Health condition · Clinically reviewed
Bronchiectasis, chronic airway dilatation — modern airway clearance and infection control.
Permanent widening of airways with recurrent infection and daily sputum. High-resolution CT confirms diagnosis; airway clearance, targeted antibiotics and immunisation are the mainstays.
Why trust this guide
- 01
Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against NICE, BTS and ERS guidance you can see at the end of this page.
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Current for 2026
Reflects UK guidance on airway clearance, long-term azithromycin and inhaled antibiotic therapy for Pseudomonas.
Key facts
Bronchiectasis at a glance.
The essentials, in plain English — what it is, how it is diagnosed, and how it is treated in the UK today.
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What it is
Permanent, irreversible widening of the bronchi with chronic inflammation, mucus retention and recurrent infection.
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How diagnosed
High-resolution CT (HRCT) of the chest is the diagnostic test — spirometry and sputum culture support management.
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Causes
Post-infectious damage, cystic fibrosis, immunodeficiency, ciliary dyskinesia, autoimmune disease and inhaled foreign body.
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Daily airway clearance
Physiotherapy-taught clearance techniques are central — they reduce sputum burden, infections and exacerbations.
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Pseudomonas colonisation
Once Pseudomonas aeruginosa is isolated, exacerbations rise and prognosis changes — eradication is attempted early.
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Immunisation matters
Annual influenza, up-to-date COVID and pneumococcal vaccination reduce exacerbations and hospital admissions.
Why this guide matters
Modern bronchiectasis care has moved on.
HRCT confirms diagnosis, daily airway clearance changes outcomes, and Pseudomonas is now managed with structured eradication and inhaled antibiotics.
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HRCT decides the diagnosis
A high-resolution CT confirms irreversible airway dilatation — spirometry and X-ray alone are not enough.
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Daily airway clearance is core
The single most important daily habit — reducing sputum load reduces infection and long-term decline.
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Pseudomonas changes the plan
Once isolated, eradication and, if it persists, inhaled antibiotics reduce exacerbations and hospital admissions.
How the diagnosis is made
From first symptoms to a clear plan.
The steps a UK GP or respiratory team will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Spotting the pattern and cultures
Phase 2 · Confirming
HRCT, immunology and cause work-up
Phase 3 · Managing
Specialist plan and long-term care
- 01
Recognising
Symptom and infection history
Chronic daily sputum, repeated chest infections, exertional breathlessness — often over years before diagnosis.
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Recognising
Sputum culture
Identifies the bacteria colonising the airways — Haemophilus, Pseudomonas and non-tuberculous mycobacteria matter most.
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Confirming
HRCT chest — diagnostic
High-resolution CT is the definitive test — shows irreversible bronchial dilatation and lobar distribution.
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Confirming
Immunoglobulins and antibodies
Serum IgG, IgA, IgM plus specific antibody response to pneumococcal vaccination — screens for immunodeficiency.
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Confirming
CF sweat test or genetics
Considered in younger adults or where the pattern suggests cystic fibrosis, especially upper-lobe disease.
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Confirming
Alpha-1 antitrypsin
A blood test to exclude alpha-1 antitrypsin deficiency, particularly with basal emphysema and bronchiectasis.
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Managing
Respiratory consultation
Confirmed bronchiectasis warrants specialist review to set airway clearance, immunisation and antibiotic strategy.
Typical timeline: 4–12 weeks from first tests to a settled specialist plan.
Symptoms
What bronchiectasis actually feels like.
Symptoms build up over years — here is the picture to look for and the signs that mean urgent help.
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Chronic sputum
Daily production of mucopurulent sputum, often in cupfuls — the hallmark symptom.
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Chronic cough
A productive cough most days for months or years — commonly present since childhood.
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Fatigue
Persistent tiredness from chronic infection and inflammation — often improves with airway clearance.
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Haemoptysis
Blood-streaked sputum during exacerbations — small amounts common, massive bleeds are an emergency.
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Breathlessness
On exertion, worsening over time — reflects sputum load and airway obstruction.
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Recurrent chest infections
Three or more infections a year needing antibiotics — a red flag for bronchiectasis.
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Pseudomonas colonisation
Green sputum and slow recovery — Pseudomonas needs targeted eradication and specialist review.
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Massive haemoptysis
Coughing up large volumes of blood — call 999 immediately.
Treatment
How bronchiectasis is treated in the UK.
Daily airway clearance first, targeted antibiotics for infection, immunisation and rehabilitation — what each option does, and where it fits.
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Daily airway clearance
Physiotherapy-taught techniques — active cycle of breathing, oscillating PEP devices — clear sputum and reduce infections.
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Mucoactive drugs
Nebulised hypertonic saline or carbocisteine to thin sputum and make clearance more effective.
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Long-term azithromycin
Three-times-weekly azithromycin reduces exacerbations in selected patients — after mycobacterial infection is excluded.
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Inhaled antibiotic for Pseudomonas
Nebulised colistin, tobramycin or gentamicin for chronic Pseudomonas colonisation — reduces bacterial load and flares.
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Rescue antibiotic packs
A personalised supply of oral antibiotics to start at the first sign of an exacerbation — 14 days is typical.
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Annual immunisation
Influenza, COVID and pneumococcal vaccination — routine for anyone with bronchiectasis.
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Pulmonary rehabilitation
A structured exercise and education programme — improves exercise capacity, breathlessness and quality of life.
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Lung surgery or transplant
Reserved for highly selected patients — localised resection for focal disease, transplant for end-stage disease.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your respiratory team or GP knows your history and can tell you which parts apply to you. If in doubt, ask for a review.
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NICE. Bronchiectasis — assessment and management (BTS-aligned guidance).
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British Thoracic Society. Guideline for bronchiectasis in adults.
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European Respiratory Society. Guidelines for the management of adult bronchiectasis.
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British Lung Foundation (Asthma + Lung UK). Patient information on bronchiectasis.
Red flags
When bronchiectasis becomes an emergency.
Most people live well with the right plan. These are the situations where you should act today.
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Massive haemoptysis
Large-volume coughing of blood is a medical emergency — call 999. Bronchial artery embolisation may be needed.
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New Pseudomonas isolation
A first positive Pseudomonas culture needs prompt eradication — seek specialist advice within days, not weeks.
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Rapid deterioration
Sudden worsening of sputum, breathlessness or oxygen levels — attend urgent care or A&E.
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Cor pulmonale
Ankle swelling, worsening breathlessness and low oxygen suggest right-heart strain — needs specialist review.
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Weight loss
Unintentional weight loss can signal severe disease or a new diagnosis such as mycobacterial infection or cancer.
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Aspergilloma
A fungal ball in a damaged airway — can cause haemoptysis and needs specialist imaging and management.
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Empyema
Pus in the pleural space — presents with fever, chest pain and breathlessness. Needs urgent drainage.
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Immunodeficiency work-up
Recurrent severe infections warrant immunology review — treatable causes must not be missed.
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Post-transplant complications
Anyone with a lung transplant needs urgent specialist review for any new respiratory symptom.
Living with it
A long-term condition, but a very manageable one.
Four things that make the biggest difference day to day — clearance, an action plan, vaccination and regular specialist review.
A quiet reminder
Frequent infections are not something to accept.
If you have three or more infections a year, or your sputum is worsening, ask for a specialist review — treatment can almost always be optimised.
- 01 Clearance
Airway clearance every day
Fifteen to thirty minutes, once or twice a day. A physiotherapist can tailor a technique that fits your life.
- 02 Action plan
Recognise an exacerbation early
More or discoloured sputum, breathlessness or fever — start your rescue antibiotics per your action plan.
- 03 Vaccines
Take the flu and COVID jabs
Both reduce exacerbations and complications — available on the NHS for anyone with bronchiectasis.
- 04 Reviews
Annual specialist review
Sputum cultures, spirometry and technique checks each year — more often if you are colonised with Pseudomonas.
Frequently asked
Everything we get asked about bronchiectasis.
Quick answers on diagnosis, airway clearance, Pseudomonas, long-term antibiotics and when to worry.
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How is bronchiectasis diagnosed?
A high-resolution CT (HRCT) scan of the chest is the definitive test — it shows irreversible widening of the airways. Sputum culture, spirometry and blood tests support management.
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Is bronchiectasis the same as COPD?
No. COPD is chronic airflow obstruction, usually smoking-related. Bronchiectasis is permanent airway dilatation with chronic infection. They can coexist — and management differs.
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Why does daily airway clearance matter?
Retained sputum feeds infection and inflammation, which damages more airway. Daily clearance reduces sputum load, exacerbations, hospital admissions and long-term decline.
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What does Pseudomonas colonisation mean?
Chronic infection with Pseudomonas aeruginosa is linked to more exacerbations and faster decline. Early eradication is attempted; if it persists, inhaled antibiotics reduce flares.
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Do I need long-term antibiotics?
Some people do — three-times-weekly azithromycin reduces exacerbations in selected patients. Mycobacterial infection must be excluded first because azithromycin alone can breed resistance.
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When should I call 999?
Coughing up large volumes of blood, severe breathlessness, blue lips, chest pain or drowsiness. Massive haemoptysis is a genuine emergency.