Bronchiectasis: Airway Clearance and Pulmonary Rehabilitation

Clinical framework

The 2025 ERS guideline strongly recommends teaching airway-clearance techniques to people with bronchiectasis. No single technique is proven superior, so selection should be personalized.

Assessment and reasoning

• Clarify sputum burden, cough effectiveness, breathlessness and exacerbation history.
• Assess exercise tolerance and barriers to self-management.
• Check whether the chosen technique can be performed independently and consistently.

Differential considerations and precautions

• A substantial change in respiratory status requires appropriate medical-pathway review.
• Do not respond to deterioration by simply increasing treatment intensity without reassessment.

Management and dosage

• Teach a repeatable airway-clearance strategy matched to symptoms, preference and ability.
• Individualize session frequency and duration to secretion burden and response.
• When exercise capacity is reduced, combine aerobic and resistance training with education and self-management.
• Progress workload gradually while monitoring symptoms and recovery.

Common mistakes and clinical pearls

• Do not claim one airway-clearance method is universally best.
• Do not reduce respiratory physiotherapy to percussion alone.
• Clinical pearl: sustainable self-management matters as much as technique selection.

Summary

Bronchiectasis rehabilitation combines personalized airway clearance, deterioration recognition and exercise-based rehabilitation when appropriate.