PURPOSE: Bronchiectasis is considered to be a disease with manifestations of disabling productive cough, dyspnea and hemoptysis demonstrating an obstructive defect in lung function. We observed that many of our patients did not present with the classic complaints. We reviewed our records to see how often cough and sputum were present.
METHODS: Retrospective chart review of patients with a diagnosis of bronchiectasis at University of Illinois at Chicago Medical Center between 1999 and 2006 was done. 50 patients were analyzed. Everyone with an ICD code 494 and a clinical diagnosis of bronchiectasis was included if they were over 18 years of age. Patients with a diagnosis of cystic fibrosis were excluded from the study. 54 patient charts were screened to obtain the sample of 50.
RESULTS: Cough was present in only 78% of the total patients and in only 67% of patients with focal bronchiectasis. 42% of the patients complained of chronic sputum production, 24% had hemoptysis and 44% had dyspnea. 60% of the patients had focal disease (limited to 1-2 lobes in the same lung). Cough was the only significantly different feature between diffuse and focal bronchiectasis (95% vs. 67%). 35 out of 50 patients had diagnosis of bronchiectasis made by CT scans. 33 out of 50 patients had evaluation of their lung function by spirometry. Only 39% of the patients had evidence of obstruction defined by FEV1/FVC < 70%. 45% of the patients had FVC<80%. Of the 22 patients who had plethysmography, 7 patients had restriction(TLC<80%). The number of patients with obstruction was not statistically different between the focal and diffuse bronchiectasis groups.
CONCLUSION: Classic symptoms of productive cough, dyspnea and hemoptysis were not sensitive for the diagnosis of bronchiectasis as previously reported. Focal disease does not produce cough as often as diffuse involvement of the lung. Patients with bronchiectasis may have a predominant restrictive defect and no obstruction on PFT.
CLINICAL IMPLICATIONS: Bronchiectasis may be overlooked if we depend on the classic signs and symptoms and PFT findings.
DISCLOSURE: Syed Ahmed, No Financial Disclosure Information; No Product/Research Disclosure Information