The injury can be localized to limited parts of the lungs, or it can involve the lungs diffusely. The airway injury in bronchiectasis can lead to:

	Trouble clearing sputum (phlegm) from the chest, and excessive amounts of phlegm.
	Chronic or recurrent infection in the affected bronchial tubes.
	Inflammation (a reaction to repeated or chronic irritation and infection) in the bronchial tubes, which can lead to further damage.
	Trouble breathing, because the damaged bronchial tubes do not function normally.

Symptoms, which can vary greatly from patient to patient and also from day to day, can include:

	Cough
	Coughing up sputum (phlegm) from the chest, often in large amounts. The phlegm may vary from clear to yellow or green even when patients are stable and feel as well as usual.
	Breathlessness, especially during exercise
	Repeated lung infections

Exacerbations

Exacerbations of bronchiectasis are episodes when the symptoms (cough, sputum production, and breathlessness) deteriorate beyond the normal daily variability. The sputum may change in color, or it may change only in volume (particularly if the color is usually dark). These episodes usually require increased or new medications to help the episodes resolve. Exacerbations can be frequent, and generally affect the patient's health in such a way that they feel less well even when the episode is over. In addition, exacerbations may increase the amount of damage to the bronchial tubes.

Deciding which extra treatment to give (antibiotics, steroids, or both) can often be difficult. However, antibiotics are only required if a bacterial infection is present. The simplest way to tell this is by looking at the colour of the sputum, using BronkoTest. Patients with bronchiectasis may not respond to conventional doses of antibiotics, and longer-term antibiotics may be appropriate. The BronkoTest system assists in determining the need for high-dose or long-term antibiotic therapy.

Important Points

1. Symptoms and general health can often be improved if treatment is given to reduce the intensity of the colour of sputum (or to change the colour of the sputum from yellow or green to clear or white).

2. BronkoTest in conjunction with the daily monitoring card have been used for many years to monitor and record usual variations in symptoms, changes needing treatment, and response to treatment.

3. Exacerbations of bronchiectasis are deteriorations in the usual symptoms beyond the normal daily fluctuations.

4. Prompt treatment speeds recovery from exacerbations.

5. Multiple exacerbations affect general wellbeing and are likely to make the bronchiectasis progress.

6. Antibiotics are helpful if the sputum has changed to a more yellow or green color than normal. In patients with bronchiectasis, conventional doses and durations of antiobiotic therapy may not be adequate. BronchoTest helps to determine when either higher-than-usual doses of antibiotics, or long-term antibiotic treatment, is required.

7. With appropriate antibiotics, the sputum colour will usually change and return to its normal or usual colour within 1-2 weeks.

8. Failure of the sputum colour to return to normal will require reassessment of the treatment.