About This Page
This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
Key points
- Permanent bronchial dilatation diagnosed on high-resolution CT (HRCT) — signet ring sign
- Chronic productive cough with daily purulent sputum is the hallmark
- Causes: post-infective (most common in UK), cystic fibrosis, immune deficiency, ABPA, ciliary dyskinesia, rheumatoid, IBD
- Management: airway clearance physiotherapy (cornerstone), prompt antibiotics for exacerbations, sputum surveillance for Pseudomonas
- NICE NG117: first-line antibiotic for acute exacerbation is amoxicillin 500 mg TDS for 7–14 days (or clarithromycin if penicillin-allergic)
Overview
Bronchiectasis is permanent abnormal dilatation of the bronchi resulting from a vicious cycle of chronic infection, inflammation, and structural airway damage. The dilated airways have impaired mucociliary clearance, leading to mucus pooling, bacterial colonisation, and recurrent infections that cause further airway damage. The condition is classified morphologically as cylindrical (most common), varicose, or cystic (most severe) on HRCT. Causes include post-infective (childhood pneumonia, TB, whooping cough), cystic fibrosis, primary ciliary dyskinesia, immune deficiency (hypogammaglobulinaemia), ABPA, and autoimmune conditions (RA, IBD). In up to 50% of cases, no cause is identified (idiopathic).
Epidemiology
Prevalence in the UK is estimated at 500–1,000 per 100,000, increasing with age. It is more common in women and in those with pre-existing lung disease. The most common identifiable cause in the UK is post-infective, though the proportion of idiopathic cases is substantial. Haemophilus influenzae is the most frequently isolated organism; Pseudomonas aeruginosa colonisation occurs in ~25% and is associated with more rapid decline in lung function and worse prognosis.
Clinical Features
Symptoms
Chronic productive cough — daily purulent sputum (often large volume)
Recurrent respiratory infections — ≥3 exacerbations per year is significant
Haemoptysis — from bronchial artery hypertrophy; occasionally massive
Breathlessness on exertion
Fatigue and reduced exercise tolerance
Signs
Coarse crackles on auscultation (typically in affected lobes — often bilateral lower zones)
Wheeze (may coexist with airflow obstruction)
Finger clubbing (in advanced disease)
Signs of cor pulmonale in end-stage disease (peripheral oedema, raised JVP)
Investigations
First-line
High-resolution CT (HRCT) thoraxDiagnostic gold standard — shows bronchial dilatation (signet ring sign = dilated bronchus larger than adjacent artery), lack of tapering, mucus plugging
Sputum cultureBaseline and during exacerbations — identifies colonising organisms, particularly Pseudomonas aeruginosa
SpirometryTypically obstructive pattern; may show mixed obstructive-restrictive in advanced disease
Second-line
Immunoglobulins (IgG, IgA, IgM)Screen for immunodeficiency — hypogammaglobulinaemia is a treatable cause
Total IgE and Aspergillus-specific IgE/IgGScreen for ABPA — an important treatable cause
CF screening (sweat test/genotyping)Consider in younger patients or those with upper lobe disease, male infertility, pancreatic insufficiency
Specialist
Nasal NO or ciliary brush biopsyFor suspected primary ciliary dyskinesia (situs inversus, chronic sinusitis, recurrent otitis media)
CT abdomenIf situs inversus present (Kartagener syndrome — a subtype of primary ciliary dyskinesia)
1
Airway clearance (cornerstone of management)
- Chest physiotherapy: active cycle of breathing technique (ACBT), oscillating PEP devices (Flutter, Acapella)
- All patients should be taught by a respiratory physiotherapist
- Perform at least once daily; increase during exacerbations
- Pulmonary rehabilitation for patients with exercise limitation
2
Acute exacerbation antibiotics
- First-line: amoxicillin 500 mg TDS for 7–14 days (NICE NG117)
- Penicillin allergy: clarithromycin 500 mg BD or doxycycline 200 mg then 100 mg OD
- If Pseudomonas colonised: ciprofloxacin 500–750 mg BD for 14 days (oral) or IV anti-pseudomonal antibiotics if severe
- Send sputum culture before/during exacerbation and adjust antibiotics accordingly
3
Long-term management
- Influenza and pneumococcal vaccination
- Mucoactive agents: nebulised hypertonic saline (6–7%) or carbocisteine for viscid sputum
- Long-term prophylactic antibiotics (azithromycin 250 mg 3×/week) if ≥3 exacerbations/year — check baseline LFTs and ECG (QTc)
- Pseudomonas eradication: seek specialist advice — typically nebulised colistin or tobramycin after initial IV course
- Treat underlying cause: immunoglobulin replacement, CF therapies, steroids/antifungals for ABPA
4
Massive haemoptysis
- Medical emergency — resuscitate with ABC approach, lie patient on affected side
- Bronchial artery embolisation (interventional radiology) is the primary treatment
- Surgical resection in selected cases
Complications
- Massive haemoptysis: Life-threatening — from hypertrophied bronchial arteries
- Progressive respiratory failure: Worsening airflow obstruction over time
- Pseudomonas colonisation: Associated with worse outcomes — difficult to eradicate
- ABPA: Allergic response to Aspergillus causing worsening bronchiectasis — treat with steroids + itraconazole
- Amyloidosis: Rare complication of chronic inflammation
UKMLA Exam Tips
- 1HRCT showing signet ring sign = bronchiectasis (dilated bronchus > adjacent artery)
- 2Daily purulent sputum + coarse crackles + finger clubbing = bronchiectasis
- 3Always investigate for treatable causes: immunoglobulins, Aspergillus serology, CF screen, ciliary function
- 4Pseudomonas colonisation worsens prognosis — needs specialist management
- 5Azithromycin prophylaxis reduces exacerbation frequency but watch for QTc prolongation and hearing loss
- 6Kartagener syndrome = primary ciliary dyskinesia + situs inversus + bronchiectasis + chronic sinusitis
practicetest your knowledge on BronchiectasisApply what you've learnt with UKMLA-style questions from the iatroX Q-Bank — Respiratory and beyond.
open q-bank regional clinical guidance
Bronchiectasis: guidance by region
Recommendations, thresholds and pathways can differ. Open the page written for the jurisdiction you need.