26 - Bronchiectasis and Chronic Suppurative Lung Disease

Abstract

Bronchiectasis, chronic suppurative lung disease, and protracted bacterial bronchitis (PBB) are increasingly recognized conditions. Bronchiectasis is now again increasingly diagnosed, and its renewed interest has resulted in further in-depth studies in children and adults. However, diagnostic labeling of childhood bronchiectasis by radiology using adult-derived criteria has substantial limitations. Thus, pediatric-derived criteria are advocated. A paradigm presenting a spectrum related to airway bacteria, with associated degradation and inflammation products causing airway damage if untreated, entails PBB (at the mild end) to irreversible airway dilatation with cystic formation as determined by chest computed tomography (CT) scan (at the severe end of the spectrum). Increasing evidence suggest that progression of airway damage can be limited by intensive treatment, even in those predestined to have bronchiectasis (e.g., immune deficiency). Treatment is aimed at achieving a cure in those at the milder end of the spectrum to limiting further deterioration in those with severe “irreversible” radiological bronchiectasis.