BRONCHIECTASIS

Bronchiectasis is a complex chronic respiratory condition traditionally characterized by

recurrent infection, airway inflammation, and progressive decline in lung function. The
defining symptom common to children with bronchiectasis is chronic wet cough. Region-
specific studies suggest that geographic locality and socioeconomic environment play a large
role in determining the likely etiology of bronchiectasis in children. Cystic fibrosis, primary
immune deficiency, defects in mucociliary clearance mechanisms (primary ciliary dyskinesia,
congenital malformations), and aspiration of a foreign body increase susceptibility to
respiratory infection and are known to be associated with bronchiectasis in children.
However, on a global scale, lower respiratory infection in the absence of known underlying
conditions accounts for the greatest number of bronchiectasis cases. The focus of this review
will be bronchiectasis with no known underlying disorder in children.(1) Respiratory in-
fection, defined as lower respiratory tract infection with significant respiratory symptoms,
such as cough and sputum, was the most common cause of bronchiectasis, followed by post-
infectious bronch- iolitis obliterans and pulmonary tuberculosis. The most common etiology
was respiratory infection (55.3%), followed by post-infectious bronchiolitis obliterans
(14.3%) and pulmonary tuberculosis (12.3%).
However, the prognosis of non-CF bronchiectasis primarily depends on the underlying cause
and whether that etiology is an acute or chronic condition. The key to a successful outcome
is determining whether the cause of the damage is ongoing (e.g., chronic aspiration) and then
treating the underlying problem. In the absence of an underlying condition, children with
isolated bronchiectasis often have a better prognosis compared to those with more diffuse
disease.(2)
The all-cause mortality rate in the bronchiectasis group was 1608.8 per 100,000 person-years
(95% confidence interval (CI), 1531.5–1690.0), which was higher than that in the control
group (133.5 per 100,000 person-years; 95% CI, 124.1–143.8; P < 0.001). The bronchiectasis
group had higher all-cause (adjusted hazard ratio (aHR), 1.26; 95% CI, 1.09–1.47),
respiratory (aHR, 3.49; 95% CI, 2.21–5.51), and lung cancer-related (aHR, 3.48; 95% CI,
2.33–5.22) mortality risks than the control group. The major causes of death in the
bronchiectasis group were malignancy (31.2%), respiratory related (30.6%), neurological
(9.0%), and cardiovascular death (7.1%).

1. Pizzutto SJ, Hare KM, Upham JW. Bronchiectasis in children: Current concepts in
immunology and microbiology. Frontiers in Pediatrics. 2017.
2. Sin S, Yun SY, Kim JM, Park CM, Cho J, Choi SM, et al. Mortality risk and causes of
death in patients with non-cystic fibrosis bronchiectasis. Respir Res. 2019;