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Background Bronchiectasis is a chronic respiratory disease that is increasingly recognised globally. However, research on its economic impact is scarce. The primary objective of this study is to document major healthcare resource use and associated costs in a U.K. patient population with a focus on exacerbationsMethods We used baseline and follow up data from the Bronchiectasis Observational Cohort and Biobank UK (BronchUK). The study includes a baseline cohort of 1,119 patients diagnosed with primary bronchiectasis, who are followed for a period of up to five years. We extracted data from the database and compared to centrally held NHS resources 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. Over the five-year period, the average annual distribution of exacerbations was as follows: 32% of patients had no exacerbations, 21% had one, 17.5% had two, and 29% had more than two. Longitudinal data show that while a significant proportion of patients (32%) experienced no exacerbations, those who did were predominantly managed in primary care settings. Based on exacerbation frequency and type, and applying 2024/25 NHS reference costs, the estimated total healthcare costs for the study population ranged from £2 million to £3.2 million. Disaggregated estimates for the highest cost scenario include GP-only exacerbations (n=2,824; £479,945), outpatient-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 £2,824, with the majority of costs attributable to inpatient-managed exacerbations.Conclusion Bronchiectasis and associated exacerbations are a significant cost to the NHS. This study, based on the BronchUK cohort, is one of the first to provide a detailed analysis of healthcare utilisation and costs associated with bronchiectasis in the UK, particularly among patients at risk of exacerbation. The findings highlight the economic burden of the disease and the importance of targeted management strategies to reduce exacerbation rates and associated healthcare costs.