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This review synthesises contemporary understanding and literature of bronchiectasis exacerbations, addressing the transition from stable state to exacerbations, underlining the importance of early and precise recognition, rigorous severity assessment, prompt treatment, and prevention measures, as well as emphasising the need for strategies to assess and improve early and long-term patient outcomes. The review highlights the interplay between stable state phases and exacerbations in bronchiectasis, introducing the concept of \u201cexogenous and endogenous changes in airways homeostasis\u201d and the \u201cadapted island model\u201d with a particular focus on \u201cfrequent exacerbators\u201d, a group of patients associated with specific clinical characteristics and worse outcomes. 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