One Bronchiectasis, Many Causes: Rethinking Disease Classification

"One Bronchiectasis, Many Causes: Rethinking Disease Classification" takes up the question of why so many different causes of bronchiectasis can end up looking clinically identical.

Dr. Swenson opens by clarifying that bronchiectasis itself is an end result, the structural airways disease that emerges once damage has occurred. Across every cause, he explains, the disease shares common features: airway remodeling alongside underlying infection and inflammation, typically neutrophilic in nature. That shared inflammatory signature, he says, underpins nearly all bronchiectasis regardless of etiology. Dr. Swenson describes bronchiectasis as "a coat of many colors," since so many different conditions can lead to the same structural outcome. Cystic fibrosis remains the most extensively studied cause, driven by CFTR dysfunction, he notes. Non-CF bronchiectasis, by contrast, encompasses a much more heterogeneous group of underlying causes that still converge on a nearly identical clinical and pathological phenotype.

Because CF and non-CF bronchiectasis look so similar structurally and inflammatorily, Dr. Swenson argues that it is often more useful, particularly for clinical trials and therapeutics development, to think of the disease as "one bronchiectasis" with many possible origins. Every patient shares the same core disease process, he explains, even though the path that led each of them there can differ substantially. That distinction matters clinically, he says, because the field is increasingly moving toward precision medicine built around treatable traits rather than one-size-fits-all management. Identifying a patient's underlying etiology, whenever possible, becomes an essential step in that approach, since it can shape which therapies are likely to help. Dr. Swenson's framing suggests that unifying bronchiectasis conceptually, while still working to uncover each patient's specific cause, gives clinicians and researchers a clearer path toward more targeted, effective treatment strategies going forward, rather than defaulting to identical management regardless of a patient's underlying origin story.

In "Diagnosing Bronchiectasis: Why It's Often Mistaken for Asthma or COPD," Dr. Swenson explains why bronchiectasis is so frequently mistaken for asthma or COPD, and what tips off an accurate diagnosis.