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British Thoracic Society Guideline for bronchiectasis in adults
  1. Adam T Hill1,
  2. Anita L Sullivan2,
  3. James D Chalmers3,
  4. Anthony De Soyza4,
  5. J Stuart Elborn5,
  6. R Andres Floto6,7,
  7. Lizzie Grillo8,
  8. Kevin Gruffydd-Jones9,
  9. Alex Harvey10,
  10. Charles S Haworth7,
  11. Edwin Hiscocks11,
  12. John R Hurst12,
  13. Christopher Johnson7,
  14. W Peter Kelleher13,14,15,
  15. Pallavi Bedi16,
  16. Karen Payne17,
  17. Hashem Saleh8,
  18. Nicholas J Screaton18,
  19. Maeve Smith19,
  20. Michael Tunney20,
  21. Deborah Whitters21,
  22. Robert Wilson14,
  23. Michael R Loebinger14
  1. 1Respiratory Medicine, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
  2. 2Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust (Queen Elizabeth Hospital), Birmingham, UK
  3. 3Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital, Dundee, UK
  4. 4Institute of Cellular Medicine, NIHR Biomedical Research Centre for Aging and Freeman Hospital Adult Bronchiectasis service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
  5. 5Royal Brompton Hospital and Imperial College London, and Queens University Belfast
  6. 6Department of Medicine, University of Cambridge, Cambridge UK
  7. 7Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge UK
  8. 8Royal Brompton Hospital, London, UK
  9. 9Box Surgery, Wiltshire, UK
  10. 10Department of Clinical Sciences, Brunel University London, London, UK
  11. 11Coventry, UK
  12. 12UCL Respiratory, University College London, London, UK
  13. 13Centre for Immunology and Vaccinology, Chelsea &Westminster Hospital Campus, Department of Medicine, Imperial College London
  14. 14Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London
  15. 15Chest & Allergy Clinic St Mary’s Hospital, Imperial College Healthcare NHS Trust
  16. 16University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
  17. 17Glenfield Hospital, Leicester, UK
  18. 18Department of Radiology, Royal Papworth Hospital, Cambridge UK
  19. 19University of Alberta, Edmonton, Alberta, Canada
  20. 20School of Pharmacy, Queens University Belfast, Belfast, UK
  21. 21Queen Elizabeth University Hospital, Glasgow, UK
  1. Correspondence to Professor Adam T Hill, Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh and University of Edinburgh, EH16 4SA, UK; adam.hill318{at}

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Summary of recommendations and good practice points

How should the diagnosis of bronchiectasis be determined?

Recommendations – Imaging

  • Perform baseline chest X-ray in patients with suspected bronchiectasis. (D)

  • Perform a thin section computed tomography scan (CT) to confirm a diagnosis of bronchiectasis when clinically suspected. (C)

  • Perform baseline imaging during clinically stable disease as this is optimal for diagnostic and serial comparison purposes. (D)

Good practice points

CT imaging protocol

  • The most appropriate imaging protocol will vary according to scanner technology and patient factors.

  • When using volumetric CT, dose reduction techniques including adaptive mA and kV and iterative reconstruction should be utilised where available.

  • Typical CT imaging parameters for the diagnosis of bronchiectasis are:

    • Slice thickness: ≤1mm

    • Reconstruction algorithm: – high spatial frequency

    • kVp: 100-140

    • mAs (or effective mAs): 100 – 200

    • Gantry rotation time: <0.5s

CT features of bronchiectasis

  • Bronchiectasis is defined by bronchial dilatation as suggested by one or more of the following:

    • Bronchoarterial ratio >1 (internal airway lumen vs adjacent pulmonary artery)

    • Lack of tapering

    • Airway visibility within 1cm of costal pleural surface or touching mediastinal pleura.

  • The following indirect signs are commonly associated with bronchiectasis:

    • Bronchial wall thickening

    • Mucus impaction

    • Mosaic perfusion / air trapping on expiratory CT


  • CT scanning can also aid in identifying an aetiology of bronchiectasis eg Allergic bronchopulmonary aspergillosis (ABPA), Non-tuberculous mycobacteria (NTM), primary ciliary dyskinesia, alpha one antitrypsin deficiency, Williams Campbell syndrome and a foreign body.

In whom should the diagnosis of bronchiectasis be suspected?


  • Consider investigation for bronchiectasis in patients with persistent production of mucopurulent or purulent sputum particularly with relevant associated risk factors. (D)

  • Consider investigation for bronchiectasis in patients with rheumatoid arthritis if they have symptoms of chronic productive cough or recurrent chest infections. (C)

  • Consider investigation for bronchiectasis in patients with Chronic Obstructive Pulmonary Disease (COPD) with frequent exacerbations (two or more annually) and a previous positive sputum culture for P. aeruginosa whilst stable. (B)

  • Consider investigation for bronchiectasis in patients with inflammatory bowel disease and …

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