What are the diagnostic workups for newly diagnosed bronchiectasis?

From the Guidelines

The workup for newly diagnosed bronchiectasis should include a comprehensive evaluation to determine the underlying cause and assess disease severity, starting with a baseline chest X-ray and a thin section computed tomography scan (CT) to confirm the diagnosis, as recommended by the British Thoracic Society guideline for bronchiectasis in adults 1.

Initial Testing

The initial testing should include:

• High-resolution computed tomography (HRCT) of the chest to confirm the diagnosis and characterize the extent and distribution of bronchiectasis
• Pulmonary function tests, including spirometry with bronchodilator response, lung volumes, and diffusion capacity, to assess baseline lung function and airflow obstruction
• Sputum cultures for microbiological analysis, including testing for common pathogens like Pseudomonas aeruginosa, Haemophilus influenzae, and nontuberculous mycobacteria

Blood Tests

Blood tests should include:

• Complete blood count
• Immunoglobulin levels (IgG, IgA, IgM, IgE)
• Specific antibody responses to pneumococcal and tetanus vaccines to assess for immunodeficiency
• Alpha-1 antitrypsin level
• Inflammatory markers like C-reactive protein and erythrocyte sedimentation rate

Additional Testing

Additional testing may include:

• Sweat chloride testing to rule out cystic fibrosis, particularly in younger patients
• Nasal nitric oxide measurement and ciliary biopsy if primary ciliary dyskinesia is suspected
• Testing for allergic bronchopulmonary aspergillosis with total IgE and Aspergillus-specific IgE
• Evaluation for rheumatologic conditions with autoimmune markers
• Measurement of baseline specific antibody levels against capsular polysaccharides of S. pneumoniae to investigate for specific antibody deficiency, as recommended by the British Thoracic Society guideline for bronchiectasis in adults 1

Comorbidities and Past Medical History

Comorbidities and past medical history should be recorded in patients diagnosed with bronchiectasis to identify relevant and possibly causative disease, such as rheumatoid arthritis, COPD, asthma, gastro-oesophageal reflux disease, and inflammatory bowel disease, as recommended by the British Thoracic Society guideline for bronchiectasis in adults 1

From the Research

Bronchiectasis Workup

The workup for newly diagnosed bronchiectasis typically involves a combination of clinical evaluation, imaging studies, and laboratory tests. The following are some of the key components of a bronchiectasis workup:

• Clinical history and physical examination to identify underlying causes and assess disease severity 2
• High-resolution computed tomography (HRCT) of the chest to confirm the diagnosis and evaluate the extent of bronchial dilation 3, 2, 4
• Laboratory tests, such as:
  • Immunoglobulins to evaluate for immune deficiency 2
  • Testing for allergic bronchopulmonary aspergillosis (ABPA) 2
  • Full blood count to evaluate for infection or inflammation 2
• Additional tests, such as:
  • Pulmonary function tests to evaluate lung function 5
  • Sputum cultures to identify underlying infections 5
  • Testing for cystic fibrosis or other genetic disorders 3, 4
• A "minimum bundle" of tests, as recommended by guidelines, which may include HRCT, pulmonary function tests, and laboratory tests 6
• A "treatable traits" approach, which involves identifying specific underlying causes or traits that can be targeted with treatment 6

Imaging Studies

Imaging studies, particularly HRCT, play a crucial role in the diagnosis and evaluation of bronchiectasis. HRCT can help to:

• Confirm the diagnosis of bronchiectasis 3, 2, 4
• Evaluate the extent and severity of bronchial dilation 3, 2, 4
• Identify underlying causes, such as cystic fibrosis or ABPA 3, 2, 4
• Monitor disease progression and response to treatment 3, 5

Laboratory Tests

Laboratory tests can help to identify underlying causes of bronchiectasis, such as immune deficiency or infection. The following laboratory tests may be ordered as part of a bronchiectasis workup:

• Immunoglobulins to evaluate for immune deficiency 2
• Testing for ABPA to evaluate for allergic bronchopulmonary aspergillosis 2
• Full blood count to evaluate for infection or inflammation 2
• Sputum cultures to identify underlying infections 5
• Testing for cystic fibrosis or other genetic disorders 3, 4