• Sara Lonni, James D Chalmers, Pieter C Goeminne, Melissa J McDonnell, Katerina Dimakou, Anthony De Soyza, Eva Polverino, Charlotte Van de Kerkhove, Robert Rutherford, John Davison, Edmundo Rosales, Alberto Pesci, Marcos I Restrepo, Antoni Torres, and Stefano Aliberti.
• 1 Health Science Department, University of Milan Bicocca, Azienda Ospedaliera San Gerardo, Monza, Italy.
• Ann Am Thorac Soc. 2015 Dec 1; 12 (12): 1764-70.

RationaleTesting for underlying etiology is a key part of bronchiectasis management, but it is unclear whether the same extent of testing is required across the spectrum of disease severity.ObjectivesThe aim of the present study was to identify the etiology of bronchiectasis across European cohorts and according to different levels of disease severity.MethodsWe conducted an analysis of seven databases of adult outpatients with bronchiectasis prospectively enrolled at the bronchiectasis clinics of university teaching hospitals in Monza, Italy; Dundee and Newcastle, United Kingdom; Leuven, Belgium; Barcelona, Spain; Athens, Greece; and Galway, Ireland. All the patients at every site underwent the same comprehensive diagnostic workup as suggested by the British Thoracic Society.Measurements And Main ResultsAmong the 1,258 patients enrolled, an etiology of bronchiectasis was determined in 60%, including postinfective (20%), chronic obstructive pulmonary disease related (15%), connective tissue disease related (10%), immunodeficiency related (5.8%), and asthma related (3.3%). An etiology leading to a change in patient's management was identified in 13% of the cases. No significant differences in the etiology of bronchiectasis were present across different levels of disease severity, with the exception of a higher prevalence of chronic obstructive pulmonary disease-related bronchiectasis (P < 0.001) and a lower prevalence of idiopathic bronchiectasis (P = 0.029) in patients with severe disease.ConclusionsPhysicians should not be guided by disease severity in suspecting specific etiologies in patients with bronchiectasis, although idiopathic bronchiectasis appears to be less common in patients with the most severe disease.

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