Diagnosis and Initial Investigation of Bronchiectasis

Francesco Amati; Edoardo Simonetta; Tommaso Pilocane; Andrea Gramegna; Pieter Goeminne; Martina Oriano; Sergi Pascual-Guardia; Marco Mantero; Antonio Voza; Martina Santambrogio; Francesco Blasi; Stefano Aliberti

doi:10.1055/s-0041-1730892

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2021; 42(04): 513-524
DOI: 10.1055/s-0041-1730892

Review Article

Diagnosis and Initial Investigation of Bronchiectasis

Francesco Amati

¹Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

,

Edoardo Simonetta

¹Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

²Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

,

Tommaso Pilocane

¹Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

²Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

,

Andrea Gramegna

¹Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

²Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

,

Pieter Goeminne

³Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium

,

Martina Oriano

¹Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

²Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

,

Sergi Pascual-Guardia

⁴Department of Respiratory Medicine, Hospital del Mar (PSMAR)—IMIM, Barcelona, Spain

⁵School of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain

⁶CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain

,

Marco Mantero

¹Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

²Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

,

Antonio Voza

⁷Emergency Department, Humanitas Clinical and Research Center, IRCCS, Milan, Italy

,

Martina Santambrogio

¹Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

,

Francesco Blasi

¹Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

²Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

,

Stefano Aliberti

¹Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

²Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

› Author Affiliations

Abstract

Bronchiectasis refers to both the name of a disease and a single radiological appearance that may, or may not, be associated with disease. As chronic respiratory disease, bronchiectasis is characterized by a variable range of signs and symptoms that may overlap with other chronic respiratory conditions. The proper identification of bronchiectasis as a disease in both primary and secondary care is of paramount importance. However, a standardized definition of radiologically and clinically significant bronchiectasis is still missing. Disease heterogeneity is a hallmark of bronchiectasis and applies not only to radiological features and clinical manifestations but also to other aspects of the disease, including the etiological and microbiological diagnosis as well as the evaluation of pulmonary function. Although the guidelines suggest a “minimum bundle” of tests, the diagnostic approach to bronchiectasis is challenging and may be driven by the “treatable traits” approach based on endotypes and biological characteristics. A broad spectrum of diagnostic tests could be used to investigate the etiology of bronchiectasis as well as other pulmonary, extrapulmonary, and environmental traits. Individualizing bronchiectasis workup according to the site of care (e.g., primary, secondary, and tertiary care) could help optimize patients' management and reduce healthcare costs.

Keywords

bronchiectasis - etiology - treatable traits - phenotype - endotype

Full Text

References

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