Bronchiectasis: the Consequence of Late Diagnosis in Chronic Respiratory Symptoms

Abstract

Bronchiectasis is still common among some developing countries like Turkey. The aim of this study was to document the number of children with non-cystic fibrosis (CF) bronchiectasis, to evaluate the risk factors and to emphasize early diagnosis and treatment. All children, except those diagnosed with CF, with bronchiectasis established by chest radiogram, bronchography and/or computed tomography or biopsy material, were retrospectively reviewed. They were tested for serum total eosinophil count, nasal smear, serum levels of immunoglobulins A, G, M, E, and serum alpha-1 antitrypsin level. Pulmonary function tests, rigid bronchoscopy, nasal biopsy, lung scintigraphy, and echocardiogram were also performed. There were 204 patients whose most common presenting symptoms were cough, sputum expectoration, and dyspnea. Bronchiectasis was present mostly in the left lower lobe. The cause could not be determined in 49 per cent of patients. Among the identified causes, infection was present in most patients, followed by asthma, primary ciliary dyskinesia, congenital immune deficiency, and foreign body aspiration. It is possible to prevent bronchiectasis in children with vaccinations and improved nutrition in developing countries. Early diagnosis and treatment will increase the quality of life and survival of patients with bronchiectasis, which has irreversible and progressive complications if untreated.

Changing epidemiology of non-cystic fibrosis bronchiectasis

“…Zaid et al 19 reported rate of BE secondary to aspiration as 22% and Li et al 20 as 18%. In the studies from our country, Karadağ et al 16 reported the rate as 3.6% and Doğru et al 18 as 3.4% but Karakoç et al 17 reported no case of BE secondary to aspiration. In our previous study our rate was higher 5 .…”

“…The BE rate secondary to asthma was reported as 31.8% by Gillard et al 22 , as 18.2% by Karakoçet et al 17 , as 11.8% by Doğru et al 18 , and as 4.5% by Karadağ et al 16 in their cases. What may be the reason for the decrease of asthma rates in the present study?…”

“…The rate of congenital malformations in BE etiology differs between 1% and 13.6% [14][15][16][17][18][19][20] . 1.8% of our cases had congenital malformations (one pulmonary sequestration and one idiopathic congenital BE) (Table I).…”

“…1.8% of our cases had congenital malformations (one pulmonary sequestration and one idiopathic congenital BE) (Table I). Doğru et al 18 reported only one congenital malformation (chest deformity) in 204 patients (0.5%).…”

Surgical Treatment of Bronchiectasis

“…Karakoc et al found bronchiectasis affecting the left lower lobe in 30.4%, and multilobar involvement in 56.5% (Karakoc et al, 2001). Dogru et al found the most common lobe affected by bronchiectasis was the left-lower lobe in the 204 children they evaluated (Dogru et al, 2005). Isolated upper lobe bronchiectasis generally relates to prior tuberculosis, bronchopulmonary aspergillosis, or bronchial obstruction.…”