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Bronchiectasis - Management
What follow-up is recommended for people with bronchiectasis in primary care?
- All children with bronchiectasis should be followed up by a specialist.
- All adults with bronchiectasis should be offered an annual review in primary care. Ask about:
- Smoking.
- The number of exacerbations in the last year.
- Breathlessness associated with activities of daily living.
- Sputum volume and character.
- Send sputum for culture and sensitivity at annual review or if it has become persistently purulent between exacerbations — to assess for chronic bacterial colonization.
- Specialist follow up is required for adults with:
- Chronic colonization with Pseudomonas aeruginosa, opportunist mycobacteria, or meticillin-resistant Staphylococcus aureus (MRSA).
- Deteriorating symptoms.
- Three or more infective exacerbations a year.
- Bronchiectasis requiring long-term prophylactic antibiotics.
- Bronchiectasis associated with rheumatoid arthritis, immune deficiency, inflammatory bowel disease, primary ciliary dyskinesia, and allergic bronchopulmonary aspergillosis.
- Advanced disease.
- Ensure all people with bronchiectasis:
- Know how to recognize exacerbations and understand the condition. A patient information leaflet on bronchiectasis is available from the British Lung Foundation.
- Have a record of sputum cultures from previous exacerbations to guide future treatment of exacerbations.
- Have been taught an airway clearance technique by a physiotherapist — for daily use by people with a chronic productive cough, and intermittent use by people with a productive cough during exacerbations.
- Offer pulmonary rehabilitation to people with bronchiectasis and breathlessness associated with activities of daily living.
- Refer the person to a specialist to arrange this.
- People who have been advised to start antibiotics themselves for exacerbations should:
- Understand when it is appropriate to start treatment and the importance of collecting sputum before starting treatment.
- Have sputum collection pots and a repeat prescription for antibiotics.
- Offer immunization against Streptococcus pneumoniae and seasonal influenza. See CKS topics on Immunizations - pneumococcal and Immunizations - seasonal influenza.
- Offer people who smoke advice and support to help them stop — for further information, see the CKS topic on Smoking cessation.
- Do not routinely repeat chest X-rays.
- Routine annual spirometry is not recommended for people who are stable, with minimal exercise limitation, and who have few exacerbations.
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