Inhaled antibiotics for bronchiectasis: are we there yet?

Chronic infection in non-CF bronchiectasis is an important risk factor for disease progression, poor quality life, admission to hospital and perhaps reduced life expectancy. The use of long-term oral and inhaled antibiotics has been included in expert consensus-based guidelines but until recently supporting evidence has been weak. The design, duration and size of adequately powered clinical trials remain challenging, and this has been reflected in some of the reported outcomes. In addition, the tolerability of nebulised antibiotics remains an issue. Despite this, it is now possible to include inhaled antibiotics in treatment strategies and be more specific about antibiotic choice and dose. New inhaled antibiotic options continue to be developed. The most difficult challenge to the success of this intensive treatment will be the promotion of patient adherence.