Inhalation Therapy in Chronic Bronchial Infections

¹ The Chest Service of Michael Reese Hospital, Chicago, Illinois, and the Winfield Sanatorium.

1. A study has been made to determine the efficacy of inhalation therapy in bronchial infection. To rule out spontaneous remission, improvement by medical treatment, and the production of the effect by a blood level of penicillin the following criteria were used in selection of cases:

a. There must be definite bronchographic evidence of bronchiectasis.

b. There must be a history which is definitely of this type of infection for a long period of time.

c. All of the patients should have been previously treated by all other methods of medical treatment including bed rest, postural drainage, sulfonamides by mouth and penicillin by injection.

2. Forty-two patients satisfying these criteria were treated over a period of two years. All of the patients have been followed for at least 1 year.

3. Of the 42 patients there were 19 cases of complete disappearance of symptoms; 14 cases of marked improvement in symptoms and general condition, although some symptoms remained; and 8 cases in which no clinical improvement could be found. Recurrence of symptoms with an entirely new bacterial flora as indication of new infection was the rule rather than the exception.

4. The concentration of penicillin per c.c. in the nebulized solution did not appear to be an important factor per se. The sensitivity of the organism to penicillin was the most important factor in the determination of the result.

5. Inhalation therapy appears to be a definite method of treatment with a definite effect upon bronchial disease. Its efficacy is limited by the effectiveness of the chemotherapeutic agent used.

6. Continued medical supervision and customary means of treatment including postural drainage remains an essential element in the treatment of chronic bronchial infections.