BRONCHOSTENOSIS COMPLICATING ALLERGIC AND INFECTIOUS ASTHMA

Abstract
Of a group of 140 patients suffering from asthma who were specially selected for bronchoscopy. the authors observed and treated 60 patients who were found to have definite stenosis of one or more bronchi. A study of this latter group revealed the fact that bronchostenosis complicating asthma generally produced characteristic symptoms and frequently, physical and roentgenologic observations which indicated that the physician might be dealing with this syndrome. One of the more prominent symptoms encountered was severe, persistent, and sometimes paroxysmal cough, which of course aggravated the asthma. A 2d and very important symptom of bronchostenosis was fever. Febrile episodes, either with or without preceding chills, occurred in 68% of the cases. The physical signs which accompanied bronchostenosis were secondary to the atelec-tasis which was present and consisted chiefly of suppression of breath sounds and fremitus over the affected region noted when the affected side, was compared with the unaffected side. Less frequently dullness to percussion was found over the atelectatic region. Only a relatively small group of patients who have asthma need bronchoscopy. and the most common indication for such instrumentation was the need for ruling out or confirming the presence of possible complicating bronchostenosis. The occurrence of allergy in the authors'' 60 cases was frequent. In half of the patients so affected, the asthma had an allergic basis. Hay fever was experienced by 10 individuals, and 7 had a definite allergy to drugs. Treatment of bronchostenosis was achieved by dilatation of the stenosed bronchus by means of dilating forceps introduced through the broncho-scope. This procedure was immediately followed by aspiration of the retained secretions from the bronchus. The immediate results, as measured by the relief of the patient, the subsidence of fever, the eventual reduction in amt. and improvement in character of the sputum, the improvement in the course of the asthma, and in many cases, the immediate reversal of physical signs of bronchial obstruction, were excellent.
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