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20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg></div></a><div class="SecondaryNavigationDesktop_tertiary-inactive__uNEtz"><ul><li class="TertiaryNavigationDesktop_tertiary-content__JmUfL"><h6 class="TertiaryNavigationDesktop_tertiary-title__j9zHz">Featured conditions</h6><div class="TertiaryNavigationDesktop_tertiary-section__NpW9N"><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/childrens-health/attention-deficit-hyperactivity-disorder-adhd" data-testid="ter_managingconditions_tertiarymenu"><p>ADHD in children</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/chest-lungs/asthma-leaflet" data-testid="ter_managingconditions_tertiarymenu"><p>Asthma</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/skin-conditions/viral-rashes/chickenpox-in-children" data-testid="ter_managingconditions_tertiarymenu"><p>Chickenpox</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/chest-lungs/chronic-obstructive-pulmonary-disease-leaflet" data-testid="ter_managingconditions_tertiarymenu"><p>COPD</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/digestive-health/inflammatory-bowel-disease/crohns-disease" data-testid="ter_managingconditions_tertiarymenu"><p>Crohn's disease</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/diabetes/diabetes-mellitus-leaflet" data-testid="ter_managingconditions_tertiarymenu"><p>Diabetes</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/womens-health/pelvic-pain-in-women/endometriosis" data-testid="ter_managingconditions_tertiarymenu"><p>Endometriosis</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/signs-symptoms/tiredness-fatigue/fibromyalgia" data-testid="ter_managingconditions_tertiarymenu"><p>Fibromyalgia</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/digestive-health/diarrhoea/gastroenteritis" data-testid="ter_managingconditions_tertiarymenu"><p>Gastroenteritis</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/skin-conditions/hives-inducible-urticaria" data-testid="ter_managingconditions_tertiarymenu"><p>Hives</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/digestive-health/irritable-bowel-syndrome-leaflet" data-testid="ter_managingconditions_tertiarymenu"><p>Irritable bowel syndrome</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/womens-health/polycystic-ovary-syndrome-leaflet" data-testid="ter_managingconditions_tertiarymenu"><p>Polycystic ovary syndrome</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/skin-conditions/psoriasis-leaflet" data-testid="ter_managingconditions_tertiarymenu"><p>Psoriasis</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/skin-conditions/viral-rashes/scarlet-fever" data-testid="ter_managingconditions_tertiarymenu"><p>Scarlet fever</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/infections/strep-a-group-a-strep-gas" data-testid="ter_managingconditions_tertiarymenu"><p>Strep A</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/ears-nose-throat-mouth/sore-throat-2/tonsillitis" data-testid="ter_managingconditions_tertiarymenu"><p>Tonsillitis</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/sexual-health/vaginal-discharge-female-discharge/vaginal-thrush-yeast-infection" data-testid="ter_managingconditions_tertiarymenu"><p>Vaginal thrush</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/signs-symptoms/dizziness/vertigo" data-testid="ter_managingconditions_tertiarymenu"><p>Vertigo</p></a></div><div class="TertiaryNavigationDesktop_tertiary-section__NpW9N"><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/managing-conditions" data-testid="ter_managingconditions_tertiarymenu"><p>Health conditions A-Z</p></a></div></li></ul></div></div><div class="SecondaryNavigationDesktop_secondary-content__X6m4s"><a href="https://patient.info" class="SecondaryNavigationDesktop_secondary-list__67206" data-testid="sec_medicine_information"><div class="SecondaryNavigationDesktop_secondary-list-menu__Chqv2"><div class="SecondaryNavigationDesktop_secondary-list-icon__4jDqd SecondaryNavigationDesktop_navigation-item--health-advice__IBQM_ SecondaryNavigationDesktop_secondary-list-icon--inactive__FLGa2 "><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 -960 960 960"><path d="M136-266q-32 0-46.5-21T86-337l109-304q8-22 30.5-37.5T272-694q23 0 45 15.5t30 37.5l112 306q11 29-3.5 49T410-266q-14 0-25.5-8.5T368-296l-24-68H200l-20 66q-4 13-17 22.5t-27 9.5Zm94-188h80l-34-132h-8l-38 132Zm379 188q-28 0-47.5-19.5T542-333q0-13 6.5-30t14.5-27l181-210H597q-20 0-33.5-13.5T550-647q0-20 13.5-33.5T597-694h194q28 0 47.5 19.5T858-626q0 13-6.5 29.5T837-570L658-360h155q20 0 33.5 13.5T860-313q0 20-13.5 33.5T813-266H609ZM411-760q-17 0-24-16t5-28l72-72q3-3 18-7 3 0 18 7l72 72q12 12 5 28t-24 16H411Zm71 683q-3 0-18-7l-72-72q-12-12-5-28t24-16h142q17 0 24 16t-5 28l-72 72q-3 3-18 7Z"></path></svg></div><div class="SecondaryNavigationDesktop_secondary-list-item__YWsVF SecondaryNavigationDesktop_secondary-list-item--active__ADoJv"><h2>Medicine information</h2><p>Information and fact sheets for patients and professionals. Find out side effects, medicine names, dosages and uses.</p></div></div><div class="SecondaryNavigationDesktop_secondary-list-navicon__Phe1K "><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg></div></a><div class="SecondaryNavigationDesktop_tertiary-inactive__uNEtz"><ul><li class="TertiaryNavigationDesktop_tertiary-content__JmUfL"><h6 class="TertiaryNavigationDesktop_tertiary-title__j9zHz">Medicine information</h6><div class="TertiaryNavigationDesktop_tertiary-section__NpW9N"><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/medicine" data-testid="ter_medicineinformation_tertiarymenu"><p>All medicines A-Z</p></a></div><div class="TertiaryNavigationDesktop_tertiary-section__NpW9N"><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/allergy-medicines" data-testid="ter_medicineinformation_tertiarymenu"><p>Allergy medicines</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/analgesics-and-pain-medication" data-testid="ter_medicineinformation_tertiarymenu"><p>Analgesics and pain medication</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/anti-inflammatory-medicines" data-testid="ter_medicineinformation_tertiarymenu"><p>Anti-inflammatory medicines</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/breathing-treatment-and-respiratory-care" data-testid="ter_medicineinformation_tertiarymenu"><p>Breathing treatment and respiratory care</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/cancer-treatment-and-drugs" data-testid="ter_medicineinformation_tertiarymenu"><p>Cancer treatment and drugs</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/contraceptive-medicines" data-testid="ter_medicineinformation_tertiarymenu"><p>Contraceptive medicines</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/diabetes-medicines" data-testid="ter_medicineinformation_tertiarymenu"><p>Diabetes medicines</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/ent-and-mouth-care" data-testid="ter_medicineinformation_tertiarymenu"><p>ENT and mouth care</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/eye-care-medicine" data-testid="ter_medicineinformation_tertiarymenu"><p>Eye care medicine</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/gastrointestinal-treatment" data-testid="ter_medicineinformation_tertiarymenu"><p>Gastrointestinal treatment</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/genito-urinary-medicine" data-testid="ter_medicineinformation_tertiarymenu"><p>Genitourinary medicine</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/heart-disease-treatment-and-prevention" data-testid="ter_medicineinformation_tertiarymenu"><p>Heart disease treatment and prevention</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/hormonal-imbalance-treatment" data-testid="ter_medicineinformation_tertiarymenu"><p>Hormonal imbalance treatment</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/hormone-deficiency-treatment" data-testid="ter_medicineinformation_tertiarymenu"><p>Hormone deficiency treatment</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/immunosuppressive-drugs" data-testid="ter_medicineinformation_tertiarymenu"><p>Immunosuppressive drugs</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/infection-treatment-medicine" data-testid="ter_medicineinformation_tertiarymenu"><p>Infection treatment medicine</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/treatment-for-kidneys" data-testid="ter_medicineinformation_tertiarymenu"><p>Kidney conditions treatments</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/muscle-bone-and-joint-pain-treatment" data-testid="ter_medicineinformation_tertiarymenu"><p>Muscle, bone and joint pain treatment</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/nausea-medicine-and-vomiting-treatment" data-testid="ter_medicineinformation_tertiarymenu"><p>Nausea medicine and vomiting treatment</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/nervous-system-drugs" data-testid="ter_medicineinformation_tertiarymenu"><p>Nervous system drugs</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/fertility-treatment" data-testid="ter_medicineinformation_tertiarymenu"><p>Reproductive health</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/treatments-for-skin-conditions" data-testid="ter_medicineinformation_tertiarymenu"><p>Skin conditions treatments</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/substance-abuse-treatment" data-testid="ter_medicineinformation_tertiarymenu"><p>Substance abuse treatment</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/vaccines-and-immunisation" data-testid="ter_medicineinformation_tertiarymenu"><p>Vaccines and immunisation</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/vitamin-and-mineral-supplements" data-testid="ter_medicineinformation_tertiarymenu"><p>Vitamin and mineral supplements</p></a></div></li></ul></div></div><div class="SecondaryNavigationDesktop_secondary-content__X6m4s"><a href="https://patient.info" class="SecondaryNavigationDesktop_secondary-list__67206" data-testid="sec_tests_investigations"><div class="SecondaryNavigationDesktop_secondary-list-menu__Chqv2"><div class="SecondaryNavigationDesktop_secondary-list-icon__4jDqd SecondaryNavigationDesktop_navigation-item--health-advice__IBQM_ SecondaryNavigationDesktop_secondary-list-icon--inactive__FLGa2 "><svg xmlns="http://www.w3.org/2000/svg" height="25" width="24" viewBox="0 0 24 25"><path d="M19 22.9932C18.45 22.9932 17.979 22.7975 17.587 22.4062C17.1957 22.0142 17 21.5432 17 20.9932V19.8932C15.85 19.6598 14.8957 19.0892 14.137 18.1812C13.379 17.2725 13 16.2098 13 14.9932V9.99316C13 9.44316 13.1917 8.97216 13.575 8.58016C13.9583 8.18883 14.4333 7.99316 15 7.99316H21C21.55 7.99316 22.021 8.18883 22.413 8.58016C22.8043 8.97216 23 9.44316 23 9.99316V14.9932C23 16.2098 22.621 17.2725 21.863 18.1812C21.1043 19.0892 20.15 19.6598 19 19.8932V20.9932H21C21.2833 20.9932 21.5207 21.0892 21.712 21.2812C21.904 21.4725 22 21.7098 22 21.9932C22 22.2765 21.904 22.5138 21.712 22.7052C21.5207 22.8972 21.2833 22.9932 21 22.9932H19ZM19.75 13.9932H21V9.99316H15V11.9932H15.75C16.3 11.9932 16.8207 12.1182 17.312 12.3682C17.804 12.6182 18.2167 12.9598 18.55 13.3932C18.6833 13.5932 18.8583 13.7432 19.075 13.8432C19.2917 13.9432 19.5167 13.9932 19.75 13.9932ZM6 17.9932H5C4.45 17.9932 3.979 17.7975 3.587 17.4062C3.19567 17.0142 3 16.5432 3 15.9932V8.49316C2.71667 8.49316 2.47933 8.3975 2.288 8.20616C2.096 8.01416 2 7.7765 2 7.49316C2 7.20983 2.096 6.97216 2.288 6.78016C2.47933 6.58883 2.71667 6.49316 3 6.49316H6V4.99316H5.5C5.21667 4.99316 4.979 4.89716 4.787 4.70516C4.59567 4.51383 4.5 4.2765 4.5 3.99316C4.5 3.70983 4.59567 3.47216 4.787 3.28016C4.979 3.08883 5.21667 2.99316 5.5 2.99316H8.5C8.78333 2.99316 9.021 3.08883 9.213 3.28016C9.40433 3.47216 9.5 3.70983 9.5 3.99316C9.5 4.2765 9.40433 4.51383 9.213 4.70516C9.021 4.89716 8.78333 4.99316 8.5 4.99316H8V6.49316H11C11.2833 6.49316 11.521 6.58883 11.713 6.78016C11.9043 6.97216 12 7.20983 12 7.49316C12 7.7765 11.9043 8.01416 11.713 8.20616C11.521 8.3975 11.2833 8.49316 11 8.49316V15.9932C11 16.5432 10.8043 17.0142 10.413 17.4062C10.021 17.7975 9.55 17.9932 9 17.9932H8V22.4932C8 22.6932 7.90833 22.8432 7.725 22.9432C7.54167 23.0432 7.36667 23.0265 7.2 22.8932L6.4 22.2932C6.26667 22.1932 6.16667 22.0765 6.1 21.9432C6.03333 21.8098 6 21.6598 6 21.4932V17.9932ZM5 15.9932H9V14.4932H7.25C7.05 14.4932 6.875 14.4182 6.725 14.2682C6.575 14.1182 6.5 13.9432 6.5 13.7432C6.5 13.5432 6.575 13.3682 6.725 13.2182C6.875 13.0682 7.05 12.9932 7.25 12.9932H9V11.4932H7.25C7.05 11.4932 6.875 11.4182 6.725 11.2682C6.575 11.1182 6.5 10.9432 6.5 10.7432C6.5 10.5432 6.575 10.3682 6.725 10.2182C6.875 10.0682 7.05 9.99316 7.25 9.99316H9V8.49316H5V15.9932Z"></path></svg></div><div class="SecondaryNavigationDesktop_secondary-list-item__YWsVF SecondaryNavigationDesktop_secondary-list-item--active__ADoJv"><h2>Tests & investigations</h2><p>Information and guidance about tests and an easy, fast and accurate symptom checker.</p></div></div><div class="SecondaryNavigationDesktop_secondary-list-navicon__Phe1K "><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg></div></a><div class="SecondaryNavigationDesktop_tertiary-inactive__uNEtz"><ul><li class="TertiaryNavigationDesktop_tertiary-content__JmUfL"><h6 class="TertiaryNavigationDesktop_tertiary-title__j9zHz">Tests & investigations</h6><div class="TertiaryNavigationDesktop_tertiary-section__NpW9N"><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/about-tests-and-investigations" data-testid="ter_testsinvestigations_tertiarymenu"><p>About tests & investigations</p></a></div><div class="TertiaryNavigationDesktop_tertiary-section__NpW9N"><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/symptom-checker" data-testid="ter_testsinvestigations_tertiarymenu"><p>Symptom checker</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/treatment-medication/blood-tests" data-testid="ter_testsinvestigations_tertiarymenu"><p>Blood tests</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/doctor/bmi-calculator" data-testid="ter_testsinvestigations_tertiarymenu"><p>BMI calculator</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/doctor/pregnancy-due-date-calculator" data-testid="ter_testsinvestigations_tertiarymenu"><p>Pregnancy due date calculator</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/signs-symptoms" data-testid="ter_testsinvestigations_tertiarymenu"><p>General signs and symptoms</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/doctor/patient-health-questionnaire-phq-9" data-testid="ter_testsinvestigations_tertiarymenu"><p>Patient health questionnaire</p></a><a class="TertiaryNavigationDesktop_tertiary-menu__AI1gf" href="https://patient.info/doctor/generalised-anxiety-disorder-assessment-gad-7" data-testid="ter_testsinvestigations_tertiarymenu"><p>Generalised anxiety disorder assessment</p></a></div></li></ul></div></div></div></li><li><div role="navigation" class="SecondaryNavigationDesktop_secondary-sidebar__svZYs SecondaryNavigationDesktop_secondary-navigation-item--health-research__Y0SVM SecondaryNavigationDesktop_secondary-sidebar-hide__A4W4s"></div><div role="navigation" class="SecondaryNavigationDesktop_secondary__cbbXD SecondaryNavigationDesktop_secondary-inactive__dSi2Y"></div></li><li><div role="navigation" class="SecondaryNavigationDesktop_secondary-sidebar__svZYs SecondaryNavigationDesktop_secondary-navigation-item--professional-hub__nczDM SecondaryNavigationDesktop_secondary-sidebar-hide__A4W4s"></div><div role="navigation" class="SecondaryNavigationDesktop_secondary__cbbXD SecondaryNavigationDesktop_secondary-inactive__dSi2Y"><div class="SecondaryNavigationDesktop_secondary-content__X6m4s"><a href="https://patient.info" class="SecondaryNavigationDesktop_secondary-list__67206" data-testid="sec_hub"><div class="SecondaryNavigationDesktop_secondary-list-menu__Chqv2"><div class="SecondaryNavigationDesktop_secondary-list-icon__4jDqd SecondaryNavigationDesktop_navigation-item--professional-hub__TLTw0 SecondaryNavigationDesktop_secondary-list-icon--inactive__FLGa2 "><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M440 696v80q0 17 11.5 28.5T480 816q17 0 28.5-11.5T520 776v-80h80q17 0 28.5-11.5T640 656q0-17-11.5-28.5T600 616h-80v-80q0-17-11.5-28.5T480 496q-17 0-28.5 11.5T440 536v80h-80q-17 0-28.5 11.5T320 656q0 17 11.5 28.5T360 696h80ZM160 976q-33 0-56.5-23.5T80 896V416q0-33 23.5-56.5T160 336h160v-80q0-33 23.5-56.5T400 176h160q33 0 56.5 23.5T640 256v80h160q33 0 56.5 23.5T880 416v480q0 33-23.5 56.5T800 976H160Zm240-640h160v-80H400v80Z"></path></svg></div><div class="SecondaryNavigationDesktop_secondary-list-item__YWsVF SecondaryNavigationDesktop_secondary-list-item--active__ADoJv"><h2>Medical professional hub</h2><p>Information and tools written by clinicians for medical professionals, and training resources provided by FourteenFish.</p></div></div><div class="SecondaryNavigationDesktop_secondary-list-navicon__Phe1K "><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 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They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find the聽<a href="https://patient.info/chest-lungs/bronchiectasis-leaflet">Bronchiectasis</a>聽article more useful, or one of our other聽<a href="https://patient.info/health">health articles</a>.</p></div></div></div></div><div class="InThisArticle_wrapper__PysyZ" data-testid="in-this-article-wrapper"><div class="InThisArticle_title__NDDRL" data-testid="in-this-article-title"><h3>In this article:</h3></div><div class="InThisArticle_content__niE0Z" data-testid="in-this-article-content"><ul data-testid="in-this-article-list" role="navigation"><li data-testid="in-this-article-list-item"><a href="https://patient.info/doctor/bronchiectasis-pro#what-is-bronchiectasis" class="Link_linkcontainer__NFFuY Link_link-quicklink__LWSK_ Link_link-professionals__uur2P InThisArticle_link__yAqS0" data-testid="in-this-article-list-link"><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg><span>What is bronchiectasis?</span></a></li><li data-testid="in-this-article-list-item"><a href="https://patient.info/doctor/bronchiectasis-pro#how-common-is-bronchiectasis" class="Link_linkcontainer__NFFuY Link_link-quicklink__LWSK_ Link_link-professionals__uur2P InThisArticle_link__yAqS0" data-testid="in-this-article-list-link"><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg><span>How common is bronchiectasis? (Epidemiology) </span></a></li><li data-testid="in-this-article-list-item"><a href="https://patient.info/doctor/bronchiectasis-pro#causes-of-bronchiectasis" class="Link_linkcontainer__NFFuY Link_link-quicklink__LWSK_ Link_link-professionals__uur2P InThisArticle_link__yAqS0" data-testid="in-this-article-list-link"><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg><span>Causes of bronchiectasis (aetiology)  </span></a></li><li data-testid="in-this-article-list-item"><a href="https://patient.info/doctor/bronchiectasis-pro#symptoms-of-bronchiectasis" class="Link_linkcontainer__NFFuY Link_link-quicklink__LWSK_ Link_link-professionals__uur2P InThisArticle_link__yAqS0" data-testid="in-this-article-list-link"><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg><span>Symptoms of bronchiectasis (presentation) </span></a></li><li data-testid="in-this-article-list-item"><a href="https://patient.info/doctor/bronchiectasis-pro#diagnosing-bronchiectasis" class="Link_linkcontainer__NFFuY Link_link-quicklink__LWSK_ Link_link-professionals__uur2P InThisArticle_link__yAqS0" data-testid="in-this-article-list-link"><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg><span>Diagnosing bronchiectasis (investigations) </span></a></li><li data-testid="in-this-article-list-item"><a href="https://patient.info/doctor/bronchiectasis-pro#differential-diagnosis" class="Link_linkcontainer__NFFuY Link_link-quicklink__LWSK_ Link_link-professionals__uur2P InThisArticle_link__yAqS0" data-testid="in-this-article-list-link"><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg><span>Differential diagnosis</span></a></li><li data-testid="in-this-article-list-item"><a href="https://patient.info/doctor/bronchiectasis-pro#management-of-bronchiectasis" class="Link_linkcontainer__NFFuY Link_link-quicklink__LWSK_ Link_link-professionals__uur2P InThisArticle_link__yAqS0" data-testid="in-this-article-list-link"><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg><span>Management of bronchiectasis</span></a></li><li data-testid="in-this-article-list-item"><a href="https://patient.info/doctor/bronchiectasis-pro#complications-of-bronchiectasis" class="Link_linkcontainer__NFFuY Link_link-quicklink__LWSK_ Link_link-professionals__uur2P InThisArticle_link__yAqS0" data-testid="in-this-article-list-link"><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg><span>Complications of bronchiectasis </span></a></li><li data-testid="in-this-article-list-item"><a href="https://patient.info/doctor/bronchiectasis-pro#prognosis" class="Link_linkcontainer__NFFuY Link_link-quicklink__LWSK_ Link_link-professionals__uur2P InThisArticle_link__yAqS0" data-testid="in-this-article-list-link"><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 0 24 24"><path d="M5.67318 20.289L13.8612 12L5.67318 3.711C5.63754 3.678 5.60289 3.643 5.57022 3.605C5.2168 3.223 5 2.709 5 2.144C5 0.959999 5.95136 0 7.12448 0C7.68975 0 8.20553 0.224001 8.58469 0.589001C8.61241 0.615001 8.63815 0.641999 8.66389 0.667999L18.3349 10.436C18.3607 10.462 18.3864 10.488 18.4112 10.515C18.9002 11.034 19.122 11.79 18.9329 12.536C18.8388 12.905 18.6547 13.228 18.4112 13.486C18.3983 13.499 18.3518 13.547 18.3399 13.558L8.66389 23.332C8.63815 23.358 8.61241 23.385 8.58469 23.411C8.20553 23.776 7.68975 24 7.12448 24C5.95136 24 5 23.04 5 21.855C5 21.291 5.2168 20.777 5.57022 20.394C5.60289 20.357 5.63754 20.322 5.67318 20.289"></path></svg><span>Prognosis</span></a></li></ul></div></div><div class="Body_wrapper__87Ugw" data-testid="body"><div class=" Markup_markup__hjGOW Body_markup__5QVEm " data-testid="markup"><div class="InlineAds_inlineads__KhwOX" data-index="1" id="inlinead"><p class="InlineAds_adslinebreak__o_d8f"><span>Continue reading below</span><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 -960 960 960"><path d="M480-362q-8 0-15-2.5t-13-8.5L268-557q-11-11-11-28t11-28q11-11 28-11t28 11l156 156 156-156q11-11 28-11t28 11q11 11 11 28t-11 28L508-373q-6 6-13 8.5t-15 2.5Z"></path></svg></p><div class="InlineAds_adswrapper__q54f_"><div class="InlineAds_wrapper__D6jdy" aria-label="Side rail Advertisement" role="complementary" data-testid="inlineads-wrapper"><div id="div-gpt-ad-1698311650922-0" data-adunit="Side Rail-App" data-dimensions="300,250" data-targeting="{}" class="InlineAds_wrapper-active__1EvdQ" data-testid-adspossibledimensions="300,250"></div></div></div></div><h2 class="ScrollMargin_anchor__VQzBd" id="what-is-bronchiectasis" data-testid="heading-2">What is bronchiectasis?</h2><p>Bronchiectasis is a permanent dilatation and thickening of the airways, characterised by chronic cough, excessive sputum production, bacterial colonisation, and recurrent acute infections.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-1" title="Bronchiectasis; NICE CKS, March 2024 (UK access only)"><span>1</span></a></sup> It may be widespread throughout the lungs (diffuse) or more localised (focal). It is caused by chronic inflammation of the airways, and is associated with, or caused by, a large number of diseases. It may develop after lung infections, particularly in childhood and in association with underlying problems, such as immunodeficiency and cystic fibrosis.</p><p>Bronchiectasis can be classified into the following forms morphologically (all three forms may be present in the same patient):</p><ul><li><p>Cylindrical bronchiectasis: bronchi are enlarged and cylindrical.</p></li><li><p>Varicose bronchiectasis: bronchi are irregular with areas of dilatation and constriction.</p></li><li><p>Saccular or cystic: dilated bronchi form clusters of cysts. This is the most severe form of bronchiectasis and is often found in patients with cystic fibrosis.</p></li></ul><p>The affected airways are inflamed and easily collapse. There is an impairment of airflow and drainage of secretions, leading to the accumulation of a large amount of mucus in the lungs. The mucus collects bacteria, predisposing to frequent and often severe lower respiratory tract infections. The severity of bronchiectasis used to be classified according to the volume of sputum produced but this has now largely been superseded by using the radiological appearance on CT scan.</p><h2 class="ScrollMargin_anchor__VQzBd" id="how-common-is-bronchiectasis" data-testid="heading-2">How common is bronchiectasis? (Epidemiology) </h2><ul><li><p>A large study across 640 general practices in the UK published in 2012 found:<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-2" title="Quint JK, Millett E, Hurst JR, Smeeth L, Brown J; Time trends in incidence and prevalence of bronchiectasis in the UK. Thorax. 2012;67:A138 doi:10.1136/thoraxjnl-2012-202678.233 "><span>2</span></a></sup></p><ul><li><p>Prevalence in 2011 in men was 227/100,000, and 309/100,000 in women.</p></li><li><p>Incidence increased each year between 2004 and 2011, from 18/100,000 person-years at risk, to 32/100,000 person-years at risk.</p></li><li><p>Prevalence was higher in women than in men.</p></li><li><p>Prevalence was higher in the older age groups (>60 years).</p></li></ul></li><li><p>It is estimated that around 1,000 people die each year from bronchiectasis in England and Wales.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-3" title="Roberts HJ, Hubbard R; Trends in bronchiectasis mortality in England and Wales. Respir Med. 2010 Jul;104(7):981-5. doi: 10.1016/j.rmed.2010.02.022. Epub 2010 Mar 19."><span>3</span></a></sup></p></li><li><p>The incidence varies between populations from 3.7/100,000 children in New Zealand to 52/100,000 adults in the USA. Features of bronchiectasis found in CXRs in the UK in the 1950s suggested a prevalence of 100/100,000.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-4" title="Guideline for non-CF Bronchiectasis; British Thoracic Society (July 2010)"><span>4</span></a></sup></p></li><li><p>Bronchiectasis can present at any age but increases with age and the highest prevalence is in older women.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-5" title="O'Donnell AE; Bronchiectasis. Chest. 2008 Oct;134(4):815-23."><span>5</span></a></sup>. Up to 70% of cases may be in women <sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-1" title="Bronchiectasis; NICE CKS, March 2024 (UK access only)"><span>1</span></a></sup><sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-6" title="King PT, Holdsworth SR, Freezer NJ, et al; Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med. 2006 Dec;100(12):2183-9. Epub 2006 May 2."><span>6</span></a></sup></p></li></ul><div class="InlineAds_inlineads__KhwOX" data-index="2" id="inlinead"><p class="InlineAds_adslinebreak__o_d8f"><span>Continue reading below</span><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 -960 960 960"><path d="M480-362q-8 0-15-2.5t-13-8.5L268-557q-11-11-11-28t11-28q11-11 28-11t28 11l156 156 156-156q11-11 28-11t28 11q11 11 11 28t-11 28L508-373q-6 6-13 8.5t-15 2.5Z"></path></svg></p><div class="InlineAds_adswrapper__q54f_"><div class="InlineAds_wrapper__D6jdy" aria-label="Side rail Advertisement" role="complementary" data-testid="inlineads-wrapper"><div id="div-gpt-ad-1698311751337-0" data-adunit="Side Rail-App" data-dimensions="300,250" data-targeting="{}" class="InlineAds_wrapper-active__1EvdQ" data-testid-adspossibledimensions="300,250"></div></div></div></div><h2 class="ScrollMargin_anchor__VQzBd" id="causes-of-bronchiectasis" data-testid="heading-2">Causes of bronchiectasis (aetiology) <sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-1" title="Bronchiectasis; NICE CKS, March 2024 (UK access only)"><span>1</span></a></sup> <sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-7" title="Murray MP, Hill AT; Non-cystic fibrosis bronchiectasis. Clin Med. 2009 Apr;9(2):164-9."><span>7</span></a></sup></h2><p>The disease is caused by chronic inflammation of the airways. It may therefore be caused by a large number of disorders which cause inflammation and infection, particularly conditions that facilitate infections, which therefore tend to be recurrent and more severe and so cause damage to the lungs. Up to 42% of cases develop post-infection. However, there is no identifiable underlying cause in about 50% of adults and 25% of children.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-8" title="ten Hacken NH, van der Molen T; Bronchiectasis. BMJ. 2010 Jul 14;341:c2766. doi: 10.1136/bmj.c2766."><span>8</span></a></sup></p><ul><li><p>Post-infection - eg, childhood respiratory viral infections (<a href="https://patient.info/doctor/measles-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">measles</a>, <a href="https://patient.info/doctor/whooping-cough-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">pertussis</a>, <a href="https://patient.info/doctor/influenza" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">influenza</a>, respiratory syncytial virus), <a href="https://patient.info/doctor/tuberculosis-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">tuberculosis</a>, <a href="https://patient.info/doctor/pneumonia-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">bacterial pneumonia</a>. Infection is the most common cause.</p></li><li><p><a href="https://patient.info/doctor/immunodeficiency-primary-and-secondary" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Immunodeficiency</a>, including <a href="https://patient.info/doctor/complications-of-hiv-infection" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">HIV infection</a>. Accounts for around 1-8% of cases. Always consider this as a cause in all ages, particularly if there have been serious, persistent or recurrent infections, or if with unusual or opportunist pathogens, or occurring at multiple sites.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-4" title="Guideline for non-CF Bronchiectasis; British Thoracic Society (July 2010)"><span>4</span></a></sup></p></li><li><p>Connective tissue diseases (3-6%) - eg, <a href="https://patient.info/doctor/rheumatoid-arthritis-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">rheumatoid arthritis</a>, <a href="https://patient.info/doctor/sjogrens-syndrome-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Sj枚gren's syndrome</a>, <a href="https://patient.info/doctor/systemic-sclerosis-scleroderma" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">systemic sclerosis</a>, <a href="https://patient.info/doctor/systemic-lupus-erythematosus-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">systemic lupus erythematosus (SLE)</a>, <a href="https://patient.info/doctor/ehlers-danlos-syndromes" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Ehlers-Danlos syndrome</a>, <a href="https://patient.info/doctor/marfans-syndrome-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Marfan's syndrome</a>.</p></li><li><p><a href="https://patient.info/doctor/asthma-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Asthma</a>.</p></li><li><p>Allergic bronchopulmonary aspergillosis (1-7%).</p></li><li><p>Gastric aspiration (up to 4%)</p></li><li><p>Congenital defects. Genetic causes include <a href="https://patient.info/doctor/cystic-fibrosis-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">cystic fibrosis</a> (3-4%), <a href="https://patient.info/doctor/kartageners-syndrome" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Kartagener's syndrome (primary ciliary dyskinesia)</a>, <a href="https://patient.info/doctor/alpha-1-antitrypsin-deficiency-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">alpha-1-antitrypsin deficiency</a>, <a href="https://patient.info/doctor/yellow-nail-syndrome" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">yellow nail syndrome.</a></p></li><li><p>Bronchial obstruction by lymphadenopathy, tumour or inhaled foreign bodies.</p></li><li><p>Inflammatory bowel disease.</p></li></ul><p>Bronchial obstruction and bronchopneumonia are more likely to cause a focal bronchiectasis, whereas the other causes are more likely to result in diffuse disease. All conditions cause dilation of the airways (due to continued inflammation destroying their elastic and muscular structure) followed by poor mucus clearance, and bacterial colonisation of collected mucus. This then can progress, as chronic infection causes further inflammation in a cyclical fashion.</p><p>Smoking does not appear to be an independent risk factor but smoking cessation is important if the patient does smoke.</p><p> </p><h2 class="ScrollMargin_anchor__VQzBd" id="symptoms-of-bronchiectasis" data-testid="heading-2">Symptoms of bronchiectasis (presentation) <sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-9" title="Hill AT, Sullivan AL, Chalmers JD, et al; British Thoracic Society guideline for bronchiectasis in adults. BMJ Open Respir Res. 2018 Dec 28;5(1):e000348. doi: 10.1136/bmjresp-2018-000348. eCollection 2018."><span>9</span></a></sup></h2><ul><li><p>The symptoms vary from intermittent episodes of expectoration and infection localised to the region of the affected lung to persistent daily expectoration of large volumes of purulent sputum.</p></li><li><p>There may be associated nonspecific respiratory symptoms including dyspnoea, chest pain and haemoptysis. Bronchiectasis may progress to respiratory failure and cor pulmonale.</p></li><li><p>Signs:</p><ul><li><p>Coarse crackles are the most common finding in around 70%, heard in early inspiration and often in the lower zones. Area of crackles on auscultation corresponds poorly with localisation of bronchiectasis radiologically.</p></li><li><p>Large airway rhonchi are present in 44% (low-pitched snore-like sounds).<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-1" title="Bronchiectasis; NICE CKS, March 2024 (UK access only)"><span>1</span></a></sup></p></li><li><p>Wheeze may be present in 34%.</p></li><li><p><a href="https://patient.info/doctor/clubbing" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Clubbing</a> is found infrequently.</p></li></ul></li><li><p>All causes of bronchiectasis should be considered and assessed as appropriate.</p></li></ul><h3>Children</h3><ul><li><p>Respiratory symptoms, especially cough and sputum production, should be assessed and recorded in all children with possible bronchiectasis.</p></li><li><p>There should be a high index of suspicion for diagnosing bronchiectasis in children with chronic respiratory symptoms.</p></li><li><p>Persistent lung crackles on auscultation indicate possible underlying bronchiectasis.</p></li><li><p>Children should be assessed for bronchiectasis if they present with: <br/></p><ul><li><p>Chronic moist/productive cough, especially between viral colds or with positive bacterial cultures.</p></li><li><p>Asthma that does not respond to treatment.</p></li><li><p>A child with chronic respiratory symptoms and a single positive sputum culture for <i>Staphylococcus aureus</i>, <i>Haemophilus influenzae</i>, <i>Pseudomonas aeruginosa</i>, non-tuberculous mycobacteria or <i>Burkholderia cepacia</i> complex.</p></li><li><p>An episode of severe pneumonia, especially if there is incomplete resolution of symptoms, physical signs or radiological changes.</p></li><li><p>Pertussis-like illness failing to resolve after six months.</p></li><li><p>Recurrent pneumonia.</p></li><li><p>Persistent and unexplained physical signs or abnormalities on CXR.</p></li><li><p>Localised chronic bronchial obstruction.</p></li><li><p>Respiratory symptoms in children with structural or functional disorders of the oesophagus and upper respiratory tract.</p></li><li><p>Unexplained haemoptysis.</p></li><li><p>Respiratory symptoms with any clinical features of cystic fibrosis, primary ciliary dyskinesia or immunodeficiency.</p></li></ul></li></ul><h3>Adult</h3><ul><li><p>Assessment of symptoms in patients with bronchiectasis should include a record of both sputum purulence and estimated or measured 24-hour sputum volume when clinically stable.</p></li><li><p>The number of infective exacerbations per annum should be noted including frequency and nature of antibiotic usage.</p></li><li><p>Adults should be assessed for bronchiectasis if they present with: <br/></p><ul><li><p>Persistent productive cough, especially if any one of the following: <br/></p><ul><li><p>Young age at presentation.</p></li><li><p>History of symptoms over many years.</p></li><li><p>Absence of smoking history.</p></li><li><p>Daily expectoration of large volumes of very purulent sputum.</p></li><li><p>Haemoptysis.</p></li><li><p>Sputum colonisation with <i>P. aeruginosa</i>.</p></li></ul></li><li><p>Unexplained haemoptysis or nonproductive cough.</p></li><li><p>Patients thought to have chronic obstructive pulmonary disease (COPD) may have bronchiectasis alone or as well as COPD and referral for investigation is appropriate if: <br/></p><ul><li><p>Management is not straightforward.</p></li><li><p>There is slow recovery from lower respiratory tract infections.</p></li><li><p>There are recurrent exacerbations.</p></li><li><p>There is no history of smoking.</p></li></ul></li></ul></li></ul><div class="InlineAds_inlineads__KhwOX" data-index="3" id="inlinead"><p class="InlineAds_adslinebreak__o_d8f"><span>Continue reading below</span><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 -960 960 960"><path d="M480-362q-8 0-15-2.5t-13-8.5L268-557q-11-11-11-28t11-28q11-11 28-11t28 11l156 156 156-156q11-11 28-11t28 11q11 11 11 28t-11 28L508-373q-6 6-13 8.5t-15 2.5Z"></path></svg></p><div class="InlineAds_adswrapper__q54f_"><div class="InlineAds_wrapper__D6jdy" aria-label="Side rail Advertisement" role="complementary" data-testid="inlineads-wrapper"><div id="div-gpt-ad-1698311686220-0" data-adunit="Side Rail-App" data-dimensions="300,250" data-targeting="{}" class="InlineAds_wrapper-active__1EvdQ" data-testid-adspossibledimensions="300,250"></div></div></div></div><h2 class="ScrollMargin_anchor__VQzBd" id="diagnosing-bronchiectasis" data-testid="heading-2">Diagnosing bronchiectasis (investigations) <sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-1" title="Bronchiectasis; NICE CKS, March 2024 (UK access only)"><span>1</span></a></sup><sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-9" title="Hill AT, Sullivan AL, Chalmers JD, et al; British Thoracic Society guideline for bronchiectasis in adults. BMJ Open Respir Res. 2018 Dec 28;5(1):e000348. doi: 10.1136/bmjresp-2018-000348. eCollection 2018."><span>9</span></a></sup></h2><p>Investigations are directed at identifying any underlying cause and to establish the severity of disease. In primary care, CXR is the main investigation, followed by referral to secondary care for confirmation by high-resolution computed tomography (HRCT), and then tests aimed at identifying a possible cause.</p><ul><li><p>Radiological investigations: <br/></p><ul><li><p>CXR: a baseline CXR should be done in all patients. Repeat CXRs need only be done if clinically indicated. CXR may be normal or show ring or tubular opacities, tramlines and fluid levels. CXR is abnormal in 90% of people with bronchiectasis, but there is not usually a diagnostic pattern. The main value is excluding other causes of symptoms.</p></li><li><p>The gold standard for diagnosis is HRCT of the chest. HRCT has a very high sensitivity and specificity for diagnosis and has now replaced bronchography.</p></li><li><p>HRCT features of bronchiectasis: bronchial wall dilation (internal lumen diameter greater than accompanying pulmonary artery or lack of tapering) is the characteristic feature; bronchial wall thickening is often also present although harder to define.</p></li><li><p>The severity of bronchiectasis on HRCT correlates with measures of airflow obstruction.</p></li><li><p>Routine repeat CXR or HRCT is not necessary; repeat imaging should be considered when there is clinical need. In cases of humoral immune deficiency, repeating HRCT at intervals may be necessary to detect asymptomatic progression.</p></li></ul></li><li><p>Sputum microbiology: <br/></p><ul><li><p>All children and adults with bronchiectasis should have an assessment of lower respiratory tract microbiology.</p></li><li><p>Respiratory tract specimens should be obtained in all patients with bronchiectasis. To maximise the chances of isolating <i>H. influenzae</i> and <i>S. pneumoniae</i>, specimens should reach the microbiology laboratory within three hours.</p></li><li><p>Persistent isolation of <i>S. aureus</i> (and/or <i>P. aeruginosa</i> in children) should lead to consideration of underlying bronchopulmonary aspergillosis or cystic fibrosis.</p></li></ul></li><li><p>Routine blood tests are nonspecific but may confirm the presence of infection or presence of any comorbidity. FBC may show raised white cell count (infection) or polycythaemia (in advanced cases).</p></li><li><p>Immune function tests: the following should be measured in all patients: <br/></p><ul><li><p>Serum immunoglobulins (IgG, IgA, IgM) and serum electrophoresis.</p></li><li><p>Serum IgE, skin prick testing or serum IgE testing to <i>Aspergillus fumigatus</i> and aspergillosis precipitins.</p></li><li><p>All patients with bronchiectasis should be screened at presentation for gross antibody deficiency by routine measurement of serum IgG, IgA and IgM levels and serum electrophoresis.</p></li><li><p>Respiratory and immunology units should develop additional local protocols for screening assessment of humoral responses to specific antigens.</p></li><li><p>Measurement of baseline specific antibody levels against tetanus toxoid and the capsular polysaccharides of both <i>S. pneumoniae</i> and <i>H. influenzae</i> type b (or suitable alternative peptide and polysaccharide antigens).</p></li><li><p>Immunisation with appropriate vaccines followed by re-assay of individual specific antibody responses after 21 days where screening baseline levels are low.</p></li></ul></li><li><p>Further assessment of immune competence is recommended in the following circumstances: <br/></p><ul><li><p>Antibody screening investigations have demonstrated the presence of an antibody deficiency disorder.</p></li><li><p>In the presence of normal antibody screening test results where the following are present: <br/></p><ul><li><p>Clinical suspicion of immune deficiency (short stature, facial abnormality, cardiac lesions, hypocalcaemia, cleft palate, oculocutaneous telangiectasias, eczema, dermatitis, petechiae, manifestations of endocrinopathy, unexplained failure to thrive, enlargement or absence of lymphoid tissues, unexplained organomegaly, unexplained joint symptoms).</p></li><li><p>A family history of known or suspected immune deficiency.</p></li><li><p>Infections which are serious, involving a threat to life, or tissue destruction or which require/have required surgical intervention (eg, lobectomy, tonsillectomy, insertion of grommets, incision of boils), are persistent or recurrent despite multiple or prolonged courses of antibiotics, involve unusual/opportunistic micro-organisms or involve multiple sites (eg, sinuses or middle ear in addition to the bronchial tree).</p></li></ul></li></ul></li><li><p>Gastrointestinal investigations: <br/></p><ul><li><p>There should be a low threshold for gastrointestinal investigations in children.</p></li><li><p>Gastric aspiration should be considered in patients following lung transplantation.</p></li><li><p>24-hour pH monitoring for those suspected of having bronchiectasis secondary to gastrointestinal reflux or aspiration.</p></li></ul></li><li><p><a href="https://patient.info/doctor/cystic-fibrosis-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Cystic fibrosis</a>: all children and all adults up to the age of 40, presenting with bronchiectasis, should have investigations for cystic fibrosis.</p></li><li><p>Tests for ciliary function: <br/></p><ul><li><p>Ciliary investigations should be considered in children with bronchiectasis when there is: <br/></p><ul><li><p>No other cause for bronchiectasis identified.</p></li><li><p>A history of continuous rhinitis since the neonatal period.</p></li><li><p>A history of neonatal respiratory distress.</p></li><li><p>Dextrocardia.</p></li></ul></li><li><p>Ciliary investigations should be considered in adults only if there is a history of chronic upper respiratory tract problems or otitis media. Factors favouring investigation include: <br/></p><ul><li><p>Problems since childhood.</p></li><li><p>Childhood chronic otitis media.</p></li><li><p>Predominantly middle lobe bronchiectasis.</p></li><li><p>Infertility or dextrocardia.</p></li></ul></li><li><p>For adults, the saccharin test and/or exhaled nasal nitric oxide (NO) may be used to screen out those not requiring detailed ciliary function tests.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-10" title="Bush A, Chodhari R, Collins N, et al; Primary ciliary dyskinesia: current state of the art. Arch Dis Child. 2007 Dec;92(12):1136-40. Epub 2007 Jul 18."><span>10</span></a></sup></p></li></ul></li><li><p><a href="https://patient.info/doctor/spirometry-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Lung function tests</a>: <br/></p><ul><li><p>Oxygen saturation in room air, or arterial blood gases where appropriate.</p></li><li><p>In all children who are old enough (usually aged >5 years) forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and forced expiratory flow (FEF) 25-75% should be measured at initial assessment.</p></li><li><p>All adults with bronchiectasis should have measures of FEV1, FVC and peak expiratory flow (PEF).</p></li><li><p>Repeat assessment of FEV1, FVC and PEF should be made at least annually in those patients attending secondary care.</p></li><li><p>Patients with immune deficiency or primary ciliary dyskinesia should have measurements of FEV1, and FVC at least four times each year.</p></li><li><p>Measurement of lung volumes and gas transfer coefficient may help in the identification of other causes of airflow obstruction such as COPD or emphysema.</p></li><li><p>Reversibility testing may identify improvement in lung function after bronchodilators and should always be considered if airflow obstruction is identified, especially in young people.</p></li><li><p>Exercise tests have a role in investigating children in whom symptoms are out of keeping with lung function or HRCT measurements. In adults, exercise testing should be part of a pulmonary rehabilitation programme.</p></li><li><p>FEV1 and FVC should be measured before and after intravenous antibiotic therapy, as this may give objective evidence of improvement.</p></li><li><p>Spirometry and lung volumes should be measured in all patients before and after commencing long-term oral or nebulised antibiotic therapy.</p></li></ul></li><li><p>Bronchoscopy: <br/></p><ul><li><p>In children, bronchoscopy is indicated when bronchiectasis affects a single lobe, to exclude a foreign body. In some acutely ill patients it may achieve a useful microbiological result.</p></li><li><p>In adults with localised disease, bronchoscopy may be indicated to exclude proximal obstruction.</p></li><li><p>In adults, bronchoscopy and bronchoscopic sampling of the lower respiratory tract do not have a place in the routine investigation of patients with bronchiectasis.</p></li><li><p>For patients in whom serial testing of sputum does not yield microbiological information and who are not responding well to treatment, bronchoscopic sampling of lower respiratory tract secretions may be indicated.</p></li><li><p>Bronchoscopy is indicated if HRCT suggests atypical mycobacterial infection and sputum culture is negative.</p></li><li><p>Cytological examination of bronchoscopic specimens can provide evidence supporting gastric aspiration.</p></li></ul></li><li><p>Comorbidity assessment; echocardiogram for left ventricular function and pulmonary hypertension.</p></li></ul><p></p><h2 class="ScrollMargin_anchor__VQzBd" id="differential-diagnosis" data-testid="heading-2">Differential diagnosis<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-1" title="Bronchiectasis; NICE CKS, March 2024 (UK access only)"><span>1</span></a></sup></h2><ul><li><p><a href="https://patient.info/doctor/chronic-obstructive-pulmonary-disease-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">COPD</a>.</p></li><li><p><a href="https://patient.info/doctor/asthma-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Asthma</a>.</p></li><li><p><a href="https://patient.info/doctor/tuberculosis-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Tuberculosis</a>.</p></li><li><p><a href="https://patient.info/doctor/sinusitis-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Chronic sinusitis</a>.</p></li><li><p>Upper airway cough syndrome (postnasal drip).</p></li><li><p>Cough due to <a href="https://patient.info/doctor/gastro-oesophageal-reflux-disease" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">gastrointestinal reflux</a>.</p></li><li><p><a href="https://patient.info/doctor/pneumonia-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Pneumonia</a>.</p></li><li><p><a href="https://patient.info/doctor/pulmonary-fibrosis" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Pulmonary fibrosis</a>.</p></li><li><p><a href="https://patient.info/doctor/lung-cancer-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Cancer of the lung</a>.</p></li><li><p><a href="https://patient.info/doctor/choking-and-foreign-body-airway-obstruction-fbao" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Inhaled foreign body</a>.</p></li></ul><h2 class="ScrollMargin_anchor__VQzBd" id="management-of-bronchiectasis" data-testid="heading-2">Management of bronchiectasis<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-9" title="Hill AT, Sullivan AL, Chalmers JD, et al; British Thoracic Society guideline for bronchiectasis in adults. BMJ Open Respir Res. 2018 Dec 28;5(1):e000348. doi: 10.1136/bmjresp-2018-000348. eCollection 2018."><span>9</span></a></sup></h2><p>Damaged lung cannot be repaired and so the basis of management is to prevent or at least slow down further deterioration. Management includes treatment of any underlying cause and any co-existing medical problems. Patients who should have regular follow-up in secondary care include:</p><ul><li><p>All children with bronchiectasis</p></li><li><p>Patients with chronic <i>P. aeruginosa</i>, opportunistic mycobacteria or meticillin-resistant <i>S. aureus</i> (MRSA) colonisation.</p></li><li><p>Deteriorating bronchiectasis with declining lung function.</p></li><li><p>Recurrent exacerbations (three or more per year).</p></li><li><p>Patients receiving prophylactic antibiotic therapy (oral or nebulised).</p></li><li><p>Patients with bronchiectasis and associated rheumatoid arthritis, immune deficiency inflammatory bowel disease and primary ciliary dyskinesia.</p></li><li><p>Patients with bronchopulmonary aspergillosis.</p></li><li><p>Patients with advanced disease and those considering transplantation.</p></li></ul><h3>General management issues</h3><ul><li><p>Maintain a healthy diet and physical exercise; ensure adequate energy intake to provide for increased energy demands.</p></li><li><p>If the patient smokes this must be stopped and smoking cessation advice and help should be offered. Passive smoking should also be avoided.</p></li><li><p>Immunisation against influenza, pneumococcus and COVID.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-11" title="Chang CC, Morris PS, Chang AB; Influenza vaccine for children and adults with bronchiectasis. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006218."><span>11</span></a></sup><sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-12" title="Chang CC, Singleton RJ, Morris PS, et al; Pneumococcal vaccines for children and adults with bronchiectasis. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006316."><span>12</span></a></sup></p></li></ul><h3>Physiotherapy: airway clearance techniques and exercise</h3><ul><li><p>All patients should be referred to a physiotherapist to be taught the airway clearance techniques (ACT) available and, where possible, be encouraged to be independent with the chosen airway clearance technique. This should then be used on a daily basis for those with chronic productive cough, and on an intermittent basis for those with productive cough during exacerbations.</p></li><li><p>A Cochrane review concluded that positive expiratory pressure (PEP) therapy appears to have similar effects on health-related quality of life, symptoms of breathlessness, sputum expectoration, and lung volumes compared to other ACTs when prescribed within a stable clinical state or during an acute exacerbation.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-13" title="Lee AL, Burge AT, Holland AE; Positive expiratory pressure therapy versus other airway clearance techniques for bronchiectasis. Cochrane Database Syst Rev. 2017 Sep 27;9(9):CD011699. doi: 10.1002/14651858.CD011699.pub2."><span>13</span></a></sup></p></li><li><p>Modified gravity-assisted positions (no head-down tilt) should be offered where the conventional tipped position is contra-indicated or unacceptable to the patient.</p></li><li><p>During an acute exacerbation or when the patient is more fatigued than usual, manual techniques may be offered as a part of an airway clearance technique regimen.</p></li><li><p>Sterile water inhalation may be used before airway clearance to facilitate clearance. The use of nebulised normal or hypertonic saline prior to airway clearance could be considered to increase sputum yield, reduce sputum viscosity and improve ease of expectoration.</p></li><li><p>Inhaled beta-2 agonists should be used prior to treatment to enhance sputum clearance.</p></li><li><p>Non-invasive ventilation or intermittent positive pressure breathing may be used to augment tidal volume and reduce the work of breathing in those patients who are becoming fatigued and finding their standard airway clearance difficult.</p></li><li><p>Pulmonary rehabilitation should be offered to individuals who have breathlessness affecting their activities of daily living.</p></li></ul><h3><b>Antibiotics for acute exacerbations</b><sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-14" title="Bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing; NICE Guidance (December 2018)."><span>14</span></a></sup><br/></h3><p>An acute exacerbation of bronchiectasis is a sustained worsening of symptoms from a person's stable state. People with bronchiectasis should be educated so they know how to recognise an acute exacerbation. Signs to look out for include:<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-1" title="Bronchiectasis; NICE CKS, March 2024 (UK access only)"><span>1</span></a></sup></p><ul><li><p>Acute deterioration over a few days.</p></li><li><p>Worsening cough.</p></li><li><p>Increased sputum volume, viscosity or purulence.</p></li><li><p>Increased wheeze, breathlessness or haemoptysis.</p></li><li><p>Feeling systemically unwell.</p></li></ul><p>If a person has an acute exacerbation:</p><ul><li><p>Send a sputum sample for culture and susceptibility testing.</p></li><li><p>Offer an initial antibiotic based on the severity of symptoms, previous exacerbation and hospital admissions, the risk of developing complications, and previous sputum culture and susceptibility results.</p></li><li><p>First-choice oral antibiotics for empirical treatment are amoxicillin, doxycycline or clarithromycin.</p></li><li><p>The European Medicines Agency's Pharmacovigilance Risk Assessment Committee has recommended restricting the use of fluoroquinolone antibiotics following a review of disabling and potentially long-lasting side-effects, mainly involving muscles, tendons, bones and the nervous system. This includes a recommendation not to use them for mild or moderately severe infections unless other antibiotics cannot be used.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-15" title="Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects; MHRA, March 2019."><span>15</span></a></sup></p></li><li><p>Review the choice of antibiotic when the results of sputum culture and susceptibility testing are available.</p></li><li><p>Refer to hospital if there are any symptoms or signs suggesting a more serious illness or condition.</p></li><li><p>Seek specialist advice if symptoms that are not improving with repeated courses of antibiotic treatment, the bacteria are resistant to oral antibiotics, or if the person cannot take oral medicines (in which case consider intravenous antibiotics at home or in the community, rather than in hospital, if appropriate).</p></li></ul><h3>Long-term antibiotics</h3><ul><li><p>Patients having three or more exacerbations per year requiring antibiotic therapy or patients with fewer exacerbations that are causing significant morbidity should be considered for long-term antibiotics. Choice will be dictated by sensitivities and local microbiology advice from sputum test results.</p></li><li><p>In the first instance, high doses should not be used, in order to minimise side-effects.</p></li><li><p>The antibiotic regimen should be determined by sputum microbiology when clinically stable.</p></li><li><p>Long-term antibiotics may result in antibiotic resistance in individual patients and alternative antibiotics should be chosen depending on sensitivity results.</p></li><li><p>Some patients may respond to antibiotic treatment despite resistance to that drug in vitro. Antibiotics should only be changed if there is no clinical response.</p></li></ul><h3><b>Other drug treatment</b></h3><ul><li><p>Bronchodilators: it is appropriate to assess patients with airflow obstruction for reversibility to beta-2 agonist and anticholinergic bronchodilators and to start treatment if lung function or symptoms improve on therapy.</p></li><li><p>Likewise, theophylline and aminophylline are occasionally used if a trial of therapy has demonstrated improvement.</p></li><li><p>The following are NOT recommended for bronchiectasis:<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-1" title="Bronchiectasis; NICE CKS, March 2024 (UK access only)"><span>1</span></a></sup></p><ul><li><p>Corticosteroids - inhaled or oral - unless there is co-existent asthma.</p></li><li><p>Mucolytics.</p></li><li><p>Leukotriene receptor antagonists.</p></li></ul></li><li><p>Oxygen therapy: <br/></p><ul><li><p>The use of oxygen therapy may need to be considered.</p></li><li><p>Non-invasive ventilation can improve quality of life in some patients with chronic respiratory failure due to bronchiectasis.</p></li></ul></li></ul><h3>Surgery</h3><ul><li><p>Lung resection surgery may be considered in patients with localised disease in whom symptoms are not controlled by medical treatment.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-16" title="De Dominicis F, Andrejak C, Monconduit J, et al; [Surgery for bronchiectasis]. Rev Pneumol Clin. 2012 Apr;68(2):91-100. doi: 10.1016/j.pneumo.2012.01.007. Epub 2012 Feb 24."><span>16</span></a></sup> There are few high quality studies but five retrospective cohort studies (1347 people in total) assessing the long-term effect of surgery on bronchiectasis-related symptoms, with a follow-up period of approximately 4.3 years, found 68% to 84% of people became asymptomatic after surgery, 14% to 24% improved, and 5% to 15% worsened.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-17" title="Magis-Escurra C, Reijers MH; Bronchiectasis. BMJ Clin Evid. 2015 Feb 25;2015:1507."><span>17</span></a></sup></p></li><li><p>Bronchial artery embolisation and/or surgery are first-line therapy for the management of massive haemoptysis.</p></li><li><p>Lung transplantation may need to be considered for end-stage disease if pulmonary function is very poor with FEV1 below 30% of predicted.</p></li></ul><h2 class="ScrollMargin_anchor__VQzBd" id="complications-of-bronchiectasis" data-testid="heading-2">Complications of bronchiectasis <sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-1" title="Bronchiectasis; NICE CKS, March 2024 (UK access only)"><span>1</span></a></sup></h2><ul><li><p>Repeated infection and deteriorating lung function.</p></li><li><p>Empyema.</p></li><li><p><a href="https://patient.info/doctor/lung-abscess" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Lung abscess</a>.</p></li><li><p><a href="https://patient.info/doctor/pneumothorax-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Pneumothorax</a> from repeated coughing.</p></li><li><p>Life-threatening haemoptysis.</p></li><li><p><a href="https://patient.info/doctor/respiratory-failure" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Respiratory failure</a>.</p></li><li><p>Right heart failure secondary to chronic respiratory disease.</p></li><li><p><a href="https://patient.info/doctor/amyloidosis-pro" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P " data-testid="wrapper-link">Amyloidosis</a> (rare).</p></li><li><p>Reduced quality of life - fatigue, embarrassment, anxiety and depression, urinary incontinence caused by cough.</p></li></ul><h2 class="ScrollMargin_anchor__VQzBd" id="prognosis" data-testid="heading-2">Prognosis<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-18" title="Bird K, Memon J; Bronchiectasis. "><span>18</span></a></sup></h2><p>The disease eventually causes respiratory failure in patients. The prognosis can be relatively good if postural drainage is performed regularly, and antibiotics are used judiciously.</p><p>Prognosis is disease severity and co-morbidity dependent and in a tertiary referral centre in the UK, male gender, age, respiratory function and <i>Pseudomonas aeruginosa</i> were all found to be independently associated with mortality.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-19" title="Quint JK, Smith MP; Paediatric and adult bronchiectasis: Diagnosis, disease burden and prognosis. Respirology. 2019 May;24(5):413-422. doi: 10.1111/resp.13495. Epub 2019 Feb 19."><span>19</span></a></sup> There are a number of scoring systems now available that may aid in prognosis</p><ul><li><p>Before antibiotics, death would occur within five years but now, with aggressive therapy, the outcome is much better. However, there continues to be a significant reduction in life expectancy in patients with bronchiectasis.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-9" title="Hill AT, Sullivan AL, Chalmers JD, et al; British Thoracic Society guideline for bronchiectasis in adults. BMJ Open Respir Res. 2018 Dec 28;5(1):e000348. doi: 10.1136/bmjresp-2018-000348. eCollection 2018."><span>9</span></a></sup></p></li><li><p>10% of adults with non-CF bronchiectasis die within 5-8 years of diagnosis, with the cause of death being respiratory in over half of those.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-20" title="King PT, Holdsworth SR, Freezer NJ, et al; Outcome in adult bronchiectasis. COPD. 2005 Mar;2(1):27-34."><span>20</span></a></sup></p></li><li><p>Good nutrition to maintain an ideal body weight and regular vaccination correlate with improved survival.<sup class="Body_reference__h__Rq" data-testid="body-reference"><a class=" Body_professionals__iDFsA " href="https://patient.info/doctor/bronchiectasis-pro#ref-21" title="Onen ZP, Gulbay BE, Sen E, et al; Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med. 2007 Jul;101(7):1390-7. Epub 2007 Mar 19."><span>21</span></a></sup></p></li></ul></div></div><div class="FurtherReading_furtherreading__rzIRH"><div class="Accordion_accordion-empty__ihyBX undefined" role="region"><div role="button" tabindex="0" class="Accordion_accordion-header__YUsYL"><h3 data-testid="furtherReading_header">Further reading and references</h3><div class="Accordion_accordion-icon__VMjnF"><svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M268 683q-11-11-11-28t11-28l184-184q6-6 13-8.5t15-2.5q8 0 15 2.5t13 8.5l185 185q11 11 11 27t-12 28q-11 11-28 11t-28-11L480 527 323 684q-11 11-27 11t-28-12Z"></path></svg></div></div><div class="Accordion_accordion-content__n7Fz_"><div class="FurtherReading_furtherreading-content__7yw9j FurtherReading_furtherreading-content-professionals__4Tg5J"><div class=" Markup_markup__hjGOW FurtherReading_markup__LrR_5 " data-testid="markup"><ul><li><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=33822364" target="_blank" rel="noreferrer" data-testid="furtherReading_url">Lee AL, Gordon CS, Osadnik CR<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="furtherReading_text">; Exercise training for bronchiectasis. Cochrane Database Syst Rev. 2021 Apr 6;4(4):CD013110. doi: 10.1002/14651858.CD013110.pub2.</span></li></ul><ol data-testid="further-reading-references"><li class="ScrollMargin_anchor__VQzBd" id="ref-1" data-testid="further-reading-reference-item"><a href="https://cks.nice.org.uk/topics/bronchiectasis/" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Bronchiectasis<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; NICE CKS, March 2024 (UK access only)</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-2" data-testid="further-reading-reference-item"><a href="http://thorax.bmj.com/content/67/Suppl_2/A138.1" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Quint JK, Millett E, Hurst JR, Smeeth L, Brown J<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Time trends in incidence and prevalence of bronchiectasis in the UK. Thorax. 2012;67:A138 doi:10.1136/thoraxjnl-2012-202678.233 </span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-3" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=20303725" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Roberts HJ, Hubbard R<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Trends in bronchiectasis mortality in England and Wales. Respir Med. 2010 Jul;104(7):981-5. doi: 10.1016/j.rmed.2010.02.022. Epub 2010 Mar 19.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-4" data-testid="further-reading-reference-item"><a href="https://www.brit-thoracic.org.uk/document-library/guidelines/bronchiectasis/bts-guideline-for-non-cf-bronchiectasis/" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Guideline for non-CF Bronchiectasis<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; British Thoracic Society (July 2010)</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-5" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=18842914" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">O'Donnell AE<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Bronchiectasis. Chest. 2008 Oct;134(4):815-23.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-6" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=16650970" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">King PT, Holdsworth SR, Freezer NJ, et al<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med. 2006 Dec;100(12):2183-9. Epub 2006 May 2.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-7" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=19435127" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Murray MP, Hill AT<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Non-cystic fibrosis bronchiectasis. Clin Med. 2009 Apr;9(2):164-9.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-8" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=20630967" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">ten Hacken NH, van der Molen T<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Bronchiectasis. BMJ. 2010 Jul 14;341:c2766. doi: 10.1136/bmj.c2766.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-9" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=30687502" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Hill AT, Sullivan AL, Chalmers JD, et al<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; British Thoracic Society guideline for bronchiectasis in adults. BMJ Open Respir Res. 2018 Dec 28;5(1):e000348. doi: 10.1136/bmjresp-2018-000348. eCollection 2018.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-10" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=17634184" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Bush A, Chodhari R, Collins N, et al<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Primary ciliary dyskinesia: current state of the art. Arch Dis Child. 2007 Dec;92(12):1136-40. Epub 2007 Jul 18.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-11" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=17636836" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Chang CC, Morris PS, Chang AB<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Influenza vaccine for children and adults with bronchiectasis. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006218.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-12" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=19370631" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Chang CC, Singleton RJ, Morris PS, et al<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Pneumococcal vaccines for children and adults with bronchiectasis. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006316.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-13" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=28952156" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Lee AL, Burge AT, Holland AE<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Positive expiratory pressure therapy versus other airway clearance techniques for bronchiectasis. Cochrane Database Syst Rev. 2017 Sep 27;9(9):CD011699. doi: 10.1002/14651858.CD011699.pub2.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-14" data-testid="further-reading-reference-item"><a href="https://www.nice.org.uk/guidance/ng117" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; NICE Guidance (December 2018).</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-15" data-testid="further-reading-reference-item"><a href="https://www.gov.uk/drug-safety-update/fluoroquinolone-antibiotics-new-restrictions-and-precautions-for-use-due-to-very-rare-reports-of-disabling-and-potentially-long-lasting-or-irreversible-side-effects" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; MHRA, March 2019.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-16" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=22365413" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">De Dominicis F, Andrejak C, Monconduit J, et al<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; [Surgery for bronchiectasis]. Rev Pneumol Clin. 2012 Apr;68(2):91-100. doi: 10.1016/j.pneumo.2012.01.007. Epub 2012 Feb 24.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-17" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=25715965" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Magis-Escurra C, Reijers MH<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Bronchiectasis. BMJ Clin Evid. 2015 Feb 25;2015:1507.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-18" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=28613561" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Bird K, Memon J<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Bronchiectasis. </span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-19" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=30779274" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Quint JK, Smith MP<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Paediatric and adult bronchiectasis: Diagnosis, disease burden and prognosis. Respirology. 2019 May;24(5):413-422. doi: 10.1111/resp.13495. Epub 2019 Feb 19.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-20" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=17136958" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">King PT, Holdsworth SR, Freezer NJ, et al<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Outcome in adult bronchiectasis. COPD. 2005 Mar;2(1):27-34.</span></li><li class="ScrollMargin_anchor__VQzBd" id="ref-21" data-testid="further-reading-reference-item"><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=17374480" target="_blank" rel="noreferrer" data-testid="further-reading-reference-link">Onen ZP, Gulbay BE, Sen E, et al<svg xmlns="http://www.w3.org/2000/svg" height="24" width="24" viewBox="0 96 960 960"><path d="M200 936q-33 0-56.5-23.5T120 856V296q0-33 23.5-56.5T200 216h240q17 0 28.5 11.5T480 256q0 17-11.5 28.5T440 296H200v560h560V616q0-17 11.5-28.5T800 576q17 0 28.5 11.5T840 616v240q0 33-23.5 56.5T760 936H200Zm160-240q-11-11-11-28t11-28l344-344H600q-17 0-28.5-11.5T560 256q0-17 11.5-28.5T600 216h200q17 0 28.5 11.5T840 256v200q0 17-11.5 28.5T800 496q-17 0-28.5-11.5T760 456V352L415 697q-11 11-27 11t-28-12Z"></path></svg></a><span data-testid="further-reading-reference-text">; Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med. 2007 Jul;101(7):1390-7. Epub 2007 Mar 19.</span></li></ol></div></div></div></div></div><div class=" Markup_markup__hjGOW ArticleHistory_articlehistory__L8Zqh " data-testid="markup"><h2>Article history</h2><p class="ArticleHistory_articlehistory-desc__2QL_N" data-testid="article-history-desc">The information on this page is written and peer reviewed by qualified clinicians.</p><div class="ArticleHistory_reviewdate__K36Xw" data-testid="article-history-data"><ul><li class="ArticleHistory_reviewlist__h0dfS " data-testid="review-due"><div class="ArticleHistory_dotted__8aA5T"><h6 data-testid="review-due-date">Next review due: 26 Jun 2027</h6></div></li><li class=""><h6 class="ArticleHistory_date__QGJMl" data-testid="last-updated-date">27 Jun 2024 <span class="ArticleHistory_date-desc__zu5gX">| Latest version</span></h6><div class="ArticleHistory_noborder__NFsQ5" data-testid="last-updated-content"><p class="ArticleHistory_updateby__j5fGu">Last updated by</p><a href="https://patient.info/authors/dr-hayley-willacy" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P Link_link-large__FTF3Z " data-testid="updated-by-link">Dr Hayley Willacy, FRCGP </a><p class="ArticleHistory_reviewby__7adYK">Peer reviewed by</p><a href="https://patient.info/authors/dr-colin-tidy" class="Link_linkcontainer__NFFuY Link_link-professionals__uur2P Link_link-large__FTF3Z " data-testid="review-by-link">Dr Colin Tidy, MRCGP</a></div></li></ul></div></div><div role="button" tabindex="0" class="SymptomCheckerUpsell_wrapper___fk52" data-testid="fluchecker-wrapper"><img alt="flu eligibility checker" data-testid="fluchecker-image" loading="lazy" decoding="async" data-nimg="fill" class="SymptomCheckerUpsell_image__NqI8N" style="position:absolute;height:100%;width:100%;left:0;top:0;right:0;bottom:0;color:transparent" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fimages.ctfassets.net%2Fxxv4b9mbhlgd%2F6Ldah2APk3TFdA2GmCfTgk%2Fcb9eec6573b0ed3376e53aa0f5bdb5aa%2FMobile.png&w=640&q=75 640w, 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Read online advice about Bronchiectasis"},"relatedPil":{"__typename":"PagePatientInformationLeaflet","title":"Bronchiectasis","slug":"/chest-lungs/bronchiectasis-leaflet"},"secondaryTopicsCollection":{"__typename":"PagePatientProfessionalArticleSecondaryTopicsCollection","items":[{"__typename":"TopicCategory","displayName":"Respiratory medicine"}]},"furtherReadingCollection":{"__typename":"PagePatientProfessionalArticleFurtherReadingCollection","items":[{"__typename":"TopicReferences","referenceText":"Lee AL, Gordon CS, Osadnik CR; Exercise training for bronchiectasis. Cochrane Database Syst Rev. 2021 Apr 6;4(4):CD013110. doi: 10.1002/14651858.CD013110.pub2.","url":"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve\u0026db=PubMed\u0026dopt=Abstract\u0026list_uids=33822364"}]},"body":{"json":{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"What is bronchiectasis?","nodeType":"text"}],"nodeType":"heading-2"},{"data":{},"content":[{"data":{},"marks":[],"value":"Bronchiectasis is a permanent dilatation and thickening of the airways, characterised by chronic cough, excessive sputum production, bacterial colonisation, and recurrent acute infections.","nodeType":"text"},{"data":{"target":{"sys":{"id":"ref_64869","type":"Link","linkType":"Entry"}}},"content":[],"nodeType":"embedded-entry-inline"},{"data":{},"marks":[],"value":" It may be widespread throughout the lungs (diffuse) or more localised (focal). It is caused by chronic inflammation of the airways, and is associated with, or caused by, a large number of diseases. It may develop after lung infections, particularly in childhood and in association with underlying problems, such as immunodeficiency and cystic fibrosis.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"Bronchiectasis can be classified into the following forms morphologically (all three forms may be present in the same patient):","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Cylindrical bronchiectasis: bronchi are enlarged and cylindrical.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Varicose bronchiectasis: bronchi are irregular with areas of dilatation and constriction.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Saccular or cystic: dilated bronchi form clusters of cysts. This is the most severe form of bronchiectasis and is often found in patients with cystic fibrosis.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"unordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"The affected airways are inflamed and easily collapse. There is an impairment of airflow and drainage of secretions, leading to the accumulation of a large amount of mucus in the lungs. The mucus collects bacteria, predisposing to frequent and often severe lower respiratory tract infections. The severity of bronchiectasis used to be classified according to the volume of sputum produced but this has now largely been superseded by using the radiological appearance on CT scan.","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"marks":[],"value":"How common is bronchiectasis? ","nodeType":"text"},{"data":{},"marks":[],"value":"(Epidemiology) ","nodeType":"text"}],"nodeType":"heading-2"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"A large study across 640 general practices in the UK published in 2012 found:","nodeType":"text"},{"data":{"target":{"sys":{"id":"ref_36028","type":"Link","linkType":"Entry"}}},"content":[],"nodeType":"embedded-entry-inline"},{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"},{"data":{},"content":[{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Prevalence in 2011 in men was 227/100,000, and 309/100,000 in women.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Incidence increased each year between 2004 and 2011, from 18/100,000 person-years at risk, to 32/100,000 person-years at risk.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Prevalence was higher in women than in men.","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Prevalence was higher in the older age groups (\u003e60 years).","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"unordered-list"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"It is estimated that around 1,000 people die each year from bronchiectasis in England and Wales.","nodeType":"text"},{"data":{"target":{"sys":{"id":"ref_36027","type":"Link","linkType":"Entry"}}},"content":[],"nodeType":"embedded-entry-inline"},{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"The incidence varies between populations from 3.7/100,000 children in New Zealand to 52/100,000 adults in the USA. Features of bronchiectasis found in CXRs in the UK in the 1950s suggested a prevalence of 100/100,000.","nodeType":"text"},{"data":{"target":{"sys":{"id":"ref_1507","type":"Link","linkType":"Entry"}}},"content":[],"nodeType":"embedded-entry-inline"},{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"},{"data":{},"content":[{"data":{},"content":[{"data":{},"marks":[],"value":"Bronchiectasis can present at any age but increases with age and the highest prevalence is in older women.","nodeType":"text"},{"data":{"target":{"sys":{"id":"ref_28196","type":"Link","linkType":"Entry"}}},"content":[],"nodeType":"embedded-entry-inline"},{"data":{},"marks":[],"value":". Up to 70% of cases may be in women ","nodeType":"text"},{"data":{"target":{"sys":{"id":"ref_64869","type":"Link","linkType":"Entry"}}},"content":[],"nodeType":"embedded-entry-inline"},{"data":{},"marks":[],"value":"","nodeType":"text"},{"data":{"target":{"sys":{"id":"ref_36029","type":"Link","linkType":"Entry"}}},"content":[],"nodeType":"embedded-entry-inline"},{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"paragraph"}],"nodeType":"list-item"}],"nodeType":"unordered-list"},{"data":{},"content":[{"data":{},"marks":[],"value":"Causes of bronchiectasis ","nodeType":"text"},{"data":{},"marks":[],"value":"(aetiology) ","nodeType":"text"},{"data":{"target":{"sys":{"id":"ref_64869","type":"Link","linkType":"Entry"}}},"content":[],"nodeType":"embedded-entry-inline"},{"data":{},"marks":[],"value":" ","nodeType":"text"},{"data":{"target":{"sys":{"id":"ref_13384","type":"Link","linkType":"Entry"}}},"content":[],"nodeType":"embedded-entry-inline"},{"data":{},"marks":[],"value":"","nodeType":"text"}],"nodeType":"heading-2"},{"data":{},"content":[{"data":{},"marks":[],"value":"The disease is caused by chronic inflammation of the airways. It may therefore be caused by a large number of disorders which cause inflammation and infection, particularly conditions that facilitate infections, which therefore tend to be recurrent and more severe and so cause damage to the lungs. Up to 42% of cases develop post-infection. 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