as it’s really hard to find info on? I have it in 5 of my lobes. I wonder if my bronchiectasis is playing a part in my continued flare ups. But as its not productive my bronchiectasis consultant discharged me. I am on tezpire but still need 3-5 courses oral steroids. 

A: “Dry” bronchiectasis simply means little or no sputum, but it does not mean the disease is inactive. In your situation, it is very plausible that bronchiectasis is contributing to ongoing asthma flare-ups, through persistent airway inflammation even without obvious mucus. Needing 3–5 courses of oral steroids despite tezepelumab suggests there are additional drivers beyond type 2 inflammation, possibly including infection or neutrophilic processes. I would not consider bronchiectasis irrelevant here, and discharge from follow-up may miss an important part of the picture. My advice would be a joint, specialist reassessment (asthma + bronchiectasis) to better integrate treatment and reduce your exacerbation burden. 

Q: There seems to be problem with reading bronchiectasis on CT scans, too many missed so patients go round the circles again. What needs to change? 

A: This is a recognized problem, especially in early or mild disease. Part of the issue is that bronchiectasis can be subtle on CT, and not all radiologists have specific experience or are actively looking for it (this is the personal opinion of the question answerer). What needs to change is greater use of standardized reporting, dedicated training, and closer collaboration between radiologists and respiratory specialists. In practice, CT scans are interpreted much more accurately when there is clinical suspicion and clear information provided to the radiologist. There is also growing interest in AI-supported imaging, which may improve detection and consistency in the future. From a patient perspective, referral to a specialist centre for review can often make a decisive difference in getting the diagnosis right. 

Q: How often should you have a CT scan?  Should you have one regularly or depending on symptoms? 

A: In bronchiectasis, CT scans are not done routinely at fixed intervals. After the initial diagnosis, we repeat a CT only if there is a clinical reason, such as worsening symptoms, more frequent exacerbations, or unclear changes. This is mainly to avoid unnecessary radiation and because CT findings alone rarely change management in stable patients. Day-to-day monitoring relies much more on symptoms, exacerbations, lung function, and sputum results. If these suggest deterioration, then a repeat CT becomes appropriate. So the approach is symptom-driven imaging, not regular scheduled scanning. 

Q: Can you tell me more about dry bronchiectasis?  

A: “Dry” bronchiectasis is clinical phenotype, and  as you mentioned deserves more attention. It means little or no daily sputum, but the underlying airway changes and inflammation are still present. These patients are often under-recognized or even discharged, yet can still have exacerbations and ongoing symptoms, especially when there is overlap with asthma or other conditions.  From a research and clinical perspective, there is growing interest in better defining this group and tailoring treatment more precisely. And I fully agree—it is a topic that absolutely merits dedicated discussion in future meetings. 

Q: Is infection always audible through stethoscope? 

A: Not always – Not hearing something through the stethoscope doesn’t meant there is no infection – it’s about how it fits with the whole picture and other symptoms. 

Q: Can CT scan indicate if someone with bronchiectasis has fungi/aspergillus infection, NTM infection or pseudomonas? 

A: Some CT findings can suggest an infection but one needs sampling of the respiratory tract to guide therapy. 

Q: In a patient with recurrent Pseudomonas and environmental triggers (like AC), what is the clinical threshold for performing a bronchoscopy with BAL (Bronchoalveolar Lavage) versus relying on spontaneous sputum cultures 

A: Invasive procedures like bronchoscopy are not trivial and must be clinically indicated. It is generally performed when further information is needed based on the clinical state (i.e. minimal response to antibiotics). Sputum, as long as of good quality, is able to make such determinations. 

Q: I have weight gain vs weight loss, is that an outlier reaction to MAC & BE? 

A: Weight loss is a common symptom; weight increase is unlikely disease-related; many other explanations can exist. I cannot judge on an individual case. 

Q: How successful are lung transplants in Bronchiectasis patient and what is the survival rate? 

A: They are very successful – a couple of recent studies showed 5 year survival of around 75% and 10 year survival 48%. This is better than many other conditions- remember that patients are often very unwell when transplanted and so these survival rates are very good for a group who are at high risk of problems. 

Q: Is there an age cut off for lung transplant? 

A: This differs between countries. Check your national guidance. 

Q: How can I live long as a COPD patient with a lobe on both lungs. I always have fatigue and mucus. 

A: Fatigue is tricky. You need to use multiple breaks and take things gradually. Exercise would help to build up capacity. If you get tired with mucus clearance, practice more breathing control in between the more vigorous parts of clearance. 

Q: What is the life expansion predicted and life quality if its starts in my 30s? 

A: For most people with appropriate treatment, bronchiectasis does not reduce life expectancy and quality of life can be excellent. It all depends on making sure treatment is good so you do not become severe and the progress of the disease is slowed. 

Q: When is surgery required for bronchiectasis? 

A: Localised bronchiectasis, very severe with symptoms that affect significantly the quality of life of the patient, good prognosis for post-surgery results. 

Q: If I catch bronchiectasis early, what should I do to prevent it from progressing to the point of needing antibiotics? 

A: Catching bronchiectasis early is a real advantage, because this is the stage where we can slow or even stabilize progression. The most important step is regular airway clearance, even if symptoms are mild, to prevent mucus build-up and infection. Staying up to date with vaccinations (flu, pneumococcal) and managing any underlying cause (e.g. asthma, reflux, sinus disease) is also key. Physical activity, good hydration, and prompt treatment of any flare-up can help prevent infections from taking hold. Equally important, do not smoke. With this approach, many patients remain stable for years without needing long-term antibiotics. 

Q: My main concern is neutrophilic/eosinophilic inflammation. It degrades elastin and collagen and splits structural proteins like laminin and fibronectin. Can this degenerative process be stopped or only slowed? What does it mean for a teenager in terms of long-term life quality and lifespan expectation? 

A: You are right that neutrophilic (and in some cases eosinophilic) inflammation drives tissue damage—but the key point is that this process can be significantly controlled, even if not fully reversed. With current treatments (airway clearance, infection control, anti-inflammatory strategies, and emerging drugs), we can slow the damage very effectively and often stabilize the disease. In a teenager diagnosed early and followed properly, the outlook is generally much better than what you may read about older cohorts, which reflect delayed diagnosis and less effective care. Many young patients today can maintain good lung function, normal daily activity, and a near-normal quality of life for decades. Life expectancy depends on severity and control. 

Q: Does chronic Pseudomonas deteriorate the lung gradually over the long term if you cannot erradicate it? 

A: Usually, chronic Pseudomonas is associated with a gradual deterioration over time, but this is not inevitable and can be modified. It drives a cycle of persistent infection and neutrophilic inflammation, which can accelerate airway damage if not controlled. Clinically, it is linked to more frequent exacerbations and faster decline in lung function compared to patients without it.
However, with appropriate management (airway clearance, suppressive therapy, close monitoring), we can significantly slow this process. Many patients live for years with stable disease despite chronic Pseudomonas when it is well controlled. 

Q: What is the difference between anxiety v worsening BE? 

A: With anxiety you probably don’t get increased sputum or change in its colour but it always worth talking to you clinician to see if there are signs that are specific to you 

Q: “What is the clinical ‘tipping point’ for transitioning from sputum cultures to an invasive bronchoscopy, and how do we determine if the procedural risks are justified to rule out hidden co-infections like NTM or fungi that may be masked by Pseudomonas? 

A: There is no perfect answer. It is usually where there is a strong suspicion of infection (either CT changes, reduced lung function or worsening of symptoms) but sputum is culture negative or the patient can’t bring something up. Changes on CT in particular push me towards bronchoscopy.  It is a low risk procedure for bronchiectasis patients so i think it is a very useful test when people are unwell. The ERS has just published a “deteriorating patient” algorithm which recommends bronchoscopy if infection is suspected and sputum isn’t giving the answer. 

Q: How common is Reactive Airway Disease (RAD) with other BE and MAC patient’s? 

A: If you mean asthma type reactive airways disease which can be detected with an airway challenge test like mannitol it can be as high as 1/3 of people with bronchiectasis. 

Q: Given the evidence that bronchiectasis is more common in women, what is known about the interplay of hormones and peri/menopause with bronchietcasis? Is there any evidence for HRT or testosterone as part of HRT has benefits ? 

A: I don’t think there is any direct evidence here in terms of studies looking at HRT and impact on bronchiectasis but, as a GP, menopause and perimenopause can have multisystem effects and in other airway disease like asthma, we recognise that changes in hormones can have an impact.  So the answer is it’s probable that hormone changes might have an effect, but we don’t know the specifics of that or whether HRT helps. 

Q: Can angina impact bronchiectasis 

A: Yes and likely vice versa- if your bronchiectasis is not well controlled it might make your angina worse.  

Q: Is there any connection between Chronic sinusitis and Bronchiectasis? 

A: Yes, there is a well-recognised connection between chronic sinusitis and bronchiectasis, and we see this quite often in clinical practice. Both conditions can be part of the same “airway disease,” where inflammation affects the nose, sinuses, and lungs together (the so-called united airways concept). Chronic sinusitis can also act as a reservoir of bacteria that may contribute to repeated lung infections. For this reason, treating the sinuses properly is an important part of managing bronchiectasis. If someone has both conditions, I usually recommend a coordinated approach between respiratory and ENT specialists and nasal lavages are crucial. 

Q: I have SSc and my Bronchiectasis was diagnosed via lots of investigations for ILD. Is there a link? 

A: There can be a link between systemic sclerosis (SSc) and bronchiectasis. SSc can affect the lungs and airways, leading to inflammation and structural changes. Bronchiectasis is often found during investigations for lung involvement.  

Q: I have Hypothyroidism as well as Bronchiectasis and have trouble controlling weight gain, what would you advise? 

A: Weight gain is often related to hypothyroidism, so the first step is to ensure thyroid levels are well controlled. Once stable, a balanced diet and regular physical activity are important. Exercise is also helpful for lung health in bronchiectasis. A dietitian may provide additional support. 

Q: How do you differentiate between asthma and bronchiectasis, or is there a crossover?  

A: This is a very common and important question, because asthma and bronchiectasis can sometimes coexist. Asthma is primarily an inflammatory condition with variable airflow obstruction that often improves with inhaled corticosteroids and inhalers, while bronchiectasis is a structural disease where the airways are permanently dilated and prone to chronic infection and mucus retention. Clinically, asthma tends to present with wheeze and variability, whereas bronchiectasis is more associated with chronic productive cough, daily sputum, and recurrent infections. The key test to differentiate them is a CT scan, which can show bronchiectasis directly, while spirometry helps identify reversible obstruction typical of asthma. That said, many patients might have both conditions and asthma can coexist or even contribute to bronchiectasis over time.
In practice, we often treat both components together, tailoring therapy based on symptoms, imaging, and inflammation profile. 

Q: Is there any connection between bronchiectasis, sinusitis and sleep apnoea?  

A: Yes, there could be a connection, although not all three conditions are always directly linked in the same patient. Bronchiectasis and sinusitis are often part of a “united airway” problem, where inflammation affects both the upper and lower airways. Sleep apnoea is a bit different, but chronic nasal obstruction from sinusitis can worsen it by increasing airway resistance during sleep. In some patients, especially those with underlying conditions (like obesity, chronic inflammation, or rare disorders affecting mucus clearance), all three can coexist.
Poor sleep from apnoea can also worsen fatigue and symptom perception in bronchiectasis.
In practice, if these conditions are present together, it’s important to assess and treat each one in a coordinated way. 

Q: Is there a link between acid reflux and bronchiechasis? 

A: Acid reflux is very common in bronchiectasis and people with bad reflux are known to have more exacerbations because reflux worsens inflammation. Whether it causes it or not is controversial. 

Q: Before my diagnosis, I smashed my nose and face after a fall on the pavement. It took 6 months to repair. Afterwards I started to have postnatal drip, my cough began and my pneumonia and chest infections began more intensely. After another pneumonia and sepsis, I was diagnosed with COPD, then Isolated Aspergillus fumigatus complex, more recently NTM and bronchiectasis.
Do you think that the breaks to my nose allowed bacteria to enter my system causing these conditions ? 

A: I would say that a nasal fracture itself does not allow bacteria to “enter the system” in a way that directly causes bronchiectasis or COPD. However, what can happen is that trauma alters sinus drainage and anatomy, leading to chronic sinusitis and post-nasal drip, which can contribute over time to repeated airway infections. In someone already susceptible, this can be one of several factors that feed into the cycle of infection and inflammation in the lungs. I would also say that the later findings (Aspergillus, NTM, bronchiectasis) are more likely related to an underlying airway vulnerability rather than the trauma alone. So, the injury may have been a trigger or contributing factor, but not the sole cause—your current management should focus on controlling infection, inflammation, and sinus disease together. 

Q: It is particularly challenging to face overlapping lung issues: asthma, plus bronchiectasis, plus lung infections like NTM-PD or else. Are there sub-groups of support for patients suffering of combined diagnosis? 

A: You’re absolutely right—overlap between asthma, bronchiectasis, and infections like NTM-PD is one of the most complex scenarios we manage. From a medical perspective, the key is to identify and treat each “component” separately but in a coordinated way because each can drive exacerbations. These patients often need a multidisciplinary approach (respiratory, infectious disease, physiotherapy, sometimes ENT), ideally in an expert centre. Equally important, we try to define the dominant driver at a given time—for example inflammation vs infection—so treatment can be prioritized appropriately. On the patient side, most associations are disease-specific, but groups like European Lung Foundation offer resources and patient advisory groups where overlap cases are increasingly represented. 

Q: I have severe M.E/ CFS and struggle with exertion and experience very severe crashes. I am due physiotherapy but very worried about the impact. How do i ensure I am supported appropriately? 

A: This is a very important concern. With M.E./CFS, I would say that the key principle is pacing and avoiding post-exertional malaise, so standard respiratory physio must be individualized, and not applied in a routine way. You should clearly explain your condition and ask for a very gradual, symptom-led approach, starting with minimal, low-effort techniques. Airway clearance can be modified to be gentle and energy-efficient, avoiding fatigue-triggering strategies. It is also reasonable to ask for short sessions, rest breaks, and possibly remote follow-up, rather than intensive programs. Ideally, your physiotherapist and respiratory team should coordinate, and manage this situation 

Q: Can gastroesophageal reflux in a Bronchiectasis patient deteriorate the lung through micro aspirations exposing the lung to acidity? 

A: Gastroesophageal reflux can lead to micro aspiration of gastric contents into the airways, especially at night, exposing the lungs to acid and other irritants. This might worsen airway inflammation and promote infections. In some patients, reflux is a key “driver” that keeps the cycle of inflammation and infection going. For this reason, we actively look for and treat reflux 

Q: What evidence is there that GERD can cause Bronchiectasis. In my case I had GERD and then Asthma symptoms which later was diagnosed as Bronchiectasis. 

A: We think people with bronchiectasis are more likely to have GERD but there isn’t much evidence GERD is a common cause for bronchiectasis 

Q: I have aspergillus sensitivity. I suffer candidiasis and its tracked into my oesophagus alongside my bronchiectasis and allergy-driven severe asthma could I have SAFS or ABPA? I had an allotment and used to get multiple flare ups of really tight chest and lack of breath. Can I return to my allotment as I am on tezspire or do I need to completely give the allotment up? 

A: This is difficult to advise you what to do without knowing your full medical history so in this instance I would recommend discussing with the team responsible for tezspire. 

Q: Can bronchiectasis lead to emphysema? What can be done to eliminate or reduce it? Thank you 

A: Bronchiectasis and emphysema are two different conditions, but they can coexist in the same patient. Bronchiectasis does not directly ‘cause’ emphysema, but chronic inflammation and, above all, smoking or other exposures can lead to the development of both. Emphysema, like bronchiectasis, is unfortunately a structural condition and is not reversible. What we can do is stabilise it and slow its progression: stop smoking, optimise inhaled therapies, prevent infections and maintain good physical activity (tailored to the patient). The best management is always personalised and aims to protect respiratory function as much as possible over time. 

Q: Is there a link between chronic sinusitis and bronchiectasis? 

A: Yes, there is a well-recognised correlation between chronic sinusitis and bronchiectasis. Both form part of the ‘unified airway’ concept, in which inflammation affects both the upper and lower respiratory tracts. Sinusitis can also act as a reservoir for bacteria, contributing to recurrent lung infections. In some cases, underlying conditions are shared. For this reason, effective treatment of sinusitis is an important part of managing bronchiectasis. A coordinated approach between a pulmonologist and an ENT specialist is often beneficial. 

Q: I have been trying all the methods for clearing the mucus out but I struggle with the muscle pain when I cough which is dry and I don’t bring out much. Is there any other way maybe with carbocistein medication? thank you. 

A: This is a common situation: frequent coughing with little sputum might mean the mucus is thick and difficult to mobilize, and the cough becomes inefficient and painful. Carbocisteine can help by making mucus less viscous, and in some patients it improves clearance and reduces cough effort. Equally important is how you clear: rather than repeated dry coughing, techniques like gentle huffing, paced breathing, and proper physiotherapy can reduce muscle strain and be more effective. Hydration and, in selected cases, inhaled therapies (such as hypertonic saline) can also help. If pain is significant, it’s worth addressing it directly, because ineffective, painful coughing can worsen fatigue and limit clearance. I would suggest reviewing your airway clearance technique with a respiratory physiotherapist and discussing mucolytic options like carbocisteine with your specialist to tailor the approach to you. 

Q: Is it possible to be producing purulent sputum but not have an infection?   

A: Absolutely- purulent sputum means there are inflammatory cells called neutrophils in the lungs – not necessarily that there is an active infection. 

Q: Is there way to bypass or help with loss of appetite with infections and/or if ongoing? Or diet advice to gain or maintain weight? 

A: Aim to switch from 3 meals a day to 5 smaller meals (your tummy feels fuller/ more prone to nausea when fighting a flare up). Aim to pack in higher calorie foods when having a  flare up. 

Q: Would bronchiectasis patients benefit from higher Vitamin D levels than normal? 

A: Vitamin D is important for the immune system, and low levels are quite common in patients with bronchiectasis. In my practice, we do check and correct deficiency, because low vitamin D may be associated with more infections and exacerbations. However, there is no strong evidence that levels higher than normal provide additional benefit. The goal is to reach and maintain a normal range, not to exceed it. Taking excessive vitamin D can also have side effects, so more is not always better. I would suggest checking your level and supplementing only if needed, under medical guidance. 

Q: Does volume of sputum naturally increase with age, even managing the condition well? 

A: We have not seen changes on sputum volume with age. However, we know that lung function is declined and maybe older people move less and get weaker cough. This could appear as increase of sputum. 

Q: Given the “variability “in individual conditions discussed , what does well controlled bronchiectasis look like? 

A: In practical terms, it means few or no exacerbations (ideally none or 1 per year), and no need for repeated antibiotics or hospitalizations. Daily symptoms are mild and manageable, with sputum that is stable in amount and colour, and no progressive worsening. Lung function is stable over time, without significant decline on spirometry. There is also no ongoing infection with aggressive pathogens (or they are well controlled), and airway clearance is effective and sustainable. We are working on that within the EMBARC community 

Q: I thought wearing an FFP3 mask o planes, in hospitals, shops etc would protect you from respiratory infections and others that are aerosol based, is this not the case? 

A: FFP3 masks will certainly prevent most viruses and particles from getting in. They are not 100% as everyone has to take them off at some point and viruses can get on hands/surfaces etc. Many people find them uncomfortable so it is a balance of the potential benefit and the issues. 

Q: How useful is it to take oxygen saturations in terms of severity of disease and daily fluctuations in condition? I am reasonably fit, able to walk, swim, ride a bike, – though nothing to the extent that I could from a respiratory and cardiovascular fitness  perspective, but in my own work as a healthcare worker, I have access to oximetry and am horrified that my oxygen sats sit b/w 93-95%. 

A: Although I recognize that oxygen saturation is a useful parameter, it has to be interpreted in context, not on its own. Values of 93–95% at rest are slightly lower than average but not uncommon in people with chronic lung disease, and do not automatically indicate severe disease. In bronchiectasis, severity is assessed by symptoms, exacerbations, lung function, and imaging, rather than oxygen saturation alone. If you are concerned, a formal assessment (including exercise oximetry or a 6-minute walk test) can give a much clearer picture. 

Q: Is it possible to stop sputum production? 

A: The goal in bronchiectasis is usually  to keep it minimal and easy to clear. Airway clearance and, in some cases, mucolytics help manage and normalize sputum rather than eliminate it. In well-controlled disease, patients may have very little or no daily sputum. So yes, it can be reduced significantly—but the aim is control and prevention. 

Q: How can you tell if you are having an exacerbation or a bad cold? 

A: A simple cold usually causes upper airway symptoms (runny nose, sore throat, mild cough) and tends to improve within a few days. An exacerbation of bronchiectasis typically involves a clear change from your baseline: more cough, increased or thicker sputum, change in color, more breathlessness, or fatigue. A key clue is whether your chest symptoms are changing, not just your nose and throat. If in doubt, especially if symptoms are worsening or not improving, it’s always safer to seek medical advice 

Q: Is it common to have more sticky sputum during an exacerbation, so that the volume cleared is less as more difficult to shift? 

A: It can be – inflammation in the airways can increase the stickiness of sputum and make it more difficult to cough up. 

Q: How risky is it living in rural areas with crops being sprayed and harvested and sprayed with manure/sewage etc? 

A: There are no major risks. Some people find chemicals in the air make them cough but no proof that this will increase any risks for bronchiectasis patients 

Q: Could your persistent drowsiness be due to this condition? 

A: Drowsiness is not a typical direct symptom of bronchiectasis, but it may occur indirectly in some cases. The presence of other associated conditions, such as anaemia or sleep disorders (e.g. sleep apnoea), should also be considered. For this reason, it is important not to automatically attribute drowsiness to bronchiectasis without a more comprehensive assessment. I would advise you to discuss this with your doctor so that any necessary targeted tests can be carried out and the cause clarified. 

Q: Should phlegm only be coughed up, or can it also be swallowed? Are there any consequences to swallowing it? 

A: Ideally, phlegm should be coughed up, as it contains bacteria, inflammatory cells and debris that are best removed from the airways. That said, swallowing small amounts is not dangerous, as the stomach neutralises them without any problems. There are no significant infectious or systemic consequences from swallowing phlegm. The issue is primarily respiratory: if it is not expelled, there is a risk of retaining secretions in the bronchi, promoting infection and inflammation. Therefore, the aim remains to facilitate its elimination, especially in patients with bronchiectasis. However, if it is occasionally swallowed, this is not a cause for concern. 

Q: What is a pulmonary rehabilitation? 

A: A programme of exercise and education for people with lung conditions. The exercise is gradual and improves how much you can do, quality of life and disease management. This might not be available on all countries. Please ask your doctor.  

Q: Has anybody been thinking about singing as a treatment? 

A: We have studies on singing and this could be a complementary programme, alongside airway clearance and other management interventions. Data show it cannot replace other management components but can be additional. 

Q: Are there any contraindications to doing upper-body strength exercises (chest exercises) at the gym? 

A: There is nothing specific to bronchiectasis- strengthening the upper body should be a good thing. 

Q: How can I mitigate the impact of airplane air conditioning and recycled air to prevent a flight-triggered exacerbation? 

A: There is no proven way to do this- some patients where masks on the flight but this will not guarantee protection as you are still breathing the recycled air. Wash hands carefully 

Q: Is high levels of air pollution a risk for exacerbations of bronchiectasis?  

A: There is research showing exposure to high air pollution increases bronchiectasis symptoms and exacerbations so you are right and its something that should be taken into account as risk. 

Q: Is sea air good for lungs? 

A: Many people say it is – a little salt in the airway might help hydrate mucus but of course it’s all anecdotal because no one can do a study of this.  

Q: Can you talk about how important it is to stop smoking?  

A: You are absolutely right to highlight this, and I would strongly reinforce it. Stopping smoking is one of the most important interventions for lung health—continuing to smoke will keep damaging the airways and accelerate disease progression. No medication, supplement, or physiotherapy can counteract the ongoing harm caused by smoking. This is why every respiratory specialist consistently emphasizes smoking cessation as a priority. The good news is that there are effective supports available, including medications and structured programs to help people quit. From a clinical perspective, quitting smoking is probably the single most impactful step you can take to protect your lungs. 

Q: I have had bronchiectasis for some 70 years. I have always been warned not to have much sun exposure. Is this so?   

A: There are specific medications that cause problems with the sun e.g doxycycline but bronchiectasis itself is no problem with the sun 

Q: Are there any statistics on how many flights are impacted due to someone’s oxygen levels dropping? 

A: It is very rare – medical emergencies happen around 1 in every 600 flights and respiratory problems are about 10% of all emergencies. Most are managed on the plane without a diversion so thankfully its rarely a big problem. This is primarily because people make the right arrangements before flying. 

Q: Why is exercise not included in the treatment components? 

A: Exercise is actually a core part of treatment in bronchiectasis, even if it’s sometimes not emphasized enough. Regular physical activity helps mobilize mucus, improve lung function, and reduce fatigue, and it’s strongly recommended in all major guidelines. In many patients, exercise works together with airway clearance—movement and deeper breathing naturally help loosen secretions. Structured pulmonary rehabilitation programs are particularly effective, especially if symptoms limit activity. Of course, exercise needs to be adapted to the individual, especially if there are comorbidities or limitations. So rather than being optional, exercise should be seen as a key pillar of long-term management. 

Q: Are vented masks as effective as n95? 

A: Vented masks are not as effective as standard N95 masks. The valve allows air to exit without filtration, which reduces protection. N95 masks without valves provide better protection for both you and others. 

Q: What else than e.g. gardening can cause bacteria in lungs? How to prevent? 

A: Common routes include micro aspiration from the mouth or stomach (especially with reflux), chronic sinus infection, contaminated water aerosols (showers, hot tubs), and close contact with people with acute respiratory infections (e.g. viral). In bronchiectasis, impaired mucus clearance makes it easier for these bacteria to persist and grow. Prevention focuses on good airway clearance, treating reflux and sinus disease, staying up to date with vaccinations, and avoiding high-risk exposures (e.g. stagnant water). I think that important are also very simple measures like good dental hygiene and careful cleaning of inhalation devices. 

Q: Can bathroom mould cause an exacerbation? 

A: Yes, especially in susceptible individuals. Mould releases spores and irritants that can trigger airway inflammation and worsen respiratory symptoms. In some patients, particularly those with asthma or fungal sensitization (e.g. Aspergillus), this effect can be more pronounced. It may not directly cause infection, but it can destabilize the airways and increase the risk of flare-ups. For this reason, I would suggest to reduce exposure: improve ventilation, clean visible mould, and address humidity issues. 

Q: For a patient with bronchiectasis where air conditioning is a consistent trigger for exacerbations, what are the recommended clinical strategies to manage this 

A: Air conditioning (AC) could be trigger/irritant if your airways are susceptible to dry and/or cold air. In this case you may try to control the temperature and moisture of your inhaled air by using scarfs, preferring nasal breathing, controlling room temperature to a more comfortable target, keeping hydrated and/or not using air conditioning in your preferred working/staying space. Another thing to keep in mind is the AC maintenance, it must be cleaned regularly and checking their filters, so it isn’t a source of bacteria or fungi spreading. 

Q: I cannot take  Azithromycin so take a daily dose of Doxycycline 100, What are the long term affects of this treatment? 

A: Using doxycycline long-term might be a reasonable alternative when azithromycin is not tolerated, but it does come with some considerations. The most common issues are gastrointestinal upset, photosensitivity, and esophageal irritation, especially if not taken with enough water. Over time, there is also a risk of antibiotic resistance and changes in normal bacterial flora. Compared to macrolides, doxycycline has less anti-inflammatory effect, so its benefit is mainly antimicrobial. I regularly reassess the indication and balance benefits  against these risks. 

Q: Is it safe to walk around damp areas like lakes and rivers, can you swim in lakes and rivers? 

A: Yes  

Q: If i have a flare up then should I cancel my flight? 

A: I think it depends on how severe it is, how long the flight is and what treatment you are taking. I would discuss with your doctor 

Q: Is it common with bronchiectasis to experience fluctuating health?  

A: Many patients report this- it is a very up and down condition varying with environmental conditions, your own diet and exposures, exposure to viruses and how effectively we have cleared the chest 

Q: What air quality apps would you recommend? 

A: Doing a quick search online you’ll have lots of available apps with characteristics that are more suited to your preferences (some examples are IQAir AirVisual, Plume Labs, Local Haze). This is not an evidence-based recommendation – it is good to look around and find something that works for you.  

Q: I find it too hard to breath with a mask on – should I still wear it?  

A: Masks are not suitable for everyone- some people find them comfortable and some people don’t. We can’t ever make a recommendation for everyone. Its about balancing risks and benefits 

Q: Should you spend time in a sauna with bronchiectasis?  

A: There is no evidence that saunas are a problem for bronchiectasis. 

Q: Can I do the following sports activities: running, swimming, push-ups, pull-ups, HIIT (high-intensity interval training), CrossFit, and gym workouts (upper-body training, mainly chest)? 

A: Yes- there are no limitations to physical activity with bronchiectasis specifically 

Q: What should I pay attention to when doing sports? Do I need to monitor my heart rate particularly closely? 

A: There is no need to monitor heart rate- exercise is safe for people with bronchiectasis and so nothing you need to worry about 

Q: Can you swim in the sea when you have bronchiectasis?  

A: There is no evidence that swimming in the sea is a problem for bronchiectasis

Q: I feel the emotional burden and isolation that comes with bronchiectasis is as debilitating as the physical symptoms. Are there any strategies being looked at to support patients with this aspect please? 

A: Emotional burden and isolation are very common in bronchiectasis and are recognized as part of the disease. Anxiety and depression can affect many patients and may worsen symptoms and quality of life. Care is evolving to include psychological support, patient education, and routine attention to mental well-being. You might want to think about pulmonary rehabilitation program that can help both physically and emotionally, peer support groups and patient communities that are also very valuable in reducing isolation, physological support. I agree that good care today means addressing both the lungs and the emotional impact of the disease. 

Q: I have severe cystic bronchiectasis, NTM, Gerd and Tracheobronchomegaly (MKS). Are there any support groups for Tracheobronchomegaly? 

A: Support groups specifically for tracheobronchomegaly (Mounier-Kuhn syndrome) are limited because it is a very rare condition. There are currently no large dedicated international patient organizations for MKS as far as I know. In practice, patients usually find support through bronchiectasis, NTM, or rare lung disease communities. Organizations like the European Lung Foundation can be helpful starting points. Many patients also connect through small online groups or via specialist centres. In complex cases like yours, broader communities might often provide meaningful support even without a disease-specific group. 

Q: I sing in a choir and whereas I’m aware that the singing is good for the lungs I do get anxious about getting a cough attack during a performance. Are there any tricks one could use in case that is about to happen? 

A: It is great you sing in a choir as it is so good for the lungs. Having some water beside you and actually telling yourself it’s not the end of the world if you do need to have a brief cough, you can always step aside, means your anxiety will be lower, you will be less tense and then you will be much less likely to cough. 

Q: At what point does the health anxiety associated with chronic bronchiectasis and germs move from ‘necessary vigilance’ to a condition requiring psychiatric medication, 

A: This is hard to answer but in general mental health issues that are persistent and impacting on quality of life are likely to need some kind of management (not always medication) 

Q: Having moved area I am finding a lack of knowledge about bronchiectasis.  How can I help those treating me to understand the condition better ? 

A: This is unfortunately quite common, and I appreciate how frustrating it can be when expertise varies between centres. The most effective approach is to share clear, reliable resources—guidelines from ERS or patient-friendly material from the European Lung Foundation are very helpful starting points. If you are followed by a specialist centre, I would suggest asking them to communicate directly with your local team or provide a brief clinical summary with key recommendations.
Bringing a concise record of your history (exacerbations, microbiology, treatments, CT findings, lung function, etc..) can also make a big difference in guiding care.
In bronchiectasis, management is highly individualized, so helping your team understand your specific pattern is more useful than general information alone. If possible, maintaining at least periodic follow-up with an experienced centre can help support your local doctors and ensure continuity of care. 

Q: How can I access equipment from the NHS who see bronchiectasis as a cough and not a lung conditions? 

A: Ask to be reviewed by a respiratory physiotherapist.  They will determine if you need any equipment to help with airway clearance and provide it.  But not everyone needs equipment to manage their airway clearance well. 

Q: Could you please provide an example of what you mean by Digial Health Tools? 

A: This is under development in our technology driven society, but it could things such as Shared Decision-Making tools, Tele-rehabilitation, Home Spirometry etc. 

Q: Do Consultants appreciate a ‘clinical handover’ sheet from patients at an appointment? 

A: Yes—speaking personally, I find a concise “clinical handover” from patients extremely helpful.
It allows me to understand your history quickly and focus the visit on what really matters, especially in complex conditions like bronchiectasis. The key is to keep it clear and brief: current symptoms, recent exacerbations, sputum results, lung function results, treatments, and any changes since the last visit. A short timeline or bullet summary works much better than long narratives. It also helps avoid missing important details and makes the consultation more efficient for both sides. In my experience, most specialists genuinely appreciate this kind of structured input. 

Q: How many GPs are really aware of the symptoms of Bronchiectacis on average? 

A: I think it’s definitely improving – lots of GPs are now aware of it but there’s always scope for improvement.  I think GPs do want to know more about it so the desire is there to be providing better care. 

Q: I live in Germany – how can I find a lung specialist with up to date knowlege of bronchiectasis and specialised physiotherapists who are familiar and can teach the various airway clearance techniques? 

A: The most reliable approach is to seek a referral to a university or tertiary lung centre, ideally linked to the German Lung Research Network (DZL), where expertise in bronchiectasis is concentrated. In practice, a “hub-and-spoke” model works best: one specialist centre for assessment, with ongoing care locally. For physiotherapy, look specifically for respiratory physiotherapists or those experienced in COPD or cystic fibrosis. Ask directly if they teach airway clearance techniques (PEP devices, huffing, drainage), as not all physiotherapists are familiar with them. Expertise in bronchiectasis is not evenly distributed, so being proactive in seeking specialized care is important. If possible, having at least one evaluation in an expert centre can significantly improve long-term management. 

Q: Is there a specialist bronchiectasis clinic in England or in the Uk? 

A: There isn’t one overall specialist bronchiectasis clinic in the UK. In theory all secondary care respiratory departments should be able to treat bronchiectasis well but in practice some respiratory doctors are more interested in bronchiectasis than others.  If you aren’t getting good treatment then you may have to try and educate the doctors you see by being aware of the latest bronchiectasis guidelines (British Thoracic Society and European Lung Foundation) and making use of the bronchiectasis patient checklist (on ELF website). And you may need to travel to find someone, your GP may be able to help with this because they should be able to find a consultant with a special interest in bronchiectasis.  Depending on where you are in the UK there are good bronchiectasis consultants at the Brompton in London, in Dundee and Edinburgh and in Newcastle just to mention a few. 

Q: What should I do if there is National Bronchiectasis Clinic in my country?  

A: Bronchiectasis is sufficiently common that it is important for all respiratory departments to be able to deal with it.  Quality of care is patchy but that is slowly changing.  There are respiratory departments with consultants who specialist in bronchiectasis and there need to be more.  It should be no different from COPD and asthma in terms of access to expertise. 

Q: Is there a specialist bronchiectasis clinic in Wales? Or in North West England?    I was diagnosed with Bronchiectasis & Asthma in 2019 & tried to access a drug trial last year but advised there are no trials in Wales and as I do not have a consultant (since discharge during Covid ) , I cannot be referred. 

A: There are bronchiectasis clinics at Liverpool Heart & Chest Hospital and Manchester also has similar clinics. Cardiff (Llandough) is in the process of setting up a dedicated bronchiectasis service. 

Q: Where can I find associations of patients in Ireland?  

A: ELF has a patient organisation network – you can search to see if there is an organisation in Ireland here: https://europeanlung.org/en/people-and-partners/elf-patient-organisation-network/ 

Q: Question about vaccines. In Spain, my son received the Prevnar 20 vaccine as a pneumococcal booster. However, some other patients have received Prevnar 23. Is there a consensus on which vaccine should be given?On the other hand, in Spain, the RSV vaccine isn’t given to all at-risk patients. Would it be advisable to give it? 

A: PCV20 is a newer vaccine and, in most cases, a single dose is considered sufficient for at-risk patients. PPSV23 is older and now used less often, or in combination strategies in selected cases. So receiving PCV20 is fully appropriate and in line with current recommendations.
Regarding the RSV vaccine, availability and indications still vary across European countries.
In patients with chronic respiratory disease, it may be beneficial, but it is not yet routinely offered to everyone. It is worth discussing with your specialist, especially if respiratory risk is significant. 

Q: I had a pneumococcal vaccine many years ago, should it be repeated? 

A: This depends on which pneumococcal vaccine you received and your current risk profile. In general, newer strategies use vaccines like PCV20, which in many cases do not require repeat dosing once given. If you had an older vaccine (such as PPSV23), a booster or updated vaccination may be recommended. The timing and need for revaccination should be individualized based on age, previous vaccines, and risk factors and according to policies at your local level. 

Q: Should RSV vaccine be given as a single course or repeated annually? 

A: RSV vaccination is generally given as a single dose, not an annual vaccine like influenza. The available data show protection lasting at least one season, likely longer, but the exact duration is still being studied. Because these are relatively new vaccines, long-term booster strategies have not yet been fully defined. Current recommendations in most countries are therefore one dose for eligible individuals, without routine yearly repetition. This may change in the future as more data become available. I would suggest you to follow ypour national guidance. 

Q: Do you think “Iovir” or perhaps any other similar products can be trusted to protect against viruses? I know that you should keep vaccines as a priority and continue to follow all necessary hygiene rules. 

A: It’s good you clarify that vaccines and hygiene remain the priority—because those are by far the most effective protections. Products like “Iovir” or similar supplements are often marketed for immune support, but there is no strong clinical evidence that they reliably prevent viral infections. Some ingredients may have theoretical or mild supportive effects, but they do not provide consistent, proven protection in real-world settings. In contrast, measures like vaccination, hand hygiene, and avoiding exposure during high-risk periods are clearly effective. If you choose to use such products, they should be seen as adjuncts at best, not protective strategies. From a clinical perspective, and this is my personal opinion, I would not rely on them to prevent infections, especially in patients with bronchiectasis. 

Q: I’ve seen BE described as ‘driven by’ inflammation. Boosting the gut microbiome seems the most effective way to reduce systemic inflammation. But BE treatments – and much of the lifestyle advice – are actively harmful to the microbiome. Are we buying short-term symptom control at the expense of long-term prognosis?  

A: Antibiotics will affect the gut and may do exactly what you said – short term benefit but long term tummy problems for some people. Most of our research is focused on trying to find alternatives to antibiotics for just this reason. At the moment, however, for many people without antibiotics quality of life would be bad. The message is only use antibiotics when they are really needed 

Q: Will the antibody trial be available in Hong Kong? 

A: I am not aware of that unfortunately. 

Q: What is DPP1 and how does someone with both Traction BE and standard BE get on any trials? 

A: DPP1 is a new type of anti-inflammatory treatment that reduces the inflammation in the lungs and therefore reduces mucus. Most trials allow patients with “standard BE” to participate even if there is some traction BE. Speak to your doctor about this. 

Q: Is there any interest from pharma or the clinical community to test the new treatments in patients with FEV <30% (as we are mostly excluded from clinical trials)? 

A: Trials should include patients with more advanced lung disease and many new trials are allowing it. The new drugs may help with stopping infections and indeed we had some patients with very low lung function in the Anti Pseudomonas monoclonal antibody trial as pseudomonas is a big problem in people with low lung function. There is a lot of hope even for advanced lung function changes but of course I hope in future we can help earlier. 

Q: Bronchiectasis is often described as irreversible, but given the advances in innovative technologies and AI, are there any ongoing studies exploring ways to reverse it — for example through imaging-guided interventions, laser-based treatments, injections, or other approaches? 

A: We are making progress, but true “reversal” is not yet achievable in clinical practice. Bronchiectasis is still considered structurally irreversible, because the airway wall has been damaged and remodeled over time. What has changed recently is that new treatments might slow disease progression and partially stabilize lung function, which is already a major step forward. There is no evidence at present supporting laser treatments, injections, or imaging-guided procedures to reverse bronchiectasis. From a clinical perspective, the realistic goal today is early detection + aggressive control of inflammation and infection = functional stabilization (and sometimes slight improvement in symptoms) 

Q: “Beyond current therapies that focus on halting disease progression, is there any ongoing research into ‘Airway Remodelling’ or regenerative treatments that aim to reverse or narrow permanently dilated bronchi, and are there non-invasive interventions currently being studied to restore original airway calibre? 

A: There are some early stage research looking at regenerative medicine type approaches but there is nothing close to the clinic yet. 

Q: Is there a new treatment to reverse it? 

A: At the moment, the answer is no—we do not yet have a treatment that can reverse bronchiectasis. It is a structural airway damage that is still considered irreversible.
However, we have made important progress: newer treatments might reduce exacerbations and slow disease progression. We are also moving toward more personalized, targeted therapies based on specific inflammatory pathways. The current goal is to stabilize the disease and prevent worsening. We cannot cure it yet, but we can manage it much more effectively than in the past. 

Q: I have two questions:
1- Brensocatib or Verducatib, which is in the third phase of the clinical trial, do they positively affect cortisol balance and have a positive impact on EV1?
2- The CLEAR Bronchiectasis & Pseudomonas Phase II AZD0292 clinical trial, which primarily targets Pseudomonas, is underway. Will treatments with Brensocatib and AZD0292 be compatible in the future? 

A: Both brensocatib and verducatib appear to slow down the decline in FEV1. The evidence is strongest for brensocatib because it has gone through the phase 3 trial whereas verducatib has not reported its phase 3 results yet but they both work in a similar way. There is no reason why Brensocatib and AZD0292 could not be combined in future as they work differently- one on the inflammation and one on the infection component 

Q: What are your thoughts on Phage therapy and the efficiency of this for someone who is seems to have constant infection (examples Burkholderia, Pseudomonas)? 

A: It is still unproven in most cases. The recent randomized trial of phage didn’t work. NHS is offering it to a very limited number of very unwell people in a personalised way. Very much reserved for when there are no other options 

Q: How can someone see if there is an open clinical trial close to where they live? 

A: It is best to speak to your healthcare professional as they should know what is going on locally