In most cases of bronchiectasis there are strong

indications for a bronchoscopic diagnosis, to eliminate such

conditions as foreign body, cicatricial bronchial stenosis, or

endobronchial neoplasm as etiologic factors. In the idiopathic types

considerable benefit has resulted from the endobronchial lavage and

endobronchial oily injections mentioned under lung abscess. It is

probable that if bronchoscopic study were carried out in every case,

definite causes for many so-called idiopathic cases would be

discovered. Lung-mapping as elsewhere herein explained is invaluable

in the study of bronchiectasis.

Bronchial asthma affords a large field for bronchoscopic study. As

yet, sufficient data to afford any definite conclusions even as to the

endoscopic picture of this disease have not been accumulated. Of the

cases seen in the Bronchoscopic Clinic some showed no abnormality of

the bronchi in the intervals between attacks, others a chronic

bronchitis. In cases studied bronchoscopically during an attack, the

bronchi were found filled with bubbling secretions and the mucosa was

somewhat cyanotic in color. The bronchial lumen was narrowed only as

much as it would be, with the same degree of cough, in any patient not

subject to asthma. The secretions were removed and the attack quickly

subsided; but no influence on the recurrence of attacks was observed.

It is essential that the bronchoscopic studies be made, as were these,

without anesthesia, local or general, for it is known that the

application of cocain or adrenalin to the larynx, or even in the nose,

will, with some patients, stop the attack. When done without local

anesthesia, allowance must be made for the reaction to the presence of

the tube. In those cases in which other means have failed to give

relief, the endobronchial application of novocain and adrenalin,

orthoform, propaesin or anesthesin emulsion may be tried. Cures have

been reported by this treatment. Argentic nitrate applied at weekly

intervals has proven very efficient in some cases. Associated

infective disease of the bronchial mucosa brings with it the questions

of immunity, allergy, anaphylaxis, and vaccine therapy; and the often

present defective metabolism has to be considered.

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