Physical Examination Findings in Bronchiectasis
Physical examination findings in bronchiectasis are nonspecific and cannot confirm the diagnosis—thin-section CT scanning is required for definitive diagnosis when clinically suspected. 1
Diagnostic Approach
The British Thoracic Society and European Respiratory Society guidelines emphasize that imaging, not physical examination, is the cornerstone of bronchiectasis diagnosis. 1
Required Diagnostic Steps:
- Perform baseline chest X-ray in patients with suspected bronchiectasis 1
- Perform thin-section CT scan to confirm diagnosis when clinically suspected 1
- Baseline imaging should be obtained during clinically stable disease for optimal diagnostic accuracy and serial comparison 1
Clinical Presentation Triggering Investigation
Consider investigation for bronchiectasis in patients with:
- Persistent production of mucopurulent or purulent sputum, particularly with relevant risk factors 1
- Chronic productive cough or recurrent chest infections in at-risk populations 1
- Cough persisting longer than 8 weeks, especially with sputum production 1
High-Risk Populations Requiring Lower Threshold for Investigation:
- Rheumatoid arthritis patients with chronic productive cough or recurrent chest infections 1
- COPD patients with frequent exacerbations (≥2 annually) and positive sputum culture for P. aeruginosa while stable 1
- Inflammatory bowel disease patients with chronic productive cough 1
- Severe or poorly-controlled asthma 1
- History of HIV-1 infection, solid organ/bone marrow transplant, or immunosuppressive therapy 1
Role of Physical Examination Techniques
While the guidelines do not provide specific recommendations for auscultation, inspection, palpation, and percussion findings, these techniques serve to:
Identify clinical features suggesting bronchiectasis:
- Chronic cough with sputum production (the cardinal clinical syndrome) 1
- Signs of recurrent respiratory infections 1
Assess disease severity and complications:
- The bronchiectasis severity index may help guide management 1
- Physical examination findings should prompt appropriate imaging rather than serve as diagnostic criteria 1
Critical Pitfall
Do not rely on physical examination alone to diagnose or exclude bronchiectasis. Radiological bronchiectasis may exist in asymptomatic individuals, and conversely, significant bronchiectasis may be present despite minimal physical findings. 1 The diagnosis requires both permanent bronchial dilatation on CT scanning AND the clinical syndrome of cough, sputum production, and/or recurrent respiratory infections. 1