Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
Bronchiectasis is defined as the irreversible dilatation of the bronchi and is characterized by chronic cough, sputum, and recurrent exacerbation due to airway infection. The mechanisms underlying the dilatation of the bronchi have been explained as follows: chronic infection causes airway inflammation and epithelial injury with mucociliary dysfunction, resulting in persistent airway infection and inflammation that lead to airway wall destruction and ectasia of the bronchi in a vicious cycle. Intriguingly, the pathogenesis of bronchiectasis with rheumatoid arthritis (RA) or inflammatory bowel disease (IBD) has been interpreted in terms of its autoimmune mechanisms in recent years. Bronchiectasis shows an abnormal increase in the size of the bronchi and is easily identified by computed tomography. However, the diagnosis requires further investigation, as the etiology of bronchiectasis is diverse, e.g. post-infectious, immunodeficiency, mucociliary dysfunction, bronchial obstruction, allergic bronchopulmonary aspergillosis, and inflammatory conditions, such as RA and IBD. Careful investigation of these etiologies may aid in a precise diagnosis and the patient' s management. The care of patients with bronchiectasis involves physical therapies, pharmacological therapies, and, in some instances, surgical therapy. In the past quarter-century, significant achievements have been made in this field in the establishment of macrolide therapy for diffuse panbronchiolitis and its application to the other conditions with bronchiectasis; however, the treatment methods available for bronchiectasis are not yet satisfactory. Further clarification of the pathogenesis and development of effective therapeutic procedures are needed.
ϊγεγο 2018; 14(2), 72-80
bronchiectasis, etiology, management
Yoshinobu Saito, Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendai, Bunkyo-ku, Tokyo 113-8603, Japan