BRONCHIECTASIS: ETIOLOGY, DIAGNOSIS, AND TREATMENT

Abstract

Bronchiectasis is a chronic, progressive respiratory disease characterized by irreversible dilation of the bronchi, persistent cough, sputum production, and recurrent respiratory infections, and it is increasingly recognized as a significant contributor to global respiratory morbidity across all age groups. This narrative review synthesizes current evidence on the etiology, pathophysiology, diagnosis, and management of bronchiectasis, drawing on the newly updated European Respiratory Society (ERS) clinical practice guideline, systematic reviews, and other peer-reviewed sources. The disease arises from a self-perpetuating “vicious vortex” of airway infection, chronic neutrophil-driven inflammation, impaired mucociliary clearance, and progressive structural airway damage, with an underlying cause identifiable in the majority of, but not all, cases. Diagnosis rests on a compatible clinical presentation confirmed by high-resolution computed tomography, followed by a structured etiologic work-up, since identifying a treatable underlying cause meaningfully changes management. Treatment is individualized around airway clearance techniques, treatment of the underlying etiology where identified, and judicious antimicrobial and anti-inflammatory therapy guided by exacerbation frequency and microbiology. Recent trial data on targeted anti-inflammatory agents such as brensocatib mark an important step toward disease-modifying therapy. A structured, guideline-based approach to identifying underlying causes and tailoring treatment to individual disease characteristics remains central to improving outcomes for patients with bronchiectasis, including within the healthcare system of Uzbekistan.