Private bronchiectasis clinic in London, same-day respiratory.

Recognising it

• a daily productive cough, often for years, with large amounts of sputum
• sputum that is thick, and green, yellow or brown much of the time
• recurrent chest infections — three or more a year needing antibiotics
• breathlessness, wheeze, fatigue and sometimes chest pain
• occasional blood-streaked sputum
• in some, finger clubbing and weight loss
• It is diagnosed on CT of the chest — a normal chest X-ray does not exclude it, which is why it is missed

Why it happens

• Previous severe infection — childhood pneumonia, whooping cough, measles or tuberculosis. A common cause in people who grew up outside the UK.
• Immune deficiency, which is treatable and should always be tested for.
• Allergic bronchopulmonary aspergillosis, particularly with asthma.
• Cystic fibrosis and primary ciliary dyskinesia.
• Inflammatory conditions — rheumatoid arthritis and inflammatory bowel disease.
• Reflux and aspiration, and airway obstruction.
• In around 40% no cause is found — but the search is worthwhile, because several causes change treatment.

Managing it

• Daily airway clearance, done consistently, including when well.
• Exercise, which is itself an effective clearance technique. Pulmonary rehabilitation is recommended.
• Nebulised saline before clearance to loosen secretions, in some people.
• Long-term azithromycin three times a week reduces exacerbations substantially in people having frequent ones — requires checking hearing, liver function and ECG, and excluding non-tuberculous mycobacteria first.
• Vaccination — flu annually, plus COVID and pneumococcal.
• Treat the cause where one is found, and treat reflux if present.

Recognising an exacerbation

• increased sputum volume, or a change in colour or thickness
• increased breathlessness, wheeze or cough
• fatigue, fever, or new chest pain
• Have an agreed rescue antibiotic pack and a written plan, and tell us when you use it so it can be replaced and the pattern tracked.