The gold standard investigation for bronchiectasis is a High Resolution CT scan (HRCT). As the great majority of patients referred to the respiratory physicians querying the diagnosis of bronchiectasis have an HRCT scan, the radiology department have agreed GPs can refer straight to test if they are confident that Bronchiectasis is the likely differential diagnosis and are >25 years.Therefore, ifthe patient meets 2 or more of the features below, please order an HRCT at the same time as referral to Chest physicians.
Newly diagnosed bronchiectasis on HRCT scanning should be referred to the Respiratory Physicians for assessment. This guideline is not intended to make new bronchiectasis a condition for primary care management. It is intended to speed up the diagnosis for those who it is appropriate for.
When to consider referral for HRCT1
Bronchiectasis should be considered in all adults who have persistently productive cough. At a very minimum this is 6 weeks. However two or more of the following would have to also apply:
· young age at presentation;
· absence of smoking history;
· daily expectoration of large volumes of very purulent sputum;
· sputum colonisation with Pseudomonas aeruginosa.
· unexplained haemoptysis or non-productive cough.
In the absence of 2 or more of these features, then please consider referral to a respiratory clinic without HRCT.
Note that patients <25 years should be referred without HRCT due to risk of irradiation.
Patients thought to have chronic obstructive pulmonary disease may have bronchiectasis alone or in addition and referral for HRCT is appropriate if:
· management is not straightforward;
· there is slow recovery from lower respiratory tract infections; recurrent exacerbations;
· there is no history of smoking
Primary care management prior to referral
· Consideration and trial of treatment of alternative explanation to the productive cough, such as Chronic Rhinosinusitis, postnasal drip etc.
· CXR (within the past 6 months)
· Spirometry (within the past 6 months)
· If the primary concern is to include or exclude a diagnosis of bronchiectasis, with bronchiectasis a likely differential diagnosis, then refer for an HRCT scan via a Xray request form at the same time as a referral to general respiratory clinic.
· If there is uncertainty if bronchiectasis is part of the differential, then please consider referral to a general respiratory clinic.
· Newly diagnosed bronchiectasis on HRCT scanning should be referred to the Respiratory Physicians for assessment
· Any patient's fitting criteria for a 2WW pathway should be referred via the 2WW pathway.
1. Guideline for non-CF Bronchiectasis; British Thoracic Society (July 2010)