Sage Journals: Discover world-class research

Abstract

Bronchiectasis is a chronic disease characterised by permanent dilatation of the bronchi, which leads to the development of chronic airways inflammation and clinical sequelae such as cough, sputum production, and recurrent infections. The clinical syndrome is typically associated with reduced quality of life and greater healthcare utilisation. Prevalence data for bronchiectasis remain limited in many parts of the world, and the available studies report heterogeneous results with overall prevalence rates reported between 52.5 and 1248.7 per 100,000. Over the past 25 years, the prevalence has steadily increased, likely due to increased awareness and improved diagnostic techniques. Bronchiectasis is most prevalent in older age groups, and it is more commonly found in females. It is associated with multiple comorbidities, including chronic obstructive pulmonary disease, chronic rhinosinusitis, asthma, hypertension, cardiovascular disease and symptoms of anxiety and depression. First Nations populations experience a disproportionately high burden of disease. Bronchiectasis is more common in First Nations patients living in rural or remote communities and in those with socioeconomic disadvantage. It is associated with a lower age at diagnosis than the general population, more frequently associated with higher smoking rates and childhood respiratory tract infections, including a higher prevalence of human T-cell lymphotropic virus 1 in Australian Indigenous populations. These factors contribute to more extensive bronchiectasis on imaging, higher exacerbation rates and greater mortality. The introduction of lung cancer screening programmes is likely to increase the incidental detection of asymptomatic bronchiectasis patients, whose consequences are likely to burden healthcare systems. It would be beneficial to determine risk factors for those likely to develop clinically significant disease and, therefore, to prioritise referrals for further assessment.

Keywords

bronchiectasis comorbidities epidemiology First Nations populations global trends healthcare burden Indigenous Maori Pacific Islander prevalence

Introduction

Bronchiectasis is a chronic respiratory condition characterised by permanent dilatation of the bronchi, which is associated with the development of chronic inflammation, impaired mucociliary function and mucus hypersecretion and retention.¹ It frequently results in recurrent infections and microbial colonisation.¹ The diagnosis of bronchiectasis is typically confirmed using pulmonary imaging, particularly CT scans.²

Patients often present with a chronic productive cough, but can experience a number of other respiratory symptoms, including breathlessness, wheeze, haemoptysis and fatigue.³ It can result in significant morbidity, reduced quality of life, loss of productivity, increased utilisation of healthcare, frequent treatment with antibiotics and hospitalisations.^4,5 However, some patients can be asymptomatic and it can be found incidentally on imaging, particularly those aged over 65 years.⁶

There are a number of aetiologies associated with bronchiectasis, such as post-infection, secondary to other respiratory diseases, immunodeficiencies, autoimmune diseases or inflammatory bowel disease.² There are also genetic causes such as cystic fibrosis, primary ciliary dyskinesia and alpha-one-antitrypsin deficiency.² Otherwise, when no cause is identified, it is considered idiopathic.²

Although once considered an orphan disease, growing interest in bronchiectasis, an upsurge in research, advances in diagnostic techniques, and ageing populations have contributed to a marked rise in prevalence.⁷ The purpose of this paper is to describe the prevalence of bronchiectasis in various adult populations, and selected paediatric populations, due to causes other than cystic fibrosis.

Search strategy

This narrative review was based on a literature search conducted in the PubMed database using the search terms ‘bronchiectasis’ with ‘epidemiology’, ‘prevalence’, ‘registry’, ‘First Nations’, ‘Indigenous’, ‘Aboriginal’, ‘Ma¯ori’, ‘Torres Strait Islander’, ‘comorbidity’, ‘chronic obstructive pulmonary disease’, ‘airways disease’, ‘rhinosinusitis’, ‘asthma’, ‘anxiety’, ‘depression’, ‘healthcare burden’, ‘hospital costs’, ‘healthcare costs’, ‘mortality’, ‘screening’ and ‘lung cancer screening’. The search was limited to papers and/or abstracts available in English, but no time restrictions were applied. Studies involving patients with cystic fibrosis were excluded. Although the focus was on adult populations, paediatric population data were included where necessary to provide a comprehensive overview of bronchiectasis prevalence.

General prevalence of bronchiectasis

The global prevalence of bronchiectasis is not yet well established, and the data available were derived from different datasets with heterogeneous results. Many regions and countries lack published data. Several studies reviewed did not define clear diagnostic criteria for bronchiectasis, and the included patients may have had either a primary or secondary diagnosis. The current evidence for the prevalence of bronchiectasis is presented here, and a summary is provided in Table 1.

Table 1.

Prevalence of bronchiectasis presented by region.

Country	Sample size	Age of population (years)	Year	Prevalence overall^a	Prevalence female^a	Prevalence male^a	Prevalence55–64 years^a	Prevalence65–74 years^a	Prevalence≧75 years^a
North America
US Weycker 2005	5.6 million	≧18	1999–2001				F 66.8M 36.3	F 259.5M 122.7	F 310.4M 213.9
USSeitz 2012	>2 million	≧65	2000–2007	1106	414.8	245.7
			2000		322	223
			2007		553	388
USWeycker 2017	33.2 million	≧18	2013	138.6	179.5	95.3	O 121.9F 157.8M 83.3	O 561.7F 461.6M 273.2	O 812.2F 920.7M 651.5
USHenkle 2018	40% of Medicare enrolees	≧65	2006–2014	701	802	617
			2012	694
			2013	694
			2014	714
Europe
UKQuint 2016	5.4 million	All	2004		350.5	301.2	O 339.0^b F 391.1^b M 286.9^b	O 557.9^c F 638.4^c M 477.4^c	O 653.0^d F 698.1^d M 608.0^d
			2013		566.1	485.5	O 254.9^b F 285.9^b M 224.0^b	O 747.7^c F 866.0^c M 629.3^c	O 1239.7^d F 1370.3^d M 1109.0^d
UKSnell 2019	5% of UK population(~52 million)	All	2012		379	281
ItalyAliberti 2020	1,054,376	≧15	2005	62
			2015	163	178	147			O 466F 446M 497
GermanyRingshausen 2015	3,895,272	All	2013	67	68	65			M 228
GermanyRingshausen 2019	4 million	All	2009	52.5
			2017	94.8					F 313.1^d M 332.6^d
SpainMonteagudo 2016	5.8 million	All	2012	362	391	333		M 1529^e
Asia
ChinaZhou 2013	10,811	≧40	2002–2004	1.2%(n = 135 of 10 811)	1.1%(n = 70 of 6429)	1.5%(n = 65 of 4382)
			Equivalent to:	1248.7	1088.8	1483.3
ChinaFeng 2022	>380 million	≧18	2013	75.48	76.12	73.42	89.41^b	134.40^c	217.52^d
			2014	112.61	115.45	109.71	114.44^b	170.72^c	285.42^d
			2015	120.41	119.19	122.03	127.21^b	199.86^c	344.38^d
			2016	131.97	133.13	131.20	143.66^b	240.79^c	398.35^d
			2017	174.45	173.60	175.03	183.22^b	308.09^c	500.46^d
South KoreaPark 2021	1,025,340	All	2007		154.3	120.9
			2015		343.1	266.4
South KoreaChoi 2019	1.4 million	≧20	2012–2017	464			523^b	1084^c	1365^f
			2012	464
			2013	441
			2014	455
			2015	474
			2016	468
			2017	480
SingaporePhua 2021	N/A	All	2017	147.1			F 88.7^g M 105.0^g	F 392.5M 478.8	F 1222.3M 1738.6

Prevalence is listed as per 100,000 unless otherwise stated.

Age 50–59 years.

Age 60–69 years.

Age 70–79 years.

Age 65–99 years.

Age 70 years and over.

40–64 years.

F, female; M, male; N/A, not available; O, overall.

The pooled prevalence in a recent meta-analysis, which included more than 437 million participants in 15 studies published from 2005 to 2024, was 680 per 100,000.⁸ The estimated pooled prevalence was 535 per 100,000 females and 467 per 100,000 males.⁸ Ever-smokers had the highest prevalence of 4677 per 100,000.⁸ Large heterogeneity in the prevalence data was noted.⁸

United States

In the earliest available data from a US healthcare database reviewing records from 1999 to 2001, 1424 patients with bronchiectasis were identified from 5.6 million people.⁹ The prevalence in the younger age group of 18–34 years was low, 5.1 per 100,000 females and 3.3 per 100,000 males, and increased to 310.4 per 100,000 females and 213.9 per 100,000 males aged 75 years and over.⁹ The prevalence was consistently 1.5–2.1 times higher in females.⁹

From 2000 to 2007, based on a 5% sample of outpatient Medicare claims in the US in those aged 65 years and over, the overall prevalence was 1106 per 100,000 persons, with an annual prevalence of 370 cases per 100,000 person-years.¹⁰ The annual percentage increase was 8.7%.¹⁰ Prevalence was highest in the Asian population, and although geographical differences were noted, no clear pattern emerged.¹⁰

In a similar study, using the same dataset and population during 2006–2014, the annual prevalence increased to 701 per 100,000 persons.¹¹ It was higher in females, 802 per 100,000, than in males, 617 per 100,000, and it was most common among Caucasians.¹¹

A separate study using a large healthcare claims database reported an overall prevalence of 139 per 100,000 persons in 2013, with an annual growth rate of 8% since 2001.¹² Prevalence was higher in females, 180 per 100,000 compared to 95 per 100,000 in males – 1.3–1.9 times higher in females across all age categories.¹² Bronchiectasis was most prevalent in those aged 75 years and over, reaching 812 per 100,000.¹²

UK/Europe

In one of the earlier studies available, data were assessed using a UK primary care research database with a sample size of 5.4 million.¹³ The prevalence in females and males was 350.5 and 301.2 per 100,000 persons, respectively, in 2004, increasing to 556.1 and 485.5 per 100,000 persons, respectively, by 2013.¹³ It was uncommon in those aged below 40 years, and the prevalence consistently increased with age, with the exception of a decline in prevalence in those aged 50–59 years.¹³

A study using a different primary care database, which included around 5% of the UK population, estimated that 211,598 people were living with bronchiectasis in 2012.¹⁴ The prevalence was 379 per 100,000 females and 281 per 100,000 males, representing a 20% increase from 2008.¹⁴ Regional differences were observed, with the highest prevalence in the Midlands and the lowest in southeast England.¹⁴

Primary care data in Italy including over one million patients revealed a prevalence of 62 per 100,000 persons in 2005, which rose to 163 per 100,000 persons in 2015.¹⁵ The prevalence was higher in females than males (178 vs 147 per 100,000, respectively, in 2015) and similar to the other studies, was most common in those aged over 75 years, 466 per 100,000 persons.¹⁵

In Germany, health insurance claims data covering up to 87% of the population showed an annual prevalence of 52.5 per 100,000 persons in 2009, increasing to 94.8 per 100,000 persons in 2017.¹⁶ This correlated to an average annual growth of 10%.¹⁶ In 2013, the overall prevalence was 67 per 100,000 with a predominance in females (68 per 100,000 vs 65 per 100,000 in males) based on a sample of nearly four million records from a federal insurance database.¹⁷ The prevalence was also highest in those aged over 75 years.¹⁷

A primary care database in Catalonia, Spain, which included 80% of the population in that region, identified 20,895 patients with bronchiectasis in 2012.¹⁸ The overall prevalence was 36.2 per 10,000 persons and was highest in males aged over 65 years, 152.9 per 10,000 persons.¹⁸

Asia

Between 2002 and 2004, a small population-based study in China reported a high prevalence of 1.2% (N = 135/10,811), which increased with age (0.5% at 40 years old, 2.1% at >70 years old).^19,20 Extrapolated estimates suggest a prevalence of 1250 per 100,000. Bronchiectasis was more common in males, 1.5% (65/4382), than in females, 1.1% (70/6429).^19,20

In a later study using large national databases in China, the prevalence was 75.48 per 100,000 in 2013 and increased to 174.45 per 100,000 in 2017.²¹ There was no clear difference between females and males, but the prevalence again increased with age.²¹

The overall prevalence was 464 per 100,000 in South Korea between 2012 and 2017, in a review of health insurance data of 1.4 million individuals.²² Prevalence increased over time, 464 per 100,000 in 2012 to 480 per 100,000 in 2017.²² It was more prevalent in females and increased with age.²²

An earlier study in South Korea assessing over 1 million health insurance patient records showed an increasing prevalence from 120.9 to 266.6 per 100,000 males and 154.3 to 343.1 per 100,000 females between 2007 and 2015.²³ The area with the highest prevalence was Gangwon-do Province, and in general, the prevalence was highest in the non-metropolitan regions.²³ The relative risk of a diagnosis of bronchiectasis was higher in those with occupational insurance than in those with local insurance.²³

Based on the Ministry of Health-hosted administrative database in Singapore, in 2017, the prevalence of those hospitalised with a primary diagnosis of bronchiectasis was 88.3 per 100,000, and in those with a primary or secondary diagnosis, the prevalence was 147.7 per 100,000.²⁴ Similar to other studies in this region, the prevalence was higher in males, and predictably increased with age.²⁴

General trends

Across all regions, bronchiectasis prevalence universally increased with age. In an early US study between 1999 and 2001, the prevalence ranged from 4.2 per 100,000 persons aged 18–34 years to 271.8 per 100,000 persons aged over 70 years.⁹ Between 2000 to 2007, the highest annual prevalence in the US was observed in females aged 80–84 years, at 537 per 100,000.¹⁰ By 2013, the prevalence had risen to 7 per 100,000 persons aged 18–34 years and 812 per 100,000 persons aged 75 years or older.¹² In Germany, the highest prevalence was noted in 2017 in the 70–79 year old group (332.6 per 100,000 males and 313.1 per 100,000 females).¹⁶ Similarly, in Italy, the prevalence was highest in those aged >75 years, 466 per 100,000 persons.¹⁵ In Catalonia, in 2012, the highest prevalence was in males aged over 65 years, 152.9 per 10,000 persons.¹⁸

The age at diagnosis was relatively consistent. The median age of diagnosis was 61.8 years 2004–2013 in the UK.¹³ The mean age was reported as 61 years in 1999–2001 in the US, 68 years in 2013 in the US, 64.2 years in 2009 to 67.7 years in 2017 in Germany, 68.3 years in Catalonia in 2012, 63.8 years in Korea between 2012 and 2017, and 59.52 years during 2013–2017 in China.^{9,12,16,18,21,22} In one study, 60% of patients were diagnosed at the age of 70 years.¹⁴

In the majority of studies, it was evident that the prevalence increased with time, although in some instances the increase was subtle, demonstrated in Figure 1.^11,21,22 It may be explained by more frequent diagnoses in ageing populations as highlighted above, but may also represent improvement in diagnostic techniques and definitions, and increasing awareness of the disease, which has previously been subject to under-recognition and diagnostic delays of several years.^3,25

Figure 1.

Bronchiectasis prevalence trends over time.

A female predominance was observed. The percentage range for the proportion of females with bronchiectasis was noted to be 51.57%–68%.^{9,10,12,13,18,21,22,26,27} Bronchiectasis registry data also showed female predominance, with one exception: 79% in the US, 71% in Australia, 60.9% in the EMBARC data, 58.2% in China, 55.9% in South Korea and 43.1% in India.^28–33 Meta-analysis data suggested a similar finding with a pooled prevalence of 535 per 100,000 in females and 467 per 100,000 in males.⁸ The exceptions to this trend were that male prevalence overtook the female prevalence in the oldest age groups or those with a comorbid diagnosis of chronic obstructive pulmonary disease (COPD).^11,15–18

Socioeconomic status was not a consistent risk factor for the development of bronchiectasis in the studies presented thus far. It was more common in individuals with higher socioeconomic status in the UK, but not in China.^13,34 When there was a dual diagnosis with COPD or asthma, it was more likely to occur in those with a lower socioeconomic status.^11,34

Comorbidities

Given that bronchiectasis is more prevalent with advancing age, it is not unexpected that the patients would have comorbid diseases.³⁵ The impact of the majority of these comorbidities on bronchiectasis is not well understood, and further determination of their effect on disease severity, symptom severity and clinical outcomes is required. The most commonly reported comorbidities and their impact on bronchiectasis are described.

COPD is one of the most frequently associated comorbidities in bronchiectasis. This association suggests a likely shared mechanism of action, primarily involving smoking and other inhalational exposures that result in inflammation of the airways and recurrent infections.³⁶ Epidemiological studies demonstrated a wide variability in the prevalence of comorbid COPD and bronchiectasis, with rates reported as: 30.1%–52% in the US, 39% in Germany, 23.2% in Italy, 19.3% in South Korea, and 8.3% in Singapore.^{9,11,12,15,17,22,24} Bronchiectasis registry data indicated somewhat similar rates of COPD: 20.% in the US, 25.5% in the UK/Europe, 37.8% in South Korea, 23.3% in India and 11.2% in China.^{28,29,32–34} A meta-analysis reported a pooled COPD prevalence of 54.3% among bronchiectasis patients, with a range of 25.6%–69%.³⁷ This combination is associated with higher production of sputum, more severe airways obstruction with lower lung function levels, elevated inflammatory markers, more frequent exacerbations, more exacerbations requiring hospitalisation, higher rates of Pseudomonas infection, increased likelihood of chronic bacterial colonisation and higher risk of mortality.^37–39

Chronic rhinosinusitis is another common comorbidity, affecting 32%–80% of patients with bronchiectasis.⁴⁰ A meta-analysis determined a pooled prevalence of 62% and in those with nasal polyposis, the pooled prevalence was 29%.⁴⁰ Patients with conditions associated with ciliary dysmotility only accounted for a small portion of patients.⁴⁰ Chronic rhinosinusitis was associated with poorer quality of life, greater disease severity and more extensive bronchiectasis.⁴⁰ The mechanism of disease is thought to involve underlying eosinophilic inflammation.⁴¹

Bronchiectasis and asthma are less frequently comorbid than COPD and chronic rhinosinusitis. The underlying pathophysiology has not been well defined, and the mechanisms are thought to be heterogeneous, as both disease processes can be mediated by allergic and non-allergic inflammation.³⁶ Prevalence rates reported in registry data were: 28.3%–29% in the US, 31% in UK/Europe, 16% in Italy, 17.2%–22% in South Korea, 22.1% in India, 5.4% in China, and 3.6% in Singapore.^{11,15,22,24,28,29,32,33,34} Whilst not well defined, emerging evidence suggest that patients with comorbid asthma and bronchiectasis may experience a poorer prognosis, more frequent exacerbations, be at higher risk of severe exacerbations, and have lower lung function.^36,41,42

Psychological disorders are increasingly recognised in patients with bronchiectasis. In the EMBARC registry, 14.3% and 14.0% of patients had anxiety and depression, respectively.²⁹ Other studies have reported symptoms of anxiety in 30%–54.1% of bronchiectasis patients and depression in 20%–65.4%.^34,43–46 These symptoms correlated with bronchiectasis symptom severity and a reduction in quality of life.^43,46

Other commonly documented comorbidities were hypertension (25.3%–25.7%), cardiovascular disease (4.5%–32%), diabetes mellitus (8.9%–14.4%), gastro-oesophageal reflux disease (GORD) (15.8%–47%), and malignancy (0.8%–11.4%).^{9,11,22,24,28,29,32,33}

Healthcare burden associated with bronchiectasis

The healthcare burden and costs associated with bronchiectasis appear to be greater than those of other chronic diseases. However, comparisons between countries are challenging due to variations in health service structures, accessibility to healthcare and economic conditions.

Overall, healthcare expenditure was found to be higher in patients with bronchiectasis than in those with other conditions, including respiratory disorders such as asthma and COPD, and non-respiratory disorders.^{5,9,21,47–49} In studies that included longitudinal data, costs increased over time, with the exception of a study in Spain where the mean cost per patient with bronchiectasis as the primary diagnosis decreased from 2004 to 2013.^21,24,50

The greatest contributor to medical expenditure originated from the inpatient admissions, ranging from 20% to 81.2% of total medical expenditures.^{5,9,21,24,51,52} Additional contributors included intensive care admissions, antibiotic prescriptions, and outpatient care.^{9,11,22,53,54} Indirect costs also contributed substantially, particularly due to patient and carer absenteeism from work.^5,55 Hospital in the home services did not appear to reduce admission-related costs in one study; however, it is unlikely that this finding is universal.^55,56 Costs were up to 87% higher in those with Pseudomonas aeruginosa.^51,57

Other factors associated with increased healthcare related costs in bronchiectasis patients were age, forced expiratory volume in 1 second (FEV₁), the number of admissions in 12 months, inpatient length of stay, chronic bacterial infection or colonisation, use of inhaled antibiotics prior to admission, tuberculosis, smoking, cough, dyspnoea, respiratory failure, cor pulmonale, malignancy, myocardial infarction, cerebrovascular disease, and death.^{22,47,51,55,57,58}

Mortality rates among patients with bronchiectasis appear to be higher than those of the general population.⁷ Mortality rates varied greatly, with the highest mortality rate being reported in Brazil at 38.7% and the lowest in the UK at 0.18%–0.3%.^14,59,60 Elsewhere, mortality rates ranged between 2.3% and 24.8%.⁷

Prevalence in First Nations populations

There are few studies to measure the prevalence of bronchiectasis in First Nations populations, but the prevalence appears to be higher than in the general population. There are a number of risk factors for the development of bronchiectasis and sequelae that are considered here and illustrated in Figure 2.

Figure 2.

Pre-disposing factors and outcomes of First Nations bronchiectasis patients.

Australia

Indigenous Australians face considerable health disadvantages compared to non-Indigenous Australians. The majority live in the Northern Territory, often in regional or remote communities with limited access to healthcare, and this population has been the focus of bronchiectasis research in Australia.⁶¹ In 2015–2017, the average life expectancy was reduced, 66.6 years for males and 69.9 years for females, compared to 78.1 years and 82.7 years, respectively, for non-Indigenous Australians.⁶¹ These disparities are compounded by socioeconomic disadvantages and overcrowded living conditions, which contribute to higher rates of acute pulmonary infections and poorer health outcomes.⁶¹

Within the Northern Territory, the majority of patients diagnosed with bronchiectasis were Indigenous, comprising 79.3%–97% of cases.^62,63 A large proportion of patients with bronchiectasis lived in regional or remote communities, in the range of 66%–98.7%.^62–65 A retrospective cohort study between 2011 and 2020 of almost 24,000 adults estimated the prevalence to be between 19.4 per 1000 and 103 per 1000, which extrapolates to 1940 per 100,000 to 10,300 per 100,000 respectively – figures substantially higher than those reported in general populations.⁶⁴ Prevalence was higher in females than males (20.6 per 1000 vs 18.0 per 1000), and the age-related peak in prevalence was in those aged 50–59 years (45.7 per 1000).⁶⁴ The age-adjusted prevalence was lower in the Darwin urban region compared to the rural districts (5.0 per 1000 vs 18-36 per 1000).⁶⁴

Female predominance, which is commonly observed in general bronchiectasis cohorts, was less marked in Indigenous patients, ranging between 40% and 55.3%.^63–66 Patients were significantly younger, with a median age of 47.5–56 years.^64,65 Those living in remote areas were even younger at diagnosis than their urban counterparts, with median ages of 47.3–47.7 years in the three rural districts compared to 56.9 years in Darwin.⁶⁴ Although Indigenous patients had lower FACED scores, indicating milder disease, it did not translate to a better prognosis, and they had significantly lower lung function.⁶⁷ There were higher rates of exacerbations in Indigenous patients compared to non-Indigenous patients, with a study reporting 29% versus 18% over a 12-month period.⁶⁸ Admission rates were also found to be higher with a more prolonged length of stay than non-Indigenous Australians.⁶⁷

The most common cause of bronchiectasis in Indigenous populations was childhood lower respiratory tract infections, with an incidence of 426.7 episodes per 1000 child-years in children aged under 12 months.^66,69 Human T-cell lymphotropic virus 1 (HTLV-1), which is rare in the general Australian population with a prevalence of 1 in 100,000, is common in the Indigenous population, with seropositivity of 52.5%–72%.^62,66,70 HTLV-1 has been associated with increased risk of bronchiectasis, bilateral involvement and more severe radiological scores.^62,66,70 HTLV-1 seropositive patients were also more likely to develop pulmonary hypertension and cor pulmonale.⁷⁰

Microbiological profiles differ between Indigenous and non-Indigenous populations. Indigenous patients were less likely to culture Pseudomonas aeruginosa and Aspergillus species and more commonly cultured Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and methicillin-resistant Staphylococcus aureus.^67,68 They were more frequently tested for NTM and had higher rates of non-mycobacterium avium complex infections.⁶⁷

The most common comorbidity in Indigenous patients was COPD (50.5%–82.8%) associated with high rates of smoking (42.7%–63% current smokers).^{62,63,65,66,68} Other common comorbidities included chronic kidney disease or end-stage renal failure, diabetes mellitus, ischaemic heart disease, hypertension and rheumatic heart disease.^65,68

Mortality rates of Indigenous bronchiectasis patients ranged from 34.2% to 42.5%.^64,66,70 The mean age of death was 16–20 years lower than non-Indigenous patients.^64,67,68 Those living in rural or remote communities had a younger mean age of death of 60.3 years compared to those in Darwin, 67.8 years.⁶⁴ HTLV-1 seropositivity did not significantly affect the mean age of death (41.2 years for seropositive patients vs 44.5 years for seronegative patients).⁷⁰ However, among those with HTLV-1 seropositivity and bronchiectasis, there was a lower median age of death compared to seropositive controls without bronchiectasis (50 years vs 58.5 years respectively).⁶⁶

New Zealand

Ma¯ori and Pacific Islander (PI) populations in New Zealand do not appear to experience outcomes as poor as Indigenous Australians when compared across multiple parameters, including lung function, microbiological patterns, exacerbation rates, admission rates and age at death.⁶⁷ However, respiratory-related mortality remains comparable to Indigenous Australians.⁶⁷ FACED scores were similar to non-Indigenous Australian and New Zealand populations.⁶⁷

In studies of bronchiectasis populations in New Zealand, 22.9%–41% were PI and 14.4%–27% were Ma¯ori, both of which were higher compared to general population figures of 17% and 15%, respectively.^71,72 In 2002, the median age was 61 years (interquartile range 53–74 years), with a female predominance of 59%, and 50% of patients were aged 61–80 years.⁷² Ma¯ori and PI patients were more likely to have higher socioeconomic deprivation scores compared to the general population.⁷² Lung function was lower in Ma¯ori and PI patients, even after adjustment for socioeconomic and smoking statuses.⁷¹ Chronic Pseudomonas aeruginosa infection was associated with lower lung function.⁷¹

The underlying aetiology of bronchiectasis was similar to that of Australian Indigenous patients with lower respiratory tract infections being the most common (26%).⁷² The comorbidity profile resembled the Australian Indigenous populations and included COPD, asthma, diabetes mellitus, ischaemic heart disease, congestive cardiac failure, rhinosinusitis, renal impairment, hypertension, GORD and atrial fibrillation.⁷² Smoking rates were somewhat lower, with 13.8% reported as current smokers.⁷²

North America

There are few studies for the native populations of Alaska and Canada.

A cohort of paediatric bronchiectasis patients (up to 76 cases) from the Yukon-Kuskokwim (YK) Delta, Alaska, born between the 1970s and 2000s, was studied.^73–75 The prevalence of bronchiectasis varied by birth decade, but consistently declined after the 1970s, with rates of 11.0 per 1000 persons born in 1940–1949, 18.0–20.5 per 1000 in 1960–1969, 15–17.8 per 1000 in 1980–1989 and 6.7 per 1000 in 2000–2009.^73,75

The majority (91%–100%) developed bronchiectasis following lower respiratory tract infections, occurring at a mean age of 4.5 years.^73,74 The most common pathogens were Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Neisseria meningitidis and respiratory syncytial virus.^73,74 Up to 80% of patients were symptomatic.⁷⁵ The most common childhood comorbidities were gastroesophageal reflux and chronic suppurative ear disease.⁷⁵ In adulthood, comorbidities included COPD, tobacco and alcohol misuse and mental health conditions.⁷⁴

Recurrent infections were common within the cohort, with a median of 32 lifetime community-treated infections (range 3–70), as were hospitalisations, with a median of five lifetime hospitalisations (range 0–16).⁷⁵ There was also a significant burden of respiratory-related ambulatory encounters by the age of 5 years, which reduced with age.⁷⁴

In Canada, a case series of Inuit patients with primary ciliary dyskinesia from the Qikiqtaaluk region, which noted bronchiectasis among other complications, including neonatal respiratory distress, meconium aspiration, situs inversus totalis, chronic atelectasis, gastro-oesophageal reflux, aspiration pneumonia, chronic otitis media and chronic rhinitis.^76,77 Based on these data, the estimated prevalence ranges of bronchiectasis were 1 in 1400 to 202 per 100,000 children.^76,77

Prevalence of bronchiectasis through radiological screening programmes

Three studies have examined the prevalence of bronchiectasis identified on CT scans performed as part of health or lung cancer screening programmes.

The prevalence was 9.1% in Korea in 2008, 11.7% in Spain in 2000–2012, and 23% in the US in 2010–2019.^78–80 Similar to other populations, a female predominance was observed (females 11.5% vs males 7.9%), and the prevalence rose to 20.4% in those 70 years or older.⁷⁸

Patients with incidentally detected bronchiectasis were older than those without (mean age 60.9-69 years vs 59–64 years respectively) and had a more extensive smoking history (mean of 35–40 pack-years in bronchiectasis patients vs 30–38 pack-years in controls).^79,80

Current challenges and future implications

This narrative review presented the current global data on the prevalence of bronchiectasis available in various populations. Reported rates varied considerably, ranging from 52.5 to 1248.7 per 100,000, with a pooled prevalence of 680 per 100,000.^8,16,19

European countries, particularly Italy and Germany, tended to report the lowest prevalence of 52.5 to 163 per 100,000, whereas the highest prevalence was noted in the US, particularly the studies by Seitz et al and Henkle et al., with rates of 701–1106 per 100,000.^{10,11,15–17} It is important to note that both of the US studies exclusively included individuals aged 65 years or older, a factor that likely contributed to the higher prevalence estimates, given the consistent association between bronchiectasis and advancing age.^10,11 Additional factors that may have contributed to the elevated prevalence in these populations include the increased utility of CT scanning and the likely identification of asymptomatic patients.^10,11 When compared to prevalence data from other regions with similar age distributions, for instance, the study by Quint et al, the results were not markedly discrepant.¹³ A notable outlier was the study by Zhou et al, with the estimated prevalence of 1248.8 per 100,000, which was significantly higher than in other Asian and international cohorts.¹⁹ The study was conducted as a cross-sectional survey and involved a relatively small cohort, which may have contributed to the elevated prevalence estimate.¹⁹

The heterogeneity of data across studies made it challenging to draw meaningful comparisons. The publications utilised a variety of data sources, including health insurance records, primary care databases, and inpatient and outpatient claims. When similar data sources within the same region were compared, variability was observed in the reported prevalence, for example 62 per 100,000 in Italy compared to 362 per 100,000 in Spain, both of which were based on primary care databases.^15,18 The absence of data on the general adult populations in Australia and New Zealand limited the ability to adequately contextualise the disease burden in First Nations populations. Inconsistent reporting practices, as demonstrated in Table 1, hindered comparisons of the true burden of the disease and its distribution.

These findings underscore the substantial gaps in epidemiological data in many countries and entire continents. The true global burden of bronchiectasis remains uncertain and may be considerably underrecognised. However, it is abundantly clear that bronchiectasis is no longer a rare disease and its prevalence is likely to continue rising as awareness grows, driven by the rapid expansion of published research since the 1990s, advances in pulmonary imaging, and the emergence of biomarkers.^81,82 Increasing patient and physician interest in the advancement of bronchiectasis research reflects its symptomatic burden and impact on quality of life.⁸³ Comprehensive longitudinal population studies and registries are essential to accurately capture the scope of bronchiectasis and inform future strategies aimed at improving treatments and outcomes.⁸³

Despite these challenges, some developments can be drawn from this review. The evidence consistently indicated that the prevalence of bronchiectasis increased over time and with advancing age. Bronchiectasis was generally more common in females; however, data from Asia suggest that the prevalence is more evenly distributed between the sexes in this region.^{19–21,23,24} This trend is further supported by the registry data from China, South Korea and India, all of which reported a lower proportion of female participants compared to other registries.^32–34 The differences in the populations may have been explained by higher prevalence of tuberculosis, high frequency of allergic bronchopulmonary aspergillosis in some centres, increased NTM infection and higher prevalence of COPD compared to European populations.^32–34 In South Korea, another potential explanation was the influence of environmental or occupational exposures as suggested by the findings in the study by Park et al., where the highest prevalence was observed in individuals residing in non-metropolitan regions and among those with occupational rather than general insurance.²³ Assessment of the relative significance of other potential associations is required.⁸³

Newer treatments with inflammation-modulating effects have the potential to revolutionise outcomes in patients with bronchiectasis. For example, brensocatib, a dipeptidyl peptidase-1 (DPP-1) inhibitor, blocks the activity of neutrophil serine proteases and thereby reduces the neutrophil-mediated inflammation that contributes to progressive bronchiectasis.⁸⁴ Brensocatib has been demonstrated to reduce the annual rate of exacerbations, prolong the time to an exacerbation and reduce the decline in FEV₁.⁸⁴ The prevalence of bronchiectasis may rise, particularly in ageing populations, if agents like brensocatib, emerging DDP-1 inhibitors and other novel agents are ultimately found to reduce mortality.^84–86 It is yet to be determined if there will be improvements in morbidity, quality of life, healthcare burden and associated costs.

Identifying the extent to which socioeconomic disadvantage, limited health literacy and restricted access to healthcare play a role in bronchiectasis is essential. Whilst the general prevalence data did not consistently demonstrate an association with socioeconomic status, marked disparities in the prevalence and outcomes were observed among First Nations populations. These groups experienced a disproportionate burden of disease, more severe symptomatology, higher exacerbation rates and poorer outcomes. With the exception of the populations with genetic predispositions, such as the Inuit population with primary ciliary dyskinesia, if biopsychosocial risk factors, such as overcrowding and smoking, could be mitigated, the development of bronchiectasis may be prevented.^61,76,77 Government support, increased funding and equitable access to healthcare, earlier diagnosis, evaluation and treatment may significantly improve outcomes.⁶¹

Several countries have set up lung cancer screening programmes and similar initiatives are expected to become more widespread globally.⁸⁷ For instance, Australia launched its lung cancer screening programme in 2025.⁸⁸ As a result, the incidental identification of other respiratory conditions, including bronchiectasis, is likely to increase.^89,90 This may lead to downstream effects, notably an increase in referrals to respiratory clinics, which could impose a considerable additional burden on healthcare systems.⁸⁹ A substantial portion of these patients are likely to exhibit asymptomatic radiological bronchiectasis, particularly in the older populations, where such changes may represent the normal ageing process.^3,90 Understanding the critical risk factors for development of clinically significant disease will allow for prioritisation of patients requiring referral and monitoring.

Conclusion

The currently known prevalence of bronchiectasis across different populations highlights consistent trends of increasing prevalence with both age and time. Bronchiectasis appears to be more common in females in most regions. It is associated with multiple comorbidities, most notably COPD, chronic rhinosinusitis, asthma, hypertension, cardiovascular disease, anxiety and depression. The development of bronchiectasis may portend poorer outcomes with regards to symptom burden, disease severity, healthcare utilisation and mortality. With the development of disease-modifying therapies and the implementation of lung cancer screening programmes, the prevalence of bronchiectasis is expected to rise.

The true burden of bronchiectasis among First Nations populations is likely underestimated, but the available data indicate that these populations have a substantially higher prevalence compared to the general population. There are multiple pre-disposing factors, including socioeconomic disadvantage, limited access to healthcare, high rates of childhood respiratory tract infection and smoking leading to increased disease severity and poorer outcomes.

Large, longitudinal population studies are required in more regions across the world to truly identify the extent of the problem and highlight the necessity for ongoing research in bronchiectasis, with the goal of improving patient outcomes and quality of life.

Footnotes

Acknowledgements

The author used ChatGPT’s assistance in the editing process. AI was not used in any other capacity for the creation of this manuscript.

Declarations

ORCID iD

Irena F. Laska

References

Chandrasekaran

Mac Aogáin

Chalmers

, et al. Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis. BMC Pulm Med 2018; 18: 83.

Hill

Sullivan

Chalmers

, et al. British Thoracic Society Guideline for bronchiectasis in adults. Thorax 2019; 74: 1–69.

Aliberti

Goeminne

O'Donnell

, et al. Criteria and definitions for the radiological and clinical diagnosis of bronchiectasis in adults for use in clinical trials: international consensus recommendations. Lancet Respir Med 2022; 10: 298–306.

Magge

Ashraf

Quittner

, et al. Quality of life in patients with bronchiectasis: a 2-year longitudinal study. Ann Transl Med 2019; 7: 334.

Diel

Chalmers

Rabe

, et al. Economic burden of bronchiectasis in Germany. Eur Respir J 2019; 53.

Winter

Manzini

Salge

, et al. Aging of the lungs in asymptomatic lifelong nonsmokers: findings on HRCT. Lung 2015; 193: 283–290.

Nigro

Laska

Traversi

, et al. Epidemiology of bronchiectasis. Eur Respir Rev 2024; 33: 20241009.

Wang

Zhao

, et al. Prevalence of bronchiectasis in adults: a meta-analysis. BMC Public Health 2024; 24: 2675.

Weycker

Edelsberg

Outer

, et al. Prevalence and economic burden of bronchiectasis. Clin Pulm Med 2005; 12: 205–209.

10.

Seitz

Olivier

Adjemian

, et al. Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest 2012; 142: 432–439.

11.

Henkle

Chan

Curtis

, et al. Characteristics and health-care utilization history of patients with bronchiectasis in US medicare enrollees with prescription drug plans, 2006 to 2014. Chest 2018; 154: 1311–1320.

12.

Weycker

Hansen

Seifer

FD.

Prevalence and incidence of noncystic fibrosis bronchiectasis among US adults in 2013. Chron Respir Dis 2017; 14: 377–384.

13.

Quint

Millett

Joshi

, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J 2016; 47: 186–193.

14.

Snell

Gibson

Jarrold

, et al. Epidemiology of bronchiectasis in the UK: findings from the British lung foundation’s ‘Respiratory health of the nation’ project. Respir Med 2019; 158: 21–23.

15.

Aliberti

Sotgiu

Lapi

, et al. Prevalence and incidence of bronchiectasis in Italy. BMC Pulm Med 2020; 20: 15.

16.

Ringshausen

Rademacher

Pink

, et al. Increasing bronchiectasis prevalence in Germany, 2009 – 2017: a population-based cohort study. Eur Respir J 2019; 54: 1900499

17.

Ringshausen

de Roux

Diel

, et al. Bronchiectasis in Germany: a populationbased estimation of disease prevalence. Eur Respir J 2015; 46: 1805–1807.

18.

Monteagudo

Rodríguez-Blanco

Barrecheguren

, et al. Prevalence and incidence of bronchiectasis in Catalonia, Spain: a population-based study. Respir Med 2016; 121: 26–31.

19.

Zhou

Wang

Yao

, et al. [The prevalence and risk factors of bronchiectasis in residents aged 40 years old and above in seven cities in China]. Zhonghua Nei Ke Za Zhi 2013; 52: 379–382.

20.

Lin

JM.

Bronchiectasis in China. Ann Am Thorac Soc 2016; 13: 609–616.

21.

Feng

Sun

, et al. Increasing prevalence and burden of bronchiectasis in urban Chinese adults, 2013-2017: a nationwide population-based cohort study. Respir Res 2022; 23: 111.

22.

Choi

Yang

Nam

, et al. Population-based prevalence of bronchiectasis and associated comorbidities in South Korea. Eur Respir J 2019; 54: 20190829.

23.

Park

Kang

Choi

Evaluating the Prevalence and Incidence of Bronchiectasis and Nontuberculous Mycobacteria in South Korea Using the Nationwide Population Data. Int J Environ Res Public Health 2021; 18 20210827.

24.

Phua

Lim

Ganesan

, et al. Epidemiology and economic burden of bronchiectasis requiring hospitalisation in Singapore. ERJ Open Res 2021; 7: 20211025.

25.

Chessari

Simonetta

Amati

, et al. Diagnostic delay in bronchiectasis: an Italian perspective. ERJ Open Res 2024; 10: 20240318.

26.

Säynäjäkangas

Keistinen

Tuuponen

, et al. Bronchiectasis in Finland: trends in hospital treatment. Respir Med 1997; 91: 395–398.

27.

Yang

Choi

Lim

, et al. The disease burden of bronchiectasis in comparison with chronic obstructive pulmonary disease: a national database study in Korea. Ann Transl Med 2019; 7: 770.

28.

Aksamit

O'Donnell

Barker

, et al. Adult patients with bronchiectasis: a first look at the us bronchiectasis research registry. Chest 2017; 151: 982–992.

29.

Chalmers

Polverino

Crichton

, et al. Bronchiectasis in Europe: data on disease characteristics from the European Bronchiectasis registry (EMBARC). Lancet Respir Med 2023; 11: 637–649.

30.

Visser

Bye

PTP

Fox

, et al. Australian adults with bronchiectasis: The first report from the Australian Bronchiectasis Registry. Respir Med 2019; 155: 97–103.

31.

Gao

Guan

WJ.

Advances in bronchiectasis registries: the new chinese registry. Arch Bronconeumol 2022; 58: 739–741.

32.

Dhar

Singh

Talwar

, et al. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. Lancet Glob Health 2019; 7: e1269–e1279.

33.

Lee

Choi

Chalmers

, et al. Characteristics of bronchiectasis in Korea: First data from the Korean Multicentre Bronchiectasis Audit and Research Collaboration registry and comparison with other international registries. Respirology 2021; 26: 619–621.

34.

Zheng

, et al. Baseline characteristics of patients in the Chinese Bronchiectasis Registry (BE-China): a multicentre prospective cohort study. Lancet Respir Med 2025; 13: 166–176.

35.

Bellelli

Chalmers

Sotgiu

, et al. Characterization of bronchiectasis in the elderly. Respir Med 2016; 119: 13–19.

36.

Polverino

Dimakou

Hurst

, et al. The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions. Eur Respir J 2018; 52: 1800328.

37.

Shi

, et al. Clinical characteristics of patients with chronic obstructive pulmonary disease with comorbid bronchiectasis: a systemic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2015; 10: 1465–1475.

38.

Jin

Liu

, et al. Bronchiectasis as a comorbidity of chronic obstructive pulmonary disease: A systematic review and meta-analysis. PLoS One 2016; 11: e0150532.

39.

Polverino

De Soyza

Dimakou

, et al. The association between bronchiectasis and chronic obstructive pulmonary disease: Data from the European Bronchiectasis Registry (EMBARC). Am J Respir Crit Care Med 2024; 210: 119–127.

40.

Handley

Nicolson

Hew

, et al. Prevalence and clinical implications of chronic rhinosinusitis in people with bronchiectasis: a systematic review. J Allergy Clin Immunol Pract 2019; 7: 2004–2012.e2001.

41.

Sheng

Yao

Wang

, et al. Prevalence and clinical implications of bronchiectasis in patients with overlapping asthma and chronic rhinosinusitis: a single-center prospective study. BMC Pulm Med 2021; 21: 211. 20210705. DOI: 10.1186/s12890-021-01575-7.

42.

Polverino

Dimakou

Traversi

, et al. Bronchiectasis and asthma: Data from the European Bronchiectasis Registry (EMBARC). J Allergy Clin Immunol 2024; 153: 1553–1562. 20240223. DOI: 10.1016/j.jaci.2024.01.027.

43.

Al Oweidat

Marie

Toubasi

, et al. The prevalence of anxiety and depression in bronchiectasis patients and their association with disease severity: a cross-sectional study. Sci Rep 2023; 13: 20886. 20231128. DOI: 10.1038/s41598-023-48276-1.

44.

Özgün Niksarlioglu

Özkan

Günlüoğlu

, et al. Factors related to depression and anxiety in adults with bronchiectasis. Neuropsychiatr Dis Treat 2016; 12: 3005–3010. 20161123. DOI: 10.2147/NDT.S121147.

45.

Bekir

Kocakaya

Balcan

, et al. Clinical impact of depression and anxiety in patients with non-cystic fibrosis bronchiectasis. Tuberk Toraks 2020; 68: 103–111. DOI: 10.5578/tt.69348.

46.

Olveira

Gaspar

, et al. Depression and anxiety symptoms in bronchiectasis: associations with health-related quality of life. Qual Life Res 2013; 22: 597–605. 20120429. DOI: 10.1007/s11136-012-0188-5.

47.

Seitz

Olivier

Steiner

, et al. Trends and burden of bronchiectasis-associated hospitalizations in the United States, 1993-2006. Chest 2010; 138: 944–949. 20100430. DOI: 10.1378/chest.10-0099.

48.

Joish

Spilsbury-Cantalupo

Operschall

, et al. Economic burden of non-cystic fibrosis bronchiectasis in the first year after diagnosis from a US health plan perspective. Appl Health Econ Health Policy 2013; 11: 299–304. DOI: 10.1007/s40258-013-0027-z.

49.

Ronco

Franco

Monzio Compagnoni

, et al. Healthcare costs and resource utilisation in bronchiectasis, asthma and COPD. ERJ Open Res 2023; 9 20230731. DOI: 10.1183/23120541.00158-2023.

50.

Sánchez-Muñoz

López

Andrés

Jiménez-García

, et al. Time trends in hospital admissions for bronchiectasis: analysis of the Spanish national hospital discharge data (2004 to 2013). PLoS One 2016; 11: e0162282.

51.

de la Rosa

Martínez-Garcia

Olveira

, et al. Annual direct medical costs of bronchiectasis treatment: Impact of severity, exacerbations, chronic bronchial colonization and chronic obstructive pulmonary disease coexistence. Chron Respir Dis 2016; 13: 361–371.

52.

Seifer

Hansen

Weycker

Health-care utilization and expenditures among patients with comorbid bronchiectasis and chronic obstructive pulmonary disease in US clinical practice. Chron Respir Dis 2019; 16: 1479973119839961.

53.

Diel

Ewig

Blaas

, et al. Incidence of patients with non-cystic fibrosis bronchiectasis in Germany – A healthcare insurance claims data analysis. Respir Med 2019; 151: 121–127. 20190409. DOI: 10.1016/j.rmed.2019.04.007.

54.

Navaratnam

Muirhead

Hubbard

, et al. Critical care admission trends and outcomes in individuals with bronchiectasis in the UK. QJM 2016; 109: 523–526. 20151117. DOI: 10.1093/qjmed/hcv206.

55.

de la Rosa Carrillo

Navarro Rolon

Girón Moreno

, et al. Cost of Hospitalizations due to Exacerbation in Patients with Non-Cystic Fibrosis Bronchiectasis. Respiration 2018; 96: 406–416. 20180711. DOI: 10.1159/000489935.

56.

Dimitrova

Gilchrist

Seaton

RA.

Outpatient parenteral antimicrobial therapy (OPAT) versus inpatient care in the UK: a health economic assessment for six key diagnoses. BMJ Open 2021; 11: e049733.

57.

Blanchette

Noone

Stone

, et al. Healthcare Cost and utilization before and after diagnosis of pseudomonas aeruginosa among patients with non-cystic fibrosis bronchiectasis in the U.S. Med Sci (Basel) 2017; 5: 20170923.

58.

Liu

, et al. Clinical features related to hospital expenses for non-cystic fibrosis bronchiectasis in China. J Int Med Res 2020; 48: 300060520931616.

59.

Machado

Jacques

Penteado

, et al. Prognostic factors in adult patients with non-cystic fibrosis bronchiectasis. Lung 2018; 196: 691–697. 20180925.

60.

Roberts

Hubbard

Trends in bronchiectasis mortality in England and Wales. Respir Med 2010; 104: 981–985. 20100319.

61.

Davey

RX.

Health disparities among Australia’s remote-dwelling aboriginal people: a report from 2020. J Appl Lab Med 2021; 6: 125–141.

62.

Steinfort

Brady

Weisinger

, et al. Bronchiectasis in Central Australia: a young face to an old disease. Respir Med 2008; 102: 574–578.

63.

Kruavit

Fox

Pearson

, et al. Chronic respiratory disease in the regional and remote population of the Northern Territory Top End: a perspective from the specialist respiratory outreach service. Aust J Rural Health 2017; 25: 275–284.

64.

Gibbs

Howarth

Ticoalu

, et al. Bronchiectasis among Indigenous adults in the Top End of the Northern Territory, 2011-2020: a retrospective cohort study. Med J Aust 2024; 220: 188–195.

65.

Heraganahally

Gibbs

J Ravichandran

, et al. Retrospective cross-sectional study on bronchiectasis in adult Aboriginal Australians: disease characteristics and comparison with ethnically diverse global bronchiectasis registry cohorts. BMJ Open Respir Res 2025; 12: e002139.

66.

Einsiedel

Pham

, et al. Predictors of non-cystic fibrosis bronchiectasis in Indigenous adult residents of central Australia: results of a case-control study. ERJ Open Res 2019; 5: 00001-2019.

67.

Blackall

Hong

King

, et al. Bronchiectasis in indigenous and non-indigenous residents of Australia and New Zealand. Respirology 2018; 23: 743–749.

68.

Mehra

Chang

Lam

, et al. Bronchiectasis among Australian Aboriginal and non-Aboriginal patients in the regional and remote population of the Northern Territory of Australia. Rural Remote Health 2021; 21: 6390.

69.

O'Grady

Torzillo

Chang

AB.

Hospitalisation of indigenous children in the Northern Territory for lower respiratory illness in the first year of life. Med J Aust 2010; 192: 586–590.

70.

Einsiedel

Fernandes

Spelman

, et al. Bronchiectasis is associated with human T-lymphotropic virus 1 infection in an indigenous Australian population. Clin Infect Dis 2012; 54: 43–50.

71.

de Boer

Lewis

Fergusson

, et al. Ethnicity, socioeconomic status and the severity and course of non-cystic fibrosis bronchiectasis. Intern Med J 2018; 48: 845–850.

72.

Roberts

Lowndes

Milne

, et al. Socioeconomic deprivation, readmissions, mortality and acute exacerbations of bronchiectasis. Intern Med J 2012; 42: e129–136.

73.

Singleton

Morris

Redding

, et al. Bronchiectasis in Alaska Native children: causes and clinical courses. Pediatr Pulmonol 2000; 29: 182–187.

74.

Sibanda

Singleton

Clark

, et al. Adult outcomes of childhood bronchiectasis. Int J Circumpolar Health 2020; 79: 1731059.

75.

Kinghorn

Singleton

McCallum

, et al. Clinical course of chronic suppurative lung disease and bronchiectasis in Alaska Native children. Pediatr Pulmonol 2018; 53: 1662–1669.

76.

Hunter-Schouela

Geraghty

Hegele

, et al. First reports of primary ciliary dyskinesia caused by a shared DNAH11 allele in Canadian Inuit. Pediatr Pulmonol 2023; 58: 1942–1949.

77.

Das

Kovesi

TA.

Bronchiectasis in children from Qikiqtani (Baffin) Region, Nunavut, Canada. Ann Am Thorac Soc 2015; 12: 96–100.

78.

Kwak

Moon

Choi

, et al. High prevalence of bronchiectasis in adults: analysis of CT findings in a health screening program. Tohoku J Exp Med 2010; 222: 237–242.

79.

Cai

Triphuridet

Zhu

, et al. Bronchiectasis in low-dose CT screening for lung cancer. Radiology 2022; 304: 437–447. 20220419.

80.

Sanchez-Carpintero Abad

Sanchez-Salcedo

de-Torres

, et al. Prevalence and burden of bronchiectasis in a lung cancer screening program. PLoS One 2020; 15: e0231204.

81.

Chalmers

JD.

Bronchiectasis: advances in diagnosis and treatment. Semin Respir Crit Care Med 2021; 42: 497–498.

82.

PubMed, https://pubmed.ncbi.nlm.nih.gov/?term=bronchiectasis (accessed 11 March 2025).

83.

Aliberti

Masefield

Polverino

, et al. Research priorities in bronchiectasis: a consensus statement from the EMBARC Clinical Research Collaboration. Eur Respir J 2016; 48: 632–647.

84.

Chalmers

Burgel

Daley

, et al. Phase 3 trial of the DPP-1 Inhibitor Brensocatib in Bronchiectasis. N Engl J Med 2025; 392: 1569–1581. DOI: 10.1056/NEJMoa2411664.

85.

Chalmers

Shteinberg

Mall

, et al. Cathepsin C (dipeptidyl peptidase 1) inhibition in adults with bronchiectasis: AIRLEAF, a phase II randomised, double-blind, placebo-controlled, dose-finding study. Eur Respir J 2025; 65: 2401551. DOI: 10.1183/13993003.01551-2024.

86.

Zhong

Qiu

Cao

, et al. Effects of the DPP-1 inhibitor HSK31858 in adults with bronchiectasis in China (SAVE-BE): a phase 2, multicentre, double-blind, randomised, placebo-controlled trial. Lancet Respir Med 2025; 13: 414–424.

87.

Lung Cancer Policy Network, https://www.lungcancerpolicynetwork.com/ (2025, accessed 10 March 2025).

88.

Australian Government Department of Health and Aged Care, National Lung Cancer Screening Programme, https://www.health.gov.au/our-work/nlcsp (2025, accessed 10 March 2025).

89.

Henderson

Kim

Tanner

, et al. Lung cancer screening and incidental findings: a research agenda: an official american thoracic society research statement. Am J Respir Crit Care Med 2025; 211: 436–451. DOI: 10.1164/rccm.202501-0011ST.

90.

O'Dowd

Tietzova

Bartlett

, et al. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur J Cardiothorac Surg 2023; 62(4): 2300533.

Prevalence of bronchiectasis: a narrative review

Abstract

Keywords

Introduction

Search strategy

General prevalence of bronchiectasis

United States

UK/Europe

Asia

General trends

Comorbidities

Healthcare burden associated with bronchiectasis

Prevalence in First Nations populations

Australia

New Zealand

North America

Prevalence of bronchiectasis through radiological screening programmes

Current challenges and future implications

Conclusion

Footnotes

Acknowledgements

Declarations

ORCID iD

References