Monitoring

Chest x-ray is not recommended for the diagnosis of bronchiectasis as chest x-ray findings are non-specific in bronchiectasis and may even be normal. However, a baseline chest x-ray may provide a useful comparator if there is subsequent clinical deterioration in adult patients.[46] A repeat computed tomography (CT) scan can be considered in adult patients with a primary immunodeficiency, with a scan interval of 3 to 5 years.[46] A repeat CT scan can also be considered in a deteriorating adult patient with bronchiectasis.[46][61]​

Guidelines from the British Thoracic Society (BTS) recommend that adults with bronchiectasis should be monitored every 12 months if their disease is of mild severity, or every 6 months if their disease is moderate to severe.[46] Adult patients with milder disease may be monitored outside the specialist setting, e.g., in primary care. The BTS recommends that adult patients with any of the following should be monitored in the hospital or specialist setting:[46]

  • Chronic Pseudomonas aeruginosa, non-tuberculous mycobacteria, or methicillin-resistant Staphylococcus aureus (MRSA) colonisation

  • Deteriorating bronchiectasis with declining lung function

  • Recurrent exacerbations (≥3 per year)

  • Requirement for long term antibiotic treatment (oral, inhaled, or nebulised)

  • Bronchiectasis with associated rheumatoid arthritis, immune deficiency, inflammatory bowel disease and/or primary ciliary dyskinesia

  • Allergic bronchopulmonary aspergillosis

  • Advanced disease

  • Possible need for transplantation.

Surveillance sputum cultures are recommended on a regular basis (e.g., every 6 to 12 months, depending on disease severity) to monitor for changes in antibiotic sensitivities of organisms present in sputum. Spirometry should be measured with most surgery visits and a reduction in the forced expiratory volume in the first second of expiration (FEV₁) or FEV₁/forced vital capacity (FVC) ratio is regarded as an indicator of disease progression or exacerbation. Body mass index and oxygen saturations should be recorded during every visit. It is also useful to know the patient’s exacerbation history and degree of breathlessness (e.g., on the Medical Research Council [MRC] dyspnoea scale).[46] If a patient is deteriorating, then a repeat of initial investigations can be considered (e.g., investigations into the underlying cause).[46]

Guidelines from the European Respiratory Society (ERS) recommend that children/adolescents with bronchiectasis should be reviewed every 3 to 6 months in outpatient clinics. This is in order to monitor patients’ general wellbeing and respiratory status, including spirometry (if the child is old enough) and pulse oximetry, and to identify any complications. The ERS also recommends that sputum samples are taken, if possible, every 6 to 12 months to detect any new pathogens (e.g., Pseudomonas aeruginosa) and to inform empirical antibiotic treatment that may be needed in the future.[10] 

For children/adolescents with bronchiectasis who are gradually deteriorating, the ERS guidelines recommend that, in addition to testing for new infections, they should also be assessed for comorbidities such as GORD, nutritional deficiencies, asthma, or dental or sleep problems.[10] Such children/adolescents may need hospitalisation for intravenous antibiotics and airway clearance.[10] The ERS also recommends that repeat CT scans should only be carried out in children/adolescents with bronchiectasis if the result will change management.[10]  

Use of this content is subject to our disclaimer