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Background Our objective is to document major healthcare resource use and associated costs in the care of patients with bronchiectasis, with a particular focus on the costs incurred by exacerbations.Methods We use a unique dataset from the Bronchiectasis Observational Cohort and Biobank UK. The study includes a baseline cohort of 1119 patients with a primary diagnosis of bronchiectasis, followed for up to five years. Data were extracted and linked to centrally held National Health Service (NHS) resource use data.Results The average age of the cohort was 64 years and 62% were female. The most common bronchiectasis aetiology was idiopathic or post-infectious. Across follow-ups, exacerbations became less frequent: the proportion of patients with no events increased for all settings, while recurrent (≥2) events declined markedly and single-event categories remained largely stable. Exacerbations were predominantly managed in primary care settings. Based on exacerbation frequency and type and applying 2024/2025 NHS reference costs, the estimated total healthcare exacerbation costs for the study population ranged from £2 million to £3.2 million. Disaggregated estimates for the highest cost scenario include: general practitioner (GP)-only exacerbations (n=2824 events; £479 945), emergency department-managed exacerbations (n=311; £260 126) and inpatient-managed exacerbations (n=680; £2 428 291). The average estimated cost per patient over the full period was £1943. This corresponds to a weighted annual average of £495 per patient (including patients with no exacerbations), with most costs attributable to inpatient-managed exacerbations. Specifically, the average cost was £2980 for individuals with one or more exacerbations, £4865 for those with two or more and £5875 for those with three or more.Conclusions The findings highlight the economic burden of bronchiectasis exacerbations and demonstrate that targeted management strategies to reduce exacerbation rates should increase health benefits and substantially reduce healthcare costs associated with bronchiectasis.