Referral criteria from primary care - bronchiectasis

Patients with suspected bronchiectasis should be seen by a respiratory physician for diagnosis, investigation to seek a cause, and to plan management.

Hospital admission should be arranged for the following patients:

• children
  • breathless patients who has increased respiratory rate and laboured breathing
  • with evidence of circulatory and respiratory failure
  • cyanosed patients
  • temperature of 38°C or more
  • who are unable to take oral therapy
  • who requires intravenous therapy due to failure of oral therapy
• adults
  • unable to manage at home
  • presence of cyanosis or confusion
  • respiratory rate of more than 25 breaths per min
  • with evidence of circulatory and respiratory failure
  • temperature of 38°C or more
  • who requires intravenous therapy due to failure of oral therapy.

Note that, for many patients, management can be in the community, with specialist involvement limited to those with frequent exacerbations (e.g. more than two or three per year), or progressive or chronic symptoms (e.g. chronic haemoptysis) between exacerbations - in such cases, lifelong secondary care monitoring and follow-up may be required.

Reference:

1. Hill AT, Sullivan AL, Chalmers JD, et al British Thoracic Society guideline for bronchiectasis in adults. BMJ Open Respiratory Research 2018;5:e000348. doi: 10.1136/bmjresp-2018-000348
2. Pasteur MC et al. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010;65 Suppl 1:i1-58