Bronchoscopy in the Diagnosis and Treatment of Bronchiectasis
Bronchiectasis is a chronic, debilitating disease characterized by dilatation of the smaller bronchi and copious, foul, purulent sputum. It robs the patient of his appetite, strength, and social contacts. In its advanced stage it is incurable. When less advanced it is curable only by lobectomy. If recognized sufficiently early it may be cured or at least its progress may be arrested by less radical means.
Certain definite factors have been quite well established in the etiology of bronchiectasis:
Bronchopneumonia, sometimes unrecognized in infancy, may result in contracting scar tissue which produces dilatation of the bronchi1,2.
Localized atelectasis due to a mucous plug or aspirated foreign body in a bronchus may produce a dilatation of the bronchi in the affected area3,4,5,6,7,8. If the obstruction is removed early and the atelectatic areas become aerated, the dilatations of the bronchi may disappear9,10. If the atelectasis is overlooked and the obstruction is not removed the dilatations will remain11.
Watson and Kibler12 have recently stated that the most common cause is allergy, the sequence of events being basal allergic bronchitis followed by atelectasis which in turn is followed by dilatation of the bronchi.
There is also a congenital form which may go unrecognized until it becomes infected.
Attempts have been made to establish a single infecting organism as the principal cause of the disease. Those most frequently accused are the Bacillus influenzae, the fusospirillum, and Treponema micro-dentium and Treponema macrodentium13. That these organisms play an important part in some cases is. . .