Bronchiectasis (Non cystic fibrosis)

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The hallmark of treatment are:

• Prompt treatment of infective exacerbations with broad spectrum antibiotics. Exacerbations are characterized by an increase in volume of sputum, change in sputum colour from white to yellowish or green plus a fever.
• Referral to physiotherapist for postural drainage and physiotherapy.
• Always send sputum to the laboratory for microscopy, culture and sensitivity together with ZN stain.
• To prevent exacerbations, patients should get an annual flu vaccine and a five yearly pneumococcal vaccine.
• Frank haemoptysis warrants referral to a Specialist.

Acute Exacerbations of Bronchiectasis

• Infectious aetiology includes pneumonia, H. influenza, P. aeruginosa, Moraxe/la, Mycobacteria and sometimes fungi.
• Antibiotics should be chosen to empirically cover pathogens. Adjust treatment when microbiology results are available.
• Inhaled bronchodilators
• Good hydration
• Chest physiotherapy and postural drainage
• Persistent haemoptysis requires cardiothoracic surgeon's attention.

Long Term care for Bronchiectasis

• Improve lung function if patient has proven airway obstruction

	Medicine	Adult Dose	Frequency	Duration
	salbutamol inhaler	200mcg	PRN
+/-	beclomethasone inhaler	200mcg	PRN

• Sputum clearance: nebulise with 0.9% Saline together with chest physiotherapy
• Pulmonary rehabilitation: inspiratory muscle training, improve exercise tolerance and endurance