At one time, the pulmonary condition, bronchiectasis, was quite common. This disease typically results from a variety of causes. It can be either idiopathic or associated with other abnormalities. Idiopathic bronchiectasis is usually caused by infection. Historically, whooping cough and measles were common antecedent conditions. With the development of vaccines though, bronchiectasis has become less common. At present, it is seldom encountered in industrialized countries.
Bronchiectasis is an anatomical abnormality. It may be defined as "permanent, abnormal, dilation of bronchi" (1:558). There are different types of bronchiectasis, each of which may present with varying degrees of severity. These include the saccular, the varicose, and the cylindrical forms. Typically the lung's lower lobes are most commonly involved; in addition, the left lower lobe is involved approximately twice as often as the right. Microscopic examination of affected lungs generally reveals extensive destruction and fibrosis of the bronchial wall. Infection and inflammation weaken the major bronchi, and obliterate the distal bronchi and bronchioles. Because of ineffective cough, damaged cilia, and distorted airway shape, smaller airways become plugged with mucous. Moreover, since this mucous is susceptible to bacterial colonization, a vicious cycle may be set up: infection weakens bronchial walls, obliterates small airways, increases the secretion of mucus and, thereby, enhances further infection.
Several different conditions have been associated with bronchiectasis. One of these, immotile cilia syndrome, results from an inherited structural abnormality affecting ciliary function. About 50% of these patients have situs inversus or dextrocardia; most are additionally sterile. Their lack of ciliary clearance abilities typically results in repeated sinobronchial infections and, ultimately, the development of bronchiectasis.
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