Last reviewed: March 2020
Last updated: March  2018



History and exam

Key diagnostic factors

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

Other diagnostic factors

  • fatigue
  • hemoptysis
  • rhinosinusitis
  • weight loss
  • wheezing
  • pleuritic chest pain
  • clubbing

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

Diagnostic investigations

1st investigations to order

  • CXR
  • high-resolution chest CT
  • CBC
  • sputum culture and sensitivity
  • serum alpha-1 antitrypsin phenotype and level
  • serum immune globulins
  • sweat chloride test
  • rheumatoid factor
  • Aspergillus fumigatus skin prick test
  • serum HIV antibody
  • nasal nitric oxide (NNO)
  • pulmonary function tests
More 1st investigations to order

Investigations to consider

  • bronchial biopsy and electron microscopy of cilia
  • cystic fibrosis transmembrane regular (CFTR) protein gene mutation testing
  • swallow study
  • sputum pH monitoring
  • 6-minute walk test
More investigations to consider

Treatment algorithm


Professor of Medicine

Chief, Division of Pulmonary, Critical Care and Sleep Medicine

Georgetown University Hospital




AEOD has been compensated by the following companies for consultation regarding new drug development and clinical trials: Bayer, Xellia, Novartis, Insmed. AEOD has been or is the Principal Investigator for trials sponsored by the following companies (research funding provided directly to Georgetown University): Bayer, Insmed, Aradigm, Gilead. AEOD is the Principal Investigator for the Bronchiectasis Research Registry, sponsored by the COPD Foundation (research funding provided directly to Georgetown University). AEOD is the author of a reference cited in this monograph.

Dr Anne E. O'Donnell would like to gratefully acknowledge Dr Pamela J. McShane and Dr Sangeeta M. Bhorade, previous contributors to this monograph. PJM and SMB declare that they have no competing interests.

Peer reviewersVIEW ALL

Consultant Physician

Honorary Senior Lecturer

Imperial College Healthcare Trust

Hammersmith Hospital




PWI declares that he has no competing interests.

Associate Professor of Medicine

Stanford University


Staff Physician

US Department of Veterans Affairs

Palo Alto Health Care System

Palo Alto



WK declares that he has no competing interests.

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