What's New-September 2017?

This pathway has been published in order to aid GPs and Practice Nurses in delivering care for patients with bronchiectasis. This includes developing a more consistent countywide approach, improving the quality of primary care diagnosis and management as well as accessing secondary care at the right time.

Bronchiectasis Care Pathway Overview

Please click the relevant flowchart box to be taken directly to textual information.


Red Flags
  • haemoptysis

Practice Point

Please the "Urgent Care: general" section on G-care for SWAST's guidance on Requesting Ambulance Transport (999 or Urgent)



Patients may present with the following symptoms:

  • chronic cough with sputum
  • recurrent "chest infections"
  • recurrent "pleurisy"
  • breathlessness and wheeze
  • green or yellow sputum in stable clinical state
  • fatigue

When to consider bronchiectasis:

  • productive cough with:
    • young age at presentation
    • symptoms over many years
    • especially if never smoked
    • daily sputum production
    • sputum positive for Pseudomonas
  • unexplained haemoptysis or cough without sputum
  • patients with particularly troublesome chronic obstructive pulmonary disease (COPD) or asthma with frequent exacerbations.


Differential Diagnosis
Initial Assessment

A high-resolution computed tomography (HRCT) scan is the gold standard indicator for bronchiectasis. This can be accessed directly-please click here for the link to direct access HRCT. All patients being referred to the bronchiectasis clinic in secondary care should have had a HRCT performed.

In bronchiectasis, the bronchi appear larger and more dilated than the accompanying bronchial artery. There may also be bronchial wall thickening (harder to define) and the CT scan may help to define aetiology. 

  • serum immunoglobulins and protein electrophoresis
  • sputum examination (state bronchiectasis on form)
  • spirometry

  • total immunoglobulin E (IgE) and radioallergosorbent (RAST) to Aspergillus
  • if joint problems or systemic symptoms consider rheumatoid factor/antinuclear antibodies (ANA)
  • sputum for acid-fast bacillus (AFB) testing
Initial Management Principles
  • identify and treat underlying causes to prevent progression of disease
  • maintain or improve lung function
  • improve quality of life by reducing daily symptoms and exacerbations

Please find below leaflets that your patient may find useful:

1. Bronchiectasis- Causes, Symptoms & Treatment

2. Living with Bronchiectasis

Airway Clearance

Patients that are having difficulty with sputum clearance or are experiencing a high sputum burden should see a physiotherapist for advice about airway clearance to develop a patient-centred regimen.


Physiotherapists may request the prescription of certain therapies to improve the efficiency and effort involved in airway clearance. Please consult a respiratory physiotherapist prior to prescribing any of these therapies as it is vital that their use can be applied to an airway clearance regimen and not just taken in isolation. Independent non-medical prescribing physiotherapists will prescribe the adjunct themselves, however there may be times where you are asked to support treatment with a prescription following the advice of the physiotherapist.

For example:

  • nebulised normal saline
  • nebulised hypertonic saline
  • nebulised bronchodilators
  • mucolytics/inhaled mannitol
  • adjuncts (e.g. Acapella)



Pulmonary Rehabilitation

As per the British Thoracic Society (BTS) and NICE guidelines, pulmonary rehabilitation should be offered to individuals who have breathlessness affecting their activities of daily living.

Pulmonary rehabilitation is provided in sites throughout the county by physiotherapists and nurses. It is a course that offers respiratory patients group session that include activity and education about their respiratory disease and includes self-management support. It is an intensive course of two sessions lasting for two hours over seven weeks and is highly recommended upon hospital discharge.

  • for patients with moderate/severe chronic obstructive pulmonary diease (COPD)/bronchiectasis and asthma -Medical Research Council (MRC) breathlessness scale 3 or more
  • motivated to attend pulmonary rehabilitation
  • on optimal therapy
  • medically fit to exercise
  • able to travel to and participate in group 

Please send referrals to: pulmonary.rehabilitation@glos-care.nhs.uk

The Gloucestershire Respiratory Team's generic referral form can be found here.

When filling in the form please stipulate pulmonary rehabilitation as the reason for referral.

Referral to Secondary Care

All patients with a high-resolution computed tomography (HRCT) confirmed diagnosis of bronchiectasis/recent HRCT, that meet the below criteria should be referred to secondary care:

  • patients with chronic Pseudomanas or Staphyloccus in sputum
  • deteriorating patients with declining lung function
  • recurrent exacerbations for more than 3 years
  • patients requiring  prophylactic antibiotics (oral or nebulised)
  • patients with allergic bronchopulmonary aspergillosis (ABPA), rheumatoid associated bronchiectasis, immuodeficiency, inflammatory bowel disease and primary ciliary dyskinesia
  • patients with severe advanced disease and those considering lung transplantation

Patient Resources

Please see the Patient & Carer Information section

Resources for Professionals

National Standards

Please see the National and NICE Guidance section

There are no siginificant variations from the national standards in this pathway

Other online Resources


Please see the GP education section

Pathway Leads

Name Role Organisation Email
Leah Carey Service Redesign & Improvement Manager Gloucestershire Clinical Commissioning Group l.carey1@nhs.net
Andrew White Consultant GHNHSFT Andrew.White@glos.nhs.uk

Reason for Pathway Selection

This pathway has been published in order to aid GPs and Practice Nurses in delivering care for patients with bronchiectasis. This includes developing a more consistent county wide approach, improving the quality of primary care diagnosis and management as well as accessing secondary care at the right time.

Completion Date

August 2017

Review Date

July 2018