CBC, quantitative immunoglobulins, and HIV testing to rule out immunodeficiency
Sputum culture for bacteria, mycobacteria, and fungi; consider BAL
Sweat chloride testing +/- genetic testing to rule out CF
Alpha-1 antitrypsin levels (<11 in deficiency)
Nasal brush/biopsy to rule out ciliary dyskinesia
Imaging
High-resolution CT
Signet-ring sign (airway >1.5x blood vessel) is best sign
Tram-tracking
Other
PFTs
Bronchoscopy
Swallowing assessment to rule out aspiration
Management
Acute Exacerbation
Send sputum cultures every time
Cover empirically with usual pneumonia treatment x 14 days
Add Pseudomonas or MRSA coverage if needed
Consider prednisone if asthma or ABPA
Chronic Management
Chest physiotherapy it most important
Mucous (questionable utility outside of CF)
Hypertonic saline
Mannitol
DNAse/Pulmozyme is BAD outside of CF
Mucomyst
Antiinflammatory
Consider inhaled bronchodilators if responsive
Consider azithromycin 500mg po MWF
Inhaled antimicrobials, if colonozed with Pseudomonas and more than 3 exacerbations annually
Inhaled tobramycin
Inhaled colistin
Possibly inhaled ciprofloxacin
Surgery: resection or transplantation can sometimes be considered
Supportive
Annual flu vaccine
Smoking cessation
Pulmonary rehabilitation
GERD treatment
Further Reading
British Thoracic Society Guideline for bronchiectasis in adults. Thorax. 2019;74:1-69. doi: 10.1136/thoraxjnl-2018-212463
References
^Bethany Milliron, Travis S. Henry, Srihari Veeraraghavan, Brent P. Little. Bronchiectasis: Mechanisms and Imaging Clues of Associated Common and Uncommon Diseases. RadioGraphics. 2015;35(4):1011-1030. doi:10.1148/rg.2015140214.