The Problem of Bronchiectasis

A Review

The incidence of bronchiectasis is greater than generally realized.

Bronchiectasis runs a progressively downward course from its inception, and usually claims its victims in the third decade. Its serious complications are: heart failure, metastatic abscesses to the brain and other parts of the body, anyloidosis, lung abscess, pleural empyema and attacks of pneumonitis or pneumonia.

Leaving aside congenital bronchal cysts and other developmental malformations, the cause of bronchiectasis is respiratory infection; stenosis of the bronchi; lack of drainage; infection of the bronchial walls with weakening and destruction of the elastic supporting elements; the rythmical inspiratory pull on the weakended walls, which may be augmented by atelectasis or a check-valve mechanism, which increase the stretching effect on the walls.

The best treatment for bronchiectasis is prevention or treatment of the early phase: removal of a plug of mucus causing atelectasis following bronchial or virus pneumonia or other respiratory infections; prompt treatment of a subacute or chronic bronchitis; prompt treatment of a sinusitis and tonsilitis; attention to respiratory allergies; removal of extrinsic foreign bodies; treatment for endobronchial tumors, extrabronchial tumors and enlarged tracheobronchial and hilar glands; drugs such as sulpha drugs or antibiotics; general hygiene and good nutrition; vaccines (autogenous or occasionally stock) and sometimes a warm, dry climate.

The treatment for advanced bronchiectasis is mainly surgical, if the patient has not advanced to a terminal stage. This consists of lobectomy, segmental resection, and occasionally pneumonectomy. The younger patient with his superior regenerative power and his greater anatomical and physiological reserves is the preferred surgical risk in operations for bronchiectasis.