Bronchiectasis Epidemiology: Why More Patients Are Being Diagnosed

Welcome back to another HCPLive Peer Exchange series. In "Bronchiectasis Epidemiology: Why More Patients Are Being Diagnosed," moderator Ashwin Basavaraj, MD, FCCP, ATSF is joined by Mark Metersky, MD, FCCP, Joseph Khabbaza, MD, and Wael ElMaraachli, MD to open the series on bronchiectasis, framing why the condition is now recognized far more often than in decades past.

Dr. Basavaraj opens the program by welcoming Dr. Metersky, Dr. Khabbaza, and Dr. ElMaraachli to discuss the evolving landscape of bronchiectasis. He notes the panel will cover pathophysiology, diagnostic challenges, and the treatment advances reshaping care for this complex chronic disease.

Dr. Metersky describes how the epidemiology of bronchiectasis has shifted over the past decade. Once considered a rare, orphan condition, it now affects an estimated half a million people in the United States. He attributes part of this shift to greater recognition of underlying causes, including single mutations in the CFTR gene and primary ciliary dyskinesia, conditions previously overlooked. Long-standing asthma and COPD are now understood to cause bronchiectasis in many patients, and imaging obtained for unrelated reasons is uncovering additional cases. Dr. Metersky points to lung cancer screening CTs as a major driver, alongside scans ordered to rule out pulmonary embolism or evaluate cardiac disease. Non-tuberculous mycobacterial infection, especially Mycobacterium avium complex, is increasingly recognized as coexisting with bronchiectasis as well.

Dr. Basavaraj adds that incidental findings extend beyond lung cancer screening, citing neck CTs and emergency department imaging as additional sources of new diagnoses. Dr. Metersky agrees, noting that many of these patients have been coughing for months or years before the incidental scan, which he says confirms that bronchiectasis remains underdiagnosed and frequently mistaken for chronic cough, COPD, or asthma.

Dr. Khabbaza emphasizes that delayed diagnosis is a significant problem, though catching subclinical disease incidentally allows clinicians to intervene before symptoms or exacerbations develop. Dr. ElMaraachli warns that misdiagnosis as COPD carries real risk, since patients are often placed on inhaled corticosteroids for years, which can raise infection risk in bronchiectasis without treating the underlying disease.

The next episode in this series, "Recognizing Bronchiectasis: Key Symptoms and Risk Factors," features the panel detailing the hallmark symptoms and risk factors that should raise clinical suspicion for bronchiectasis.