Chest
Volume 108, Issue 4, October 1995, Pages 955-961
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Clinical Investigations: Infection: Articles
Clinical, Pathophysiologic, and Microbiologic Characterization of Bronchiectasis in an Aging Cohort

https://doi.org/10.1378/chest.108.4.955Get rights and content

Study objective

Awareness of bronchiectasis on the part of clinicians has been low in recent years, although it was previously well recognized. We believe that bronchiectasis is underdiagnosed, and that current literature is skewed toward the esoteric etiologies of bronchiectasis.

Design

We reviewed the clinical, radiologic, microbiologic, and physiologic findings in 123 well-studied patients with proved bronchiectasis.

Setting

The University of Texas Health Center at Tyler Hospital and Clinics.

Measurements and results

There were 38 men and 85 women with a mean (±SD) age of 57.2±16.7 years; 55% were lifetime nonsmokers. Diagnosis was confirmed with CTs of the chest in 56%, by bronchogram in 28%, and surgery with the remainder. Seventy percent of patients gave a history of an antecedent potentially causative event for the bronchiectasis, usually pneumonia. Symptoms of bronchiectasis included chronic cough with the production of purulent sputum, hemoptysis, recurrent fever, and pleurisy. The finding of crackles on chest examination was the rule (70%) with wheezing present in 34% of the group. Pulmonary function studies documented airway obstruction to be present in 54% of the lifetime nonsmokers. The chest radiographs were abnormal in 91.3%, showing fibrotic stranding and infiltrates. A variety of pathologic microbial flora, particularly Pseudomonas aeruginosa and other opportunistic organisms, were isolated from the sputum. Patients who had smoked had much the same picture as nonsmokers, although they had a greater degree of airway obstruction.

Conclusions

A characteristic clinical picture of bronchiectasis emerges after review and evaluation of these data. Knowledge of this picture should allow ready recognition of the disease.

Section snippets

Methods

A retrospective review of patients seen at the University of Texas Health Center at Tyler from 1985 to 1993 with a diagnosis of bronchiectasis was carried out. In each case, the diagnosis had been made by the patient's primary physician on the basis of an assessment of the overall clinical picture. Because of the retrospective nature of this report, it was not possible to determine what diagnostic criteria were being used for the original diagnosis by the primary physician.

The charts were

Results

A total of 363 patients with a diagnosis of bronchiectasis were found by a search of the medical records database. In 97% of patients, we were able to review the charts. The diagnosis was incorrect due to miscoding or insufficient clinical data were available for review in 40 (8%) of the patients. In 200 (55%) of the patients, the diagnosis was unproved. The remaining 123 patients form the basis for this report.

In 69 (56%) of the patients, the clinical diagnosis was confirmed on the basis of

Discussion

Bronchiectasis as a primary pulmonary diagnosis seems to be uncommon, judging by a review of current literature,3 although we are not aware of any incidence or prevalence data for bronchiectasis for the United States. The reason for the apparent underdiagnosis of this debilitating lung disease may reside in the fact that few textbooks in pulmonary medicine portray bronchiectasis as a significant and/or common lung problem. This may be partly due to the lack of recent descriptive data in

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