Quality statement 1	People with bronchiectasis should be investigated for treatable causes of bronchiectasis.
Quality measure	Structure: Evidence of local arrangements for people with bronchiectasis to record confirmed aetiology or relevant negative investigations; and access to relevant tests for clinicians treating patients with bronchiectasis. Process: Proportion of people with bronchiectasis investigated for aetiology. Numerator: Number of people with bronchiectasis who have had appropriate aetiological investigations and the results included in the patient record. Denominator: Total number of people with bronchiectasis.
Description of what the quality statement means for each audience	Service providers ensure systems are in place to carry out appropriate testing that is, immunological investigation for immunodeficiency and allergic bronchopulmonary aspergillosis (ABPA), tests for reflux or aspiration if indicated, screening tests for genetic disease if indicated. Healthcare professionals ensure that people with bronchiectasis are tested at the time of diagnosis, or at the first referral to specialist services if not already done, and results recorded in the notes. Commissioners ensure that appropriate services are available to investigate aetiology in people with bronchiectasis: access to immunology advice, sweat testing, nasal nitric oxide testing where available and genetic testing. People with bronchiectasis will be appropriately investigated and given the results of aetiological investigations.
Relevant existing indicators	BTS Guideline for Bronchiectasis in Adults 2019.2 BTS Quality Standard for Bronchiectasis.3 BTS National Audits of Bronchiectasis 2010, 2011.4
Other possible national data sources	None identified
Source references	BTS Guideline for Bronchiectasis in Adults 2019.2 BTS Quality Standard for Bronchiectasis.3 BTS National Audits of Bronchiectasis 2010, 2011.4
Rationale	The BTS guideline recommends that all people with bronchiectasis have aetiological investigation: To prevent further progression if a treatable aetiology is identified. To predict whether a progressive course is likely (such patients should have enhanced monitoring). To guide family screening. Aetiological tests include: Screening for non-tuberculous mycobacteria (treatable). Screening for immunodeficiency (treatable in many cases; worse prognosis). Screening for ABPA (treatable). Screening for reflux/aspiration (treatable). Screening for genetic causes (family screening, worse prognosis), that is, cystic fibrosis (requires specialist care and has specific treatment in some cases) and primary ciliary dyskinesia (national service in place and may have specific treatment in future)