GPAtlas🧭 When to suspect
Suspect bronchiectasis in any adult with a persistent productive cough lasting more than 8 weeks, particularly when there is daily expectoration of mucopurulent or purulent sputum. The story is typically one of recurrent lower respiratory tract infections, intermittent haemoptysis, and persistent coarse crackles that fail to clear with treatment. Bronchiectasis is permanent, abnormal dilatation of the bronchi, which pool secretions and become a focus for the self-perpetuating cycle of infection → inflammation → further airway damage.
Raise your index of suspicion in two groups in particular:
• The younger, never-smoking patient whose respiratory symptoms began early and do not fit a smoking history.
• Patients with a recognised predisposing condition – previous severe respiratory infection (childhood pneumonia, whooping cough, measles or tuberculosis, TB), rheumatoid arthritis (RA), inflammatory bowel disease (IBD), chronic obstructive pulmonary disease (COPD) with frequent exacerbations, immunodeficiency, or allergic bronchopulmonary aspergillosis (ABPA).
The primary-care task is twofold: recognise the pattern and refer for high-resolution computed tomography (HRCT) to confirm the diagnosis, and treat exacerbations promptly while keeping daily airway clearance at the centre of long-term care.
Source: BTS Guideline for bronchiectasis in adults (2019)
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