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Review
. 2025 Nov;41(4):539-551.
doi: 10.1016/j.cger.2025.07.006. Epub 2025 Aug 7.

Considerations in the Diagnosis and Management of Bronchiectasis in Older Adults

Lauren R Pollack  1 , Christopher H Goss  2 , Kenneth N Olivier  3
Affiliations
Review

Considerations in the Diagnosis and Management of Bronchiectasis in Older Adults

Lauren R Pollack et al. Clin Geriatr Med. 2025 Nov.

Abstract

Bronchiectasis is characterized by chronic airway inflammation and scarring resulting in cough and recurrent respiratory infections. It is strongly associated with aging. Risk factors include impaired mucociliary clearance, structural lung and chest wall changes, aspiration, and comorbidities such as chronic obstructive pulmonary disease. Radiographic bronchiectasis is a common incidental finding in older adults; clinical diagnosis of bronchiectasis requires characteristic symptoms. Management involves both nonpharmacologic strategies (airway clearance, pulmonary rehabilitation) and pharmacologic therapies (antibiotics, inhaled treatments). Shared decision-making about treatment is essential and should take into account impact on quality of life, functional ability, cognition, comorbid conditions, and risks of polypharmacy.

Keywords: Aging; Bronchiectasis; Elderly; Older adults.

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Conflict of interest statement

Disclosure L.R. Pollack has no disclosures. C.H. Goss has received grants from the National Institutes of Health, United States, the Cystic Fibrosis Foundation, United States, and the Federal Drug Administration unrelated to this work. C.H. Goss has received fees from Enterprise Therapeutics for providing clinical trial design advice. He received honoraria from Gilead Sciences to serve as grant review committee chair and from Vertex Pharmaceuticals, United States for speaking at the UK LEAD conference. He served as a DSMB Chair for a trial supported by Novartis, Switzerland and the European Commission, European Union. He serves as the Deputy Editor of the Annals of the American Thoracic Society. C.H. Goss has stock in Air Therapeutics. C.H. Goss receives funding from the National Institute of Diabetes and Digestive and Kidney Diseases, United States (P30 DK 089,507). K.N. Olivier receives funding from the National Institutes of Health and the Cystic Fibrosis Foundation. He has received consulting fees for clinical trial design advice and served as a site investigator for Spero Therapeutics, Paratek Pharma, AN2 Therapeutics, and ReCode Therapeutics. K.N. Olivier has received consulting fees and serves as a DSMB Chair for Mannkind Corporation. He has received consulting and speaker fees for Insmed, Inc and serves as a site investigator for Verona Pharma. K.N. Olivier is an Assembly Chair and member of the Board of Directors for the American Thoracic Society and is a member of the Medical and Scientific Advisory Committee for the Primary Ciliary Dyskinesia Foundation. K.N. Olivier receives consulting fees as a Steering Committee Member of the Bronchiectasis and NTM Clinical Center Network (COPD Foundation). K.N. Olivier is Specialty Chief Editor of Non-Tuberculous Mycobacteria, Frontiers in Tuberculosis Journal.

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