PEDIATRICS Vol. 4 No. 3 September 1949, pp. 355-372
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BRONCHIECTASIS IN CHILDHOOD

III. Prophylaxis, Treatment and Progress with a Follow-up Study of 202 Cases of Established Bronchiectasis

C. ELAINE FIELD M.D.1

1 The Hospital for Sick Children, Great Ormond Street, and University College Hospital, London.

Prevention of bronchiectasis means prevention or better treatment of the predisposing conditions, particularly pneumonia, pertussis, pulmonary collapse and so-called "chronic bronchitis." When the cough persists after one of these conditions adequate convalescent care coupled with postural drainage and breathing exercises is advocated.

Once bronchial dilatation is considered irreversible, the treatment offered can be surgical or curative, medical or palliative, or partial surgical removal to alleviate the symptoms.

In general radical surgical treatment is recommended in all cases where an adequate amount of healthy lung can be preserved.

Medical treatment can be carried out at home, at an open air school or at a convalescent home. It includes postural drainage, breathing exercises and general health measures.

Chemotherapy for established bronchiectasis has so far been disappointing. Aerosol penicillin in a number of cases produced no lasting effect but more promising results have been reported with combined penicillin and streptomycin.

Two hundred and two cases of proved bronchiectasis have been followed for varying periods up to 10 years. Although fewer cases were treated surgically, twice as many were classified as cured compared with the medically treated cases. However, 13 of the latter lost all signs and symptoms. Out of 19 deaths, 9 had been treated surgically.

Ten cases classified as cured had bilateral lobectomy.

Serial bronchograms taken over the years revealed the frequent deterioration or increase of dilatation in the antero-lateral (pectoral) branches of the upper lobes in contrast to the improvement or cure of the apical branches.

Varicose and fusiform types of bronchiectasis produce the least physical disturbance.

Although the clinical progress of established cases of bronchiectasis showed improvement in the majority of cases in the first two decades, it is feared that deterioration may occur in the third and fourth decades.

The fact that after lobectomy the remaining lung increases its functional capacity in growing children makes it desirable to operate during childhood.

Submitted on October 24, 1947




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