Diagnosing Bronchiectasis: Why It's Often Mistaken for Asthma or COPD

In "Diagnosing Bronchiectasis: Why It's Often Mistaken for Asthma or COPD," Dr. Swenson turns to the diagnostic detours that keep so many bronchiectasis patients undiagnosed for years.

Dr. Swenson separates cystic fibrosis from non-CF bronchiectasis when describing the path to diagnosis. Infants with CF are typically identified through early screening, he explains, but adults with non-CF bronchiectasis often face a long, winding diagnostic journey. Many patients live with symptoms for years, sometimes decades, before receiving an accurate diagnosis. Dr. Swenson notes that patients are frequently labeled with asthma despite no history of allergic sensitization, or with COPD despite never having smoked, both red flags he encourages clinicians to watch for. Because symptoms like cough, sputum production, and shortness of breath overlap heavily with asthma and COPD, misdiagnosis is common, and some standard treatments for those conditions can actually worsen bronchiectasis.

Dr. Swenson illustrates the stakes with a recent patient: a 59-year-old woman who had been misdiagnosed with simple asthma since her teens. By the time she reached his clinic, her FEV1 had fallen to just 32% predicted, placing her near the threshold for lung transplant evaluation. An emergency room CT scan finally identified bronchiectasis specifically, prompting her referral. Dr. Swenson walks through distinguishing clues clinicians can use: bronchiectasis exacerbations tend to be infection-driven, producing more purulent sputum than the clear, white sputum typical of asthma, and hemoptysis, rarely seen in COPD or asthma, can appear. Constitutional symptoms such as fever, weight loss, and cachexia are also more common, he says, and the physical exam often reveals crackles rather than the wheezing typical of asthma. Above all, Dr. Swenson emphasizes taking a careful history, since a COPD diagnosis without a smoking history should immediately raise suspicion for bronchiectasis instead.

Up next, in "Measuring Bronchiectasis Severity Beyond Lung Function Tests," the discussion turns to how clinicians can better gauge exacerbation severity when lung function tests fall short.