Can We Predict and Prevent Bronchiectasis Exacerbations Accordingly?

"Bronchiectasis exacerbations remain a significant cause of morbidity in children, associated with increased symptom burden, reduced quality of life, and recurrent health care utilisation and future lung function deterioration. Growing evidence indicates that exacerbation risk is shaped by a combination of clinical, microbiological, and radiological factors rather than by a single determinant. Previous exacerbation frequency, prior hospitalisation, younger age at presentation, chronic bacterial infection, and more extensive structural lung disease have all been associated with a higher likelihood of subsequent events. Although prediction is still imprecise at the individual level, these features may help define a higher-risk phenotype that can support closer surveillance and earlier intervention. Our recent work showed that the ‘daily wet-cough dominant’ and ‘Wheeze Dyspnoea’ phenotypes were associated with increased risk of hospitalisations post-recruitment. We have also identified six neutrophil-associated genes were associated with a future exacerbation, suggesting that peripheral blood gene expression may help identify children at risk of exacerbations. Prevention strategies are more established and include regular airway clearance, prompt treatment of wet cough episodes, vaccination, nutritional support, and individualized action plans. In selected children, long-term macrolide therapy may reduce exacerbation frequency, while careful follow-up and early intervention can limit progression. Overall, the current evidence supports a risk-stratified approach that combines clinical assessment with proactive management. We need future research that use validated paediatric prediction tools that integrate clinical, microbiologic, and imaging data to better guide prevention and treatment. "