Health-related quality of life and associated factors in children with bronchiectasis: A systematic review

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Not quantified — descriptive synthesis only; no pooled effect size reported

• Primary Outcome: HRQoL scores in children with bronchiectasis were significantly lower than those in healthy controls across most scales, with variability observed between physical and psychosocial domains

• Nnt Or Sensitivity: Not applicable — observational/descriptive systematic review; associated factors identified include impaired lung function, frequent exacerbations, higher symptom burden, and anxiety/depression. Parent-proxy scores were consistently lower than child self-reports across included studies.

• Confidence Interval: Not reported — no meta-analysis performed

Clinical Application

Routine HRQoL assessment using validated paediatric instruments (e.g., PedsQL, CHQ, or bronchiectasis-specific tools where available) is feasible in outpatient settings. Integration of psychological screening (anxiety, depression) into bronchiectasis review clinics is achievable with multidisciplinary team support including paediatric psychology. The parent-proxy versus self-report discordance finding has direct implications for clinical assessment protocols — both perspectives should be routinely captured. Bronchiectasis carries particular significance in the Australian context, where it disproportionately affects Aboriginal and Torres Strait Islander children, often arising from recurrent lower respiratory tract infections in early childhood. The Thoracic Society of Australia and New Zealand (TSANZ) and RACGP have highlighted the under-recognition and under-treatment of bronchiectasis in Indigenous paediatric populations. This review's findings support the integration of HRQoL assessment into existing chronic disease management frameworks under the RACGP's Aboriginal and Torres Strait Islander Health Assessment (MBS Item 715). No bronchiectasis-specific HRQoL tool is currently listed on the PBS or endorsed by TGA; however, generic instruments such as the PedsQL are freely available. The psychosocial burden identified in this review aligns with the need for culturally safe, integrated care models in remote and regional Australian settings. Clinicians should note that the evidence base is predominantly derived from non-Indigenous populations, and direct extrapolation to Australian Indigenous children requires caution. Children with confirmed bronchiectasis, particularly those with impaired lung function (reduced FEV₁), frequent pulmonary exacerbations, high symptom burden, or comorbid anxiety and depression. Findings are most directly applicable to paediatric respiratory medicine and general paediatrics settings managing chronic suppurative lung disease.

Abstract

UNLABELLED: This systematic review aimed to summarize the current evidence on health-related quality of life (HRQoL) and its associated factors in children with bronchiectasis. Following the PRISMA guidelines, we systematically searched PubMed, Embase, Web of Science, ScienceDirect, CINAHL, CENTRAL, CNKI, WanFang, VIP, and CBM published from inception to October 2025. Two reviewers independently screened studies, extracted data, and assessed quality using standardized tools. Descriptive synthesis was performed. Nine studies were included, with overall moderate to high quality. HRQoL scores in children with bronchiectasis were significantly lower than those in healthy controls across most scales, though findings varied across physical and psychosocial domains. Parent-proxy scores were generally lower than child self-reports. Lower HRQoL was associated with impaired lung function, frequent exacerbations, higher symptom burden, and anxiety/depression. CONCLUSION: HRQoL is substantially impaired in children with bronchiectasis. Routine assessment of HRQoL and integrated interventions addressing both physical and psychosocial aspects are warranted in clinical practice. WHAT IS KNOWN: • Bronchiectasis is a chronic respiratory disease that causes coughing and breathing difficulties in children. • Previous studies have reported inconsistent findings on quality of life in children with bronchiectasis. WHAT IS NEW: • This systematic review consolidates evidence from nine studies, confirming that children with bronchiectasis have significantly lower quality of life than healthy children. • Poor lung function, frequent exacerbations, and anxiety/depression are key determinants; parents tend to rate their child's quality of life lower than the children themselves, underscoring the need for integrated care including psychological support.

References

1. 1.Pi, A., Li, Y., Zang, N., Zhang, S., Liu, C., & Liu, Y. (2026). Health-related quality of life and associated factors in children with bronchiectasis: A systematic review. European Journal of Pediatrics. https://doi.org/10.1016/j.chest.2025.08.021