CLINICAL, PATHOPHYSIOLOGIC, AND MICROBIOLOGIC CHARACTERIZATION OF BRONCHIECTASIS IN AN AGING COHORT

Study objective: Awareness of bronchiectasis on the part of clinicians has been low in recent years, although it was previously well recogni zed, We believe that bronchiectasis is underdiagnosed, and that curren t literature is skewed toward the esoteric etiologies of bronchiectasi s. Design: We reviewed the clinical, radiologic, microbiologic, and ph ysiologic findings in 123 well-studied patients with proved bronchiect asis. Setting: The University of Texas Health Center at Tyler Hospital and Clinics. Measurements and results: There were 38 men and 85 women with a mean (+/-SD) age of 57.2+/-16.7 years; 55% were lifetime nonsm okers, Diagnosis was confirmed with CTs of the chest in 56%, by bronch ogram in 28%, and surgery with the remainder, Seventy percent of patie nts gave a history of an antecedent potentially causative event for th e bronchiectasis, usually pneumonia, Symptoms of bronchiectasis includ ed chronic cough with the production of purulent sputum, hemoptysis, r ecurrent fever, and pleurisy, The finding of crackles on chest examina tion was the rule (70%) with wheezing present in 34% of the group, Pul monary function studies documented airway obstruction to be present in 54% of the lifetime nonsmokers, The chest radiographs were abnormal i n 91.3%, showing fibrotic stranding and infiltrates, A variety of path ologic microbial flora, particularly Pseudomonas aeruginosa and other opportunistic organisms, were isolated from the sputum, Patients who h ad smoked had much the same picture as nonsmokers, although they had a greater degree of airway obstruction. Conclusions: A characteristic c linical picture of bronchiectasis emerges after review and evaluation of these data, Knowledge of this picture should allow ready recognitio n of the disease.