Importance of a diagnosis

The importance of a correct diagnosis

Getting the right diagnosis is crucial.  Failing to get the right diagnosis may lead to inappropriate  increases in the doses of corticosteroids and bronchodilators ie COPD / asthma directed therapies, which may be harmful.

The symptoms and signs of bronchiectasis are not diagnostic and may be mild in the early stages of the illness. Shortness of breath, chest discomfort, cough and sputum production are non-specific symptoms that frequently occur in asthma, bronchitis, COPD and even interstitial lung disease.

Consider bronchiectasis in a child with:

A chronic wet cough (lasting longer than six weeks)

Wheeze that does not respond to treatment

Partial resolution of severe pneumonia or recurrent pneumonia

Persistent lung crackles

Persistent x-ray changes

Respiratory symptoms with structural or functional disorders of the oesophagus and upper respiratory tract

Consider bronchiectasis in an adult with:

A chronic productive cough (particularly if there is no history of smoking)

Recurrent lower respiratory tract infections (particularly with slow recovery)

Unexplained haemoptysis

Bronchiectasis should be considered in patients being treated for COPD when:

management is complicated

there is slow recovery from lower respiratory tract infections

there are frequent exacerbations

there is no history of smoking

sputum is colonised with Pseudomonas aeruginosa

Establishing the correct diagnosis should lead to a meeting with a physiotherapist and respiratory physician to establish a focused action plan including exercise, airway clearance strategies, mucolytics/mucoactives, bronchodilators and strategies for antibiotic maintenance and exacerbation management.

See TSANZ Bronchiectasis Guidelines