From the Guidelines
The diagnostic workup for bronchiectasis should begin with a detailed history and physical examination, followed by a high-resolution computed tomography (HRCT) scan of the chest, which is the gold standard for diagnosis, as recommended by the British Thoracic Society guideline for bronchiectasis in adults 1. The HRCT scan is essential for confirming the diagnosis of bronchiectasis, as it shows dilated airways and bronchial wall thickening, and is considered the reference standard for evaluation, with sensitivity and specificity exceeding 90% 1. In addition to HRCT, the diagnostic workup may include:
- Pulmonary function tests to assess lung function, typically showing obstructive patterns
- Sputum cultures to identify pathogens, particularly Pseudomonas aeruginosa, Haemophilus influenzae, or nontuberculous mycobacteria
- Blood tests, including complete blood count, immunoglobulin levels, and specific antibody responses to evaluate for immunodeficiency
- Alpha-1 antitrypsin levels to rule out deficiency
- Sweat chloride testing or genetic testing for CFTR mutations to exclude cystic fibrosis, especially in younger patients
- Consideration of testing for primary ciliary dyskinesia with nasal nitric oxide measurement and ciliary biopsy if clinically suspected
- Bronchoscopy may be necessary in localized bronchiectasis to exclude foreign body or tumor obstruction, as recommended by the European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis 1. This comprehensive approach helps identify treatable causes and guides management strategies, including airway clearance techniques, antibiotics for exacerbations, and long-term preventive measures, ultimately improving morbidity, mortality, and quality of life outcomes for patients with bronchiectasis.
From the Research
Diagnostic Workup for Bronchiectasis
The diagnostic workup for bronchiectasis involves several steps, including:
- Clinical history and physical examination to identify symptoms and potential underlying causes
- High-resolution computed tomography (HRCT) to confirm the diagnosis and identify the location and extent of bronchiectasis 2, 3, 4
- Pulmonary function tests (PFTs) to assess lung function and identify any impairments 5
- Laboratory tests, such as immunoglobulins, testing for allergic bronchopulmonary aspergillosis, and full blood count, to identify potential underlying causes 6
Imaging-Based Diagnosis
HRCT is a crucial diagnostic tool for bronchiectasis, allowing for the confirmation of diagnosis, localization of disease, and direction of management 2, 3, 4. The HRCT score can be used to correlate with pulmonary function tests and pulmonary artery pressure 5.
Location-Based Approach
A location-based approach to diagnosis can help identify specific underlying causes of bronchiectasis, such as:
- Upper lobe distribution: cystic fibrosis, allergic bronchopulmonary aspergillosis, and traction bronchiectasis caused by prior tuberculosis, sarcoidosis, and silicosis with progressive massive fibrosis 4
- Lower lobe distribution: chronic aspiration, hypogammaglobulinemia, Mounier-Kuhn syndrome, primary ciliary dyskinesia, and traction bronchiectasis caused by usual interstitial pneumonitis and nonspecific interstitial pneumonitis 4
- Right middle lobe and lingula: atypical mycobacterial infections, primary ciliary dyskinesia, and Kartagener syndrome 4
Further Management
Once the diagnosis of bronchiectasis is confirmed, further management involves identifying the underlying cause, if possible, and addressing infection, inflammation, and bronchial toilet 2, 6.