Table 2.

International bronchiectasis guidelines: recommendations on the use of ICSs in bronchiectasis

Guidelines	Inhaled corticosteroid recommendations
European BE guidelines (EMBARC) [16]	Do not offer treatment with ICSs to adults with bronchiectasis (conditional recommendation, low quality of evidence) The diagnosis of bronchiectasis should not affect the use of inhaled corticosteroids in patients with comorbid asthma or COPD (best practice advice, indirect evidence)
British Thoracic Society BE guidelines [18]	Do not routinely offer ICSs to patients with bronchiectasis without other indications (such as ABPA, chronic asthma, COPD, and inflammatory bowel disease)
Spanish BE guidelines [17]	Routine use is not recommended except in patients with bronchial hyperresponsiveness, asthma, or significant bronchorrhea that cannot be controlled with other treatments. Strong recommendation. Low-quality evidence Care should be taken with inhaled corticosteroid treatment in patients with chronic bronchial infection caused by PPMs, as these drugs can increase susceptibility to infection
Saudi Thoracic Society BE guidelines [110]	A therapeutic trial may be justified in adults with difficult-to-control symptoms and in the subset of patients who show evidence of airway hypersensitivity, asthma, COPD, or ABPA No recommendation can be made for the use of ICSs in adults during an acute exacerbation or in stable bronchiectasis unless they have evidence of reversible airway disease
Thoracic Society of Australia and New Zealand BE guidelines [111]	Should not be prescribed routinely unless there is an established diagnosis of co-existing asthma or COPD GRADE; strong; evidence: moderate

ABPA allergic bronchopulmonary aspergillosis, BE bronchiectasis, COPD chronic obstructive pulmonary disease, ICSs inhaled corticosteroids, PPMs potentially pathogenic microorganisms