[Bronchiectasis in children: An underdiagnosed disease with accessible screening and etiological assessment]

Long considered as a rare and neglected disease, non-cystic fibrosis bronchiectasis in children is now recognized as an emerging cause of chronic respiratory morbidity worldwide. Its incidence is strikingly variable, ranging from 0.2-2.3 per 100,000 children annually in high-income countries to more than 700 per 100,000 in some groups of children living in highly deprived socio-economic settings. Recent data from the Child-BEAR-Net international registry confirm the predominance of post-infectious forms (∼30%) and immunodeficiencies (∼20%), while also highlighting the role of primary ciliary dyskinesia (∼10-15%) and rarer etiologies such as congenital malformations or allergic bronchopulmonary aspergillosis. In low-resource settings, pediatric bronchiectasis remains underdiagnosed and frequently misinterpreted as asthma or tuberculosis, leading to delayed management and worsened bronchial damage. However, unlike in adults, the pediatric bronchial tree retains capacity for remodeling, and if promptly treated, early lesions may regress. Recognizing chronic productive cough as a cardinal symptom, combined with early screening and a multidisciplinary approach (respiratory physiotherapy, targeted antibiotic therapy, immunoglobulin replacement, and nutritional support), can significantly improve outcomes. Future priorities include dissemination of international guidelines (ERS 2021), establishment of national registries, and development of screening programs tailored to low-resource contexts. Some forms of pediatric bronchiectasis, particularly post-infectious forms, may be preventable, and early lesions in selected children may improve following timely diagnosis and management.