A major international study recently published in The Lancet Respiratory Medicine has found that people with bronchiectasis who experience severe daily symptoms are at higher risk of future flare-ups, termed ‘exacerbations’, even if they have not had frequent flare-ups before. The findings show more patients may benefit from preventive long term treatment with the antibiotic azithromycin than previously thought.
Key findings
- The study analysed data from the EMBARC study from more than 9,400 people from 27 countries to show that patients with more daily symptoms such as cough, sputum production and breathlessness have a higher risk of future exacerbations, even if they previously did not have many exacerbations.
- Analysing data from three clinical trials which looked at the effect in patients with bronchiectasis of long term treatment with azithromycin or a related antibiotic erythromycin (BLESS, BAT and EMBRACE) showed that patients with a lot of symptoms benefited just as much from azithromycin or erythromycin treatment as patients who were having three or more flare-ups per year.
Why this matters
These findings challenge current treatment guidelines for bronchiectasis, which recommend azithromycin only for patients with frequent exacerbations. The results suggest that azithromycin should also be given to patients with a lot of symptoms even if they are not having frequent exacerbations.
Our view
Professor Brown, from Breathing Matters, explained: “What this research tries to show is that although macrolides are recommended by guidelines only for patients with frequent exacerbations, they also benefit patients with lots of symptoms. In fact, the results support our real-world clinical practice as we often already use azithromycin for patients with a lot of daily symptoms (especially sputum production) as well as those with frequent flare-ups.”
At Breathing Matters, we welcome research that helps improve care for people living with bronchiectasis. Studies like this bring us closer to more personalised treatment and better outcomes for everyone affected by this long-term lung condition.
You can read the full article here.
[Posted October 2025]