Reversible Bronchiectasis

Tn the ohio State University Health Center during the past few years an effort has been made to demonstrate bronchographically all of the bronchopulmonary segments in patients suspected of having bronchiectasis. Furthermore, in order to determine whether or not there has been progression of the disease, we believe a careful repetition of the broncho-gram is advisable immediately prior to contemplated operation if several months have elapsed between the original broncho-graphic study and the admission for elective surgery. As a result of this practice, we have seen, during a fifteen-month period, 4 patients in whom a later bronchogram showed complete disappearance of bronchiectasis which had been clearly evident on the previous examination. It is the purpose of this paper to emphasize the fact that bronchiectasis may in some instances be reversible, particularly in children and young adults who have had the benefit of modern medical therapy before the occurrence of destructive changes in the musculo-elastic tissues of the bronchial wall. There is no doubt that progress in lung surgery and the use of antibiotics have been the factors responsible for the re-markable improvement in the prognosis of bronchiectasis, which ranks second only to tuberculosis among the chronic lung diseases. When there has been destruction of the musculo-elastic skeleton of the bronchial wall, with subsequent permanent dilatation of the bronchi, the only curative treatment is the surgical excision of the involved area. It is difficult, however, to assess clinically and radiologically the extent of permanent damage in some cases. In the study of surgical and postmortem specimens, it has been noted that the dilated bronchi were sometimes microscopically and grossly intact, except for inflammatory changes. Therefore, from the strict pathological standpoint, it is understandable that a return to normal is possible if intensive medical therapy is successful in alleviating the infection before actual tissue destruction has occurred. Etiologic Mechanisms and Factors Influencing Reversibility Bronchiectasis has been the subject of many papers since its first description by Réné Laennec in 1819. Its pathogenesis is highly controversial, because of the simultaneous presence of several causative factors, none of which by itself can explain the disease, and all of which together probably eventually play a role, regardless of which occurs first or seems to be the most important in any given case. It is not the purpose of this paper to dwell at length on the controversies of pathogenesis, but rather to consider the causative factors in the light of a possible reversibility following early and vigorous treatment by modern therapeutic regimens. Laennec believed that the main etiologic mechanism in bronchiectasis was the increased intrabronchial pressure due to retained secretions.