Bronchiectasis evaluation 2025: pediatric and adult perspectives

There is a significant overlap between the diagnostic evaluation for adult and pediatric patients with bronchiectasis; however, also important age-specific unique considerations. This review focuses on these specific considerations.

Bronchiectasis refers to the radiographic evidence of dilation of distal and proximal bronchi secondary to chronic infection and inflammation. Bronchiectasis can be suspected on plain chest radiograph but is confirmed and detailed through computed tomography (CT) imaging. Several different measures and descriptions of the radiographic findings of bronchiectasis exist, but the most common is a bronchial diameter equal to or greater than an adjacent blood vessel. Consideration for the presence of bronchiectasis begins with recognition of clinical symptoms of suppurative lung disease including persistent sputum producing cough and recurrent respiratory infections. Bronchiectasis etiologies include inherited forms, such as cystic fibrosis and primary ciliary dyskinesia, as well as secondary forms including chronic aspiration as well as certain infections, and immunodeficiency. Up to 40% remain idiopathic even after a comprehensive evaluation.

It is important to start a bronchiectasis evaluation with a broad differential, but secondary testing should focus on etiologies specific to the patient. A thoughtful combination of testing is often required to arrive at an etiology. Patients with bronchiectasis require ongoing monitoring including longitudinal follow-up of respiratory cultures, lung function testing, and repeat CT imaging.