Abstract Rationale Bronchiectasis is a chronic airway disease associated with infection, frequent exacerbations, and accelerated lung function decline; however, diagnosis is often delayed until advanced disease, missing a critical early intervention window. Low-dose CT lung cancer screening (CTLS) programs offer a scalable opportunity to systematically detect bronchiectasis in high-risk individuals and intervene earlier, yet the real-world burden, timing of diagnosis, and clinical outcomes following radiology-identified bronchiectasis on CTLS are not well characterized. As evidence-based management strategies mature and new therapeutic options emerge, linking radiology-detected bronchiectasis to structured evaluation pathways will be essential to reduce exacerbations, prevent disease progression, and ensure timely access to evolving therapies. Methods This retrospective multi-center cohort included CTLS-eligible patients from Lahey Hospital 2015-2019 MAH) with follow-up through 2019 (LHMC) and 2020 (MAH). Pneumonia/COPD hospitalizations were evaluated using Cox proportional hazards models adjusted for age, sex, BMI, smoking status, and pack-years. A nested cohort with an in-network primary care provider (LHMC n = 102; MAH n = 50) underwent chart review through July 2025 to assess diagnosis timing, pulmonary referral, PFTs, and exacerbations, defined as COPD or bronchiectasis exacerbation encounters. Results Bronchiectasis prevalence was 3.1% (143/4,673) at LHMC and 4.3% (55/1,271) at MAH. Radiology-identified bronchiectasis was associated with significantly increased pneumonia hospitalizations (LHMC HR 3.10, 95% CI 1.86-5.15, p 0.001; MAH HR 2.88, 95% CI 1.21-6.83, p = 0.016) and higher COPD admissions at LHMC (HR 1.98, 95% CI 1.04-3.78, p = 0.039). In the nested cohort, 80.4% (LHMC) and 48.0% (MAH) remained undiagnosed during follow-up. Median time to diagnosis was 2.42 years (IQR 0.57-10.05) at LHMC versus 0.28 years (0.02-0.97) at MAH. At LHMC, 48% experienced ≥1 exacerbation and 29.4% had ≥2 within a year; two-thirds of frequent exacerbators were never diagnosed. Similar patterns were observed at MAH, reinforcing a reproducible care gap across institutions (Table 1). Conclusions Radiology-identified bronchiectasis on CTLS is common and strongly associated with increased respiratory hospitalizations, yet most patients remain undiagnosed for years, including many with recurrent exacerbations. CTLS programs represent a scalable platform to close recognition gaps, enable follow-up pathways, and facilitate earlier evidence-based care. These findings underscore an actionable population-health opportunity to link imaging detection with structured navigation and specialty evaluation, supporting earlier intervention and improving readiness for emerging bronchiectasis therapies to reduce exacerbations and preventable morbidity. This abstract is funded by: Tufts-Harold Williams, M.D. Summer Research Fellowship
Shubeck et al. (Fri,) studied this question.