BRONCHIECTASIS IN CHILDHOOD

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Abstract
In a study of 160 cases of irreversible bronchiectasis in childhood the following observations have been made: From the history given by the parents, it was found that the age at onset of symptoms lay in the first year of life in approximately one fifth of the cases, the number thereafter declining with advancing age (except for a slight and possibly insignificant rise at age 5). In 55.6% of cases the parental history associated the onset of symptoms with an attack of pneumonia or pertussis. The characteristic features of the disease included a constant cough with or without sputum (this is often swallowed by children). Haemoptysis was rare, but in 33.1% of cases there were associated asthmatic symptoms. More children were underweight than overweight for age and many had abnormal chest deformities. Clubbing occurred in 43.7% and when present was diagnostic of irreversible bronchiectasis in this series. Physical signs in the chest were variable, but the most useful diagnostic finding was localized rales on deep inspiration over the suspected area of lung. In comparison with nonpulmonary and normal children, there was a marked increased incidence of pneumonia at all ages. There was, however, no suggestion that bronchiectasis increased or decreased susceptibility to tuberculosis. Sinusitis is frequently associated with bronchiectasis although its exact relationship remains obscure. In diagnosis, roentgenographic findings are frequently inconclusive, unless confirmed by bronchogram. Bronchography is by far the most important diagnostic procedure and is an invaluable method of studying the development of the disease. Tubular dilatation was the commonest type of bronchiectasis. In 85.6% of cases the disease was situated in the left lower lobe, and in 65.6%, in the lingula lobe, but in no case was the lingula affected as the only lobe. The disease has shown a predilection for lobes whose bronchi are directed upwards against gravity towards the main bronchus and those which have an anatomic peculiarity impeding drainage. Massive collapse of the lung was associated with bronchiectasis in 74 (46.3%) cases. It is important to recognize in children that bronchial dilatation may be reversible. In the diagnosis of irreversibility, duration of the dilatation and its contour are helpful. Bronchoscopy was not helpful in diagnosis or localization of bronchiectasis. The sedimentation rate was frequently raised, but was of little help in assessing activity of the disease. Alterations in the blood count were few and usually only of significance in severe active cases of the disease. Complications were infrequent, the commonest being pneumonia which occurred in 16.3% of cases.

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