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PubMedDate not supplied

Unilateral vascular plethora--a sign in advanced unilateral basal bronchiectasis.

Unilateral basal bronchiectasis results in a regional high vascular pressure and the flow of blood is thereby diverted to the uninvolved portion of the lung through bronchopulmonary anastomoses. Unilateral plethora of the upper lobe vessels in significant basal bronchiectasis of the same lung constitutes an important additional sign in the recognition of bronchiectasis on the plain chest radiograph. Attention is drawn to the fact that this will not occur if the adjacent lung is compromised by a related or unrelated disease process.

Adolescent↗

PubMed1978

Deficiency of alpha1-antitrypsin and bronchiectasis.

60 consecutive patients with bronchiectasis were screened for alpha1-antitrypsin deficiency. Six cases (10%) with genotype PiMZ (alpha1-antitrypsin less than 66% of normal) were found. This frequency (10%) was statistically significantly (p less than 0.005) higher than the frequency of PiMZ (2.7%) in the control group. In two patients the bronchiectasis was cystic. It is suggested that the deficiency states of alpha1-antitrypsin promoting the proteolysis can participate in the genesis of bronchiectasis.

Adolescent↗

PubMedDate not supplied

Immunobiochemical evaluation of bronchoalveolar lavage (BAL) in atopic bronchial asthma, chronic bronchitis and bronchiectasis.

The protease-antiprotease balance and concentration of immunoglobulin was evaluated in some respiratory tract diseases. Analysis was carried out on 24 patients with atopic bronchial asthma, 21 with chronic bronchitis, 27 with bronchiectasis and 18 healthy smokers volunteers. In examination of BAL fluid some selective changes of proteolytic enzymes activities and concentrations of their natural inhibitors were documented. In atopic bronchial asthma the increased activity of acid protease, acid phosphatase and concentration of alpha-2-macroglobulin was the most characteristic. In chronic bronchitis there was an increase of acid protease, alkaline phosphatase and concentration of alpha-1-antitrypsin, haptoglobin, but in bronchiectasis the increase of neutral and acid proteases activities and concentration of all examined natural inhibitors was noted. The changes in concentration of IgA and IgG confirmed their participation in local defense response. All examined BAL enzyme activities and concentrations of inhibitors and immunoglobulins were compared with the results of the parameters in serum, mentioned above. The obtained finding supports the suggestion that the proteolytic enzymes, their natural inhibitors and immunoglobulins play an important role in the respiratory tract pathology. Immunobiochemical analysis of BAL in atopic bronchial asthma, chronic bronchitis and bronchiectasis may be useful for clinical prognosis and pharmacological treatment.

Adolescent↗

PubMed1978

Bronchial vascularization in patients with bronchiectasis.

An analysis of the angiographic patterns of bronchial vascularization in 22 patients with bronchiectasis is presented. The studies disclosed three types of angiographic patterns: (1) bronchial hypervascularization alone; (2) bronchial hypervascularization associated with bronchopulmonary anastomoses, and (3) bronchial hypervascularization with plexiform enlargement of bronchial arteries, vascular collections or angiomatous structures. These types of angiographic pattern show a good correlation with the clinical features and supplment the global assessment of the extent and character of bronchiectasis. Selective bronchial arteriography is useful in patients with bronchiectasis where surgical treatment has been planned, especially if the disease is associated with hemoptysis.

Bronchi↗

PubMed1993

[Surgery for bronchiectasis. Operative indications and results. 48 observations].

Forty-eight patients: 27 women and 21 men, with mean age of 36 +/- 14 years were operated on for bronchiectasis from 1976 to 1989. In 20 cases bronchiectasis was the sequelae of acute bronchopathy of childhood, 6 cases of tuberculosis and 5 cases of inhalated foreign bodies. The bronchiectasis was apparently primitive in 12 occasions. Five varied etiologies were found of which 2 congenital hypogammaglobulinemias. The anatomic extension of the lesions was precised in 47 cases by bronchography and CT scan in 6 cases, in 1 case with CT scan only. The lesions were bilateral in 5 cases. One pneumonectomy, 42 lobectomies (of which 10 bilobectomies) and 5 segmentectomies were performed. The operative mortality was nil. The morbidity (14 cases among 48, i.e. 29%) was not negligible and was comparable with the literature data. The evalued results for 36 patients (mean post-operative follow-up: 54 +/- 58 months) showed that 24 patients (67%) were asymptomatic, 34 have taken their normal professional activities.

Adolescent↗

PubMed1997

Dissociation of neutrophil emigration and metabolic activity in lobar pneumonia and bronchiectasis.

In animal models of pulmonary inflammation, neutrophils exhibit a dramatic influx of glucose in periods of high metabolic activity. This information was utilized to develop a technique, involving positron emission tomography (PET) of 2-[18F]-fluoro-2-deoxy-D-glucose (18FDG), which measures neutrophil activity in situ. This technique was applied in a comparative study of neutrophil function in patients with acute lobar pneumonia or bronchiectasis. Neutrophil emigration was measured by gamma-scintigraphy of intravenously injected 111In-labelled granulocytes and neutrophil activity determined by PET of 18FDG. Neutrophil emigration was evident in 4 out of 5 bronchiectasis patients, whilst no emigration was apparent in the two pneumonia patients studied, consistent with animal studies showing maximum emigration soon after challenge. In contrast, 18FDG uptake was markedly increased in 4 out of 5 pneumonia patients but not in the patients with bronchiectasis. Localization of radioactivity to neutrophils was confirmed by microautoradiography of lavage fluid in a patient with pneumonia. These results suggest that the elevated uptake of glucose by neutrophils during the inflammatory response is a postmigratory event, most likely reflecting the respiratory burst, and that high levels of neutrophil emigration are not necessarily associated with significantly increased metabolic activity of these cells.

Adult↗

PubMed1998

Accelerated obstructive pulmonary disease in HIV infected patients with bronchiectasis.

Human immunodeficiency virus (HIV) infection has been associated with a wide spectrum of pulmonary disease. We report three HIV-seropositive patients with rapidly worsening airway obstruction associated with bronchiectasis. All subjects (age range 33-39 yrs) were cigarette smokers. Two had previously used intravenous drugs. The CD4 lymphocyte count ranged 40-250 cells x mm(-3). All individuals had complained of increasing dyspnoea for 3-6 months. Within 1 yr, they all developed severe airway obstruction with a decrease in both forced expiratory volume in one second (FEV1) and ratio of FEV1 to forced vital capacity (FEV1/FVC) to less than 60% of predicted value, and a decrease in mean forced expiratory flow at 25-75% of the forced vital capacity (FEF25-75) to less than 35% of predicted value. Computed tomography of the chest disclosed bilateral dilated and thickened bronchi. No classical causes of genetic or acquired bronchiectasis were identified in our patients. Recurrent bacterial bronchitis occurred in the follow-up period of the three patients. In conclusion, unusually rapid airway obstruction associated with bronchiectasis should be added to the wide spectrum of respiratory complications of human immunodeficiency virus infection.

Adult↗

PubMed2003

Bronchiectasis in secondary care: a comprehensive profile of a neglected disease.

Background: Bronchiectasis is poorly characterised in secondary care. Methods: Over 6 months, 410 bronchiectasis patients attended our clinics. One hundred randomly selected patients were characterised in detail. Results: Patients had a mean and standard error of mean (S.E.M.) age of 57 (2) years and a median and interquartile range (IQR) of three (two to four) reviews in the last 12 months. Aetiologies identified included tuberculosis (n=15), childhood pneumonia (n=7), fibrosis (n=6), connective tissue disease (n=6), whooping cough (n=5), childhood measles (n=4) and others (n=5). There was widespread use of inhaled therapy. Treatments included oral antibiotics (n=77), corticosteroid courses (n=27) and intravenous antimicrobials (n=27, 12 domicillary) in the last year. Thirty patients had hospital admissions (13 because of the inability to administer domicillary antibiotics). Haemophilus influenzae and Pseudomonas spp. were the commonest bacterial isolates. Patients culturing Pseudomonas spp. were older and had had more reviews and intravenous antibiotic courses. Conclusions: Bronchiectasis imposes a considerable burden on hospital services. Patients culturing Pseudomonas spp. impose a greater burden. Aetiology is often unknown. Therapies with unproven benefit are often used.

Journal Article↗

PubMed2000

Surgery vs non-surgical treatment for bronchiectasis.

BACKGROUND: Standard treatment for bronchiectasis comprises postural drainage and various regimes of antibiotic therapy. If the disease is confined to localised areas of lung, surgical resection of the affected segments is often performed. OBJECTIVES: To assess the benefit of surgical resection compared with standard ("conservative") treatment. SEARCH STRATEGY: The Cochrane Airways Group trials register derived from MEDLINE, EMBASE and hand searching of major journals was searched using the terms [bronchiect* AND surg* OR resection OR lobect* OR pneumonect* OR segementect*]. SELECTION CRITERIA: Only randomised, controlled trials were considered DATA COLLECTION AND ANALYSIS: The titles, abstracts and citations were independently reviewed by the two reviewers to assess potential relevance for full review. STATISTICAL CONSIDERATIONS Not applicable MAIN RESULTS: No randomised or controlled clinical trials were found, other than case series or case-controlled studies. REVIEWER'S CONCLUSIONS: Surgical treatment of bronchiectasis is widely used, but there appear to be no randomised controlled trials. It is not possible to provide an unbiased estimate of its benefit compared to conservative therapy.

Adult↗

PubMed2003

Nurse specialist care for bronchiectasis.

BACKGROUND: Nurses have expanded and developed their roles to meet the needs of patients. This review evaluates the safety, effectiveness and health outcomes of nurses practising in autonomous roles, using advanced practice skills, within the context of a dedicated bronchiectasis clinic. OBJECTIVES: To determine the effectiveness of nurse-led care in the management of bronchiectasis. SEARCH STRATEGY: The Cochrane Airways Group specialised register was searched on 12/06/02. SELECTION CRITERIA: Randomised controlled trials were eligible for inclusion in the review. DATA COLLECTION AND ANALYSIS: Two reviewers extracted and entered data from included studies. MAIN RESULTS: One study was included in the review. No statistically significant changes were observed in infective exacerbations, lung function, exercise capacity, quality of life and hospital admissions. More healthcare resources were utilised by nurse-treated participants during the first arm of the study. REVIEWER'S CONCLUSIONS: This review has found one trial that does not demonstrate significant differences in clinical outcomes between nurse led care and doctor led care within the setting of a specialist clinic is, but there may be increased cost implications. Further research is required to review whether nurse led care provides the same outcomes in the community or secondary care setting.

Adult↗

PubMed1993

Familial congenital bronchiectasis: Williams-Campbell syndrome.

Williams-Campbell syndrome was first described in 1960 as a rare form of bronchiectasis. Its pathogenesis is characterized by the absence or markedly diminished cartilage around the bronchi. Although the familial nature was postulated early on, only one possible familial occurrence has been reported in the literature. We present two family members in whom respiratory symptoms developed within the first year of life and were found to have histopathologic changes consistent with Williams-Campbell syndrome. This world lend further support of a developmental origin for this type of bronchiectasis.

Bronchi↗

PubMed1986

A double-blind randomized study comparing ofloxacin and amoxicillin in treating infective episodes in bronchiectasis.

32 hospitalized adult patients with infective episodes of bronchiectasis were enrolled in an ongoing double-blind, placebo-controlled study comparing ofloxacin with amoxicillin. They were randomized to receive either 200 mg ofloxacin or 1 g amoxicillin, both t.i.d. orally for ten days. In the ofloxacin group (15 patients), clinical response was excellent (clinical cure) in 11 and fair (clinical improvement or early reinfection) in three patients with one failure. In the amoxicillin group (17 patients), clinical response was excellent in six, fair in five, and poor (treatment failure) in six patients. Ofloxacin levels at 2 h (day 5) were 2.3 to 8.2 mg/l (mean 3.9 mg/l) for serum and 1.3 to 15 mg/l (mean 4.5 mg/l) for sputum. Sputum: serum ratio was 1.2:1. Amoxicillin levels at 2 h were 10 to 40 mg/l (mean 19.9 mg/l) for serum and 0 to 1.5 mg/l (mean 0.3 mg/l) for sputum, with no amoxicillin detected in sputum in 10 of 17 patients. Sputum: serum ratio was 0.02:1. One patient in the ofloxacin group had nausea. In the amoxicillin group, four patients had nausea and stomach pain, one had vertigo and one had transient peripheral eosinophilia. Ofloxacin thus yielded higher sputum concentration and appeared to be more effective and better tolerated than amoxicillin in infective episodes of bronchiectasis.

Adult↗

PubMed1998

[A case of congenital partial pericardial defect and anomaly of phrenic nerve with cystic bronchiectasis].

Congenital partial pericardial defect is a rare anomaly that causes no symptoms and is often noticed by chance at autopsy or thoracotomy. During an operation on a patient with bronchiectasis, a partial pericardial defect and anomaly of left phrenic nerve were found incidently. A 58-year-old man complaining hemoptysis was referred to our hospital for surgical treatment of the left cystic bronchiectasis. During a thoracotomy, a partial pericardial defect was noticed. Moreover the left phrenic nerve could not be found within the operative field. We performed left pneumonectomy without repair of pericardial defect, and the patient had a satisfactory postoperative course. A relationship was suggested between congenital pericardial defect and the anomaly of the phrenic nerve.

Bronchiectasis↗

PubMed1988

Pulmonary epithelial permeability in bronchiectasis.

We measured pulmonary epithelial permeability in 17 non-smoking patients with generalized bronchiectasis, of whom six had cystic fibrosis, by determining the half-time clearance from lung to blood (T1/2LB) of inhaled 99mTc-labelled diethylene triamine pentaacetate. Their age range was 15-79 years and the range of their FEV1 measurements was 20-87% of the predicted normal. Sputum obtained by prestudy chest physiotherapy revealed significant colonies of Pseudomonas aeruginosa in six, Haemophilus influenzae in three, Staphylococcus aureus in three and Pasteurella mitocida in one patient, while in the remainder there was normal flora only. Lung clearance was significantly faster in the 13 culture-positive patients (mean T1/2LB = 28 minutes) compared with the four culture-negative patients (mean T1/2LB = 54 minutes). There was no correlation between T1/2LB and prestudy FEV1. The study was repeated in six patients following a course of antibiotics. In two patients only was the sputum cleared of organisms and in those the lung permeability decreased significantly. There was no change in lung permeability in the four patients in whom it was impossible to eradicate the sputum organisms. Thus, in our patients with generalized bronchiectasis, lung permeability was increased only in those with both purulent sputum and significant colonization of the respiratory tract by bacterial pathogens. However, this increase in lung permeability was not associated with worse lung function.

Adolescent↗

PubMed1993

Incidental lung adenocarcinoma in a 20-year-old woman with bronchiectasis.

A case of lung adenocarcinoma in a 20-year-old woman with bronchiectasis is presented. The patient showed no clinical and radiological findings in regard to the carcinoma. The tumor was discovered incidentally in the parenchyma of the lung specimen resected due to chronic bronchiectasis.

Adenocarcinoma↗

PubMed2004

Bronchiectasis: sex and gender considerations.

Bronchiectasis in women may act more virulently. Identified gender and sex differences range from increased exposure risks to altered inflammatory responses. Common among the most well-documented examples is a differential immune response. There is sufficient evidence to suggest that chronic airway infection, most notably non-CF bronchiectasis, is a more common and more virulent disease in women. This is particularly evident in CF-and non-HIV-related environmental mycobacterial respiratory tract infections. Whether this represents an inflammatory-immune process, or environmental, anatomic, or other genetic difference remains to be detailed fully.

Bronchiectasis↗

PubMed2005

Nebulised gentamicin-suitable for childhood bronchiectasis.

UNLABELLED: Nebulised antibiotic therapy is an established, safe and effective therapy for cystic fibrosis with chronic pseudomonas infection resulting in improved pulmonary function and reduced hospitalisation. Despite similar respiratory disease, this therapy has not been evaluated in children with non cystic fibrosis bronchiectasis. This study evaluates the suitability of a gentamicin solution and nebuliser combination for use in this population. MATERIALS AND METHODS: Four millilitres of gentamicin (80 mg) in saline delivered by a PARI LC plus nebuliser and PARI Turboboy N compressor was used. The pH, osmolarity, chloride concentration and aerosol particle size was determined. Ten children with non cystic fibrosis bronchiectasis received nebulised antibiotic and had peak gentamicin concentrations measured in sputum and serum. Pulmonary function was measured pre and post nebulisation. RESULTS: The solution had an osmolarity of 199 mOsm/l, pH of 4.1, chloride concentration of 75 mmol/l and the aerosol a mass median aerodynamic diameter of 3.3 microm. Nebulisation was well tolerated, with no significant change in FEV1. Peak serum levels were at the threshold of detectability (0.3 mg/l). Sputum concentrations had a mean of 624 mg/g and lower 95th confidence interval 25 times the minimum inhibitory concentration for the predominant infecting organism, Haemophilus influenzae. CONCLUSION: Nebulisation of 80 mg of gentamicin in saline achieved bactericidal concentrations in sputum, was well tolerated and had negligible systemic absorption making it a suitable choice for this population.

Adolescent↗

PubMed2006

Paediatric bronchiectasis in Europe: what now and where next?

Bronchiectasis has been defined as the abnormal and permanent dilation of bronchi. It has a variety of causes and has traditionally been viewed as a condition that is irreversible, often progressive and associated with significant morbidity and mortality. In the past, patients had relatively advanced disease by the time the diagnosis was established. By using high-resolution computed tomography (HRCT) scanning of the chest, the potential now exists for the much earlier detection and treatment of children with lesser degrees of bronchial dilation and bronchial wall thickening than was previously possible. In some, the HRCT changes have been seen to improve or completely resolve. This calls into question exactly what now should be termed bronchiectasis and how the parents of children with such HRCT findings should be counselled about the likely prognosis and the necessary or desirable treatment options.

Bronchiectasis↗