Synopsis
Recognise the clinical syndrome, confirm bronchial dilatation on thin-section CT, complete a cause-changing aetiology screen, and organise airway clearance, vaccination, rehabilitation and longitudinal review.
- Bronchiectasis is a clinical-radiological syndrome: permanent bronchial dilatation on thin-section CT must be interpreted with chronic cough, sputum, infection, haemoptysis or another compatible presentation.
- Suspect it with persistent mucopurulent sputum, recurrent lower-respiratory infections or unexplained haemoptysis, especially with rheumatoid disease, inflammatory bowel disease, childhood infection or chronic rhinosinusitis.
- A baseline cause panel matters because immune deficiency, allergic bronchopulmonary aspergillosis, cystic fibrosis, primary ciliary dyskinesia and aspiration can change treatment and family advice.
Key red flags
Blood-streaking may accompany an exacerbation, but recurrent or substantial bleeding requires assessment for malignancy, tuberculosis, pulmonary embolism and vascular complications rather than automatic attribution to known bronchiectasis.
Investigation priorities
Confirm abnormal airway dilatation and map extent, mucus plugging and associated lung disease.
Management branches
Persistent productive cough, repeated chest infection, unexplained haemoptysis or suggestive imaging.
- Document sputum pattern, prior pneumonia or tuberculosis, childhood and ENT history, aspiration symptoms, inflammatory disease, fertility and family history, then obtain baseline radiography and diagnostic thin-section CT.
- Send stable routine and mycobacterial sputum, perform the BTS core blood panel and add CF, PCD, immune, autoimmune, aspiration or AAT tests only where phenotype and guideline criteria support them.
Key medicines
Nebulised hypertonic saline as a mucoactive trialConcentration, volume and frequency should follow the respiratory physiotherapist's local bronchiectasis protocol after an observed airway-reactivity assessment; there is no single universal UK schedule.