BRONCHIECTASIS - NEW ASPECTS OF AN OLD DI SEASE

Bronchiectasis is pathologically defined as an abnormal and permanent dilatation of one or several bronchi. There are localized and generali zed types of bronchiectasis. A vicious circle hypothesis, including an initial insult to the lower airways, impaired mucociliary clearance, microbial colonization/infection, bronchial obstruction and a local in flammatory response, has been proposed to explain the damage to the br onchial tree and the adjacent lung parenchyma. The clinical picture is variable and affected individuals might be asymptomatic or suffer fro m severe respiratory failure. Daily sputum production is the most comm on, though unspecific symptom of bronchiectasis. Other common symptoms are hemoptysis and recurrent episodes of sputum purulence, fever and pleurisy. Occasionally, major, life-threatening hemoptysis from a rupt ured bronchial artery occurs. Infectious complications, e.g. lung absc ess, empyema, brain abscess, and secondary amyloidosis are rarely seen today. The chest radiograph reveals changes suggestive of bronchiecta sis in the majority of patients with clinically important disease. Hig h resolution computed tomography of the lung has almost completely rep laced bronchography for diagnosis, the latter rarely being of value if surgery is contemplated. No etiology is identified in about one- to t wo-thirds of the patients, although there are many diseases eventually associated with bronchiectasis. Prevention and therapy of underlying diseases are most important. Traditionally, the therapy of symptomatic bronchiectasis is based on antibiotics, antibronchoobstructive medica tion, and chest physical therapy. Surgical resection is the treatment of choice for localized symptomatic disease. Bilateral lung transplant ation should be considered in younger patients with severe, generalize d bronchiectasis and respiratory failure. Prospective, randomized, lar ge-scale trials supporting any of the different treatment strategies a re not available, but antibiotics and surgery probably have improved t he long-term outcome of many patients with bronchiectasis. In this rev iew, some recent findings regarding the classification, pathogenesis, pathology, etiology, diagnosis, treatment, and prognosis of bronchiect asis are discussed.