Bronchiectasis is a chronic respiratory disease of airway dilatation, where patients typically suffer from respiratory infections, fatigue, sputum, cough, dyspnoea and poor quality of life [12].  A number of new treatment approaches have been proposed including long term antibiotic therapies and immune modulating drugs [671112].

Nevertheless the area of bronchiectasis care that has received the least attention during this period is the aspect of management that most healthcare professionals caring for bronchiectasis agree is the most important: airway clearance and exercise [1314]. The evidence base for respiratory physiotherapy has not advanced at the same pace as other aspects of bronchiectasis care [15].

To assist clinical decision-making, bronchiectasis guidelines synthesise, evaluate the evidence and provide recommendations for clinical practice, and a number of clinical guidelines in bronchiectasis have been published since 2008 (table 1). Although usually similar, guidelines can present some variability in their recommendations even for the same topic [1621]. This is particularly the case for physiotherapy, because of the limited evidence on which to base guideline recommendations. The purpose of this editorial is to discuss the current state of play worldwide with regard to airway clearance and pulmonary rehabilitation and suggest the need to prioritise research into these topics.

To view the paper: Respiratory physiotherapy in the bronchiectasis guidelines: is there a loud voice we are yet to hear?