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Radiological Phenotypes of Bronchiectasis Based on Airway Generation
Xueqing Yang1, Jianping Song1, Hongqing Zhang1
1Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Biomedicines
|February 27, 2026
Summary
Bronchiectasis has distinct radiological phenotypes linked to airway generation. These differences impact clinical severity, inflammation, and microbiome, guiding personalized treatment for better patient outcomes.
Area of Science:
- Pulmonology
- Radiology
- Microbiology
- Metabolomics
Background:
- High-resolution computed tomography (HRCT) shows significant radiological heterogeneity in bronchiectasis.
- Clinical characteristics associated with these radiological patterns remain unclear.
- Understanding these differences is crucial for effective bronchiectasis management.
Purpose of the Study:
- To investigate the clinical, inflammatory, microbial, and metabolic features of distinct bronchiectasis radiological phenotypes.
- To classify patients into distal airway (DA) and proximal-intermediate airway (PIA) phenotypes based on HRCT findings.
- To compare disease severity and exacerbation rates between these phenotypes.
Main Methods:
- Prospective observational cohort study of 334 bronchiectasis patients.
- Classification into DA and PIA phenotypes based on radiological assessment.
- Regular follow-up to record exacerbations, alongside comprehensive clinical, inflammatory, microbial, and metabolomic profiling.
Main Results:
- The DA phenotype was associated with lower FEV1%pred, higher Bhalla and FACED scores, and more frequent exacerbations.
- DA phenotype showed increased Pseudomonas aeruginosa colonization and more extensive lung damage.
- PIA phenotype had a higher prevalence of allergic bronchopulmonary aspergillosis and distinct inflammatory profiles (eosinophilic).
- Microbiome analysis revealed unique ecological structures for each phenotype.
- Elevated 4-hydroxynonenal levels were observed in the DA group, correlating with higher exacerbation rates.
Conclusions:
- Distinct radiological phenotypes in bronchiectasis, defined by airway generation, correlate with significant differences in clinical presentation and disease severity.
- These phenotypes exhibit unique inflammatory responses, microbial compositions, and metabolic profiles.
- Identifying these radiological phenotypes can facilitate personalized management strategies for bronchiectasis patients.
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