Bronchiectasis often presents with recurrent pulmonary infections, including a chronic daily productive cough with mucopurulent sputum production.
High-resolution chest computed tomography is the confirmatory test.
Diagnostic testing is geared towards identifying the underlying aetiology, as treatment will be successful only if it treats both the bronchiectasis and any underlying disease process.
A sputum sample should be obtained when the patient is in a stable state and during acute exacerbations. Antibiotics are used in three scenarios: to treat acute exacerbations, eradication of a first or new isolation of Pseudomonas aeruginosa, and long-term antibiotics to suppress chronic bacterial infection. Where possible, antibiotic choice should be based on culture and sensitivity from sputum samples.
Daily airway clearance is essential for treatment success.
Exercise training is often offered as part of a pulmonary rehabilitation programme, combined with patient education and training in self-management, and delivered on an outpatient basis or remotely via telerehabilitation. Self-management plans aim to increase patients' confidence in managing their own condition.
Maintenance aerosolised antibiotics may be used for treatment of severe bronchiectasis or recurrent Pseudomonas aeruginosa infections.
Surgical therapy, including lung transplantation, should be considered for adult patients who continue to deteriorate despite optimal medical management, but is rarely undertaken in children.
Bronchiectasis is the abnormal dilation of bronchi due to the destruction of the elastic and muscular components of the bronchial wall. It is often caused as a consequence of recurrent and/or severe infections secondary to an underlying disorder. The majority of patients will present with a chronic cough and sputum production.
This topic covers the diagnosis and management of non-cystic fibrosis bronchiectasis in children, adolescents, and adults. For detailed information on the treatment of cystic fibrosis, see Cystic fibrosis.
History and exam
Key diagnostic factors
- presence of risk factors
- sputum production
- crackles, high-pitched inspiratory squeaks and rhonchi
Other diagnostic factors
- weight loss
- pleuritic chest pain
- cystic fibrosis
- host immunodeficiency
- previous infections
- congenital disorders of the bronchial airways
- primary ciliary dyskinesia
- alpha-1 antitrypsin deficiency
- connective tissue disease
- inflammatory bowel disease
- aspiration or inhalation injury
- focal bronchial obstruction
- tall, thin, white females, aged 60 or over
1st investigations to order
- high-resolution chest CT
- sputum culture and sensitivity
- serum alpha-1 antitrypsin phenotype and level
- serum immunoglobulins
- sweat chloride test
- rheumatoid factor
- specific IgE or skin prick test to Aspergillus fumigatus
- serum HIV antibody
- nasal nitric oxide (NNO)
- pulmonary function tests
Investigations to consider
- primary ciliary dyskinesia (PCD) testing
- cystic fibrosis transmembrane regulator (CFTR) protein gene mutation testing
- swallow study
- pH monitoring of oesophagus
- 6-minute walk test
- tuberculosis testing
- diagnostic bronchoscopy with bronchoalveolar lavage
acute exacerbation: mild to moderate underlying disease
acute exacerbation: severe underlying disease or not responding/resistant to initial antibiotics
3 or more exacerbations per year despite maintenance therapy
first or new isolation of Pseudomonas aeruginosa at outpatient review
- European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis
- British Thoracic Society guideline for long-term macrolides in adults with respiratory disease
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Bronchiectasis: what treatments work?More Patient leaflets
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