Non-cystic fibrosis bronchiectasis: An updated review

Non-cystic fibrosis bronchiectasis is a chronic and heterogeneous respiratory disease characterized by irreversible dilation of the bronchi, persistent inflammation, and recurrent respiratory infections. Its global prevalence varies widely, from 52.3 to more than 1000 cases per 100,000 individuals, with a progressive increase attributed to improved diagnostic techniques and greater clinical awareness. The condition mainly affects older adults and is currently recognized as the third most frequent chronic inflammatory airway disease, after chronic obstructive pulmonary disease and asthma. The causes are diverse and include post-infectious damage, particularly after tuberculosis or pneumonia, immune deficiencies, autoimmune disorders, congenital malformations, and chronic aspiration.
The pathophysiological basis of the disease is a self-perpetuating cycle of infection and inflammation, driven by chronic bacterial colonization especially by Pseudomonas aeruginosa and neutrophilic inflammation that progressively destroys the bronchial wall. Alterations in the bronchial microbiome and structural remodeling aggravate mucus retention and infection. Clinically, patients present with a persistent productive cough and frequent exacerbations that impair lung function, reduce quality of life, and increase mortality. Diagnosis is established through high-resolution computed tomography, lung function tests, and microbiological cultures. Prognostic indices such as the Bronchiectasis Severity Index, the FACED score, and the E-FACED score allow objective assessment of severity and risk of mortality.
Treatment aims to reduce bacterial load, prevent exacerbations, and improve symptoms through prolonged antibiotic therapy, macrolides, respiratory physiotherapy, and pulmonary rehabilitation. Managing comorbidities and maintaining vaccination coverage are also essential. Despite therapeutic advances, this disease entails a significant physical and psychological burden, requiring a multidisciplinary approach that integrates medical, functional, and psychosocial care to improve adherence, prognosis, and quality of life.