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Bronchiectasis


Clinical features of Bronchiectasis include large volumes of purulent sputum, cough, breathlessness, haemoptysis, coarse crackles during early inspiration, wheeze, high pitched inspiratory squeaks, palpable chest secretions on coughing4.
*This list is not exhaustive.

The gold standard investigation for bronchiectasis is a High Resolution CT scan (HRCT). Radiology have agreed GPs can refer straight for HRCT if they are confident that Bronchiectasis is the likely differential diagnosis and they are >25yrs old.

 

When to consider referral for HRCT* (also refer to resp. clinic at same time)

(*Note patients <25 years should be referred without HRCT due to risk of radiation)

1. Persistently productive cough (min. 6 weeks) plus 2 or more of:

  • Young age at presentation;
  • Absence of smoking history;
  • Daily expectoration of large volumes of very purulent sputum;
  • Haemoptysis;
  • Sputum colonisation with Pseudomonas aeruginosa.

In the absence of 2 or more of these features, then please consider referral to a respiratory clinic without HRCT.


2. COPD (Patients may have bronchiectasis alone or in addition): Referral for HRCT is appropriate if:

  • There is slow recovery from lower respiratory tract infections
  • Recurrent exacerbations (2 or more annually4)
  • There is no history of smoking

 

Primary care management prior to referral:

  • Consider alternative diagnosis, such as chronic rhinosinusitis or postnasal drip, and trial of treatment as appropriate
  • CXR (within the past 6 months)
  • Spirometry
  • Sputum sample

 

Clinic options:

  • If the primary concern is to include or exclude a diagnosis of bronchiectasis, with bronchiectasis a likely differential diagnosis, then refer for an HRCT scan via ICE at the same time as a referral to general respiratory clinic.
  • If there is uncertainty if bronchiectasis is part of the differential, then please consider referral to a general respiratory clinic.
  • Newly diagnosed bronchiectasis on HRCT scanning should be referred to the Respiratory Physicians for assessment
  • Any patient's fitting criteria for a 2WW pathway should be referred via the 2WW pathway.

 

Known bronchiectasis management:

  • Exacerbation (combination of feeling unwell PLUS increased breathlessness PLUS change in cough – colour alone, or positive culture is not an indication alone for treatment, equally negative sputum cultures do not mean no infection if other criteria met) – send sputum sample and antibiotics should be for 2 weeks, usually higher doses e.g. doxycycline 100mg twice a day; amoxicillin 1000mg three times a day; ciprofloxacin (if pseudomonas) 750mg twice a day – warn to watch for tendonitis
  • If not improving or further infection within 6 weeks may need IV antibiotics via ACAH
  • Follow individualized management plan if provided
  • Refer if 3 or more exacerbations a year and ensure recent sputum sample sent.

 

References

1. Bronchiectasis in Adults | British Thoracic Society | Better lung health for all

2. British Thoracic Society guideline for bronchiectasis in adults | BMJ Open Respiratory Research

3. NG117 Bronchiectasis (acute exacerbation): Visual summary 19/09/2024

4. https://cks.nice.org.uk/topics/bronchiectasis/

 

Page Review Information

 

Date reviewed                   25 March 2025                   

Next review due                 25 March 2027

GP Sifter                            Dr Kate Northridge

Contributors                      Dr Ben Soar, Consultant in Respiratory Medicine, RCHT