Aetiology, Pathophysiology and Investigation in Bronchiectasis

Syazatul Syakirin Sirol Aflah​
Institut Perubatan Respiratori, Kuala Lumpur, Malaysia

Bronchiectasis is a chronic respiratory condition characterized by irreversible dilation of the bronchi, resulting from a complex interplay between host susceptibility and environmental insults. 

Aetiology of bronchiectasis is heterogeneous ranging from post-infectious sequelae and immune deficiencies to genetic disorders such as cystic fibrosis and primary ciliary dyskinesia. Non-infectious causes, including autoimmune diseases and airway obstruction, further contribute to its varied presentation across populations.

The disease is driven by a vicious cycle of infection, inflammation, and structural airway damage. Persistent bacterial colonization triggers neutrophilic inflammation, perpetuating tissue destruction and mucus retention, which in turn promotes further infection.

Accurate diagnosis and etiological assessment are essential for individualized management. High-resolution computed tomography (HRCT) remains the gold standard for anatomical confirmation, while a structured investigative algorithm including sputum microbiology, immunoglobulin profiling, ciliary function testing, and screening for systemic diseases is recommended to identify treatable causes.