Clinical Examination

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Clinical Examination 2017-04-27T04:43:50+00:00

 A comprehensive medical history taken by GP or respiratory physician.

Subjective assessment:

History of childhood infection or childhood respiratory symptoms

Family history of bronchiectasis, especially cystic fibrosis

Smoking history

Presence of symptoms to suggest a systemic inflammatory disorder (joint problems, skin rash, muscle pain)

Duration and severity of symptoms

Frequency of infective exacerbations

Objective clinical examination:

Peripheral examination for signs of chronic lung disease e.g nail changes (clubbing) occur in some forms of bronchiectasis

Cough quality, strength and sputum production

Signs to suggest a systemic inflammatory disorder (joints, skin, muscles, eyes)

Listening to the chest. Bronchiectasis is characterised by focal or generalised noises (crepitations, wheeze) heard with the stethoscope

Assessment of results from:

Radiology – HRCT and Chest X-Ray

Lung Function – including spirometry +/- TLCO. gas transfer factor

Sputum Pathology – surveillance of sputum MCS should be considered every 3 to 6 months to guide future antibiotic therapy in the event of an exacerbation.

Blood gas analysis, if required – peripheral venous blood gas analysis is less invasive than arterial blood gases (ABG) and provides clinically important information to assess acutely unwell patients (TSANZ Oxygen Guidelines 2015). ABG’s should be considered in the following situations:

  • Critically ill patient with cardiorespiratory or metabolic dysfunction
  • In patients with SpO2 < 92% in whom hypoxaemia may be present
  • Deteriorating oxygen saturation requiring increases FiO2
  • Patients at risk of hypercapnia
  • Breathless patients in whom a reliable oximetry signal cannot be obtained

(TSANZ Oxygen Guidelines 2015)