CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Bronchiectasis - Management
Basis for recommendation
Recommendations on who should receive follow up in secondary care
Record of sputum cultures from previous exacerbations
- Experts consider that treatment of exacerbations is more likely to be effective when this is based on previous sputum culture results [British Thoracic Society, 2010].
- The recommendation to send sputum samples for analysis at annual review, when the person is clinically stable, is based on the opinion of a CKS expert reviewer.
Physiotherapy
- It is not possible, from the limited available evidence, to assess the effectiveness of physiotherapy for people with bronchiectasis.
- It is widely believed by experts that airway clearance techniques are an important component of managing bronchiectasis [British Thoracic Society, 2010].
Pulmonary rehabilitation
- Pulmonary rehabilitation is recommended for people with bronchiectasis associated with exercise limitation. This is based on limited evidence summarized by the British Thoracic Society [British Thoracic Society, 2010].
- A Cochrane systematic review showed that inspiratory muscle training improved exercise endurance and health-related quality of life [Bradley et al, 2002].
- Further evidence from a randomized controlled trial compared exercise capacity in three groups of people. The first group received 8 weeks of a high intensity pulmonary rehabilitation programme with inspiratory muscle training; the second group received pulmonary rehabilitation with sham inspiratory muscle training; and a control group received no rehabilitation.
- There was a statistically significant improvement in exercise capacity in both groups receiving pulmonary rehabilitation.
- This improvement was maintained in the group receiving additional inspiratory muscle training but not in the group that received sham inspiratory muscle training.
Immunization
- There is a lack of evidence on the benefit of vaccination in people with bronchiectasis [ten Hacken et al, 2007]. The recommendation to offer people with bronchiectasis immunization against seasonal influenza and Streptococcus pneumoniae is based on expert opinion from the British Thoracic Society [British Thoracic Society, 2010].
Smoking cessation advice
- Recommendations on smoking cessation advice are based on accepted good clinical practice.
© NHS Institute for Innovation and Improvement