Respiratory[autotexts]

Bronchiectasis / Patient information

Bronchiectasis exacerbation plan

The written plan the patient keeps: what counts as an exacerbation, which antibiotic, for how long, and when 14 days is not enough.

Paste block 6 fields 
Your plan for chest infections

What counts as an infection needing treatment

A change from your usual state, lasting more than 48 hours, with any of:

- more phlegm than usual, or thicker phlegm
- phlegm that has changed colour
- more coughing
- more breathlessness
- feeling unwell, feverish or unusually tired
- coughing up blood.

What to do

1. Send a sputum sample before you start antibiotics. You have been given pots
for this. Even if you have already started, still send one.

2. Increase your airway clearance. Do it more often than usual - three or four
times a day if you can manage it - and for longer. This is as important as the
antibiotic.

3. Start your antibiotic:

First choice: [] [] mg [] times a day for 14 days.
If you are allergic to it, or it has not worked before: [] [] mg [] times a
day for 14 days.

Take the full 14 days. Courses of 5 or 7 days often leave the infection
smouldering, and it comes back within a few weeks.

4. Drink plenty of fluid, and rest.

5. Tell your GP practice or the respiratory team that you have started the
plan.

If you are not improving

Contact us if you are no better after 5 to 7 days of antibiotics, or if you get
worse at any point. You may need a different antibiotic based on your sputum
result, or treatment through a drip.

Get help urgently, or call 999, if you are severely breathless, have chest pain,
are coughing up a large amount of blood, are confused or drowsy, or cannot keep
fluids down.

How often is too often

If you are needing this plan three or more times a year, please ask for a
review rather than simply repeating it. Frequent infections mean there is more
we should be doing - which may be a change in your clearance regime, a
long-term antibiotic, or treatment aimed at a specific organism in your
sputum.

How to use it

Fourteen days is the number that most often gets shortened by someone unfamiliar with bronchiectasis, so it appears three times in the block. The sputum-before-antibiotics instruction is first for the same reason it is first in the guideline: it is the only step that becomes impossible once treatment starts. The last section exists so that a self-management plan does not quietly substitute for escalation — three exacerbations a year is the threshold at which long-term macrolide or inhaled antibiotic treatment should be considered, and the patient is the person best placed to notice they have hit it.

Why it says that

None of this is in the copied text. It is here so you can check the block against its source, and change it when the source changes.

Trials behind it

  • ASPEN 2025 Brensocatib cut exacerbations by about 20% — the first drug licensed specifically for bronchiectasis
  • PROMIS 2024 Inhaled colistimethate reduced exacerbations in one trial and not in its replicate
  • BAT 2013 Maintenance azithromycin roughly halved the proportion of patients having any exacerbation
  • BLESS 2013 Erythromycin modestly cut exacerbations, including in Pseudomonas-infected patients, at the cost of increased macrolide resistance
  • EMBRACE 2012 Azithromycin cut exacerbations by 62% without improving lung function or quality of life

Records on respiratorytrials.org.

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