{"id":3752,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/bronchiectasis\/"},"modified":"2024-10-23T09:54:32","modified_gmt":"2024-10-23T08:54:32","slug":"bronchiectasis","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/bronchiectasis\/","title":{"rendered":"Bronchiectasis"},"content":{"rendered":"\n<p><strong>Bronchiectasis<\/strong> is defined as having inflamed, permanently and irreversibly damaged and dilated airways leading to symptoms of chronic cough, chronic sputum production and recurrent respiratory tract infections.<\/p>\n\n\n\n<p>The disease is life-long, and the prognosis depends on the severity of the bronchiectasis.&nbsp; In severe cases, life expectancy will be reduced. <\/p>\n\n\n\n<p>Patients chronically colonised with <em>Pseudomonas aeruginosa<\/em> tend to have poorer health related quality of life, more exacerbations and increased mortality.<\/p>\n\n\n\n<p><strong>Refer all patients suspected of having bronchiectasis.&nbsp; <\/strong><em>Please let the patient know that they are likely to receive an appointment for a CT scan of their chest (looking for radiological signs of bronchiectasis) in advance of their clinic appointment. <\/em><\/p>\n\n\n\n<p>Royal Infirmary of Edinburgh&nbsp;(Lead Centre)&nbsp;&#8211; Dr&nbsp;Anna Lithgow<\/p>\n\n\n\n<p>St John&#8217;s Hospital&nbsp;\u2013 General Respiratory Physician<\/p>\n\n\n\n<p>Western General Hospital &#8211;&nbsp;General Respiratory Physician<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Definition of Severity<\/h4>\n\n\n\n<p>The <strong>Bronchiectasis Severity Index (BSI)<\/strong> may also be used to define severity of bronchiectasis. The table below documents the variables within the BSI index and its scoring system. A total score 0 \u2013 4 indicates mild disease, 5 \u2013 8 moderate disease and \u2265 9 severe disease. The BSI can be used as an adjunct when assessing a patient and deciding on their management.<\/p>\n\n\n\n<p><strong>Variables involved in calculating the severity score in the Bronchiectasis severity index<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table border=\"1\"><tbody><tr><td><strong>Factor and points for scoring system<\/strong><\/td><td>\u200b<\/td><td>\u200b<\/td><td>\u200b<\/td><td>\u200b<\/td><\/tr><tr><td><strong>Age (years)<\/strong><strong>&nbsp;<\/strong><\/td><td>&lt;50 (0 points)<\/td><td>50-69 (2 points)<\/td><td>70-79 (4 points)<\/td><td>&gt;80 (6 points)<\/td><\/tr><tr><td><strong>BMI (Kg\/m<\/strong><strong><sup>2<\/sup><\/strong><strong>)<\/strong><strong>&nbsp;<\/strong><\/td><td>&lt;18.5 (2 points)<\/td><td>18.5-25 (0 points)<\/td><td>26-30 (0 points)<\/td><td>&gt;30 (0 points)<\/td><\/tr><tr><td><strong>FEV<\/strong><strong><sub>1<\/sub><\/strong><strong>% predicted<\/strong><strong>&nbsp;<\/strong><\/td><td>&gt;80 (0 points)<\/td><td>50-80 (1 point)<\/td><td>30-49 (2 points)<\/td><td>&lt;30 (3 points)<\/td><\/tr><tr><td><strong>Hospital admission within last 2 years<\/strong><\/td><td>No (0 points)<\/td><td>&nbsp;<\/td><td>Yes (5 points)<\/td><td>&nbsp;<\/td><\/tr><tr><td><strong>Number of exacerbations in previous 12 months<\/strong><\/td><td>0 (0 points)<\/td><td>1 \u2013 2 (0 points)<\/td><td>\u22653 (2 points)<\/td><td>&nbsp;<\/td><\/tr><tr><td><strong>Modified MRC breathlessness score<\/strong><\/td><td>0-2 (0 points)<\/td><td>3 (2 points)<\/td><td>4 (3 points)<\/td><td>&nbsp;<\/td><\/tr><tr><td><strong><em>P. Aeruginosa<\/em><\/strong><strong>&nbsp;colonisations<\/strong><\/td><td>No (0 points)<\/td><td>&nbsp;<\/td><td>Yes (3 points)<\/td><td>&nbsp;<\/td><\/tr><tr><td><strong>Colonisation with other organisms<\/strong><\/td><td>No (0 points)<\/td><td>&nbsp;<\/td><td>Yes (1 point)<\/td><td>&nbsp;<\/td><\/tr><tr><td><strong>Radiological severity<\/strong><\/td><td>&lt;3 lobes affected(0 points)<\/td><td colspan=\"3\">\u22653 lobes of cystic bronchiectasis in any lobe (1 point) \u200b\u200b<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong><sup>0-4 point s =mild disease; 5\u20138 = moderate disease; 9 and over = severe disease<\/sup><\/strong><sup>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/sup><sup>The BTS Guideline for Bronchiectasis in Adults, BTS (2019)<\/sup><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p><strong>Suspected bronchiectasis \u2013 new referral<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with persistent cough productive of mucopurulent or purulent sputum.<\/li>\n\n\n\n<li>\u2265 2 chest infections in the past year with evidence of&nbsp;<em>positive sputum bacterial cultures<\/em><\/li>\n\n\n\n<li>Patients with COPD who have had their treatment optimised but still have a chronic productive cough with positive sputum bacterial cultures whilst stable, or have had 2 or more exacerbations with&nbsp;<em>positive sputum bacterial cultures<\/em>&nbsp;in the preceding 12 months.<\/li>\n<\/ul>\n\n\n\n<p><em>Please let the patients know that they are likely to receive an appointment for a CT scan of their chest (looking for radiological signs of bronchiectasis) in advance of their clinic appointment.<\/em><\/p>\n\n\n\n<p>For mild cases, care will be in the community. For severe cases, care will be with regular hospital review.<strong><\/strong><\/p>\n\n\n\n<p><strong>For new cough (no known pathology) greater &gt; 3 weeks think Detect Cancer Early (DCE) pathway<\/strong><\/p>\n\n\n\n<p><strong>Known bronchiectasis \u2013 indications for re-referral<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with chronic Pseudomonas aeruginosa, non-tuberculous mycobacteria (NTM) or methicillin-resistant Staphylococcus aureus colonisation (MRSA)<\/li>\n\n\n\n<li>Deteriorating bronchiectasis with declining lung function<\/li>\n\n\n\n<li>Recurrent exacerbations (\u22653 per year)<\/li>\n\n\n\n<li>Haemoptysis: new or unusual. Large volumes (&gt;10 mls over 24 hours) will need emergency admission.<\/li>\n\n\n\n<li>Patients receiving long term antibiotic therapy (oral, inhaled or nebulised)<\/li>\n\n\n\n<li>Patients with bronchiectasis and associated rheumatoid arthritis, immune deficiency, inflammatory bowel disease, primary ciliary dyskinesia and allergic bronchopulmonary aspergillosis (ABPA)<\/li>\n\n\n\n<li>Patients with advanced disease and those considering transplantation.<\/li>\n<\/ul>\n\n\n\n<p><strong>Indications for IV antibiotics and hospital admissions<\/strong><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter\"><img decoding=\"async\" src=\"\/files\/sites\/2\/Bronchiectasis-Page.png\" alt=\"Bronchiectasis page\" \/><figcaption class=\"wp-element-caption\">flowchart copyright NHS Lothian<\/figcaption><\/figure>\n<\/div>\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with occasional LRTI and an already established respiratory disease<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer via SCI-Gateway (Respiratory)<\/li>\n\n\n\n<li>Recommended investigations:<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>sputum culture (commonly&nbsp;<em>Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pneumoniae<\/em>&nbsp;and&nbsp;<em>Pseudomonas aeruginosa<\/em>)<\/li>\n\n\n\n<li>CXR (a normal CXR does not exclude bronchiectasis)<\/li>\n<\/ul>\n\n\n\n<p><em>If a CXR shows radiological signs of lung cancer, then refer URGENTLY via lung cancer pathway<\/em>.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Structured Secondary Care Letters<\/h4>\n\n\n\n<p>Secondary care clinic letters, from the RIE outpatient settings are structured. The first section contains the most relevant information for primary care. The second section includes further background information.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Diagnosis<\/li>\n\n\n\n<li>Recommended antibiotic for exacerbation<\/li>\n\n\n\n<li>Radiology &#8211; CT scan result<\/li>\n\n\n\n<li>Plan, Investigations and Follow-up<\/li>\n\n\n\n<li>For GP: please consider KIS e.g.&nbsp;<em>recommended antibiotics for exacerbations, current O2 sats, last FEV<\/em><em><sub>1,&nbsp;<\/sub><\/em><em>whether on long-term antibiotics, usual level of breathlessness if present<\/em><\/li>\n\n\n\n<li>Long Term Antibiotics<\/li>\n\n\n\n<li>Date of last IV antibiotics\/hospital admission<\/li>\n\n\n\n<li>Number of antibiotic courses since last assessment<\/li>\n\n\n\n<li>Weight\/BMI<\/li>\n\n\n\n<li>Spirometry and O2 saturations<\/li>\n\n\n\n<li>Sputum production and sputum colour<\/li>\n\n\n\n<li>Whether chronically colonised<\/li>\n\n\n\n<li>Microbiology since last seen<\/li>\n\n\n\n<li>Current Medication<\/li>\n\n\n\n<li>Bronchiectasis status \u2013 stable or exacerbation<\/li>\n<\/ul>\n\n\n\n<p><em>Further background information<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Date of bronchiectasis diagnosis<\/li>\n\n\n\n<li>Smoking history<\/li>\n\n\n\n<li>Presence of rhinitis\/GORD<\/li>\n\n\n\n<li>Usual and previous sputum pathogens<\/li>\n\n\n\n<li>Whether performing regular chest physiotherapy<\/li>\n\n\n\n<li>Annual flu vaccination and pneumococcal vaccination status<\/li>\n\n\n\n<li>Last CT chest scan and CXR results<\/li>\n\n\n\n<li>Results of previous relevant investigations e.g. immunology, aspergillus, echo<\/li>\n<\/ul>\n\n\n\n<p>Resources<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hill&nbsp;AT, Sullivan&nbsp;AL, Chalmers&nbsp;JD, et&nbsp;al.&nbsp;<a href=\"https:\/\/www.brit-thoracic.org.uk\/quality-improvement\/guidelines\/bronchiectasis-in-adults\/\" data-type=\"URL\" data-id=\"https:\/\/www.brit-thoracic.org.uk\/quality-improvement\/guidelines\/bronchiectasis-in-adults\/\" target=\"_blank\" rel=\"noreferrer noopener\"><em>BTS Guidelines for Bronchiectasis in Adults<\/em><\/a><em>.&nbsp;<\/em>Thorax 2019; 74 (Suppl 1):1\u201369<\/li>\n\n\n\n<li>Gruffydd-Jones, K., Keeley, D., Knowles, V.&nbsp;<em>et al.<\/em>&nbsp;<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6597720\/pdf\/41533_2019_Article_136.pdf\" data-type=\"URL\" data-id=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6597720\/pdf\/41533_2019_Article_136.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Primary care implications of the British Thoracic Society Guidelines for bronchiectasis in adults 2019.&nbsp;npj Prim. Care Respir. Med.<\/em>&nbsp;<strong>29,&nbsp;<\/strong>24 (2019)<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Cornerstone of Bronchiectasis Management in Primary Care<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Self-management advice<\/strong>&nbsp;for patients is available on the NHS Lothian Patient Bronchiectasis website:&nbsp;<a rel=\"noreferrer noopener\" href=\"http:\/\/www.bronchiectasis.scot.nhs.uk\/\" target=\"_blank\">www.bronchiectasis.scot.nhs.uk<\/a>. Patient should also have a&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/respiratory\/wp-content\/uploads\/sites\/30\/2022\/03\/BronchiectasisSelfManagementPlan.pdf\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/respiratory\/wp-content\/uploads\/sites\/30\/2022\/03\/BronchiectasisSelfManagementPlan.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong><em>personalised bronchiectasis self-management plan<\/em><\/strong>&nbsp;booklet.<\/a><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Consider a<\/strong>&nbsp;<strong>KIS<\/strong>&nbsp;which can include the following information: recommended antibiotics for exacerbations, current O2 sats, last FEV<sub>1<\/sub>, whether on long-term antibiotics and usual level of breathlessness if present.<\/li>\n\n\n\n<li><strong>E<\/strong><strong>ncourage chest physiotherapy<\/strong>&nbsp;(chest clearance) once or twice per day and increase during bronchiectasis exacerbations. Direct patients to&nbsp;<a href=\"http:\/\/www.bronchiectasis.scot.nhs.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.bronchiectasis.scot.nhs.uk<\/a>&nbsp;for a reminder on chest clearance techniques.<\/li>\n\n\n\n<li>Recommend&nbsp;<strong>annual flu vaccinations.<\/strong><\/li>\n\n\n\n<li>For<strong>&nbsp;bronchiectasis exacerbations\/chest infections<\/strong>&nbsp;send a sputum sample for routine bacterial culture and start prompt antibiotics (don&#8217;t wait until the sputum cultures are available). This should be for 14 days (7 days may suffice in mild bronchiectasis).<\/li>\n\n\n\n<li><strong>Antibiotics<\/strong>&nbsp;for exacerbations of bronchiectasis should (if possible) be based on previous sputum pathogen\/s and sensitivities. If there are no previous sputum pathogen\/s or sensitivities, below are the recommended &nbsp;antibiotics and doses for common sputum organisms found in bronchiectasis.<\/li>\n<\/ul>\n\n\n\n<p><strong>Recommended antibiotics and doses for common sputum pathogens found in bronchiectasis.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>Sputum Pathogen<\/td><td>Antibiotics (14 days)<\/td><\/tr><tr><td><strong><em>Haemophilus Influenzae&nbsp;<\/em><\/strong><strong><em>\u03b2<\/em><\/strong><strong><em>-lactamase negative<\/em><\/strong><\/td><td>Amoxicillin 500mg TDS&nbsp;<strong>or<\/strong>&nbsp;clarithromycin 500mg BD<\/td><\/tr><tr><td><strong><em>Haemophilus Influenzae&nbsp;<\/em><\/strong><strong><em>\u03b2<\/em><\/strong><strong><em>-lactamase positive<\/em><\/strong><\/td><td>Co-amoxiclav 625mg TDS&nbsp;<strong>or<\/strong>&nbsp;doxycycline 100mg BD<\/td><\/tr><tr><td><strong><em>Moraxella catarrhalis<\/em><\/strong><\/td><td>Co-amoxiclav 625mg&nbsp;<strong>or<\/strong>&nbsp;doxycycline 100mg BD<\/td><\/tr><tr><td><strong><em>Streptococcus pneumonia<\/em><\/strong><\/td><td>Amoxicillin 500mg TDS&nbsp;<strong>or<\/strong>&nbsp;clarithromycin 500mg BD<\/td><\/tr><tr><td><strong><em>Staphylococcus aureus<\/em><\/strong><\/td><td>Flucloxacillin 500mg QDS&nbsp;<strong>or<\/strong>&nbsp;clarithromycin 500mg BD<\/td><\/tr><tr><td><strong><em>Pseudomonas aeruginosa<\/em><\/strong><\/td><td>Ciprofloxacin 500mg BD<\/td><\/tr><tr><td><strong><em>Methicillin-resistant Staphylococcus aureus (MRSA)<\/em><\/strong><\/td><td>Doxycycline 100mg BDIf there is no response or the patient is unwell then refer to secondary care for IV antibiotics<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>Please see&nbsp;separate flowcharts for management advice&nbsp;on the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Guideline-for-Managing-Individual-Chest-Infections-in-Non-CF-Bronchiectasis-April-2020.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Guideline-for-Managing-Individual-Chest-Infections-in-Non-CF-Bronchiectasis-April-2020.pdf\" target=\"_blank\">Guidelines for Managing Individual Chest Infections<\/a><\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Guideline-for-Managing-Recurrent-Chest-Infections-in-Non-CF-Bronchiectasis-April-2020.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Guideline-for-Managing-Recurrent-Chest-Infections-in-Non-CF-Bronchiectasis-April-2020.pdf\" target=\"_blank\">Guidelines for Managing Recurrent Chest Infections<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Managing-Mild-to-Moderate-Non-CF-Bronchiectasis-Respiratory-Symptoms-April-2020.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Managing-Mild-to-Moderate-Non-CF-Bronchiectasis-Respiratory-Symptoms-April-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Managing Mild to Moderate Non-CF Bronchiectasis<\/a><\/li>\n<\/ul>\n\n\n\n<p>For further questions please see <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Frequently-Asked-Questions-in-Non-CF-Bronchiectasis-April-2020.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Frequently-Asked-Questions-in-Non-CF-Bronchiectasis-April-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Frequently Asked Questions<\/a> in Bronchiectasis<\/p>\n\n\n\n<p>All above guidelines are recommendations of best practice based on the latest National Guidelines for Bronchiectasis 2019.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/respiratory\/Documents\/Guideline%20for%20diagnosis%20and%20treatment%20of%20adult%20%20bronchiectasis%20Version%202.0%202019.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Guideline for diagnosis and treatment of adult bronchiectasis<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.bronchiectasis.scot.nhs.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">Lothian Bronchiectasis Website<\/a>&nbsp;(<a href=\"http:\/\/www.bronchiectasis.scot.nhs.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.bronchiectasis.scot.nhs.uk<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6597720\/pdf\/41533_2019_Article_136.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Primary care implications of the British Thoracic Society Guidelines for Bronchiectasis in Adult 2019<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/services.nhslothian.scot\/respiratory\/wp-content\/uploads\/sites\/30\/2022\/03\/BronchiectasisSelfManagementPlan.pdf\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/respiratory\/wp-content\/uploads\/sites\/30\/2022\/03\/BronchiectasisSelfManagementPlan.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Bronchiectasis Self-Management Plan<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/services.nhslothian.scot\/respiratory\/wp-content\/uploads\/sites\/30\/2022\/03\/BronchiectasisCard.pdf\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/respiratory\/wp-content\/uploads\/sites\/30\/2022\/03\/BronchiectasisCard.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Bronchiectasis Antibiotic\/Infection Card<\/a>&nbsp;(these are available from Kim Turnbull, Bronchiectasis Nurse Specialist, RIE)<\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Lothian-COPD-Guidance-April-2018-v0-4-Combined-2-1.pdf\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Lothian-COPD-Guidance-April-2018-v0-4-Combined-2-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Lothian COPD Guidance April 2018 v0 4 Combined<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.nice.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">National Institute for Health and Care Excellence (NICE)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.sign.ac.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Intercollegiate Guidelines Network (SIGN)<\/a><\/li>\n\n\n\n<li><a rel=\"noreferrer noopener\" href=\"https:\/\/respiratoryacademy.co.uk\/resources\/bts-guideline-for-bronchiectasis-in-adults-clin\/\" target=\"_blank\">BTS Guidelines for Bronchiectasis in Adults<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Frequently-Asked-Questions-in-Non-CF-Bronchiectasis-April-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Respiratory-Frequently Asked Questions in Non-CF Bronchiectasis-April 2020<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Guideline-for-Managing-Individual-Chest-Infections-in-Non-CF-Bronchiectasis-April-2020.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Guideline-for-Managing-Individual-Chest-Infections-in-Non-CF-Bronchiectasis-April-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Respiratory-Guideline for Managing Individual Chest Infections in Non-CF Bronchiectasis- April 2020<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Guideline-for-Managing-Recurrent-Chest-Infections-in-Non-CF-Bronchiectasis-April-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Respiratory-Guideline for Managing Recurrent Chest Infections in Non-CF Bronchiectasis-April 2020<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Managing-Mild-to-Moderate-Non-CF-Bronchiectasis-Respiratory-Symptoms-April-2020.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-Managing-Mild-to-Moderate-Non-CF-Bronchiectasis-Respiratory-Symptoms-April-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Respiratory-Managing Mild to Moderate Non-CF Bronchiectasis &#8211; Respiratory Symptoms- April 2020<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-BRONC-Guideline-for-diagnosis-and-treatment-of-adult-bronchiectasis-updated-23-09-2016.docx\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-BRONC-Guideline-for-diagnosis-and-treatment-of-adult-bronchiectasis-updated-23-09-2016.docx\" target=\"_blank\" rel=\"noreferrer noopener\">Respiratory BRONC &#8211; Guideline for diagnosis and treatment of adult bronchiectasis (updated 23-09-2016)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-BRONC-Bronchiectasis.Scot-www.bronchiectasis.scot_.nhs_.uk_.html\" target=\"_blank\" rel=\"noreferrer noopener\">Respiratory BRONC Bronchiectasis.Scot (www.bronchiectasis.scot.nhs.uk)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Respiratory-BRONC-Guideline-for-Non-CF-Bronchiectasis-www.brit-thoracic.org_.uk_.html\" target=\"_blank\" rel=\"noreferrer noopener\">Respiratory BRONC Guideline for Non-CF Bronchiectasis (www.brit-thoracic.org.uk)<\/a><\/li>\n<\/ul>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Bronchiectasis is defined as having inflamed, permanently and irreversibly damaged and dilated airways leading to symptoms of chronic cough, chronic sputum production and recurrent respiratory tract infections. The disease is life-long, and the prognosis depends on the severity of the bronchiectasis.&nbsp; In severe cases, life expectancy will be reduced. Patients chronically colonised with Pseudomonas aeruginosa<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4381,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[591],"class_list":["post-3752","page","type-page","status-publish","hentry","category-bronchiectasis"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/respiratory\/bronchiectasis\/\" rel=\"tag\">Bronchiectasis<\/a>","rttpg_excerpt":"Bronchiectasis is defined as having inflamed, permanently and irreversibly damaged and dilated airways leading to symptoms of chronic cough, chronic sputum production and recurrent respiratory tract infections. The disease is life-long, and the prognosis depends on the severity of the bronchiectasis.&nbsp; In severe cases, life expectancy will be reduced. Patients chronically colonised with Pseudomonas aeruginosa","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3752","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3752"}],"version-history":[{"count":15,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3752\/revisions"}],"predecessor-version":[{"id":21279,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3752\/revisions\/21279"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4381"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3752"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3752"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}