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. 2019 Nov 20;28(154):190055. doi: 10.1183/16000617.0055-2019

TABLE 1.

Definition of exacerbation according to different guidelines

Spanish guidelines 2008 [19] British guidelines 2010 [20] Consensus definition for clinical research 2016 [22] Spanish guidelines 2017 [21]
At least one of the following:

  1. Changes in sputum characteristics (increased volume, thicker consistency, greater purulence, or haemoptysis)

  2. Increased breathlessness unrelated to other causes

 Worsening of one or more of the following:

  1. Increasing sputum volume or purulence

  2. Worsening dyspnoea

  3. Increased cough

  4. Decline in lung function

  5. Increased fatigue/malaise

 Deterioration in three or more of the following key symptoms for at least 48 h:

  1. Cough

  2. Sputum volume and/or consistency

  3. Sputum purulence

  4. Breathlessness and/or exercise tolerance

  5. Fatigue and/or malaise

  6. Haemoptysis

 Increasing cough AND changes in sputum characteristics (increased volume, thicker consistency, greater purulence)
May be accompanied by:

  1. Worsening of cough

  2. Fever

  3. Asthenia

  4. General discomfort

  5. Anorexia

  6. Weight loss

  7. Pleuritic chest pain

  8. Physical changes in the lungs found during examination

  9. Chest radiograph findings suggestive of infection

  10. Declining lung function

  11. Elevated markers of systemic inflammation

 AND new appearance of one or more of the following:

  1. Fever

  2. Pleurisy

  3. Haemoptysis

  4. Requirement of antibiotic treatment

 AND a clinician determines that a change in bronchiectasis treatment is required May be accompanied by:

  1. Worsening dyspnoea

  2. Fever

  3. Asthenia

  4. General discomfort

  5. Anorexia

  6. Weight loss

  7. Chest pain

  8. Haemoptysis

  9. Changes in thoracic objective exam

  10. Requirement of changes in bronchiectasis treatment

  11. Declining lung function

Severe exacerbation: a severe exacerbation is one in which there is tachypnoea, acute respiratory failure, exacerbated chronic respiratory failure, a significant decline in oxygen saturation or respiratory function, hypercapnia, fever >38°C, haemoptysis, haemodynamic instability, and/or impaired cognitive function. Very severe exacerbation: haemodynamic instability, altered mental status or the need of admission to an intensive or intermediate care unit.