Respiratory[autotexts]

Bronchiectasis / Test explainer

Bronchiectasis tests - what we are looking for

The baseline aetiology bundle, in two versions: the list for the request form and the explanation for the patient.

Paste block 2 fields 
Baseline investigation of newly diagnosed bronchiectasis.

Everyone:
Full blood count with differential white cell count
Serum immunoglobulins G, A and M
Serum electrophoresis
Total IgE, and specific IgE or skin prick testing to Aspergillus fumigatus
Aspergillus IgG (precipitins)
Sputum culture for bacteria, including specific request for Pseudomonas
Sputum culture for mycobacteria, including non-tuberculous mycobacteria
Sputum for fungal culture
CRP
Spirometry with reversibility

Guided by the history and the pattern on CT:
Specific antibody responses to pneumococcal capsular polysaccharide, with
post-immunisation levels if baseline is low
Rheumatoid factor, anti-CCP antibodies, ANA and ANCA
Alpha-1 antitrypsin level
Cystic fibrosis testing: sweat test and CFTR genetics
Testing for primary ciliary dyskinesia: nasal nitric oxide, then referral to a
diagnostic centre
HIV testing
Assessment of aspiration and reflux
Bronchoscopy if the disease is focal, to exclude an obstructing lesion

Findings so far: []

Cause identified: [], or no cause identified after full assessment.

Variants

For the patient

The same bundle, written to go into the clinic letter so that someone handed six blood forms knows what each one is for.

For the patient no fields 
About the tests we have arranged

Bronchiectasis is a description of what your airways look like, not a cause
in itself. Something damaged them, and in around half of people we can find
out what. It is worth looking, because a few of the causes have specific
treatments, and finding one can change what we do next.

The blood tests look for:

- problems with the immune system, particularly low levels of antibodies,
  which can be treated with replacement antibody
- an allergic reaction to a common mould called aspergillus, which is
  treated with steroids and antifungal medicine
- conditions such as rheumatoid arthritis, which are associated with
  bronchiectasis
- inherited conditions, including cystic fibrosis and a protein deficiency
  called alpha-1 antitrypsin deficiency.

The sputum tests look for the bacteria living in your airways, so that if
you need antibiotics we can choose one that will work. We also test
specifically for a group of bacteria related to tuberculosis, called
non-tuberculous mycobacteria. These are common in soil and water and are
usually harmless, but they can settle in damaged airways, and if they are
present they change which treatments are safe to use. This test is slow: the
bacteria grow very slowly in the laboratory, and it can take up to eight
weeks for a final result.

The breathing tests measure how much your airways are affected, and give us
a number to compare with in future.

In many people, no single cause is ever found. That is a common result
rather than a failure of the tests, and it does not change how well the
condition can be managed.

How to use it

Angshu's original bronchiectasis block ended with a note hoping someone would improve it, so this is that attempt: the management advice is now its own patient-facing block, and this one covers the investigation the guidelines put at the front of the pathway. The everyone list is the minimum bundle recommended for every newly diagnosed adult; the second list is what a history or a CT pattern should prompt. Two practical points earn their place in the patient version — that a cause is found in only about half of people, and that mycobacterial cultures take weeks — because both otherwise generate an anxious phone call.

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.

Use with