Bronchiectasis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 14 Aug 2025

Last updated: 06 Mar 2025

Bronchiectasis often presents with recurrent pulmonary infections, including a chronic daily productive cough with mucopurulent sputum production.

High-resolution chest computed tomography is the confirmatory test.

Diagnostic testing is geared toward identifying the underlying etiology, as treatment will be successful only if it treats both the bronchiectasis and any underlying disease process.

A sputum sample should be obtained when the patient is in a stable state and during acute exacerbations. Antibiotics are used in three scenarios: to treat acute exacerbations, eradication of a first or new isolation of Pseudomonas aeruginosa, and long-term antibiotics to suppress chronic bacterial infection. Where possible, antibiotic choice should be based on culture and sensitivity from sputum samples.

Daily airway clearance is essential for treatment success.

Exercise training is often offered as part of a pulmonary rehabilitation program, combined with patient education and training in self-management, and delivered on an outpatient basis or remotely via telerehabilitation. Self-management plans aim to increase patients' confidence in managing their own condition.

Maintenance aerosolized antibiotics may be used for treatment of severe bronchiectasis or recurrent Pseudomonas aeruginosa infections.

Surgical therapy, including lung transplantation, should be considered for adult patients who continue to deteriorate despite optimal medical management, but is rarely undertaken in children.

Definition

Bronchiectasis is the abnormal dilation of bronchi due to the destruction of the elastic and muscular components of the bronchial wall.[1][2] It is often caused as a consequence of recurrent and/or severe infections secondary to an underlying disorder. The majority of patients will present with a chronic cough and sputum production.[3][4]

This topic covers the diagnosis and management of noncystic fibrosis bronchiectasis in children, adolescents, and adults. For detailed information on the treatment of cystic fibrosis, see Cystic fibrosis.

History and exam

Key diagnostic factors

cough
sputum production
crackles, high-pitched inspiratory squeaks and rhonchi
dyspnea
fever

Full details

Other diagnostic factors

fatigue
hemoptysis
rhinosinusitis
weight loss
wheezing
pleuritic chest pain
clubbing

Full details

Risk factors

cystic fibrosis
host immunodeficiency
previous infections
congenital disorders of the bronchial airways
primary ciliary dyskinesia
alpha-1 antitrypsin deficiency
connective tissue disease
inflammatory bowel disease
aspiration or inhalation injury
focal bronchial obstruction
tall, thin, white females, age 60 or over
prematurity

Full details

Diagnostic investigations

1st investigations to order

high-resolution chest CT
CXR
CBC
sputum culture and sensitivity
serum alpha-1 antitrypsin phenotype and level
serum immunoglobulins
sweat chloride test
rheumatoid factor
specific IgE or skin prick test to Aspergillus fumigatus
serum HIV antibody
nasal nitric oxide (NNO)
pulmonary function tests

Full details

Investigations to consider

primary ciliary dyskinesia (PCD) testing
cystic fibrosis transmembrane regulator (CFTR) protein gene mutation testing
swallow study
pH monitoring of esophagus
6-minute walk test
tuberculosis testing
diagnostic bronchoscopy with bronchoalveolar lavage

Full details

Treatment algorithm

INITIAL

initial presentation

ACUTE

acute exacerbation: mild to moderate underlying disease

acute exacerbation: severe underlying disease or not responding/resistant to initial antibiotics

3 or more exacerbations per year despite maintenance therapy

ONGOING

first or new isolation of Pseudomonas aeruginosa at outpatient review

Contributors

Authors

Anne E. O'Donnell, MD

Professor of Medicine

Chief, Division of Pulmonary, Critical Care and Sleep Medicine

The Nehemiah and Naomi Cohen Chair in Pulmonary Disease Research

Georgetown University Medical Center

Washington

Disclosures

AEOD has received scientific consulting fees from the following companies: Bayer, Xellia, Horizon, Grifols, Insmed, and Electromed. AEOD is the Principal Investigator for trials sponsored by the following companies (research funding provided directly to Georgetown University): Bayer, Insmed, Aradigm, Parion, Zambon. AEOD has been a faculty member at the annual meetings of CHEST (American College of Chest Physicians), the American Thoracic Society, and the European Respiratory Society. AEOD is the author of a reference cited in this topic.

Acknowledgements

Dr Anne E. O'Donnell would like to gratefully acknowledge Dr Pamela J. McShane and Dr Sangeeta M. Bhorade, previous contributors to this topic.

Disclosures

PJM and SMB declare that they have no competing interests.

Peer reviewers

Philip W. Ind, BA (Cantab), MB BChir, MA (Cantab), FRCP

Emeritus Professor of Practice (Respiratory Medicine)

National Heart and Lung Institute

Imperial College London

London

Disclosures

PWI declares that he has no competing interests.

Meg Coleman, MBBS, BSc, MRCP

Respiratory Consultant

Honorary Senior Clinical Lecturer

Imperial College Hospitals NHS Trust and National Heart and Lung Institute

London

Disclosures

MC has received honoraria from Pfizer and Gilead for delivering educational sessions.

Amanda Messinger, MD, MS

Assistant Professor

Section of Pediatric Pulmonary and Sleep Medicine

Department of Pediatrics

Children's Hospital Colorado

University of Colorado Denver School of Medicine

Aurora

Disclosures

AM declares that she has no competing interests.

Ware Kuschner, MD

Associate Professor of Medicine

Stanford University

Stanford

Staff Physician

US Department of Veterans Affairs

Palo Alto Health Care System

Palo Alto

Disclosures

WK declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Chang AB, Fortescue R, Grimwood K, et al. European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J. 2021 Aug;58(2):2002990.Full text Abstract

Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax. 2019 Jan;74(suppl 1):1-69.Full text Abstract

Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017 Sep 9;50(3):1700629.Full text Abstract

O'Donnell AE. Bronchiectasis - a clinical review. N Engl J Med. 2022 Aug 11;387(6):533-45. Abstract

Hill AT, Barker AF, Bolser DC, et al. Treating cough due to non-CF and CF bronchiectasis with nonpharmacological airway clearance: CHEST Expert Panel Report. Chest. 2018 Apr;153(4):986-93.Full text Abstract

Smith D, Du Rand I, Addy CL, et al. British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease. Thorax. 2020 May;75(5):370-404.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Guidelines
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Bronchiectasis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

initial presentation

acute exacerbation: mild to moderate underlying disease

acute exacerbation: severe underlying disease or not responding/resistant to initial antibiotics

3 or more exacerbations per year despite maintenance therapy

first or new isolation of Pseudomonas aeruginosa at outpatient review

Contributors

Authors

Anne E. O'Donnell, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Philip W. Ind, BA (Cantab), MB BChir, MA (Cantab), FRCP

Disclosures

Meg Coleman, MBBS, BSc, MRCP

Disclosures

Amanda Messinger, MD, MS

Disclosures

Ware Kuschner, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice