Nasreen Khalil, MD, FRCPC, FCCP, Associate Professor of Medicine, The University of British Columbia, Jack Bell Research Centre, Vancouver, BC.

Bronchiectasis is an anatomic abnormality of the airway characterized by irreversible dilatation and thickening of the airway wall. The most common etiology in older patients appears to be a previous pulmonary infection. Prior to the antibiotic era the age group most frequently affected by bronchiectasis was young children. Currently, bronchiectasis is seen primarily in individuals between the ages of 60 and 80. Pseudomonas aeruginosa and Hemophilus influenza are the most commonly isolated pathogens in the sputum of bronchiectatic patients. Treatment consists of ruling out reversible or correctible causes, commencing antibiotic therapy, and improving bronchial hygiene.

Key words: bronchiectasis, chronic cough, chronic sputum, mucociliary, immunodeficiency.

Samir Gupta, MD, FRCPC, Division of Respirology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, ON.

Robert Hyland, MD, FRCPC, Division of Respirology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, ON.

Hemoptysis is an important clinical problem that is especially ominous when seen in older patients. The main causes of hemoptysis in first world nations are bronchogenic carcinoma, bronchitis, and bronchiectasis. In older patients cancer remains the main concern, especially if there is a smoking history. The diagnostic approach to nonmassive hemoptysis starts with a chest x-ray, followed by a CT scan and then fibre optic bronchoscopy, which is well tolerated by older adults. In massive hemoptysis, chest x-ray is usually followed immediately by fibre optic or rigid bronchoscopy. Older patients require closer monitoring due to poor cardiopulmonary reserve; management options include endoscopic interventions, bronchial artery embolization,
surgery, and radiation.

Key words: hemoptysis, etiology, management, older adults, bronchiectasis.

Nariman Malik, BSc

The word bronchiectasis is derived from the Greek words bronchos, meaning windpipe, and ektasis, which means extension or stretching.¹ Bronchiectasis is defined as the abnormal and persistent dilatation of bronchi due to destructive changes in the elastic and muscular layers of the bronchial wall.² It is a condition that can affect airways of all sizes but tends to mainly affect medium-sized airways. It can be either focal, affecting the air supply to a limited region of lung parenchyma, or diffuse in nature. Bronchiectasis most often is a consequence of chronic or recurrent infections and the associated secretions that pool in these airways.³

In North America, fewer and fewer patients present with gross disease.⁴ The advent of antibiotics has lead to a dramatic decrease in severe respiratory infections and the subsequent development of bronchiectasis. However, because its incidence has decreased in developed countries, it is now believed that low clinical suspicion is a factor in the underdiagnosis of bronchiectasis.⁵ Bronchiectasis is characterized by the production of large amounts of sputum, which is also a defining trait of chronic bronchitis. As such, patients who are producing copious amounts of sputum and who smoke are likely to be misdiagnosed with chronic bronchitis.