Wait long enough for a bus and two arrive at once. As with buses, so with bronchiectasis scoring systems. In this issue of the European Respiratory Journal Martinez-Garcia et al. [1] report the development of a “FACED” bronchiectasis prognostic score. This follows the recent publication by Chalmers et al. [2] of the “Bronchiectasis Severity Index” (BSI). Bronchiectasis is a neglected disease and research in the area is to be welcomed, especially when it enables us to manage our patients more appropriately. But, like any good research, these studies raise as many questions as answers: most importantly, what do we even mean when we talk about bronchiectasis “severity”?
Current definitions of bronchiectasis have two components. The landmark British Thoracic Society guidance emphasises the concept of “clinically significant” bronchiectasis [3]; the presence of “symptoms of persistent or recurrent bronchial sepsis”, in addition to the permanent airway structural damage that represents the accepted pathology definition. Tools to grade the degree and extent, or “severity” of the radiological component already exist; e.g. scoring systems described by Reiff et al. [4] and Bhalla et al. [5]. These are not without problems. Importantly, patients can have similar severity scores arising from structurally more abnormal but localised disease, or …
