Considerations in the Diagnosis and Management of Bronchiectasis in Older Adults

Bronchiectasis is characterized by chronic airway inflammation and scarring resulting in cough and recurrent respiratory infections. It is strongly associated with aging. Risk factors include impaired mucociliary clearance, structural lung and chest wall changes, aspiration, and comorbidities such as chronic obstructive pulmonary disease. Radiographic bronchiectasis is a common incidental finding in older adults; clinical diagnosis of bronchiectasis requires characteristic symptoms. Management involves both nonpharmacologic strategies (airway clearance, pulmonary rehabilitation) and pharmacologic therapies (antibiotics, inhaled treatments). Shared decision-making about treatment is essential and should take into account impact on quality of life, functional ability, cognition, comorbid conditions, and risks of polypharmacy.