Non-Disabling Bronchiectasis

Abstract

The purpose of this report is to point out that a diagnosis of bronchiectasis does not always indicate a chronically ill patient with severe cough and abundant expectoration of sputum, and to direct attention to a group of soldiers with bronchial dilatation with few symptoms, or none at all, who were able to perform full military duty. These men have been followed for as long as two years, even though most of them were discharged from the army. Our interest in this disease was stimulated by the discovery of 41 cases in the course of routine chest examination of 156,000 candidates for flying training (1, 2). All the men were first examined by the photoroentgen method, with 4 × 5-inch films. Suspicious findings were checked on 14 × 17-inch films, and if they were confirmed, the candidate was hospitalized. Several factors account for the relatively small number of cases of bronchiectasis discovered. The men were in the 18–26 year age group and all had had at least one previous physical examination. Thus, those with frank pulmonary disease had already been disqualified. Moreover, as Evans and Galinsky (3) point out, if one is to recognize bronchiectasis he must bear in mind its possibility. This is exemplified in the following table, which shows the incidence in successive groups of approximately 32,000 men each. The first group of 32,000 men had the lowest percentage of previous chest films and the lowest incidence of bronchiectasis. Those in the other groups had practically all had earlier x-ray studies. It is probable that some cases were missed in the first group as a result of our not attaching enough importance to or failing to recognize the slight roentgenographic signs on the miniature films, which in the succeeding groups led us to obtain bronchograms in a large number of cases. There are few reports in the literature concerning mildly symptomatic or “dry” bronchiectasis. The cases described by Evans and Galinsky (3) were found in soldiers who were admitted to the hospital for treatment of acute respiratory infections. Our patients were ambulatory and the disease was discovered on routine examination. Martin and Berridge's series (4) most closely resembles ours. Twenty-five recruits for the British armed forces were found to have bronchiectasis, of whom 23 had cough and expectoration and 7 had hemoptysis. The authors felt that the prognosis was quite good and that there would probably be little future disability. Clinical Features All the men in our series had been in active service for some time, from two months to as long as two years. None had been incapacitated to any degree, though several had had pneumonia since entering the service. None of the 41 men had been to sick call an excessive number of times.