Introduction

‘Chronic bronchial sepsis’ has been used as a term to describe chronic bronchial infection leading to daily production of purulent sputum. However, the term sepsis implies that bacteremia is part of the syndrome, but this is rare in these patients because an exuberant immune response confines the infection to the lung. ‘Chronic bronchial suppuration’ is therefore a better term to use. Chronic expectoration of mucopurulent or purulent sputum should lead to suspicion of the presence of bronchiectasis. Bronchiectasis is defined as abnormal chronic dilation of one or more bronchi. This structural abnormality results in poor mucus clearance from affected areas, predisposing the patient to recurrent or chronic bacterial infections.

There are a number of different types of bronchiectasis that are characterized by the form of airway dilation. Saccular or cystic bronchiectasis occurs when there is severe loss of structural elements in the bronchial wall leading to large balloon like dilations. This type of bronchiectasis usually follows severe lung infections and is characterized by the production of large volumes of sputum and finger clubbing. It is now infrequently seen in developed countries. In varicose bronchiectasis there are local constrictions superimposed on cylindrical changes. Traction bronchiectasis occurs in fibrotic lung conditions such as fibrosing alveolitis in which the airway walls are pulled apart by the fibrotic process. Much more frequently seen nowadays is a cylindrical form of bronchiectasis in which the damage to the bronchial wall is less severe than cystic bronchiectasis. This has been termed ‘modern’ bronchiectasis.