Paradox of bronchiectasis.

Abstract

Septic bronchiectasis in its commonest development is another penalty imposed on modern man for his evolutionary assumption of an erect posture. The normal bronchus prevents the accumulation of secretions by ciliary action and peristalsis. Loss of these excretory actions in dependent bronchi results in the collection and concentration of secretions, thus providing a perfect environment for the culture of bacilli. Such a mechanical factor can explain a seeming paradox of bronchiectasis: widespread ectasia of bronchi ascendant from the hilum may produce few symptoms, whereas, in a different patient, involvement of a small dependent subsegment may produce such symptoms as toxicity, hemoptysis, harassing cough, and production of purulent sputum. ETIOLOGY There is little proved knowledge of the pathogenesis of bronchiectasis. Mallory1lists five potential etiological factors: chronic bronchial infection; congenital abnormalities of the bronchial tree; bronchostenosis; pneumonitis, or its sequel, pulmonary fibrosis; and pulmonary atelectasis. Anspach2has presented convincing