Primary care summary of the British Thoracic Society Guideline on the management of non-cystic fibrosis bronchiectasis

Department of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Scotland, UK.
Primary care respiratory journal: journal of the General Practice Airways Group (Impact Factor: 2.5). 02/2011; 20(2):135-40. DOI: 10.4104/pcrj.2011.00007
Source: PubMed


The British Thoracic Society (BTS) has recently published a guideline for the management of non-cystic fibrosis (non-CF) bronchiectasis in children and adults. This paper summarises the key recommendations applicable to the primary care setting. The key points are: • Think of the diagnosis of bronchiectasis in adults and children who present with a chronic productive cough or unexplained haemoptysis, and in children with asthma which responds poorly to treatment; • High resolution computed tomography (HRCT) scanning is needed to confirm the diagnosis • Sputum culture should be obtained at the start of an exacerbation prior to initiating treatment with antibiotics; Treatment should be started whilst awaiting the sputum result and should be continued for 14 days; • Patients with bronchiectasis have significant morbidity. Management in primary care is aimed at improving morbidity, and includes; patient education, treatment and monitoring, as well as appropriate referral to secondary care including assessment for long term antibiotics.

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    • "The identification of microorganisms in bronchial washing fluids may assist the treatment of future complications such as hemoptysis and pneumonia, but pathogens can be also isolated by analysis of sputum samples alone in 77-88% of patients with bronchiectasis.20,22 Antibioitcs are recommended when patients with bronchiectasis have purulant sputum.23 Meanwhile, when hemoptysi is the main presentation, the additional role of bronchial washing fluid to sputum exam could be low due to relatively small amount of bacterial load. "
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    • "Off-label treatments for non-CF bronchiectasis include systemic and nebulised antibacterials, oral and inhaled mucolytics, hyperosmolar agents, bronchodilators and sputum clearance techniques [7, 8]. However, these treatments do not adequately manage the number of exacerbations that patients may experience and, in some cases, their benefits have not been investigated fully. "
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