Highlights and interpretation of the 2025 European Respiratory Society clinical practice guideline for the management of adult bronchiectasis

In 2025, the European Respiratory Society (ERS) released the latest Clinical Practice Guideline for the Management of Adult Bronchiectasis. This guideline addressed eight PICO (Population, Intervention, Comparison, Outcome) questions and three narrative questions. The guideline strongly recommends airway clearance techniques for most patients, as well as pulmonary rehabilitation for those experiencing dyspnea or impaired exercise capacity. Long-term macrolide therapy is strongly recommended for patients at high risk of exacerbations, and long-term inhaled antibiotics are strongly advised for patients with chronic Pseudomonas aeruginosa infection and frequent exacerbations. Eradication therapy and the use of mucoactive agents are conditionally recommended in certain cases. Routine long-term use of non-macrolide oral antibiotics or inhaled corticosteroids is not recommended. In addition, the guideline provides updated recommendations on etiological evaluation, acute exacerbation management, and the care of patients with disease progression. This article aims to systematically interpret the core updates of the new ERS guideline, compare them with previous versions, and offer insights for improving the clinical management of adult bronchiectasis in China.

2025年欧洲呼吸学会（ERS）发布了最新版《成人支气管扩张症管理临床实践指南》。该指南共涵盖8个PICO问题及3个叙述性问题。强烈推荐大多数支气管扩张症（简称支扩）患者采用气道廓清技术，以及呼吸困难或运动耐力受损患者进行肺康复。对急性加重高风险患者，强烈推荐长期使用大环内酯类药物治疗；对于慢性铜绿假单胞菌感染且存在急性加重高风险的患者，强烈推荐长期吸入抗生素治疗。在特定情况下，有条件推荐根除治疗或使用黏液活性药物。该指南不建议常规使用长期口服的非大环内酯类抗生素治疗或吸入糖皮质激素。此外，该指南还提供了关于病因学检测、急性期管理及病情恶化患者管理的补充指导。本文旨在系统解读新版指南的核心要点，并与既往版本进行比较，为我国成人支扩的诊疗实践提供参考和借鉴。.