Aetiology in adult patients with bronchiectasis
Bronchiectasis has a number of causes. Their prevalence is not well documented. The aim of this study was to identify aetiology in a population of patients referred to a specialist clinic with symptoms suggestive of bronchiectasis, to determine the proportion of patients in whom knowing the aetiology altered management. In addition we wished to describe in detail those patients who remained idiopathic to facilitate future studies of this group; and establish the diagnosis in those without bronchiectasis. A total of 240 consecutive patients referred to the Royal Brompton Hospital with a history of recurrent chest infections, chronic cough and regular sputum production underwent a 3 day program of investigation. A total of 165 patients had bronchiectasis on CT scan, an underlying cause was identified in 122 (74%) and this affected management in 61 (37%). The common aetiologies were: post-infection (52), primary ciliary dyskinesia (17), allergic bronchopulmonary aspergillosis (13), and immune deficiency (11). Fourty-three patients had idiopathic bronchiectasis. They had symmetrical predominant lower lobe disease with onset of chronic chest and sinus symptoms in middle age. Full investigation of problematic cases should occur in a specialist centre because results affect management in a third of cases.