The most important step in the diagnosis of bronchiectasis is suspicion of the diagnosis. Uh, there are groups of patients, uh, that are at high risk, uh, among them postmenopausal, uh, women who are tall and thin, uh, and present generally with chronic cough. But any patient who has a chronic cough without an explanation should be suspected of having bronchiectasis. Um, the most important diagnostic procedure is the chest CT scan, usually a high-resolution chest CT scan. And there are well, uh, described criteria for identifying bronchiectasis. Uh, there is not an easy way to do it, uh, otherwise. Unfortunately, we don't have good biomarkers, uh, for identifying, uh, bronchiectasis. Once a patient is identified with that diagnosis, It's important to look at the respiratory pathogens, uh, that might be associated with that patient's bronchiectasis, and that can include bacteria, mycobacteria, and, and fungi. Um, all of that is in anticipation of beginning therapy for the patient's bronchiectasis. The word bronchiectasis, uh, has a Greek origin, which means, uh, dilated bronchus. And so bronchial dilation is the characteristic finding on a chest CT scan from a patient with bronchiectasis. Now, the location of the uh bronchiectasis can give you a clue as to the etiology. So for instance, uh, patients with upper lobe bronchiectasis, um, that tends to occur in people with cystic fibrosis. Uh, patients who have right middle lobe and lingular bronchiectasis primarily, uh, and those are the postmenopausal women in general, uh, tend to also have associated non-tuberculous mycobacterial disease. Uh, patients who have basilar predominant bronchiectasis, um, sometimes have alpha-1 antitrypsin deficiency, uh, sometimes have immunoglobulin deficiency. Or uh may have recurrent aspiration. But nevertheless, the key to identifying a patient with bronchiectasis is demonstration of dilated bronchi uh on the chest CT scan.
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