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Bronchiectasis - Management
How do I manage an infective exacerbation of bronchiectasis in primary care?

  • Send sputum for culture and sensitivity testing before starting antibiotics (even if the person is taking long-term antibiotics).
    • Collect expectorated sputum after deep coughing. A pharyngeal swab after coughing may be of value in very young children.
    • Ensure prompt transport of specimens to the laboratory, as Haemophilus influenzae and Streptococcus pneumoniae may only be viable if the specimen is processed within 3 hours.
  • Promptly prescribe an antibiotic for 10–14 days.
  • Prescribe a short-acting inhaled beta2-agonist (such as salbutamol) if necessary for wheeze or breathlessness in the acute phase.
  • Avoid using inhaled or oral corticosteroids, unless required for the treatment of coexisting asthma or chronic obstructive pulmonary disease.
  • Ensure that a suitable airway clearance technique (that has been taught by a respiratory physiotherapist) is used during the exacerbation.
    • Arrange an urgent appointment with a physiotherapist if the person has not already been taught this or if they cannot manage this alone.
  • Review the response to empirical treatment when sputum culture and sensitivity results are available.
    • If the person is responding well, continue with the prescribed antibiotic. Do not change the treatment based on the culture results.
    • If the person has not responded well to treatment, prescribe a different antibiotic. The choice of antibiotic should be guided by the results of sputum culture and sensitivity testing.
  • If the person deteriorates at any stage after starting treatment, re-assess to see if hospital admission is indicated.

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