Improving shared decision-making in bronchiectasis

Bronchiectasis is a heterogeneous lung disease. There is an increasing focus on personalised medicine in bronchiectasis, with targeted pharmacological interventions for inflammation, immunology and infection. Airway clearance techniques (ACTs) are non-pharmacological treatments used to manage bronchiectasis. Approximately half of patients with bronchiectasis perform ACTs. There have been attempts to personalise ACT prescriptions, including consideration of patient physiology, disease status and psychosocial factors. Guidelines suggest that patient preference or choice should be considered when prescribing ACTs. There is a lack of literature showing patient preference or choice being taken into consideration when prescribing ACTs in bronchiectasis. This article discusses the role of shared decision-making (SDM), the potential use of SDM for ACTs in bronchiectasis to support patient choice of and adherence to ACTs and the steps involved in designing an SDM intervention for ACTs in bronchiectasis for future research. Development and use of an SDM intervention to support patient choice of ACT in bronchiectasis may result in a patient-centred, pragmatic approach to empower patients to be actively involved in their care, improve their knowledge on the importance of ACTs and support improvement in adherence to this essential therapy.