An Investigation into Causative Factors in Patients with Bronchiectasis

TLDR

Bronchiectasis is characterized by inflamed, dilated bronchi, and its diverse causes can influence treatment and prognosis. The study aimed to identify causative factors in 150 adults with bronchiectasis using high‑resolution CT. Researchers performed a comprehensive evaluation including clinical history, cystic‑fibrosis gene testing, immunoglobulin profiling, neutrophil function assays, ciliary function assessment, and screening for allergic bronchopulmonary aspergillosis. Causative factors were found in 47 % of patients, with immune defects, cystic fibrosis, ABPA, and early childhood infections being most common, and 15 % of cases had causes that influenced prognosis and treatment.

Abstract

Bronchiectasis is a pathologic description of lung damage characterized by inflamed and dilated thick-walled bronchi. These findings may result from a number of possible causes and these may influence treatment and prognosis. The aim of this study was to determine causative factors in 150 adults with bronchiectasis (56 male, 94 female) identified using high-resolution computerized tomography. Relevant factors were identified in the clinical history; cystic fibrosis gene mutation analysis was performed; humoral immune defects were determined by measuring immunoglobulins, IgG subclasses and functional response to Pneumovax II vaccine; assessment was made of neutrophil function (respiratory burst, adhesion molecule expression, and chemotaxis); ciliary function was observed and those likely to have allergic bronchopulmonary aspergillosis (ABPA) were identified. Causes identified were: immune defects (12 cases), cystic fibrosis (4), Young's syndrome (5), ciliary dysfunction (3), aspiration (6), panbronchiolitis (1), congenital defect (1), ABPA (11), rheumatoid arthritis (4), and early childhood pneumonia, pertussis, or measles (44). Intensive investigation of this population of patients with bronchiectasis led to identification of one or more causative factor in 47% of cases. In 22 patients (15%), the cause identified had implications for prognosis and treatment.