Heterogeneity of non-cystic-fibrosis bronchiectasis in multiethnic Singapore: A prospective cohort study at a tertiary pulmonology centre

INTRODUCTION@#Non-cystic fibrosis bronchiectasis (NCFB) is a highly heterogenous disease. We describe the clinical characteristics of NCFB patients and evaluate the performance of Bronchiectasis Severity Index (BSI) in predicting mortality.@*METHODS@#Patients attending the bronchiectasis clinic between August 2015 and April 2020 with radiologically proven bronchiectasis on computed tomography were recruited. Clinical characteristics, spirometry, radiology, microbiology and clinical course over a median period of 2.4 years is presented.@*RESULTS@#A total of 168 patients were enrolled in this prospective cohort study. They were predominantly women (67.8%), Chinese (87.5%) and never-smokers (76.9%). Median age of diagnosis was 64 years (interquartile range 56-71) and the most common aetiology was "idiopathic" bronchiectasis (44.6%). Thirty-nine percent had normal spirometries. Compared to female patients, there were more smokers among the male patients (53.8% versus 8.5%, @*CONCLUSION@#The NCFB cohort in Singapore has unique characteristics with sex differences. Over half the patients had a history of haemoptysis. The BSI score is a useful predictor of mortality in our population.

Bronquiectasias no relacionadas con fibrosis quística en niños: guías de diagnóstico, seguimiento y tratamiento / Bronchiectasis not related to cystic fibrosis in children: Guidelines for diagnosis, monitoring and treatment

Las bronquiectasias se encuentran dentro del espectro de enfermedad pulmonar crónica caracterizada por la dilatación bronquial progresiva y, a menudo, irreversible, causada por cambios estructurales en la pared bronquial e inflamación crónica de las vías respiratorias. El síntoma cardinal es la tos crónica persistente húmeda y productiva, que debe alertar para realizar una intervención oportuna e interrumpir el ciclo de inflamación, infección y daño de la vía aérea. Un diagnóstico precoz a través de la tomografía axial computarizada de alta resolución de tórax y el monitoreo clínico facilitan la implementación de un tratamiento intensivo que reduce y minimiza el daño de la vía aérea. Si bien las acciones terapéuticas actuales para el manejo de bronquiectasias son efectivas, existen pocos estudios clínicos aleatorizados en pediatría. El objetivo del documento es proporcionar una actualización sobre el diagnóstico, seguimiento y tratamiento de las bronquiectasias no relacionadas con fibrosis quística en niños

Bronchiectasis is within the spectrum of chronic lung disease characterized by progressive and often irreversible bronchial dilation caused by structural changes in the bronchial wall and chronic inflammation of the airways. The cardinal symptom is persistent moist and productive chronic cough that should alert to timely intervention and interrupt the cycle of inflammation, infection, and airway damage. Early diagnosis through high-resolution computed tomography of the chest and clinical monitoring facilitate the implementation of intensive treatment that reduces and minimizes damage to the airway. Although current therapeutic actions for the management of bronchiectasis are effective, there are few randomized clinical trials in pediatrics. The objective of the document is to provide an update on the diagnosis, monitoring and treatment of bronchiectasis not related to cystic fibrosis in children

Extracorporeal membrane oxygenation and lung transplantation: initial experience at a single brazilian center

OBJECTIVE: To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation. METHODS: Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018. RESULTS: A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%). CONCLUSION: Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.

Characterization of the severity of dyspnea in patients with bronchiectasis: correlation with clinical, functional, and tomographic aspects / Caracterização da gravidade de dispneia em pacientes com bronquiectasias: correlação com aspectos clínicos, funcionais e tomográficos

ABSTRACT Objective: To characterize a population of patients with bronchiectasis, correlating clinical, radiological, and functional aspects with the severity of dyspnea. Methods: This was a cross-sectional study involving adult patients with HRCT-confirmed bronchiectasis, categorized according to the severity of dyspnea (as being mildly or severely symptomatic, on the basis of the modified Medical Research Council scale). We correlated the severity of dyspnea with clinical parameters, functional parameters (spirometry values, lung volumes, and DLCO), and CT parameters. Results: We evaluated 114 patients, 47 (41%) of whom were men. The median age (interquartile range) was 42 years (30-55 years). The most common form was idiopathic bronchiectasis. Of the 114 patients, 20 (17.5%) were colonized with Pseudomonas aeruginosa and 59 (51.8%) were under continuous treatment with macrolides. When we applied the Exacerbation in the previous year, FEV1, Age, Colonization, Extension, and Dyspnea score, the severity of dyspnea was categorized as moderate in 54 patients (47.4%), whereas it was categorized as mild in 50 (43.9%) when we applied the Bronchiectasis Severity Index. The most common lung function pattern was one of obstruction, seen in 95 patients (83.3%), and air trapping was seen in 77 patients (68.7%). The prevalence of an obstructive pattern on spirometry was higher among the patients with dyspnea that was more severe, and most functional parameters showed reasonable accuracy in discriminating between levels of dyspnea severity. Conclusions: Patients with bronchiectasis and dyspnea that was more severe had greater functional impairment. The measurement of lung volumes complemented the spirometry data. Because bronchiectasis is a complex, heterogeneous condition, a single variable does not seem to be sufficient to provide an overall characterization of the clinical condition.

RESUMO Objetivo: Caracterizar uma população de portadores de bronquiectasias e correlacionar aspectos clínicos, radiológicos e funcionais com a gravidade da dispneia. Métodos: Estudo transversal realizado em adultos, portadores de bronquiectasias confirmadas por TCAR, categorizados de acordo com a gravidade da dispneia (pacientes pouco e muito sintomáticos), correlacionando-os com seus parâmetros clínicos, funcionais (espirometria, volumes pulmonares e DLCO) e tomográficos. Resultados: Foram avaliados 114 pacientes (47 homens, 41%). A mediana (intervalo interquartil) de idade foi de 42 (30-55) anos. A etiologia mais frequente foi idiopática. Em relação à colonização, 20 pacientes (17,5%) eram colonizados por Pseudomonas aeruginosa e grande parte fazia uso de macrolídeo continuamente (51,8%). Quanto à gravidade da dispneia, ela foi considerada moderada em 54 pacientes (47,4%) pelo escore Exacerbation in previous year, FEV1, Age, Colonization, Extension, and Dyspnea e leve em 50 (43,9%) pelo Bronchiectasis Severity Index. O padrão funcional mais encontrado foi distúrbio ventilatório obstrutivo (em 83%), e 68% apresentavam aprisionamento aéreo. Pacientes com maior grau de dispneia apresentaram maior prevalência de distúrbio obstrutivo na espirometria, e a maioria dos parâmetros funcionais apresentaram acurácia razoável em discriminar a gravidade da dispneia. Conclusões: Pacientes com bronquiectasias e maior gravidade da dispneia apresentaram um comprometimento funcional mais expressivo. A medida de volumes pulmonares complementou os dados da espirometria. Por se tratar de uma condição complexa e heterogênea, uma única variável parece não ser suficiente para caracterizar a condição clínica de forma global.

Bronquiectasias no fibrosis quística: desde la infancia a la adultez: enfoque diagnostico y terapéutico / Bronchiectasis no cystic fibrosis: from childhood to adult: diagnostic and therapeutic approach

Bronchiectasis is a suppurative lung disease with heterogeneous phenotypic characteristics. It is defined as abnormal dilation of the bronchi, losing the existing relationship between bronchial sizes and accompanying artery. According to their form, they can be cylindrical, varicose, saccular or cystic. According to its location, they could be diffuse or localized. The diagnosis of bronchiectasis is usually suspected in patients with chronic cough, mucopurulent bronchorrea, and recurrent respiratory infections. The etiology can be varied, being able to classify in cystic fibrosis bronchiectasis, when there is cystic fibrosis transmembrane regulator (CFTR) gene mutation and not cystic fibrosis, being post infectious the most frequent. Its relationship with childhood is unknown. Severe respiratory infections can predispose in a susceptible subject the so-called theory of the "vicious circle" and the development of these. Persistent bacterial bronchitis in children has been described as a probable cause of not cystic fibrosis bronchiectasis in adults. The treatment is based on the management of symptoms and the prevention of exacerbations. The evidence is poor and many treatments are extrapolated from cystic fibrosis bronchiectasis. We are going to describe the diagnostic and therapeutic approach of non-cystic fibrosis bronchiectasis in adults.

La bronquiectasia es una enfermedad pulmonar supurativa con características fenotípicas heterogéneas. Se define como la dilatación anormal de los bronquios, perdiendo la relación existente entre tamaño bronquial y arteria que acompaña. Según su forma, pueden ser clasificadas en cilíndricas, varicosas, saculares o quísticas y según su etiología presentarse de forma difusa o localizada. El diagnóstico de bronquiectasias se sospecha generalmente en pacientes con tos crónica, broncorrea mucosa, mucupurulenta e infecciones respiratorias recurrentes. La etiología es variada, pudiendo clasificarse en bronquiectasias fibrosis quística, aquellas que se encuentran en el contexto de la mutación del gen regulador transmembrana de fibrosis quística (CFTR) y no fibrosis quística, de etiologías diversas, siendo post infecciosas la gran mayoría. No se conoce con certeza su relación con la infancia, es sabido que infecciones respiratorias severas pueden predisponer en un sujeto susceptible, a la llamada teoría del "circulo vicioso" y el desarrollo de estas. La bronquitis bacteriana persistente en niños se ha descrito como una causa probable del desarrollo de bronquiectasias no fibrosis quística en adultos. El tratamiento se basa en el manejo de los síntomas y la prevención de las exacerbaciones. La evidencia es escasa y la mayoría de las terapias se han investigado en las bronquiectasias tipo fibrosis quística. En este trabajo se explicará el enfrentamiento diagnóstico y terapéutico de los adultos portadores de bronquiectasias no fibrosis quística.

Bronquiectasias secundarias a Tuberculosis pulmonar en pacientes de un hospital general / Bronchiectasis secondary to pulmonary tuberculosis in patients in a general hospital

La tuberculosis pulmonar (TBP) supone un problema de Salud Pública. Se estima que la mitad de los pacientes con TBP desarrollan a lo largo de su vida una complicación, siendo la más frecuente la bronquiectasia. Objetivos: Determinar las principales características epidemiológicas y clínicas de pacientes con bronquiectasias secundarias a TBP en un hospital general. Material y métodos: Estudio observacional, retrospectivo, descriptivo, transversal. Se revisaron las historias clínicas de los casos con diagnóstico de bronquiectasia secundaria a TBP. Resultados: El 69% fue de sexo femenino y 40% fue adulto mayor. Las manifestaciones clínicas más frecuentes fueron tos en 66,6%, expectoración 56,0% y hemoptisis 49,2%. El 43% tuvo patrón tomográfico sacular. El 53% recibió broncodilatadores, 41% corticoides inhalados, 33% antibióticos y 16% mucolíticos. El tiempo promedio entre el diagnóstico de TBP y el desarrollo de la bronquiectasia fue 16,76 ± 11,94 años. Conclusiones: Las bronquiectasias por TBP fueron más frecuentes en mujeres y en adultos mayores. Las manifestaciones más frecuentes fueron tos, expectoración y hemoptisis. El patrón tomográfico más frecuente fue el sacular. El tratamiento más frecuente fue el uso de broncodilatadores. (AU)

Pulmonary tuberculosis (PT) is a public health problem, it is estimated that patients with PT developed one complication during life with bronchiectasis being the most frequent. Objectives: Ton describe clinical and epidemiologic features of patients with bronchiectasis secondary to PT in a general hospital in Lima. Methods: A cross-sectional study was conducted in which medical reports of patients with bronchiectasis secondary to PT were reviewed. Results: 69% of patients were female; 40% were elder. Most frequent clinical manifestations were cough in 66.6%, expectoration in 56.0% and hemoptysis in 49.2%. Saccular tomographic pattern was observed in 43%. Bronchodilators were prescribed for 53%, 41% received inhaled bronchodilators, 33 received antibiotics and 16% mucolytic medications. Mean time from diagnosis of PT to development of bronchiectasis was 16.76 ± 11.94 years. Conclusions: Bronchiectasis secondary to PT were more common in females and in the elder population. The most common clinical manifestations were cough, expectoration and hemoptysis. The most common pattern at CT scan was the saccular and bronchodilators were the most common drugs used. (AU)

Características clínico epidemiólogicas y laboratoriales de los pacientes pediátricos con infección de VIH y bronquiectasia en el Instituto de Salud del Niño: Periodo 2011-2012, Lima Perú / Clinical epidemiological and laboratory characteristics of pediatric patients with HIV infection and bronchiectasis at the Institute of Child Health: Period 2011-2012, Lima Peru

Nuestro objetivo fue describir las características epidemiológicas, clínicas y de laboratorio de pacientes pediátricos con infección VIH y bronquiectasias. Este estudio fue retrospectivo, basado en revisión de historias clínicas de niños infectados con VIH que recibieron la atención en el Instituto Nacional de Salud del Niño de Lima-Perú. Los casos (VIH-1 los niños infectados que desarrollaron bronquiectasias mientras era atendido entre 2011 y 2012, período). Las variables analizadas incluyen: aspectos epidemiológicos, clínicos y de laboratorio. Epidemiológicos: De los 25 pacientes cuyas Historias clínicas fueron revisados, 11 cumplieron con los criterios de elegibilidad para este estudio. El promedio de edad fue de 10 años 6 meses. Los pacientes varones fue 6 (54.54 por ciento) y mujeres fue de 5 (45,45 por ciento). El 60 por ciento provenía de la ciudad de Lima. 36,4 por ciento viven con ambos padres. La edad promedio de diagnóstico VIH fue de 3 años 5 meses, bronquiectasias 7 años 2 meses y el inicio del TARGA 6 años 10 meses. En el 100 por ciento la forma de contagio fue transmisión vertical. Clínica: El número promedio de neumonía fue 2,5 antes del diagnóstico de VIH, 4,4 antes de bronquiectasias y 3,6 antes de iniciar TARGA. El 90,9 por ciento de los pacientes tuvieron neumonía recurrente. El 27,3 por ciento de los pacientes tuvieron tuberculosis pulmonar. Características laboratoriales: Los niveles promedios de ARN del VIH (copias/ml) al diagnóstico de VIH fue de 484.630, al momento del diagnóstico de bronquiectasia fue de 289.219 y al inicio de la terapia HAART fue 45.3.984. El porcentaje de linfocitos CD4 + en relación a linfocitos totales al momento del diagnóstico de VIH fue de 9,81 por ciento, al momento de diagnóstico de bronquiectasia fue de 11,2 por ciento, al inicio de la TARGA fue de 10,1 por ciento Por lo tanto estos resultados como un diagnóstico tardío del VIH contribuye al aumento de la frecuencia de las infecciones respiratorias y el...

Our objective was to describe Epidemiological, clinical and laboratory features of pediatric patients with HIV infection and bronchiectasis. This study was a retrospective, based upon medical record review of HIV-1 infected children receiving primary care at a single large, urban medical center in Instituto Nacional Salud Niño of Lima-Peru. Cases (HIV-1 infected children who developed bronchiectasis while being cared for between 2011 and 2012 period). Variables analyzed including: epidemiological, clinical and laboratorial. Epidemiological: Of the 25 patients whose charts were reviewed, 11 met the eligibility criteria for this study. Average age was 10 years 6 months. Male patients was (54.54 per cent) and female was 5 (45.45 per cent). In 60 per cent was from Lima city. 36.4 per cent of patients living with both parents. The average age of VIH diagnosis was 3 years 5 months, bronchiectasis 7 years 2 months and start of TARGA 6 years 10 months. In 100 per cent Infection form was vertical transmission. Clinical: pneumonia average was 2.5 before VIH diagnosis; 4.4 before bronchiectasis and 3.6 before HAART start. The 90.9 per cent of patients had recurrent pneumonia. The 27.3 per cent of patients had pulmonary tuberculosis. Laboratorial characteristics: The average levels of HIV RNA (copies / ml) at HIV diagnosis was 484.630, at bronchiectasis diagnosis was 289.219 and at start of HAART was 453.984. The percentage of CD4 + lymphocytes over total lymphocytes at HIV diagnosis was 9.81 per cent, at diagnosis of bronchiectasis was 11.2 per cent, at start of HAART was 10.1 per cent. Therefore these findings such as late diagnosis of HIV contributes to increased frequency of respiratory infections and immune prognosis is poor despite HAART therapy institute.

Bronquiectasias en pediatría, aproximación diagnóstica y tratamiento / Bronchiectasis in pediatrics, diagnosis approach and management

Las bronquiectasias son un problema de salud en países desarrollados y en vías de desarrollo. La fibrosis quística es una causa importante, si bien fuera de ésta existen causas que convierten a las bronquiectasias no relacionadas con fibrosis quística en un diagnóstico frecuente. Su diagnóstico precoz basado en la clínica y posterior confirmación radiológica es el punto de partida para determinar la etiología e instaurar un tratamiento dirigido a la causa subyacente. Para ello es menester una evaluación ordenada y sistemática. Se presenta una revisión sobre la etiología y tratamiento de las bronquiectasias, especialmentede las no relacionadas con fibrosis quística.

Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis

Bronchiectasis continues to be one of the major causes of morbidity and mortality in developing countries, with a probably underestimated higher prevalence than in developed countries. To assess the clinical profile of adult patients with bronchiectasis. We retrospectively reviewed the clinical, radiologic, and physiologic findings of 304 patients with bronchiectasis confirmed by high-resolution computed tomography. Mean age of participants [45.7% males, 54.3% females] was 56 +/- 25 years and 65.8% of them were lifetime non-smokers. Most common identified causes of bronchiectasis were childhood disease [22.7%], tuberculosis [15.5%], and pneumonia [11.5%]. The predominant symptoms were productive cough [83.6%], dyspnea [72%], and hemoptysis [21.1%]. The most common findings on chest examination were crackles [71.1%] and rhonchi [28.3%]. Types of bronchiectasis were cylindrical in 47%, varicose in 9.9%, cystic in 45.1%, and multiple types in 24.3%. Involvement was multilobar in 75.3% and bilateral in 62.5%. Of 274 patients, 20.8% displayed normal pulmonary function test results, whereas 47.4%, 8% and 23.7% showed obstructive, restrictive, and mixed pattern, respectively. Patients with cystic disease had a higher frequency of hemoptysis [42%] and a greater degree of functional impairment, compared to other types. In patients with bronchiectasis from southern Turkey, generally presenting with recurrent productive cough, hemoptysis, dyspnea, and persistent bibasilar rales, the etiology remains mainly idiopathic. Post-infectious bronchial destruction is one of the major identified underlying pathological processes. The clinical picture and the deterioration of the pulmonary function test might be more severe in patients with cystic type bronchiectasis

Prevalence of Depression and Anxiety in Outpatients with Chronic Airway Lung Disease

BACKGROUND/AIMS: Patients with chronic airway lung diseases often experience depression and anxiety, but little information is available regarding Koreans with these conditions. We thus assessed depression and anxiety in Korean patients with chronic airway lung diseases. METHODS: The degree of depression and anxiety in 84 outpatients with chronic obstructive pulmonary disease (COPD), 37 with asthma, 33 with bronchiectasis, and 73 healthy controls were evaluated by the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). RESULTS: The patients with COPD and bronchiectasis had higher BDI scores and were more likely than controls to experience depression ([COPD, 17; range, 0 to 42; prevalence, 55%], [bronchiectasis, 16; range, 3 to 51; prevalence, 55%], [controls, 13; range, 0 to 31; prevalence, 30%], p < 0.05). The state-anxiety scores of the patients were higher than those of the controls, but only the bronchiectasis group demonstrated a higher frequency of state-anxiety compared with the controls (39 vs. 16%, patients vs. controls, p = 0.015). Among all patients, 22% presented with concomitant depression and state-anxiety, and 25% demonstrated depression and trait-anxiety. Depression was positively correlated with both state-anxiety (r = 0.644) and trait-anxiety (r = 0.597, p < 0.0001). Irrespective of individual diagnosis, post-bronchodilator FEV1 (odds ratio [OR], 0.972; p = 0.027) and smoking history (OR, 3.894; p = 0.018) were independent risk factors for depression in patients with chronic airway lung diseases. CONCLUSIONS: Chronic airway lung diseases are associated with depression and/or anxiety, particularly in those with a higher airflow limitation and/or history of smoking.

Comorbidities in severe asthma: frequency of rhinitis, nasal polyposis, gastroesophageal reflux disease, vocal cord dysfunction and bronchiectasis

OBJECTIVES: Severe asthma is found in approximately 10 percent of patients with asthma. Some factors associated with worse asthma control include rhinitis, gastroesophageal reflux disease, vocal cord dysfunction (VCD), nasal polyposis and bronchiectasis. Therefore, we evaluated the prevalence of these illnesses in patients with severe asthma. METHODS: We conducted a retrospective analysis of data obtained from electronic medical records of patients with severe asthma between January 2006 and June 2008. Symptoms of rhinitis and gastroesophageal reflux disease were evaluated as well as intolerance to nonsteroidal anti-inflammatory drugs. We evaluated the results of esophagogastroduodenoscopy, videolaryngoscopy and CT scans of the chest in order to confirm gastroesophageal reflux disease, nasal polyposis, vocal cord dysfunction and bronchiectasis. RESULTS: We evaluated 245 patients. Rhinitis symptoms were present in 224 patients (91.4 percent); 18 (7.3 percent) had intolerance to nonsteroidal anti-inflammatory drugs, and 8 (3.3 percent) had nasal polyposis. Symptoms of gastroesophageal reflux disease were reported for 173 (70.6 percent) patients, although the diagnosis of gastroesophageal reflux disease was confirmed based on esophagogastroduodenoscopy or laryngoscopy findings in just 58 (33.6 percent) patients. Vocal cord dysfunction was suspected in 16 (6.5 percent) and confirmed through laryngoscopy in 4 (1.6 percent). The patient records provided CT scans of the chest for 105 patients, and 26 (24.8 percent) showed bronchiectasis. DISCUSSION: Rhinitis and gastroesophageal reflux disease were the most common comorbidities observed, in addition to bronchiectasis. Therefore, in patients with severe asthma, associated diseases should be investigated as the cause of respiratory symptoms and uncontrolled asthma.

Bronquiectasias no asociadas a fibrosis quística / Non-cystic fibrosis bronchiectasis

Las bronquiectasias no asociadas a fibrosis quística (FQ) son causa frecuente de morbimortalidad de acuerdo a la severidad de la patología subyacente. Su diagnóstico precoz en base a la clínica y el scanner, toda vez que se haya descartado una FQ, es clave para el manejo oportuno y sistemático de los distintos tipos asociados a las diversas etiologías que se menciona. Se han realizado avances en el estudio genético de los factores intrínsecos presentes en poblaciones específicas. El manejo adecuado de la patología de base, cuando se descubre, no siempre resulta exitoso y el tratamiento definitivo es motivo de investigación. Por ahora, el uso de antibióticos sistémicos e inhalados más fisioterapia son las únicas herramientas que han demostrado eficacia en mejorar síntomas y calidad de vida en la mayoría de los casos. Se presenta una revisión actualizada de las causas de bronquiectasias no relacionadas con FQ, incidencia y prevalencia, aspectos clínicos más relevantes, junto a las evidencias y controversias sobre su tratamiento.

[Aetiologies and outcome of bronchiectasis in children: a study of 41 patients]

Bronchiectasis remains an important cause of chronic suppurative lung disease in the developing world. This study is to describe the epidemiological characteristics, clinical features, underlying aetiologies and Outcome of bronchiectasis in the paediatric hospital of Tunis. A retrospective study of 41 children with bronchiectasis was conducted between January 1994 and December 2006. Diagnosis was made in patients with clinical suspicion of bronchiectasis associated with abnormalities on chest X ray [n=37] and/or on high resolution computed tomography [HRCT] [n=36]. Mean age at diagnosis was 5 years 9 months; [range: 6 months-14 years]. Persistent cough and bronchorhea were the most common symptoms. Fourteen patients [34%] had dyspnoea on first presentation, 11 of them [26.8%] had chest deformation and/or finger clubbing. Haemoptysis was noted in only two cases. Mean time to diagnosis from symptom onset was 2.7 years [range: 2 months- 4 years]. The underlying aetiologies were identified in 52% of patients. Cystic fibrosis [17%], previous pneumonic illness [9.7%], primary ciliary dyskinesia [9.7%] and immunodeficiency [9.7%] were the most common causes. After a mean follow-up of 6.6 years, the annual lower respiratory infection rate decreased from 7.2 +/- 3 to 3.1 +/- 2.6 [p<0.05], Twenty one point nine per cent of patients had chronic respiratory failure and five patients required surgery. Delays diagnosis of bronchiectasis remains important in our country. Congenital and indeterminate aetiologies are the most common forms. Prognosis is poor with a high prevalence of chronic respiratory failure

Clinical profile of Saudi children with bronchiectasis.

OBJECTIVE: This study represents the experience of a tertiary care center in Saudi Arabia on non-cystic fibrosis bronchiectasis. METHODS: A retrospective review of all patients with confirmed Non-Cystic Fibrosis (Non-CF) bronchiectasis by chest X-ray and or CT chest in a pulmonary clinic for the period 1993-2005 at a tertiary care center in Riyadh. RESULTS: A0 total of 151 cases were diagnosed as Non-CF bronchiectasis. Siventy-five (49.7%) were males, 76(50.3%) were females. One hundred forty-eight (98%) are alive and 3(2%) died. The southwestern regions constituted 72(50%) of the cases. There is a period (5+/- 3.2) years between the start of symptoms and the diagnosis of bronchiectasis. More than 2/3 of the patients had cough, tachypnea, wheezing, sputum production and failure to thrive. Ninety one (60%) had associated disease: Pulmonary diseases in 48(32%), immunodefficiency in 27(18%), CNS in 18(12%), cardiac in 12(8%) and asthma in 103(68%) of the patients. Left lower lobes were commonly involved in 114(76%) cases. Sixty-eight (67%) were found to have sinusitis. Forty-nine (32%) developed gastroesophgeal reflux (GER). Hemophilus influenza was cultured in 56(37%), Strept pneumoniae in 25(17%) and Pseudomonas aeruginosa in 24(16%) of the patients. 80% of the patients who had pulmonary function test had abnormal changes. Disease progression was related to development of symptoms before 5 years of age, persistent atelectasis and right lower lobe involvement (p<0.05). CONCLUSION: Non-CF bronchiectasis is a common problem in Saudi Arabia. Early recognition and institution of treatment with proper vaccination of available anti-bacterial and anti-viral vaccines are encouraged to prevent progression of the disease.

Persistent pneumonia in children.

With the aim to study the clinical profile and describe the predisposing causes of persistent pneumonia in Indian children, the clinical details and the investigations of children presenting with persistent pneumonia to Pediatric/Chest Clinic services of a tertiary care center in north India were reviewed. Nineteen children (16 boys) were evaluated for persistent pneumonia over a period of 5 years. Based on the clinical features and the results of the investigations, underlying illness could be identified in 16 (84.2%) children. The most frequent underlying causes for persistent pneumonia in children were asthma (26.3%) and post-tubercular bronchiectasis (26.3%).