Clinical features of bronchiectasis
Most patients with bronchiectasis have a chronic productive cough and recurrent bronchial infection; the sputum is usually purulent and may be intermittently bloodstained. Other symptoms of bronchiectasis may include fatigue, breathlessness and pleuritic chest pain. Coarse crackles are commonly heard on chest auscultation. A small proportion of patients (less than 5%) have clubbing of the fingers.
Always consider bronchiectasis in patients presenting with coarse crackles, chronic productive cough and recurrent or difficult-to-treat chest infections. Also consider bronchiectasis if Pseudomonas aeruginosa or Haemophilus influenzae is found on sputum culture.
Some patients present with life-threatening haemoptysis requiring urgent hospitalisation.
Bronchial dilatation in bronchiectasis is potentially reversible in children with early diagnosis and intervention. Promptly refer children with suspected bronchiectasis to a paediatric specialist for assessment; see Indications for paediatric referral for investigation of bronchiectasis for clinical features suggestive of bronchiectasis in children.
Refer to a paediatric specialist for investigation of bronchiectasis if a child has any of the following:
- clinical features suggestive of bronchiectasis, including children with
- recurrent episodes of chronic productive (wet or moist) cough, with each episode lasting for more than 4 weeks
- clubbing
- hyperinflation or chest wall deformity
- persistent auscultatory findings (eg crackles)
- productive (wet or moist) cough persisting for more than 4 weeks despite appropriate antibiotics
- recurrent pneumonia or recurrent hospitalisations for lower respiratory tract infections
- persistent parenchymal changes on X-ray over time.