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Bronchiectasis

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Checked: 05-01-2024 by Vicky Ryan Next Review: 02-01-2026

Overview

Refer to the local BNSSG Bronchiectasis Guidelines (2023) which cover diagnosis, management and referral.

This also includes advice on management of exacerbations including antibiotic therapy

Who to Refer

The BNSSG guidelines advise that the following patients are referred to respiratory clinic:

Bronchiectasis in patients <50 years old or other suspicion of underlying causes e.g. immunodeficiency, primary ciliary dyskinesia, cystic fibrosis
Persisting growth of Pseudomonas Aeruginosa
Patients with recurrent exacerbations or infections (≥ 3/year) after eradication attempts
Deteriorating bronchiectasis with declining lung function
Patients previously established on prophylactic antibiotics with new symptoms/organisms in sputum
Evidence or suspicion of Allergic Broncho-Pulmonary Aspergillosis (ABPA)
Advanced disease - multilobar or described as 'extensive' on CT
Chronic Pseudomonas aeruginosa, nontuberculous mycobacteria or MRSA colonisation
Frequent non-respiratory infections (especially skin or sinus) may suggest underlying immune defect
Patients with bronchiectasis and associated rheumatoid arthritis, immune deficiency, IBD or primary ciliary dyskinesia

In addition, consider referral to Respiratory HOT clinic if:

Inadequate response to appropriate oral therapy
Infection/deterioration for which there are unlikely to be oral treatment options

If referral is not necessarily required then where available, a specialist opinion can be obtained via respiratory advice and guidance.

Referrals

Respiratory out patients

Referral can be made to either UHBW or NBT respiratory clinic via eRS.

Pulmonary Rehabilitation

If MRC dyspnoea score is 3 or more then consider referral for Pulmonary Rehabilitation

Home Oxygen Assessment

If O2 saturation is 92% or less then consider referral for Home Oxygen assessment

What to do before referral

Consider the current investigations prior to referral:

High Resolution CT - gold standard test for diagnosis of bronchiectasis.
Sputum sample for routine bacterial culture (plus AFB if regular infections), specify that the sample is for bronchiectasis
Serum immunoglobulins (IgG, IgA, IgM) and FBC to screen for gross antibody deficiency and eosinophil count

Management in primary care

Management of exacerbations

See the BNSSG guidelines for advice on managment of exacerbations and antibiotic therapy.

Monitoring and annual review

It is advised that patients with bronchiectasis are reviewed regularly as with other patients with chronic respiratory disease.

There is advice on maintenance therapy and annual reviews in the BNSSG guidelines. There is also an Ardens template to help guide reviews (now available in many practices).

Air pollution and health

Please see the Remedy page on Air pollution and health.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.