From the Guidelines
The workup for bronchiectasis should begin with a thorough clinical 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 British Thoracic Society guideline for bronchiectasis in adults 1. Initial testing should include:
- Complete blood count
- Comprehensive metabolic panel
- Sputum culture and sensitivity
- Pulmonary function tests Specific etiologic investigations should follow, including:
- Immunoglobulin levels (IgA, IgG, IgM, IgE)
- Alpha-1 antitrypsin level
- Sweat chloride test for cystic fibrosis
- Testing for primary ciliary dyskinesia if clinically indicated Bronchoscopy may be necessary to obtain samples for microbiological analysis, particularly to identify pathogens like Pseudomonas aeruginosa, Haemophilus influenzae, or nontuberculous mycobacteria. Serological testing for allergic bronchopulmonary aspergillosis (ABPA) should include total IgE, Aspergillus-specific IgE and IgG antibodies. For patients with recurrent infections, consider evaluating for gastroesophageal reflux disease with 24-hour pH monitoring or barium swallow. This comprehensive approach is essential because identifying the underlying cause of bronchiectasis guides specific treatment strategies and improves long-term management, as supported by the European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis 2, 3. Early diagnosis and appropriate treatment can help prevent disease progression, reduce exacerbations, and improve quality of life for patients with this chronic condition, as highlighted in the ACCP evidence-based clinical practice guidelines for chronic cough due to bronchiectasis 4, 5, 6, 7. The use of HRCT is also supported by the ACR Appropriateness Criteria for chronic cough, which considers HRCT the reference standard for the evaluation of bronchiectasis 8.
From the Research
Workup for Bronchiectasis
The workup for bronchiectasis involves a combination of clinical evaluation, imaging studies, and laboratory tests to determine the underlying cause and extent of the disease.
- High-resolution computed tomography (HRCT) is the imaging modality of choice for diagnosing bronchiectasis, as it provides detailed images of the airways and lung parenchyma 9, 10, 11, 12.
- Pulmonary function tests, such as spirometry and diffusing capacity for carbon monoxide (DLco), can help assess the severity of lung function impairment and guide management decisions 9, 11.
- Laboratory tests, including complete blood count, immunoglobulin levels, and testing for allergic bronchopulmonary aspergillosis, may be ordered to identify underlying conditions that may be contributing to the development of bronchiectasis 10, 13.
Diagnostic Approach
The diagnostic approach to bronchiectasis involves a step-wise evaluation of the patient's clinical history, physical examination, and diagnostic test results.
- The European Respiratory Society guidelines recommend a minimal bundle of tests, including immunoglobulins, testing for allergic bronchopulmonary aspergillosis, and full blood count, to diagnose the cause of bronchiectasis 10.
- Additional testing, such as HRCT and pulmonary function tests, may be ordered based on the clinical history, radiological features, and severity of disease 10, 13.
- The pattern and distribution of bronchiectasis on HRCT can provide clues to the underlying etiology and guide further management 12.
Etiological Diagnosis
Etiological diagnosis is essential in bronchiectasis, as it can guide specific treatment and improve patient outcomes.
- Common etiological factors for bronchiectasis include obstructive airway diseases, post-tubercular bronchiectasis, and immunodeficiency 9, 10, 13, 12.
- Recognition of the pattern of involvement and distribution of bronchiectasis on HRCT can help identify the underlying etiology and guide further management 12.
- A significant association has been found between the etiological factors and patterns and distribution of bronchiectasis on HRCT, highlighting the importance of HRCT in outlining the differential diagnosis of bronchiectasis 12.