Bronchiectasis is a chronic respiratory disease characterized by irreversible dilatation of the bronchi, usually associated with chronic cough, sputum production, and recurrent respiratory infections [1]. The condition arises due to a vicious cycle of infection and inflammation, leading to progressive structural lung damage [2]. Although traditionally considered a consequence of pulmonary tuberculosis in developing countries, the etiological spectrum of bronchiectasis has widened with increasing recognition of post-infectious causes, immunodeficiency disorders, allergic bronchopulmonary aspergillosis (ABPA), and connective tissue diseases [3,4].

High-resolution computed tomography (HRCT) of the thorax remains the gold standard for diagnosis, providing detailed visualization of bronchial dilatation, distribution, and severity [5]. Clinically, patients often present with cough, expectoration, dyspnea, and hemoptysis, which significantly impact quality of life [6]. Pulmonary function testing generally reveals an obstructive pattern, although restrictive or mixed defects may also occur, especially in advanced disease [7].

Microbiological evaluation of sputum plays a critical role in disease management. Chronic bacterial colonization, particularly with Pseudomonas aeruginosa, is associated with frequent exacerbations, accelerated lung function decline, and poorer prognosis [8]. Other pathogens such as Klebsiella pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and non-tuberculous mycobacteria (NTM) are also implicated [9,10]. The presence of fungal organisms like Aspergillus species is linked to allergic manifestations and more severe disease [11].

Despite being increasingly recognized worldwide, the epidemiology and microbiological profile of bronchiectasis vary significantly between populations due to differences in underlying etiologies, environmental exposures, and healthcare practices [12]. In India, where tuberculosis and post-infective sequelae remain major contributors, systematic studies addressing the clinico-radiological and microbiological profile of bronchiectasis are limited [13,14].

This study was therefore undertaken to evaluate the clinico-radiological and microbiological characteristics of bronchiectasis patients attending a tertiary care hospital, with the aim of identifying predominant patterns and potential associations that could guide better disease management and patient outcomes.

MATERIALS AND METHODS

Study Design and Setting

This was an observational, cross-sectional study conducted in the Department of Respiratory Medicine, PGIMER & Capital Hospital, Bhubaneswar, in collaboration with the Departments of Radiodiagnosis and Microbiology. The study was carried out over a period of 12 months, from May 2023 to April 2024.

Study Population

A total of 100 patients attending the Outpatient Department (OPD) and Inpatient Department (IPD) of Respiratory Medicine, who were diagnosed with bronchiectasis based on clinical and radiological findings, were included after obtaining written informed consent.

Inclusion Criteria

• Patients aged 14–65 years diagnosed with bronchiectasis on clinical and radiological grounds.

Exclusion Criteria

• Patients with active tuberculosis (TB) or HIV infection.
• Patients with interstitial lung disease (ILD).
• Pregnant females.

Data Collection Tools

A structured study proforma was used to record demographic details, clinical presentation, physical examination findings, laboratory investigations, radiological features, and microbiological results.

Clinical Assessment

• Detailed medical history, including symptoms (fever, cough, expectoration, hemoptysis, night sweats, weight loss, loss of appetite, etc.) and risk factors (smoking, alcohol, co-morbidities).
• General physical examination and systemic examination (respiratory, cardiovascular, abdominal, CNS, and musculoskeletal systems).

Laboratory Investigations

• Routine blood tests: Complete blood count (CBC), fasting blood sugar (FBS), HbA1c, liver function tests (LFT), kidney function tests (KFT), and C-reactive protein (CRP).
• Sputum analysis: Ziehl–Neelsen (ZN) stain, CBNAAT/TrueNat for Mycobacterium tuberculosis, bacterial culture, lactophenol cotton blue (LCB) mount, and fungal culture. Sputum samples showing growth of ≥2 organisms were categorized as mixed infection.

Pulmonary Function Tests

• Spirometry was performed for each subject, measuring forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC ratio.
• At least three maneuvers were recorded, and the best value was selected.
• Post-bronchodilator testing was done 20 minutes after administration of 4 puffs (100 mcg each) of salbutamol.
• Results were interpreted as normal, obstructive, restrictive, or nonspecific according to ATS/ERS guidelines [6].

Radiological Assessment

• Chest X-ray (PA view) for initial evaluation.
• High-Resolution Computed Tomography (HRCT) Thorax was performed for definitive diagnosis and assessment of extent of bronchiectasis.
• Distribution was categorized as:
• Unilateral upper lobe (UUL)
• Bilateral upper lobes (BUL)
• Unilateral lower lobe (ULL)
• Bilateral lower lobes (BLL)
• Lingula & middle lobe (ML & L)
• Diffuse unilateral bronchiectasis (DUB: all lobes of one hemithorax involved)
• Diffuse bilateral bronchiectasis (DBB: ≥3 lobes bilaterally involved)

Statistical Analysis

Data was entered into Microsoft Excel and analyzed using SPSS version 26.0. Descriptive statistics (mean, standard deviation, proportions) were calculated. Associations between clinical, radiological, and microbiological findings were assessed using appropriate statistical tests, with p < 0.05 considered statistically significant.

RESULTS AND OBSERVATIONS

A total of 100 patients diagnosed with bronchiectasis were included in the study. The following observations were made:

Table 1: Demographic Characteristics of the Study Population (n = 100)

Table 2: Clinical Presentation of Patients (n = 100)

Table 3: Spirometry Findings (n = 100)

Figure 2: : Spirometry Findings (n = 100)

Table 4: Distribution of Bronchiectasis on HRCT (n = 100)

Figure 3: Distribution of Bronchiectasis on HRCT (n = 100)

Table 5: Microbiological Profile of Sputum Samples (n = 100)

Figure 4: Microbiological Profile of Sputum Samples (n = 100)

Table 6: Correlation of HRCT Pattern with Microbiological Findings (n = 100)

Table 7: Sputum Production and Hemoptysis Severity in Bronchiectasis Patients (n = 100)

Table 8: Association of Smoking with Radiological Pattern (n = 100)

Table 9: Association of Diabetes with Microbial Growth and HRCT-Based Severity of Bronchiectasis (n = 100)

Table 10: Correlation of Spirometry Pattern with HRCT Extent (n = 100)

Table 11: Microbial Pattern in Diffuse vs Localized Bronchiectasis (n = 100)

DISCUSSION

Bronchiectasis is a chronic, progressive lung disease that continues to be an important cause of morbidity worldwide, especially in developing countries such as India, where post-infectious etiologies remain common [1]. The present study aimed to assess the clinico-radiological and microbiological profile of 100 patients with bronchiectasis in a tertiary care hospital.

In our study, the majority of patients (32%) were in the 41–55 year age group, with a male predominance (58%). This demographic pattern is consistent with studies from India and other developing nations, where middle-aged adults are most commonly affected [2,3]. However, Western studies often report older age groups due to different etiological distributions, including idiopathic and immunological causes [4].

Cough with expectoration (92% and 88%, respectively) was the most common symptom, followed by breathlessness (70%) and hemoptysis (28%). These findings align with studies by Angrill et al. [5] and Dhar et al. [6], who reported similar symptom frequencies. The relatively high occurrence of hemoptysis in our study reflects the severity of airway inflammation and vascular involvement in Indian patients.

Radiological assessment by HRCT showed that diffuse bilateral bronchiectasis (25%) and bilateral lower lobe involvement (18%) were the most common patterns. This observation is consistent with the Indian Bronchiectasis Registry, which reported a predominance of multilobar and bilateral disease [6]. In contrast, studies from Western cohorts, such as Chalmers et al. [7], describe a higher prevalence of localized or upper lobe disease, reflecting underlying etiological differences, including cystic fibrosis in Western populations.

Microbiological analysis revealed Pseudomonas aeruginosa as the most frequently isolated pathogen (30%), followed by Klebsiella pneumoniae (15%) and Staphylococcus aureus (10%). Colonization with Pseudomonas has been consistently associated with severe disease, frequent exacerbations, and worse prognosis [8,9]. Similar findings have been documented in both Indian [10] and Western cohorts [11]. The isolation of fungal organisms such as Aspergillus (8%) in our study further highlights the importance of considering allergic bronchopulmonary aspergillosis (ABPA) as a comorbidity, a finding also emphasized in studies from North India [12].

Pulmonary function testing revealed that 55% of patients had an obstructive defect, 15% had restrictive, and 8% had mixed/nonspecific patterns. These results are in agreement with previous reports indicating obstruction as the predominant spirometric abnormality [13,14]. Importantly, our study demonstrated a significant correlation between HRCT severity and spirometry patterns, with diffuse bronchiectasis associated with obstructive impairment. This supports the concept that disease extent strongly influences lung function decline [15].

We also found notable associations between comorbidities and microbial colonization. Diabetic patients had a higher prevalence of Pseudomonas aeruginosa infection (50%), suggesting that impaired host immunity in diabetes may predispose to more virulent colonizers. This has been observed in earlier studies highlighting diabetes as an independent risk factor for recurrent infections in bronchiectasis [16].

The strengths of our study include a comprehensive evaluation combining clinical, radiological, and microbiological profiles in a sizable cohort. However, limitations include its single-center design, lack of long-term follow-up, and absence of treatment outcome data. Future multicenter longitudinal studies are required to better establish causal associations and evaluate interventions for improving outcomes in bronchiectasis.

CONCLUSION

This study highlights the clinico-radiological and microbiological profile of bronchiectasis patients in a tertiary care hospital in Eastern India. The majority of patients were middle-aged adults, with cough, expectoration, and breathlessness being the predominant symptoms. HRCT revealed diffuse bilateral involvement as the most common radiological pattern, while Pseudomonas aeruginosa emerged as the leading pathogen, particularly in patients with diabetes and extensive disease. Pulmonary function impairment, mainly obstructive in nature, correlated with the radiological severity of bronchiectasis.

Our findings emphasize the importance of a comprehensive approach integrating clinical assessment, radiological evaluation, and microbiological profiling to guide management and improve patient outcomes. Early detection, timely microbiological surveillance, and individualized treatment strategies—especially targeting chronic colonization with Pseudomonas—are crucial for preventing disease progression and reducing morbidity.

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