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Bronchiectasis

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Evidence last reviewed: 1 Aug 2026
Topic last updated: 25 Aug 2026

Summary

Definition

History and exam

Key diagnostic factors

  • chronic 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 (CF)
  • 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
  • prematurity
Full details

Diagnostic tests

1st tests to order

  • thin section chest CT
  • chest x-ray
  • CBC
  • sputum culture and sensitivity
  • serum alpha-1 antitrypsin phenotype and level
  • serum immunoglobulins
  • sweat chloride test
  • autoantibody tests
  • specific IgE or skin prick test to Aspergillus fumigatus
  • serum HIV antibody
  • nasal nitric oxide (NNO)
  • pulmonary function tests
Full details

Tests to consider

  • primary ciliary dyskinesia (PCD) confirmatory testing
  • CFTR protein gene mutation testing
  • modified barium swallow
  • pH monitoring of esophagus and/or esophageal manometry
  • 6-minute walk test and ABG
  • 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

B. Shoshana Zha, MD, PhD

Assistant Professor

Division of Pulmonology, Critical Care, Allergy, and Sleep Medicine

Director, Bronchiectasis and Pulmonary NTM Program (INTEGRATE)

Department of Medicine

University of California, San Francisco

San Francisco, CA

Disclosures

BSZ is a member of the advisory committee for Bronchiectasis Clinical Care Network. BSZ is a paid consultant for Genentech and Boehringer Ingelheim, and she has received grant funding from the American Thoracic Society (ATS) and Cystic Fibrosis Foundation. BSZ has also presented on the topic at national conferences and is a faculty member for the ATS bronchiectasis education center.

Meghan Marmor, MD

Assistant Professor

Division of Pulmonary, Allergy and Critical Care Medicine

Department of Medicine

Stanford School of Medicine

Palo Alto, CA

Disclosures

MM has given industry sponsored talks for Insmed and Electromed. MM serves on writing committees for the Bronchiectasis Clinical Care Network.

Acknowledgements

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

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. 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

UK

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

UK

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, CO

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, CA

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

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

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

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.
  • Bronchiectasis images

  • Differentials

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  • Guidelines

    • ACR appropriateness criteria: chronic dyspnea - noncardiovascular origin
    • ACR appropriateness criteria: tracheobronchial disease
    More Guidelines

  • Patient information

    Bronchiectasis: what is it?

    Bronchiectasis: what are the treatment options?

    More Patient information

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    Early inspiratory crackles

    More videos
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