Reviews for patients with bronchiectasis
This page will help you to deliver an effective annual review to your patient with bronchiectasis in primary care.
This is not a substitute for completing an appropriate respiratory assessment module. For advice and support on choosing the right course for you, please see our training and development page.
Effective respiratory reviews are shown to improve outcomes for patients. Patients with bronchiectasis should be reviewed:
- yearly, and
- following an exacerbation.
The annual review is essential for helping your patient manage their condition and identify any issues that are emerging, and which have the potential to worsen their condition.
The guide below gives you some ideas about the questions you can ask during an annual review. You can use your patient’s answers to update their self-management plan.
| Ask your patient | Why this question matters |
|---|---|
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How are you getting on with your bronchiectasis? Do you understand your diagnosis?
|
his gives your patient the opportunity to share the impact bronchiectasis is having on their activities of daily living and any ideas, concerns and expectations they have for the review appointment and their ongoing treatment . This will also help you identify any new or increased difficulties or symptoms or which can be addressed. Listening with compassion and respect helps to build the therapeutic relationship with your patient This is essential for motivating them to become involved with and take ownership of their care, which will improve their outcome. Send your patient a link to our bronchiectasis health advice pages and our Living with Bronchiectasis leaflet |
|
Have you had any exacerbations/flare ups since your last review? Have you used your rescue pack? (if applicable) |
Repeated exacerbations are associated with worse patient outcomes and many exacerbations go unreported. Understanding the number of exacerbations you patient has provides an opportunity to:
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How are you getting on with your airway clearance exercises? Are they effective? How often do you do them? |
Asking this question encourages your patient to be open about their mental health. People with chronic respiratory conditions are more likely to experience anxiety and/or depression than people without and tend to have worse outcomes if they do. Refer to the patient’s GP for further assessment, or to local mental health services. They can also join one of A+LUK’s support groups, so that they can understand more about their condition and meet other people living with a lung condition. |
|
What medications are you currently taking? Are they working well for you? Are you having any side effects? |
Understanding what your patient is actually taking and how it is helpful or unhelpful will guide you to optimisng their medications. |
|
Can you show me how you use your inhaler? How often are you using your reliever inhaler? |
If your patient is using inhaled medication, ensure that they are able to use their inhaler device, understand when to use it and is taking it as prescribed. |
| Do you smoke or vape at all? |
Non-judgemental questioning makes sure that your patient can be honest and not feel ashamed or guilty about smoking, especially if they have relapsed. Offering smoking cessation advice should be offered at every contact in case this is the right moment for your patient to quit. |
|
Tell me about your cough. Do you ever avoid activities because of your cough? Does it affect your sleep? Do you ever leak wee or poo when you cough? |
Encourage your patient to talk about how their cough affects their everyday life. The Let’s Talk About Cough website has a wealth of resources for patients to learn strategies to manage their cough. Cough incontinence is often under reported in bronchiectasis and can be highly distressing for patients. Your patient may not raise this with you so you should ensure that you ask if this is a problem for them. You can refer them to your local continence service. |
|
How often are you coughing up sputum? How much? What colour is it? Is it ever bloody?
.
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Understanding your patient’s sputum production and the effect is having on their life enables you to:
You should send a sputum sample yearly as well as during an exacerbation monitor airway colonisation and guide treatment. |
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Can I tell you about something I think you’ll really benefit from – it’s called pulmonary rehabilitation.
|
Offer pulmonary rehab even if they have previously declined. You can also make them aware of our Keeping Active programme |
| Have you had all the vaccinations that you need? | Use this opportunity to talk through any worries or concerns your patient might have about vaccinations and give missed vaccines for flu, RSV, COVID and pneumonia opportunistically. |
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Do you have any concerns around money?
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Your patient may not be aware of the benefits that are available to them, including winter fuel payments and attendance allowance. |
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How’s everything at home? Are you managing cooking/cleaning/shopping/washing etc?
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To identify if they have any care needs due to change in their physical condition. Refer to social prescriber if necessary.
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Physical assessment
Identify any comorbidities and complications by doing the following:
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Record their mMRC score Check heart rate and rhythm, blood pressure and assess nutritional status Check for peripheral oedema |
To measure changes in breathlessness and health status since their last review. To identify any comorbidities such as hypertension, atrial fibrilation, cor pulmonale, or malnutrition. |
| Check oxygen saturations | To identify early signs of respiratory failure |
| Check their vitamin D levels | Low vitamin D is associated with more frequent exacerbations |
Consider referring your patient back to the specialist team in secondary care if
- you feel that they are deteriorating
- they have had 3 or more exacerbations in a 12 month period
- have symptoms that are not improving with repeated courses of oral antibiotics, or
- have bacteria in their sputum that are resistant to the available oral antibiotics.
Review your patient’s self-management plan, and make sure they know what to do if they become unwell again.