Assessment and investigation of adults with bronchiectasis

The diagnosis of bronchiectasis is made on the basis of highresolution computed tomography (HRCT) scan findings. A diagnosis of bronchiectasis should be considered in all patients with persistent cough productive of sputum, where another clear diagnosis has not been made. This includes patients with an initial diagnosis of chronic obstructive pulmonary disease or severe asthma. Once bronchiectasis has been confirmed by HRCT scanning, patients should undergo a range of investigations to determine whether or not there is an underlying cause. This can usually be determined in approximately 50% of patients with bronchiectasis. The common conditions which should be sought are cystic fibrosis, immunodeficiency syndromes, primary ciliary dyskinesia, and autoimmune diseases, such as rheumatoid arthritis and ulcerative colitis. For many of these conditions, there is specific treatment to improve symptoms and reduce lung injury but, without an accurate diagnosis, appropriate therapy may not be instituted.