44 - Bronchiectasis and Chronic Suppurative Lung Disease

Abstract

Bronchiectasis, chronic suppurative lung disease, and protracted bacterial bronchitis are now part of the recognized spectrum. Bronchiectasis is now again increasingly diagnosed, and its renewed interest has resulted in further in-depth studies in children and adults. Diagnostic labeling of childhood bronchiectasis by radiology using adult-derived criteria has substantial limitations, and pediatric-derived criteria are now recommended. The spectrum related to airway bacteria and other insults, with associated degradation and inflammation products causing airway damage if untreated, entails protracted bacterial bronchitis (at the mild end) to initially reversible then later irreversible airway dilatation with cystic formation determined by chest CT scan (at the severe end of the spectrum). Increasing evidence suggests that the 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.