Quality statement 2	People with bronchiectasis should be offered a review by a specialist respiratory physiotherapist or qualified healthcare professional.
Quality measure	Structure: Evidence of local arrangements to ensure that all patients with bronchiectasis are reviewed by a specialist respiratory physiotherapist or qualified healthcare professional at initial review and if the patient is thought to be deteriorating. Process: Proportion of adults with a diagnosis of bronchiectasis who are seen by a respiratory physiotherapist or qualified healthcare professional. Numerator: The number of people with a diagnosis of bronchiectasis who are seen by a respiratory physiotherapist or qualified healthcare professional. Denominator: The total number of people with a diagnosis of bronchiectasis.
Description of what the quality statement means for each audience	Service providers ensure systems are in place to allow people with bronchiectasis to see a specialist respiratory physiotherapist or qualified healthcare professional at initial diagnosis and access to review for patients who are deteriorating. Healthcare professionals ensure that all people with a diagnosis of bronchiectasis are referred to a specialist respiratory physiotherapist or qualified healthcare professional to be taught appropriate airway clearance techniques, which may include adjuncts, and advised of the frequency and duration with which these should be carried out. Commissioners ensure that access to specialist respiratory physiotherapy services or qualified healthcare professional are available including the use of airways clearance adjuncts and pulmonary rehabilitation. People with a diagnosis of bronchiectasis to be taught appropriate airway clearance techniques, which may include adjuncts, and advised of the frequency and duration with which these should be carried out.
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 Joint BTS/Association of Chartered Physiotherapists in Respiratory Care Guidelines for the Physiotherapy Management of the Adult, Medical, Spontaneously Breathing Patient, 2009.5
Rationale	People with bronchiectasis should be reviewed by a specialist respiratory physiotherapist (band 6 and above) or qualified healthcare professional to optimise airway clearance techniques. Refresher courses may also be of benefit, to ensure techniques are optimised. Regular airway clearance is regarded as a key component in the management of bronchiectasis because it may improve symptoms and reduce exacerbation frequency. In patients with more advanced disease, a modified airway clearance regimen may be beneficial. This may include an alternative airway clearance technique or increased frequency and/or duration of current technique. Patients who are deteriorating should be offered a review to ensure airway clearance is optimised and for consideration of additional techniques or adjuncts to therapy. Specialist respiratory physiotherapists (band 6 and above): further information Specialist Respiratory Physiotherapists section of BTS website. The BTS guidelines as a good practice point recommend considering a trial of mucoactive treatment in people with bronchiectasis who have difficulty in sputum expectoration.