When should I consider referring a patient with bronchiectasis to a specialist for further evaluation?

Consider referring a patient with bronchiectasis to a specialist for further evaluation if they:

• Have had three or more infective exacerbations in a year or fewer exacerbations causing significant morbidity, as they may be candidates for long-term prophylactic antibiotic treatment.
• Are chronically colonized with Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), or non-tuberculous mycobacteria.
• Show deteriorating bronchiectasis with declining lung function or have advanced disease.
• Have allergic pulmonary aspergillosis.
• Require or are being considered for long-term antibiotic therapy.
• Have associated conditions such as rheumatoid arthritis, immune deficiency, inflammatory bowel disease, allergic bronchopulmonary aspergillosis, or primary ciliary dyskinesia.
• Are under 40 years old or have clinical features suggestive of cystic fibrosis or other underlying causes requiring specialist investigation.
• Have a body mass index (BMI) less than 20, warranting specialist nutritional advice.
• Have not been taught airway clearance techniques and need referral to a physiotherapist.
• Require bronchoscopy for localized disease to rule out endobronchial lesions or foreign body aspiration.
• Are being considered for lung transplantation or have advanced disease requiring specialist management.

Additionally, all patients with suspected bronchiectasis should be referred to a respiratory consultant for investigations to confirm diagnosis, determine underlying cause, and initiate appropriate treatment.

Routine monitoring frequency should be tailored to disease severity, with more frequent assessments for severe cases in secondary care.

Smoking cessation advice and immunizations should be offered in primary care, but specialist referral is indicated for the above clinical scenarios.

References: NICE CKS