Medical versus surgical management in patients with bronchiectasis

Recent advancements in the fields of antibiotic therapy, vaccination and general health have decreased the number of surgical interventions for the treatment of bronchiectasis. On the other hand, improvements made in the field of lung surgery prompt some physicians and patients to pursue surgical treatment. We assessed the results of surgical treatment of bronchiectasis and compared them with the results of medical treatment during the same period of time. The study population consisted of all patients who had referred to Masih Daneshvari Hospital and were admitted for treatment of bronchiectasis during a period of seven and a half years [March 1999 to September 2006]. In this descriptive study, surgical or non-surgical treatment was adopted according to the usual indications for the treatment of bronchiectasis. Response to treatment was evaluated by referring to the patient's medical records and out-patient visits. The results were categorized into the following categories: Sputum production and other major signs completely disappeared. Satisfactory: Signs and symptoms did not totally disappear, but the patient was satisfied with the treatment results. Poor: No significant change was seen after the treatment. Technique of surgery was postero-lateral thoracotomy under one lung ventilation and lobar or segmental resections. Medical treatment consisted of physiotherapy, antibiotic administration and vaccination against influenza and pneumococcus. Statistical analysis was performed using Access and SPSS software. Fisher exact and chi square tests were used for qualitative comparison of the results. The mean duration of follow- up was 35.9 months [range 1-96 months]. Eighty-three patients were studied [48 females, 35 males, mean age 37.8 years, range: 8-71 years]; 40 patients underwent surgery while 43 underwent medical treatment. The results of surgery were good in 16[55.2%], satisfactory in 10 [34.5%] and poor in 2 [6.9%] patients. The results of medical treatment were good in 4 [13.8%], satisfactory in 11[37.9%], and poor in 13 [44.8%] patients. Good results were significantly more [P=0.002] and poor results were significantly less [P=0.002] after surgical treatment. In each group, one death occurred during the treatment course. Fourteen patients in the medical group and 11 patients in the surgical group were lost during the follow-up period. When indicated, surgical therapy offers advantages over medical therapy in the treatment of bronchiectasis