Bronchiectasis

Overview 
Teoria 
Diagnóstico 
Tratamento 
ACOMPANHAMENTO 
Recursos 

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Última revisão das evidências: 15 Aug 2026

Última atualização do tópico: 25 Aug 2026

Bronchiectasis is diagnosed by thin section chest computed tomography, which shows dilated airways.

Symptoms include chronic cough, excess mucus production, dyspnea, fatigue, and episodes of exacerbations.

Daily airway clearance is the core treatment and is essential for success.

Exercise training is often offered as part of a pulmonary rehabilitation program, combined with patient education and training in self-management.

Based on culture and sensitivity from sputum samples, antibiotics are used to: treat acute exacerbations; eradicate a first or new isolation of Pseudomonas aeruginosa; and to suppress chronic bacterial infection.

Definição

Bronchiectasis is the abnormal dilation of bronchi due to the destruction of the elastic and muscular components of the bronchial wall.[1][2]

The pathophysiology of bronchiectasis is incompletely understood, but is best described as a "vicious vortex" where a complex interplay between airway dysfunction, host inflammatory response, airway structural changes, and infection result in disease.[3] Most patients present with a chronic cough, sputum production, and history of recurrent lung infections.[4][5][6]

This topic covers the diagnosis and management of bronchiectasis not due to cystic fibrosis.

Detailed information on the treatment of cystic fibrosis can be found elsewhere. See Cystic fibrosis.

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Outros fatores diagnósticos

fatigue
hemoptysis
rhinosinusitis
weight loss
wheezing
pleuritic chest pain
clubbing

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

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

Detalhes completos

Algoritmo de tratamento

Inicial

initial presentation

AGUDA

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

CONTÍNUA

first or new isolation of Pseudomonas aeruginosa at outpatient review

Colaboradores

Autores

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

Declarações

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

Declarações

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

Agradecimentos

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.

Declarações

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.

Revisores

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

Declarações

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

Declarações

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

Declarações

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

Declarações

WK declares that he has no competing interests.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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.Texto completo Resumo

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.Texto completo Resumo

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

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.Texto completo Resumo

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.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

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Diretrizes
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Bronchiectasis: what are the treatment options?
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Bronchiectasis

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

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

Colaboradores

Autores

B. Shoshana Zha, MD, PhD

Declarações

Meghan Marmor, MD

Declarações

Agradecimentos

Declarações

Revisores

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

Declarações

Meg Coleman, MBBS, BSc, MRCP

Declarações

Amanda Messinger, MD, MS

Declarações

Ware Kuschner, MD

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Videos

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice