Skip to main content
Top
Published in: Current Pulmonology Reports 4/2015

01-12-2015 | Bronchiectasis (G Tino, Section Editor)

Diagnostic approach to bronchiectasis

Authors: Daniel J. Dorgan, Gregory Tino, Anne O’Donnell

Published in: Current Pulmonology Reports | Issue 4/2015

Login to get access

Abstract

Bronchiectasis has been noted at increasing rates in recent years. It is associated with significant morbidity and mortality, although there is a wide range in the severity of bronchiectasis in different patients. There are many different potential causes of bronchiectasis. The aim of this review is to provide a structured approach to the clinical assessment of patients with known or suspected bronchiectasis, including evaluation of severity, airway microbiology, and potential causes of bronchiectasis. The discussion includes a rationale for each component of the diagnostic workup, including how certain diagnostic features can impact treatment, but this is not a comprehensive review of bronchiectasis treatment.
Literature
2.
go back to reference Seitz AE, Olivier KN, Adjemian J, et al. Trends in bronchiectasis among Medicare beneficiaries in the United States, 2000 to 2007. Chest. 2012;142:432–9.PubMedCentralCrossRefPubMed Seitz AE, Olivier KN, Adjemian J, et al. Trends in bronchiectasis among Medicare beneficiaries in the United States, 2000 to 2007. Chest. 2012;142:432–9.PubMedCentralCrossRefPubMed
3.
go back to reference Seitz AE, Olivier KN, Steiner CA, et al. Trends and burden of bronchiectasis-associated hospitalizations in the United States, 1993–2006. Chest. 2010;138(4):944–9.PubMedCentralCrossRefPubMed Seitz AE, Olivier KN, Steiner CA, et al. Trends and burden of bronchiectasis-associated hospitalizations in the United States, 1993–2006. Chest. 2010;138(4):944–9.PubMedCentralCrossRefPubMed
4.
go back to reference Weycker D, Edelsberg J, Oster G, Tino G. Prevalence and economic burden of bronchiectasis. Clin Pulm Med. 2005;12:205–9.CrossRef Weycker D, Edelsberg J, Oster G, Tino G. Prevalence and economic burden of bronchiectasis. Clin Pulm Med. 2005;12:205–9.CrossRef
5.
go back to reference McShane PJ, Naureckas ET, Tino G, Strek ME. Non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2013;188(6):647–56.CrossRefPubMed McShane PJ, Naureckas ET, Tino G, Strek ME. Non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2013;188(6):647–56.CrossRefPubMed
6.••
go back to reference Pasteur MC, Bilton D, Hill AT, et al. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010;65:i1–i58. This is the most comprehensive assessment to date of the evidence base for management of bronchiectasis, including grading of the evidence for all recommendations.CrossRefPubMed Pasteur MC, Bilton D, Hill AT, et al. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010;65:i1–i58. This is the most comprehensive assessment to date of the evidence base for management of bronchiectasis, including grading of the evidence for all recommendations.CrossRefPubMed
7.
go back to reference Onen ZP, Gulbay BE, Sen E, Yildiz OA, Saryal S, Acican T, et al. Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med. 2007;101:1390–7.CrossRefPubMed Onen ZP, Gulbay BE, Sen E, Yildiz OA, Saryal S, Acican T, et al. Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med. 2007;101:1390–7.CrossRefPubMed
8.
go back to reference Loebinger MR, Wells AU, Hansell DM, Chinyanganya N, Devaraj A, Meister M, et al. Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J. 2009;34:843–9.CrossRefPubMed Loebinger MR, Wells AU, Hansell DM, Chinyanganya N, Devaraj A, Meister M, et al. Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J. 2009;34:843–9.CrossRefPubMed
9.•
go back to reference Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index: an international derivation and validation study. Am J Respir Crit Care Med. 2014;189(5):576–85. This study provides the most rigorous criteria for assessing the clinical severity of bronchiectasis. It is useful in the assessment of prognosis and when deciding treatment priorities in bronchiectasis.PubMedCentralCrossRefPubMed Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index: an international derivation and validation study. Am J Respir Crit Care Med. 2014;189(5):576–85. This study provides the most rigorous criteria for assessing the clinical severity of bronchiectasis. It is useful in the assessment of prognosis and when deciding treatment priorities in bronchiectasis.PubMedCentralCrossRefPubMed
10.
go back to reference Tanaka E, Amitani R, Niimi A, et al. Yield of computed tomography and bronchoscopy for the diagnosis of Mycobacterium avium complex pulmonary disease. Am J Respir Crit Care Med. 1997;155:2041–6.CrossRefPubMed Tanaka E, Amitani R, Niimi A, et al. Yield of computed tomography and bronchoscopy for the diagnosis of Mycobacterium avium complex pulmonary disease. Am J Respir Crit Care Med. 1997;155:2041–6.CrossRefPubMed
11.
go back to reference Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175:367–416.CrossRefPubMed Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175:367–416.CrossRefPubMed
12.
go back to reference Altenburg J, de Graaff CS, Stienstra Y, et al. Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non-cystic fibrosis bronchiectasis. JAMA. 2013;309(12):1251–9.CrossRefPubMed Altenburg J, de Graaff CS, Stienstra Y, et al. Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non-cystic fibrosis bronchiectasis. JAMA. 2013;309(12):1251–9.CrossRefPubMed
13.
go back to reference Serisier DJ, Martin ML, McGuckin MA, et al. Effect of long-term, low-dose erythromycin on pulmonary exacerbations among patients with non-cystic fibrosis bronchiectasis. JAMA. 2013;309(12):1260–7.CrossRefPubMed Serisier DJ, Martin ML, McGuckin MA, et al. Effect of long-term, low-dose erythromycin on pulmonary exacerbations among patients with non-cystic fibrosis bronchiectasis. JAMA. 2013;309(12):1260–7.CrossRefPubMed
14.
go back to reference Wong C, Jayaram L, Karalus N, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE). Lancet. 2012;380:660–67.CrossRefPubMed Wong C, Jayaram L, Karalus N, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE). Lancet. 2012;380:660–67.CrossRefPubMed
15.••
go back to reference Shoemark A, Ozerovitch L, Wilson R. Aetiology in adult patients with bronchiectasis. Respir Med. 2007;101:1163–70. This study is the largest studies assessing the underlying etiologies of bronchiectasis.CrossRefPubMed Shoemark A, Ozerovitch L, Wilson R. Aetiology in adult patients with bronchiectasis. Respir Med. 2007;101:1163–70. This study is the largest studies assessing the underlying etiologies of bronchiectasis.CrossRefPubMed
16.••
go back to reference Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med. 2000;162(4):1277–84. This study is the largest studies assessing the underlying etiologies of bronchiectasis. CrossRefPubMed Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med. 2000;162(4):1277–84. This study is the largest studies assessing the underlying etiologies of bronchiectasis. CrossRefPubMed
17.
go back to reference McShane PJ, Naureckas ET, Strek ME. Bronchiectasis in a diverse US population: effects of ethnicity on etiology and sputum culture. Chest. 2012;142:159–67.CrossRefPubMed McShane PJ, Naureckas ET, Strek ME. Bronchiectasis in a diverse US population: effects of ethnicity on etiology and sputum culture. Chest. 2012;142:159–67.CrossRefPubMed
18.
go back to reference Moore EH. Atypical mycobacterial infection in the lung: CT appearance. Radiology. 1993;187:777–82.CrossRefPubMed Moore EH. Atypical mycobacterial infection in the lung: CT appearance. Radiology. 1993;187:777–82.CrossRefPubMed
20.
go back to reference Kartalija M, Ovrutsky AR, Bryan CL, Pott GB, Fantuzzi G, Thomas J, et al. Patients with nontuberculous mycobacterial lung disease exhibit unique body and immune phenotypes. Am J Respir Crit Care Med. 2013;187:197–205.CrossRefPubMed Kartalija M, Ovrutsky AR, Bryan CL, Pott GB, Fantuzzi G, Thomas J, et al. Patients with nontuberculous mycobacterial lung disease exhibit unique body and immune phenotypes. Am J Respir Crit Care Med. 2013;187:197–205.CrossRefPubMed
21.
go back to reference Chan ED, Iseman MD. Underlying host risk factors for nontuberculous mycobacterial lung disease. Semin Respir Crit Care Med. 2013;34:110–23.CrossRefPubMed Chan ED, Iseman MD. Underlying host risk factors for nontuberculous mycobacterial lung disease. Semin Respir Crit Care Med. 2013;34:110–23.CrossRefPubMed
22.
go back to reference Cole PJ. Inflammation: a two-edged sword—the model of bronchiectasis. Eur J Respir Dis Suppl. 1986;147:6–15.PubMed Cole PJ. Inflammation: a two-edged sword—the model of bronchiectasis. Eur J Respir Dis Suppl. 1986;147:6–15.PubMed
23.
go back to reference Eijkhout HW, van Der Meer JW, Kallenberg CG, et al. The effect of two different dosages of intravenous immunoglobulin on the incidence of recurrent infections in patients with primary hypogammaglobulinemia. Ann Intern Med. 2001;135:165–74.CrossRefPubMed Eijkhout HW, van Der Meer JW, Kallenberg CG, et al. The effect of two different dosages of intravenous immunoglobulin on the incidence of recurrent infections in patients with primary hypogammaglobulinemia. Ann Intern Med. 2001;135:165–74.CrossRefPubMed
24.
go back to reference Pifferi M, Di Cicco M, Bush A, et al. Uncommon pulmonary presentation of IgG 4-related disease in a 15-year-old boy. Chest. 2013;144(2):669–71.CrossRefPubMed Pifferi M, Di Cicco M, Bush A, et al. Uncommon pulmonary presentation of IgG 4-related disease in a 15-year-old boy. Chest. 2013;144(2):669–71.CrossRefPubMed
25.
go back to reference CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(No. RR-14). CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(No. RR-14).
26.
go back to reference Chalmers JD, McHugh BJ, Doherty C, et al. Mannose-binding lectin deficiency and disease severity in non-cystic fibrosis bronchiectasis: a prospective study. Lancet Respir Med. 2013;1:224–32.CrossRefPubMed Chalmers JD, McHugh BJ, Doherty C, et al. Mannose-binding lectin deficiency and disease severity in non-cystic fibrosis bronchiectasis: a prospective study. Lancet Respir Med. 2013;1:224–32.CrossRefPubMed
28.
go back to reference Bienvenu T, Sermet-Gaudelus I, Burgel P-R, et al. Cystic fibrosis transmembrane conductance regulator channel dysfunction in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2010;181:1078–84.CrossRefPubMed Bienvenu T, Sermet-Gaudelus I, Burgel P-R, et al. Cystic fibrosis transmembrane conductance regulator channel dysfunction in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2010;181:1078–84.CrossRefPubMed
29.
go back to reference Hubert D, Fajac I, Bienvenu T, et al. Diagnosis of cystic fibrosis in adults with diffuse bronchiectasis. J Cyst Fibros. 2004;3:15–22.CrossRefPubMed Hubert D, Fajac I, Bienvenu T, et al. Diagnosis of cystic fibrosis in adults with diffuse bronchiectasis. J Cyst Fibros. 2004;3:15–22.CrossRefPubMed
30.
go back to reference Stewart B, Zabner J, Shuber AP, et al. Normal sweat chloride values do not exclude the diagnosis of cystic fibrosis. Am J Respir Crit Care Med. 1995;151:899–903.CrossRefPubMed Stewart B, Zabner J, Shuber AP, et al. Normal sweat chloride values do not exclude the diagnosis of cystic fibrosis. Am J Respir Crit Care Med. 1995;151:899–903.CrossRefPubMed
31.
go back to reference Ramsey BW, Davies J, McElvaney MG, et al. A CFTR potentiator in patients with cystic fibrosis and the G551D mutation. New Engl J Med. 2011;365:1663–72.PubMedCentralCrossRefPubMed Ramsey BW, Davies J, McElvaney MG, et al. A CFTR potentiator in patients with cystic fibrosis and the G551D mutation. New Engl J Med. 2011;365:1663–72.PubMedCentralCrossRefPubMed
32.
go back to reference Wainwright CE, Elborn JS, Ramsey BW, et al. Lumacaftor–ivacaftor in patients with cystic fibrosis homozygous for Phe508del CFTR. New Engl J Med. 2015;373:220–31.CrossRefPubMed Wainwright CE, Elborn JS, Ramsey BW, et al. Lumacaftor–ivacaftor in patients with cystic fibrosis homozygous for Phe508del CFTR. New Engl J Med. 2015;373:220–31.CrossRefPubMed
33.
go back to reference Katsuhara K, Kawamoto S, Wakabayashi T, Belsky JL. Situs inversus totalis and Kartagener’s syndrome in a Japanese population. Chest. 1972;61(1):56–61.CrossRefPubMed Katsuhara K, Kawamoto S, Wakabayashi T, Belsky JL. Situs inversus totalis and Kartagener’s syndrome in a Japanese population. Chest. 1972;61(1):56–61.CrossRefPubMed
35.
go back to reference Shapiro AJ, Davis SD, Ferkol T, et al. Laterality defects other than situs inversus totalis in primary ciliary dyskinesia. Chest. 2014;146(5):1176–86.PubMedCentralCrossRefPubMed Shapiro AJ, Davis SD, Ferkol T, et al. Laterality defects other than situs inversus totalis in primary ciliary dyskinesia. Chest. 2014;146(5):1176–86.PubMedCentralCrossRefPubMed
36.
go back to reference Leigh MW, Hazucha MJ, Chawla KK, et al. Standardizing nasal nitric oxide measurement as a test for primary ciliary dyskinesia. Ann Am Thorac Soc. 2013;10(6):574–81.PubMedCentralCrossRefPubMed Leigh MW, Hazucha MJ, Chawla KK, et al. Standardizing nasal nitric oxide measurement as a test for primary ciliary dyskinesia. Ann Am Thorac Soc. 2013;10(6):574–81.PubMedCentralCrossRefPubMed
37.
go back to reference Knowles MR, Daniels LA, Davis SD, et al. Primary ciliary dyskinesia. Recent advances in diagnostics, genetics, and characterization of clinical disease. Am J Respir Crit Care Med. 2013;188:913–22.PubMedCentralCrossRefPubMed Knowles MR, Daniels LA, Davis SD, et al. Primary ciliary dyskinesia. Recent advances in diagnostics, genetics, and characterization of clinical disease. Am J Respir Crit Care Med. 2013;188:913–22.PubMedCentralCrossRefPubMed
38.
go back to reference Greenberger PA, Miller TP, Roberts M, et al. Allergic bronchopulmonary aspergillosis in patients with and without evidence of bronchiectasis. Ann Allergy. 1993;70:333–8.PubMed Greenberger PA, Miller TP, Roberts M, et al. Allergic bronchopulmonary aspergillosis in patients with and without evidence of bronchiectasis. Ann Allergy. 1993;70:333–8.PubMed
39.
go back to reference Rosenberg M, Patterson R, Mintzer R, et al. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med. 1977;86:405–14.CrossRefPubMed Rosenberg M, Patterson R, Mintzer R, et al. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med. 1977;86:405–14.CrossRefPubMed
40.
go back to reference Angus RM, Davies ML, Cowan MD, et al. Computed tomographic scanning of the lung in patients with allergic bronchopulmonary aspergillosis and in asthmatic patients with a positive skin test to Aspergillus fumigatus. Thorax. 1994;49:586–9.PubMedCentralCrossRefPubMed Angus RM, Davies ML, Cowan MD, et al. Computed tomographic scanning of the lung in patients with allergic bronchopulmonary aspergillosis and in asthmatic patients with a positive skin test to Aspergillus fumigatus. Thorax. 1994;49:586–9.PubMedCentralCrossRefPubMed
41.
go back to reference Krustins E, Kravale Z, Buls A. Mounier-Kuhn syndrome or tracheobronchomegaly. Respir Med. 2013;107:1822–8.CrossRefPubMed Krustins E, Kravale Z, Buls A. Mounier-Kuhn syndrome or tracheobronchomegaly. Respir Med. 2013;107:1822–8.CrossRefPubMed
42.
go back to reference Willams H, Campbell P. Generalized bronchiectasis associated with deficiency of cartilage in the bronchial tree. Arch Dis Child. 1960;35:182–91.CrossRef Willams H, Campbell P. Generalized bronchiectasis associated with deficiency of cartilage in the bronchial tree. Arch Dis Child. 1960;35:182–91.CrossRef
43.
go back to reference Demourelle MK, Weisman MH, Simonian PL, et al. Brief report: airways anomalies and rheumatoid arthritis-related autoantibodies in subjects without arthritis: early injury or initiating site of autoimmunity? Arthritis Rheum. 2012;64:1756–61.CrossRef Demourelle MK, Weisman MH, Simonian PL, et al. Brief report: airways anomalies and rheumatoid arthritis-related autoantibodies in subjects without arthritis: early injury or initiating site of autoimmunity? Arthritis Rheum. 2012;64:1756–61.CrossRef
44.
go back to reference Soto-Cardenas MJ, Perez-De-Lis M, Bove A, et al. Bronchiectasis in primary Sjogren’s syndrome: prevalence and clinical significance. Clin Exp Rheumatol. 2010;28:647–53.PubMed Soto-Cardenas MJ, Perez-De-Lis M, Bove A, et al. Bronchiectasis in primary Sjogren’s syndrome: prevalence and clinical significance. Clin Exp Rheumatol. 2010;28:647–53.PubMed
46.
47.
go back to reference Ryu JH, Myers JL, Swensen SJ. Bronchiolar disorders. Am J Respir Crit Care Med. 2003;168:127–1292.CrossRef Ryu JH, Myers JL, Swensen SJ. Bronchiolar disorders. Am J Respir Crit Care Med. 2003;168:127–1292.CrossRef
48.
go back to reference Martinez-Garcia M-A, de la Rosa CD, Soler-Cataluna J-J, et al. Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187(8):823–31.CrossRefPubMed Martinez-Garcia M-A, de la Rosa CD, Soler-Cataluna J-J, et al. Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187(8):823–31.CrossRefPubMed
49.
go back to reference Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res. 2010;11:122.PubMedCentralPubMed Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res. 2010;11:122.PubMedCentralPubMed
50.
go back to reference Rasmussen JE, Sheridan JT, Polk W, et al. Cigarette smoke-induced Ca2+ release leads to cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction. J Biol Chem. 2014;289:7671–81.PubMedCentralCrossRefPubMed Rasmussen JE, Sheridan JT, Polk W, et al. Cigarette smoke-induced Ca2+ release leads to cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction. J Biol Chem. 2014;289:7671–81.PubMedCentralCrossRefPubMed
Metadata
Title
Diagnostic approach to bronchiectasis
Authors
Daniel J. Dorgan
Gregory Tino
Anne O’Donnell
Publication date
01-12-2015
Publisher
Springer US
Published in
Current Pulmonology Reports / Issue 4/2015
Electronic ISSN: 2199-2428
DOI
https://doi.org/10.1007/s13665-015-0127-3

Other articles of this Issue 4/2015

Current Pulmonology Reports 4/2015 Go to the issue

Bronchiectasis (G Tino, Section Editor)

Inhaled antibiotics for bronchiectasis: are we there yet?

Smoking Cessation (S. Veeraraghavan, Section Editor)

Waterpipe tobacco-smoking: a new smoking epidemic among the young?

Smoking Cessation (S. Veeraraghavan, Section Editor)

Pharmacological therapies in smoking cessation: an evidence-based update

Smoking Cessation (S Veeraraghavan, Section Editor)

Computed tomography of smoking-related lung disease: review and update

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.