Pulmonary exacerbations (PExs) are events in the course of bronchiectasis which are defined as an increase in disease symptoms lasting a period of a few days. It is established that the tendency toward having PEx is stable throughout the course of the disease. Certain conditions were found to be associated with an increased risk of developing a PEx. Among these are chronic airway infection with Pseudomonas aeruginosa or Aspergillus species, concomitant airway diseases (asthma, chronic obstructive pulmonary disease, and chronic rhinosinusitis), genetic factors such as primary ciliary dyskinesia, and nutritional factors. The immediate events underlying the onset of a PEx are less clearly determined. Although acute changes in bacterial airway composition have been the paradigm for decades, recent microbiome-focused research has not uniformly established such acute changes at the onset of PEx. Other acute changes such as air pollution, viral infection, and changes in bacterial metabolic activity have also been implicated as causes of a PEx. Despite these gaps in our knowledge of the biology of PEx, antimicrobial therapy directed against the identified pathogens in sputum is currently the recommended therapeutic strategy. Various long-term therapies, including antimicrobial and anti-inflammatory strategies, have been proven effective in reducing the frequency of PEx, leading to a recommendation for the use of these strategies in people with frequent PEx.

肺部恶化 (PEx) 是支气管扩张过程中的事件，其定义为持续几天的疾病症状增加。已经确定，在整个疾病过程中，患有 PEx 的趋势是稳定的。发现某些情况与发生 PEx 的风险增加有关。其中包括铜绿假单胞菌或曲霉的慢性气道感染种、伴随的气道疾病（哮喘、慢性阻塞性肺病和慢性鼻窦炎）、遗传因素（如原发性纤毛运动障碍）和营养因素。PEx 发作背后的直接事件尚不清楚。尽管几十年来细菌气道成分的急性变化一直是范式，但最近以微生物组为重点的研究并未统一确定 PEx 发作时的这种急性变化。其他急性变化，如空气污染、病毒感染和细菌代谢活动的变化也被认为是 PEx 的原因。尽管我们对 PEx 生物学的认识存在这些差距，但目前推荐的治疗策略是针对痰中已鉴定的病原体进行抗菌治疗。各种长期疗法，