Bronchiectasis.

Bronchiectasis, a condition characterized by abnormal and permanent dilatation of pulmonary airways, is an old disease, well recognized in the era before widespread immunization for childhood diseases and the development of antibiotics. After that time, interest in this disease waned. The recognition of bronchiectasis in association with congenital diseases awakened interest in the disease. Review of literature relating to the etiologies of bronchiectasis does not substantiate a congenital origin in most; it appears that the majority of cases of bronchiectasis result from prior infections of the lungs, either viral or bacterial, including mycobacterial. The initial insult triggers an inflammatory change in the bronchial wall that persists even after the episode ends. Over time, the bronchial wall is damaged, making it subject to permanent dilatation. Clinical findings of bronchiectasis include chronic cough with sputum production, often purulent, sometimes hemoptoic. Recurrent pleurisy and fever occur. Spirometry in most patients shows airway obstruction, even if the patient has never smoked. Chest radiographs are usually abnormal, with chronic increased markings caused by infiltrates or scarring, atelectasis, and pleural thickening. Microbiological studies may show a variety of organisms, some commensals, others pathogenic. Diagnosis is made based on the clinical picture with a compatible chest radiograph and confirmed with a high-resolution computed tomography (CT) scan. Therapy of bronchiectasis is directed at airway obstruction, including chest physiotherapy and bronchodilators, and at the infections. Few controlled studies to evaluate any therapy have been performed.