In this updated guidance BTS suggest a 4-step management plan. Step 1 includes treating any underlying cause, performing airways clearance, providing annual influenza vaccine, encouraging use of a self-management plan and prompt use of appropriate antibiotics for exacerbations. Step 2 recommends review by respiratory physiotherapist in patients that are experiencing 3 or more exacerbations per year and consideration of use of mucoactive agents. Steps 3 and 4 consider the addition of single or combined long-term antibiotic treatment and gives guidance based on their known sputum bacteriology status. Patients who remain very symptomatic with high exacerbation burdens (>5 per year) can be considered for regular intravenous antibiotic therapy every 2–3 months.