Pulmonology · Medical Literature
Health-related quality of life and associated factors in children with bronchiectasis: A systematic review.
Abstract
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. 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. • 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. • 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.
Clinical relevance
Bronchiectasis is a chronic, progressive respiratory disease in children associated with significant morbidity, yet health-related quality of life (HRQoL) has been inconsistently characterized in the pediatric literature. This systematic review (9 studies, PRISMA-compliant, moderate-to-high quality) addresses that gap by consolidating current evidence on HRQoL burden and its determinants in this population. Pediatric pulmonologists and primary care providers should prioritize HRQoL assessment, as impairment spans both physical and psychosocial domains and is frequently underrecognized in routine clinical encounters.
Key findings
1. HRQoL scores in children with bronchiectasis were significantly lower than those in healthy controls across most validated scales, confirming a substantial disease burden relative to the general pediatric population. 2. Impaired lung function was identified as a key determinant of lower HRQoL, consistent with the known relationship between spirometric decline and functional limitation in obstructive/suppurative airway disease. 3. Frequent exacerbations were independently associated with worse HRQoL, highlighting the cumulative impact of acute pulmonary deteriorations on children's well-being. 4. Higher symptom burden (e.g., chronic cough, dyspnea, sputum production) correlated with reduced HRQoL, underscoring the direct symptomatic contribution to quality-of-life impairment. 5. Comorbid anxiety and depression were significant psychosocial determinants of lower HRQoL, indicating that mental health sequelae are a clinically meaningful and potentially modifiable factor in this cohort. 6. Parent-proxy HRQoL ratings were consistently lower than child self-reports across studies, revealing a systematic perception gap between caregivers and patients that has important implications for clinical assessment and shared decision-making. NOTE: Specific effect sizes, confidence intervals, p-values, and NNT/NNH were not reported in the available abstract; precise quantitative estimates should be extracted from the full-text publication.
Practice implications
Clinicians managing children with bronchiectasis should incorporate validated HRQoL instruments into routine follow-up visits — particularly for patients with impaired spirometry, recurrent exacerbations, or high symptom burden — as these factors are the strongest identified correlates of quality-of-life deterioration. Given the significant parent-proxy versus child self-report discordance, both caregiver and patient perspectives should be captured independently to avoid systematic underestimation or overestimation of disease impact. Integrated, multidisciplinary care models that address psychological comorbidities (screening for anxiety and depression) alongside standard pulmonary management are warranted and should be considered best practice in pediatric bronchiectasis clinics.