From the Guidelines
The workup for bronchiectasis should include a comprehensive evaluation to determine the underlying cause and assess disease severity, starting with a detailed history and physical examination, followed by high-resolution computed tomography (HRCT) of the chest, which is the gold standard for diagnosis, as recommended by the European Respiratory Society guidelines 1.
Key Components of the Workup
- A detailed history and physical examination to identify symptoms and signs of bronchiectasis, such as recurrent or persistent wet/productive cough, airway infection and inflammation, and abnormal bronchial dilatation on chest computed tomography (CT) scans 1
- High-resolution computed tomography (HRCT) of the chest, which is the gold standard for diagnosis, as it can detect bronchiectasis and bronchial wall thickening, even in asymptomatic patients 1
- Pulmonary function tests, including spirometry with bronchodilator response, to assess lung function and identify any obstructive or restrictive patterns 1
- Laboratory testing, including complete blood count, immunoglobulin levels (IgG, IgA, IgM), and specific antibody responses to vaccines, to identify any underlying immune deficiencies or infections 1
- Sputum cultures, including testing for mycobacteria and fungi, to identify any infectious causes of bronchiectasis 1
Additional Testing
- Sweat chloride test to rule out cystic fibrosis, a common cause of bronchiectasis in children and adolescents 1
- Alpha-1 antitrypsin level, to identify any deficiency, which can increase the risk of bronchiectasis 1
- Ciliary function studies, if primary ciliary dyskinesia is suspected, as it can cause bronchiectasis and other respiratory symptoms 1
- Bronchoscopy, in selected cases, to obtain samples for culture or to evaluate for structural abnormalities, such as bronchial dilatation or bronchiectasis 1
Importance of Comprehensive Workup
The comprehensive workup for bronchiectasis is essential to identify the underlying cause and assess disease severity, which can significantly impact treatment strategies and long-term management, potentially slowing disease progression and improving quality of life, as recommended by the European Respiratory Society guidelines 1 and supported by other studies 1.
From the Research
Bronchiectasis Workup
- The European Respiratory Society guidelines recommend a minimal bundle of tests for diagnosing the cause of bronchiectasis, consisting of immunoglobulins, testing for allergic bronchopulmonary aspergillosis, and full blood count 2.
- High-resolution computed tomography (HRCT) features can be useful to detect the underlying causes of bronchiectasis, and clinical history can help identify specific causes 2.
- The clinical history and HRCT features can help recognize "clinical phenotypes" of bronchiectasis that require specific testing 2.
- Pulmonary function tests, such as spirometry and whole-body plethysmography, can be used to assess the impact of different etiologies of bronchiectasis on lung function 3.
- The extent and severity of bronchiectasis on HRCT can affect pulmonary function, with a negative correlation between forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1) and the extent of bronchiectasis 4.
Diagnostic Tests
- HRCT is a key diagnostic test for bronchiectasis, allowing for the assessment of the extent and severity of the disease 2, 3, 4, 5.
- Spirometry and whole-body plethysmography can be used to assess lung function and the impact of bronchiectasis on pulmonary function 3, 4.
- Full blood count and immunoglobulin tests can help identify underlying causes of bronchiectasis 2.
- Testing for allergic bronchopulmonary aspergillosis can help identify a specific cause of bronchiectasis 2.
Correlation with Health-Related Quality of Life
- There is a correlation between the severity of bronchiectatic disease on HRCT and health-related quality of life, particularly in patients with more severe disease 5.
- The St George's Respiratory Questionnaire (SGRQ) can be used to assess health-related quality of life in patients with bronchiectasis, and correlates with HRCT scores and pulmonary function tests 6, 5.