Advancing bronchiectasis diagnosis through lung function testing

Drawing on a recent European Medical Journal (EMJ) publication, “Real-World Data and Treatment Guidelines Support Better Bronchiectasis Management: A Year in Review,” this Insight focuses on the ongoing challenges of diagnosing bronchiectasis and explores how advances in respiratory diagnostics can provide deeper clinical insights and support more effective disease management. 

Non-cystic fibrosis bronchiectasis (NCFB) is a chronic and progressive lung condition characterised by permanent widening of the airways, ongoing inflammation, and repeated respiratory infections. While awareness of the disease is increasing, bronchiectasis remains underdiagnosed and is often mistaken for other respiratory conditions, leading to delays in appropriate treatment. 

Real-world data shows that bronchiectasis continues to place a heavy burden on patients and healthcare systems. Many patients experience frequent flare-ups, high rates of hospitalisation, and an ongoing need for medical care, even with current treatment approaches. This underlines the importance of improving early diagnosis and adopting more integrated diagnostic strategies 

Diagnosing bronchiectasis presents several challenges. Symptoms such as chronic cough, sputum production, and breathlessness are common across respiratory diseases, meaning patients are frequently misdiagnosed with asthma or COPD, or identified only when bronchiectasis appears alongside other conditions. The condition is also highly complex, often occurring with other health issues, which can make an accurate assessment more difficult. As a result, diagnosis is frequently delayed, sometimes by more than a decade, allowing the disease to progress and increasing the risk of complications. 

Current diagnostic pathways rely on a combination of clinical symptoms and imaging, with high-resolution CT (HRCT) scans playing a central role in confirming structural changes in the airways. However, imaging alone does not always capture the full picture of disease activity or progression. This highlights the growing importance of respiratory diagnostics in supporting earlier and more accurate diagnosis. 

Advanced respiratory testing, including lung function assessment, can provide valuable insights into how the disease affects airway function and how it progresses over time. Bronchiectasis is driven by a complex cycle of inflammation, infection, and impaired mucus clearance, meaning that understanding both structural and functional changes is essential. By combining imaging with objective respiratory data, clinicians can gain a more complete view of the disease, enabling better-informed treatment decisions. 

Respiratory function testing in management of bronchiectasis*

Note: Bronchiectasis is confirmed radiologically by HRCT. Spirometry is the routine physiological test. Selective tests are added according to clinical question, disease complexity or monitoring need. Aetiology-directed testing is used when clinical features suggest a specific underlying cause.

Updated European Respiratory Society (ERS) guidelines emphasise a more proactive and personalised approach to managing bronchiectasis, including early risk assessment and targeted intervention. In this context, respiratory diagnostics play a key role in moving beyond symptom-based care, providing objective insights that support better long-term management. 

Improving how bronchiectasis is diagnosed, through the use of both imaging and advanced respiratory diagnostics, will be key to addressing the unmet needs in bronchiectasis care, creating opportunities to identify patients earlier, guide more effective treatment, and ultimately improve outcomes. 

Main Source: Cross CE. Real-World Data and Treatment Guidelines Support Better Bronchiectasis Management: A Year in Review. European Medical Journal. 2025;10(4):36–44. doi:10.33590/emj/CMXS7672 

The original main source publication brings together insights from presentations at the American Thoracic Society (ATS) and European Respiratory Society (ERS) congresses, alongside updated ERS clinical guidelines, to highlight evolving understanding of non-cystic fibrosis bronchiectasis (NCFB). It can be read in full here: Real-World Data and Treatment Guidelines Support Better Bronchiectasis Management: A Year in Review - European Medical Journal  

*Additional References: 
Chalmers JD, Haworth CS, Flume P, Long MB, Burgel P-R, Dimakou K, et al. European Respiratory Society clinical practice guideline for the management of adult bronchiectasis. European Respiratory Journal. 2025;66(6):2501126. doi:10.1183/13993003.01126-2025. 
Hill AT, Sullivan AL, Chalmers JD, De Soyza A, Elborn JS, Floto RA, et al. British Thoracic Society Guideline for bronchiectasis in adults. Thorax. 2019;74(Suppl 1):1–69. doi:10.1136/thoraxjnl-2018-212463.