Benign nontuberculous bronchostenosis is a complication of either intrinsic or extrinsic asthma that too often is unrecognized. By bronchostenosis is meant a definite stricture-like narrowing of a bronchus that is considered to be inflammatory in nature and not the result of allergic edema or spasm. In 1939, two of us (L. E. P. and H. J. M. )1 described the symptoms, physical findings, and the laboratory information that characterize bronchostenosis in asthma, and, in 1940,2 we reviewed our experience at the Mayo Clinic with 140 patients with asthma who had been especially selected for bronchoscopic examination. Of this series, 60 patients were found to have definite stenosis of one or more bronchi. Subsequently, others 3 have reported their experiences with this complication of asthma.Recently we reviewed the records of 1,034 consecutive asthmatic patients who underwent bronchoscopic examination during the decade ending in 1950. Of these, 327 were found to have stenosis of one of more bronchi.There were 182 female and 145 male patients in this series. All age groups were represented, the youngest pa¬ tient being 3 years of age and the oldest 74 ( fig. 1). The largest number of cases in any decade of life were found in the age group 40 to 49 years inclusive; however, in the decades preceding and following this one many cases were seen. SYMPTOMS The syndrome of bronchostenosis complicating asthma is a rather definite one and will be reviewed in some detail.The most prominent symptom is cough, which is usually persistent and at times paroxysmal. This, of course, ag¬ gravates the patient's asthma. The cough is usually pro¬ ductive of sputum, which varies in amount and character.During the period when a bronchus is stenosed, there is retention of secretions distal to the point of obstruction of the bronchus, and sputum may be absent or scanty.A localized obstructive pneumonitis develops and per¬ sists until this site is drained, either spontaneously or by bronchoscopic dilatation and aspiration of the retained secretions. Such secretions are mucopurulent, and after bronchoscopy they may drain in considerable quantity. Thus, it is not unusual for the cough to be nonproductive during an episode of bronchostenosis. The paroxysms of coughing are the patient's involuntary effort to overcome the stenosis and raise the retained secretions.The second commonest symptom noted in our patients was fever, and the fever was occasionally accompanied by chills. Fifty-nine per cent of the patients gave a history of fever with their attacks. The fever was usually moderate and lasted from a few to many days. Often, as the febrile episode subsided, the cough became productive of in¬ creasing amounts of yellow or greenish sputum. The fever may be explained as resulting from the retention of secre¬ tions and from the inflammatory reaction in the adjacent lung. Fever was usually accompanied by leukocytosis.Hemoptysis was noted in 35% of the patients reviewed and is an important symptom. Hemoptysis does not oc-cur in uncomplicated asthma, a...
