The European respiratory society guideline for adult bronchiectasis 2025: summary and implementation guide for primary care.

Abstract

Bronchiectasis is a common chronic respiratory disease with rising prevalence, hospitalisation rates, and mortality. It is estimated to affect approximately 1 in 200 adults, imposing a substantial symptom burden and significant healthcare costs, largely driven by exacerbations. Although diagnosis and long-term management are usually led by respiratory specialists, most patient care interactions occur in primary care, including the management of multimorbidity and acute exacerbations. In December 2025, the European Respiratory Society (ERS) published updated global clinical practice guidelines for adult bronchiectasis. This article summarises the 2025 ERS recommendations with a specific focus on their implementation in primary care practice. Key priorities include improving early recognition and reducing diagnostic delay, undertaking standardised investigations to identify underlying causes and treatable traits, and recognising features associated with poor outcomes that warrant specialist referral. The guidance emphasises the importance of sputum microbiology, including testing for non-tuberculous mycobacteria, and targeted blood investigations such as immunoglobulins and allergic bronchopulmonary aspergillosis serology. Core management strategies relevant to primary care are reviewed, including airway clearance techniques, pulmonary rehabilitation, and evidence-based use of inhaled therapies. The article outlines best practice for the management of acute exacerbations, highlights differences from asthma and COPD care, and clarifies the limited role of inhaled corticosteroids in bronchiectasis. The identification and monitoring of patients who may benefit from long-term antibiotic therapy, including those with Pseudomonas aeruginosa infection, are also discussed. By translating specialist guideline recommendations into a primary care context, this summary aims to support timely diagnosis, optimise ongoing management, and improve outcomes for adults with bronchiectasis.