Bronchiectasis. A long-term follow-up of medical and surgical cases from childhood.

Over the past 30 years the natural history of bronchiectasis must have been considerably modified by the varying treatments which have been introduced. Laennec's original description in 1829 was made from post-mortem material, the diagnosis in those early years only being made in severe clinical cases or at autopsy. With the introduction by Sicard and Forestier in 1922 of an opaque substance to outline the bronchial tree, more accurate diagnosis was possible, but whilst this new diagnostic technique was being improved, measures to combat the disease were introduced. Physiotherapy with postural drainage and breathing exercises was soon assisted by the introduction of chemotherapy and antibiotics. At about the same tiesurgical procedures, i.e. lobectomyandpneumonectomy, were adopted and later multiple segmental resections were practised in an attempt to remove, if possible, all the diseased parts. But it was soon realized that bronchiectasis was not just an anatomical dilatation of certain bronchi, but usually a general disease complex, and removal of all diseased parts did not necessarily relieve all the symptoms. As a result surgery was recommended less and less, particularly as chemotherapy was able to control the respiratory exacerbations. The present survey of 225 patients observed over a perio of eight to 21 years covers this period of changing conditions. In most cases the diagnosis was made before the introduction of antibiotics and in some cases before the use of sulphonamides. In spite of the varying treatments a definite pattern of disease seems to emerge in which the onset of damage to the lung is maximal in the first five years of life. Thereafter the symptoms may be troublesome until puberty, when a surprising improvement in health occurs, lasting usually through the 'teens