Prognosis in Bronchiectasis

In 1927, we published in this journal' a communication embodying the results of our experience of bronchiectasis in childhood.We then expressed doubt regarding the correctness of the view held by some authors that the condition is curable.Nobecourt2, for example, in support of Hutinel3, has stated that recovery not infrequently does take place.This, he thinks, is brought about by the dilatation of the bronchi ceasing to increase, and, as the lung grows, the bronchi ultimately coming to have the normal proportions.Hutinel believed that the younger the age at which the bronchiectasis appeared the more likely was a cure to result.Thursfield and Paterson4 more recently have re-affirmed this favourable prognostic outlook.So far as we could see at the time of our first analysis the condition tended to get worse.From a study of the post-mortem material it was difficult, if not impossible, to understand how recovery could take place.Many of the lungs had the naked-eye appearance of a sponge or a hydatidiform mole.Naturally, of course, the post-mortem examples would be the most severe, though it is only fair to state that in several cases death had resulted from operative inter- ference and not in consequence of advancing pulmonary involvement.We also mentioned in support of our scepticism of a possible cure that Sir Andrew Clark5 and Wilson Fox6 remarked on the relative infrequency with which the condition was met with during adult life, a fact which these writers took to indicate that in the main life was shortened.They estimated the average duration of life after the inception of bronchiectasis at 11I8 years.No one to-day will deny that the great difficulty in the past of deciding on the matter of prognosis in bronchiectasis was the uncertainty of diagnosis of the mischief by ordinary physical examination.As Armand Delille7 has stated, and we have been able to confirm, there are examples with signs but no symptoms, examples with symptoms but-no signs, and examples with neither signs nor symptoms.It must be remembered also that amphoric breathing and whispered pectoriloquy, the two classical signs, may be present in the absence of any bronchiectasis.In fact, it is only with the aid of intratracheal injections of lipiodol that a definite diagnosis of bronchiectasis can be made in any individual case.Not only in this way can the presence of bronchiectasis alone be categorically affirined but also, and this is a matter of prime importance, can the degree of bronchial dilatation be appreciated.It was on these grounds that we expressed the opinion in 1927 that 'the truth regarding the course of this disease is reserved for the future.'Since 1924, when we first practised intra-tracheal injections of lipiodol as a routine aid to diagnosis in all cases of suspected bronchiectasis, we have kept on August 12, 2023 by guest.