Health Insights · Respiratory
Bronchiectasis: a persistent productive cough
Bronchiectasis is permanent widening and scarring of the airways, so mucus pools and becomes infected. It causes a daily productive cough and repeated chest infections, and it is frequently mislabelled as COPD or asthma for years. The single most effective treatment is not a drug — it is daily airway clearance.
Call 999 or seek urgent care if you have
- coughing up a large amount of blood, or blood repeatedly
- severe breathlessness at rest, or blue lips
- chest pain with breathlessness
- confusion or drowsiness with a chest infection
- high fever with rigors and feeling very unwell
- a sudden increase in breathlessness with one-sided chest pain
Coughing blood in bronchiectasis is not uncommon in small amounts, but large or repeated volumes are an emergency requiring hospital assessment. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
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.
Airway clearance is the treatment
Mucus sitting in damaged airways breeds infection, which causes more damage, which traps more mucus. Breaking that cycle with daily airway clearance does more than any antibiotic. A respiratory physiotherapist will teach you a technique — the active cycle of breathing, autogenic drainage, or a device such as an Acapella or flutter valve — and it takes 10 to 30 minutes once or twice a day, every day, for life. Most people with bronchiectasis have never been shown how, and it is the most valuable referral in the condition.
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.
Send a sputum sample before starting antibiotics
Bronchiectasis airways are often colonised with specific organisms — Haemophilus, Pseudomonas, Staphylococcus — and the right antibiotic depends on which. A sputum sample sent before each course guides treatment and builds a picture over time. Courses are also longer than usual, typically 14 days rather than 5 to 7. If you are given a short course of amoxicillin without a sputum sample, that is worth questioning.
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.
Why come to us. Bronchiectasis is frequently managed as recurrent bronchitis, with short antibiotic courses and no clearance training. We take a proper history, send sputum for culture, and test immunoglobulins, IgE and aspergillus in-house to look for a treatable cause. We arrange CT chest through our CQC-registered partners — the test that actually makes the diagnosis — give vaccinations here, and refer for respiratory physiotherapy so you are actually taught to clear your chest.
Private assessment for bronchiectasis in London
Bronchiectasis causes a long-term cough with phlegm and repeated chest infections, and the right diagnosis and management reduce flare-ups. A private GP in East London can assess you, arrange blood and sputum tests and a CT scan of the chest, and coordinate ongoing care and prompt treatment of infections. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.
Bronchiectasis in London: common questions
How is bronchiectasis diagnosed?
A CT scan of the chest is the key test, along with lung function and sputum tests, which we can arrange.
How is it managed?
With airway-clearance techniques, prompt treatment of chest infections, and sometimes preventive measures; physiotherapy can help.
When should a flare-up be treated?
A change in phlegm colour or volume, or feeling more unwell, usually needs prompt antibiotic treatment.
Can I be seen the same day?
Yes — same-day private GP appointments are available most days.
The right test, and someone to teach you clearance
Sputum and immune bloods in-house, CT arranged fast.