Pulmonary function tests and airway responsiveness to methacholine in chronic bronchiectasis of the adult

Fifty adults with chronic bronchiectasis (mean duration since diagnosis: 25 +/- 16.4 years), excluding those cases secondary to tuberculosis or hypogammaglobulinemia, were investigated by a questionnaire, a chest radiograph and lung function tests. Of these, 29 with an FEV1 greater than 1.5 1 underwent methacholine inhalation tests. Fourty-three subjects and three subjects respectively showed an obstructive or a mixed obstructive and restrictive defect, only four having normal lung function tests. Sixty-nine percent of subjects tested had a provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) less than 16 mg X ml-1. Subjects with daily sputum production had lower values of FEV1 and FEV1/forced vital capacity (FVC) compared to subjects with less than daily sputum. Subjects with clinical features of bronchial hyperexcitability had significantly lower baseline FEV1, vital capacity, and maximal mid-expiratory flow rate (FEF25-75). Subjects with lower PC20 values had significantly lower baseline FEV1, FEV1/FVC and FEF25-75. Finally, subjects with the greatest extent of radiological abnormalities had lower baseline FEV1, FEV1/FVC and diffusing capacity, and a higher residual volume. We conclude that chronic bronchiectasis is associated with significant changes in lung function tests and increased responsiveness to methacholine in the majority of affected individuals.