Drugs & agingJul 20, 2026

Bronchiectasis in Older Adults: Unique Causes, Diagnosis, and Disease Progress Compared to Younger People

Longevity & Aging Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Jul 21, 2026

Abstract

Older adults represent the majority of contemporary cases of non-cystic fibrosis bronchiectasis, which is associated with higher mortality and increased healthcare utilization.

The prevalence of bronchiectasis is rising, particularly among older adults due to improved diagnostic imaging and clinical awareness.
Older patients exhibit a distinct clinical profile marked by multimorbidity, frailty, and worse health outcomes.
The disease process involves a cycle of airway inflammation, impaired mucus clearance, chronic infection, and structural lung damage.
Factors such as immunosenescence and age-related lung changes contribute to persistent infection and progressive airway injury in older individuals.
Older patients are more likely to be diagnosed at an advanced stage due to atypical symptoms and overlap with other chronic conditions.
There is a notable shift in microbial profiles among older patients, with increased prevalence of virulent and resistant pathogens.

Simplified

Non-cystic fibrosis bronchiectasis is increasingly recognized as a major cause of chronic respiratory morbidity, particularly among older adults. Its rising prevalence is largely attributable to improved diagnostic imaging and heightened clinical awareness, with epidemiological data consistently demonstrating a marked age-related increase in disease burden. Older patients represent the majority of contemporary cases and exhibit a distinct clinical phenotype characterized by multimorbidity, frailty, and worse outcomes. Pathophysiologically, bronchiectasis is driven by a 'vicious vortex' of airway inflammation, impaired mucociliary clearance, chronic infection, and structural lung damage. In older individuals, this process is amplified by immunosenescence, inflammaging, and age-related structural and functional lung changes, which together promote persistent infection and progressive airway injury. Additional contributors, such as microaspiration, cumulative environmental exposures, and coexisting conditions, including chronic obstructive pulmonary disease and gastroesophageal reflux disease, further exacerbate disease progression. Diagnosis in older adults with bronchiectasis is frequently delayed due to atypical presentations and clinical overlap with other chronic conditions, resulting in more advanced disease at the time of recognition. Microbiologically, older patients show a shift toward more virulent and resistant pathogens, particularly Pseudomonas aeruginosa and Enterobacteriaceae, with important implications for management. Prognosis is poorer in this population, with higher mortality, increased healthcare utilization, and reduced quality of life, largely driven by frailty and comorbidities rather than by disease severity alone. These findings highlight the need for a comprehensive, geriatric-informed approach integrating respiratory care with systematic assessment of functional status, comorbidities, and patient-centered outcomes to optimize management in older patients with bronchiectasis.

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Competing interests

Declarations. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Availability of data and materials: Not applicable. Competing interests: Prof. Mario Cazzola, Prof. Fabio Perrotta, Dr Raffaela Pagliaro, Dr Vincenzo Parente, and Prof. Maria Gabriella Matera declare that they do not have any conflict of interest that might be relevant to the content of this manuscript. Maria Gabriella Matera is an Editorial Board member of Drugs & Aging, but she was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Author contributions: MC and MGM supervised the project. All authors searched and screened all relevant literature. MC and MGM conducted the data extraction and collection. All authors performed the data analysis and review. MC and MGM drafted the manuscript. FP, RP, and VP critically revised the content. All authors read and approved the final version of the manuscript.

PubMed

Bronchiectasis in Older Adults: Unique Causes, Diagnosis, and Disease Progress Compared to Younger People

Abstract

Full Text

Funding

Competing interests

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