Clinical manifestations and evaluation of bronchiectasis in children
- Khoulood Fakhoury, MD
Khoulood Fakhoury, MD
- Assistant Professor of Pediatrics
- Baylor College of Medicine
- Adaobi Kanu, MD
Adaobi Kanu, MD
- Associate Professor of Pediatrics
- Texas Tech Health Sciences Center
Bronchiectasis is a structural abnormality characterized by abnormal dilation and distortion of the bronchial tree, resulting in chronic obstructive lung disease. This condition is typically the end result of a variety of pathophysiologic processes that render the bronchial walls weakened, easily collapsible, chronically inflamed, and plugged with mucus secretions. Associated findings include atelectasis, emphysema, fibrosis, and hypertrophy of the bronchial vasculature.
In developed nations, cystic fibrosis (CF) is the most common cause of bronchiectasis in children. The evaluation of CF-related bronchiectasis is presented elsewhere. (See "Cystic fibrosis: Clinical manifestations and diagnosis" and "Cystic fibrosis: Clinical manifestations of pulmonary disease".)
Bronchiectasis can be caused by a variety of disease processes other than CF, most of which include some combination of bronchial obstruction and infection. The types of disorders that cause bronchiectasis vary among populations and age groups. Infections and acquired causes of bronchiectasis are more common in adults and in developing nations, whereas congenital anomalies of the bronchi or immune system are more prominent in children and in industrialized nations.
This topic review will outline the clinical manifestations and evaluation of non-CF-related bronchiectasis in children. The causes and management of non-CF-related bronchiectasis in children, and the clinical manifestations and diagnosis of bronchiectasis in adults are discussed separately. (See "Causes of bronchiectasis in children" and "Management of bronchiectasis in children without cystic fibrosis" and "Clinical manifestations and diagnosis of bronchiectasis in adults".)
The most common symptom in children with bronchiectasis is persistent cough, which is present in 80 to 90 percent of pediatric patients with bronchiectasis, and is typically "wet" or productive [1,2]. Fifty-seven to 74 percent of children also produce purulent sputum. The absence of sputum production does not exclude bronchiectasis because young children may not be able to expectorate sputum.
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