Diagnostic Management of Pediatric Bronchiectasis: A Literature Review and Clinical Examples

Bronchiectasis is an often underdiagnosed chronic respiratory disease in children and adolescents. Recent international guidelines highlighted the management of bronchiectasis in pediatric patients in comparison to adults. The purpose of this manuscript is to review the diagnostic, etiological workup and follow-up in children and adolescents with bronchiectasis, using real-life clinical cases that highlight the multidisciplinary approach required for this complex condition.

The diagnostic process requires both thoracic imaging and a clinical evaluation with the addition of pulmonary function tests and microbiological exams, when possible. Specific workup should include past medical history (e.g., recurrent pneumonia, otitis or extra-respiratory infections), including family history, testing for genetic diseases (e.g., cystic fibrosis), evaluation of airway abnormalities and obstruction (e.g., bronchial foreign body), exclusion of concomitant immunodeficiencies and conditions associated to impaired mucociliary clearance. Main comorbidities and possible etiological conditions include chronic pulmonary aspiration and gastroesophageal reflux, upper respiratory tract and otologic diseases, particularly rhinosinusitis, otitis, and asthma. Patients should be followed up every 3-6 months, with closer monitoring for those with severe disease; transition to adult care should be individualized, with emphasis on patient education, treatment adherence, and multidisciplinary support.

The diagnostic workup for children and adolescents with bronchiectasis is challenging and requires input from multiple experts. Early detection of bronchiectasis is crucial for establishing effective diagnostic and therapeutic strategies and may help prevent further progression.