New bronchiectasis patient

Referred with: []

History:
Duration of cough: []
Daily sputum: [volume, colour when well, colour when unwell]
Blood in the sputum: [never, streaking, or frank, and how often]
Breathlessness, MRC [1 to 5]
Chest pain, fatigue, fevers, weight loss: []
Exacerbations in the last 12 months: [number, and how many needed
intravenous antibiotics or admission]
Antibiotics in the last 12 months: []

Points to a cause:
Childhood pneumonia, whooping cough, measles or tuberculosis: []
Recurrent sinus or ear infection since childhood: []
Infertility or situs inversus: []
Neonatal respiratory distress: []
Rheumatoid arthritis or other connective tissue disease: []
Inflammatory bowel disease: []
Reflux, swallowing difficulty or recurrent aspiration: []
Previous or current asthma, and any history of allergic bronchopulmonary
aspergillosis: []
Smoking and occupational exposure: []
Immunosuppressive treatment, past or present: []
Family history of bronchiectasis, cystic fibrosis or immunodeficiency: []

Current treatment:
Airway clearance: [technique, taught by whom, how often actually done]
Nebulised or inhaled treatment: []
Inhaled corticosteroid, and the indication for it: []
Long-term antibiotic: []
Vaccination: [influenza, pneumococcal, COVID-19]

Examination:
SpO2 []% on air   Height [] cm   Weight [] kg   BMI []
[crackles, wheeze, clubbing, nasal disease]

Investigations:
CT chest: [lobes involved, traction bronchiectasis or cystic change, mucus
plugging, tree-in-bud]
Sputum culture including mycobacteria: []
Spirometry: FEV1 [] L ([]%), FVC [] L, ratio []%
Aetiology screen: [see the bronchiectasis test bundle]

Severity:
Bronchiectasis Severity Index [] or FACED []
Chronic Pseudomonas aeruginosa infection: [yes or no]

Impression:
Bronchiectasis affecting [], with [] exacerbations per year, [chronic
infection with organism or no chronic infection], cause [established or under
investigation].

Plan:
1. Referral to respiratory physiotherapy for airway clearance: []
2. Aetiology screen: [sent, awaited]
3. Sputum for culture and mycobacteria: []
4. Vaccination brought up to date: []
5. Pulmonary rehabilitation if exercise-limited: []
6. Self-management plan and exacerbation antibiotic plan: []
7. Review in [] months with [sputum, spirometry]