BRONCHIECTASIS IN CHILDHOOD

Abstract

Non-aeration of alveoli is a feature common to the childhood illnesses predisposing to bronchiectasis and is regarded as the important factor in the aetiology of the disease, infection playing a subsidiary part. Pulmonary collapse is therefore regarded as a prebronchiectatic state and in order to assess its importance two groups of cases have been studied: (1) 272 cases of pulmonary collapse; (2) 99 cases in which the diagnosis of bronchiectasis was doubtful at first examination. Pulmonary collapse was seen most frequently in the right middle lobe and left lower lobe. It was usually persistent in the left upper lobe but frequently the right lower lobe reexpanded. The duration of cough, according to the history, was commonly of three months' duration ion or less in cases of pulmonary collapse that reexpanded, in contrast to the long history of two years or more in the majority of cases that developed bronchiectasis. Of the 272 cases of pulmonary collapse, only 157 reexpanded without permanent bronchiectatic changes. It was not uncommon, however, to find temporary bronchial dilatation in this group, the bronchi returning to normal calibre when the collapse reexpanded—a condition described as reversible bronchiectasis. The treatment recommended for pulmonary collapse includes steam inhalations, postural drainage, and breathing exercises. Unless foreign body is suspected, immediate bronchoscopy is no longer considered necessary. No significant difference in the incidence of reexpansion of the lung was found between the cases treated with bronchoscopy and those treated without. Ninety-nine cases were classified as doubtful bronchiectasis when first seen. Of these, 47.5% suffered from asthma, a disease frequently difficult to differentiate from bornchiectasis. Forty of the 99 cases have now developed true irreversible bronchiectasis after a period of three or more years. It was necessary to observe cases showing doubtful bronchial dilatation over a period of years, the bronchograms being repeated at intervals in order to determine the permanently diseased parts.