Tuberculous Tracheobronchitis

¹ Medical Director, Laennec Tuberculosis Dispensary, Havana, Cuba
² Professor of Otolaryngology, University of Havana, Cuba

The tuberculous lesions of the tracheobronchial tree, although having been known for more than a century, have not been studied adequately until the last ten years, when North American authors have shown the greatest interest in this disease entity.

These lesions are much more frequent than generally believed, and represent as much as about 20 per cent of the cases of pulmonary tuberculosis. In the great majority of cases they are secondary to a parenchymal lesion, but one which may be healed or at least arrested when bronchial lesions are diagnosed. On the other hand, cases of evident primary tuberculous lesions of the tracheobronchial tree have been described. It seems to be more frequent in females than in males.

Tuberculous tracheobronchitis is perhaps of more importance than laryngeal tuberculosis, because it alters the course and evolution, also the results of treatment of, the parenchymal lesions more harmfully than does the latter; as in its serious form of the ulcerostenotic type bronchial tuberculosis causes about a 50 per cent mortality no matter what treatment may be exclusively used against the pulmonary lesion.

Only bronchoscopy can establish the diagnosis with certainty. Clinical and radiological symptoms and signs are only presumptive. Nevertheless, stenotic lesions can also be diagnosed by bronchography.

Parenchymal lesions do not contraindicate the bronchoscopic examination, except in very special cases. Complications are very rare. Biopsy seems to be contraindicated if the bronchial lesion is suspected to be of tuberculous nature.

In patients under treatment by any type of collapse therapy, the persistence of positive sputum in spite of an apparently effective treatment must lead us to suspect the presence of an ulcerative lesion of the bronchus, and in these cases, before deciding whether to increase or change the collapse, a bronchoscopic examination must be performed. The same can be said of those cases where positive sputum is present without any radiological signs of parenchymal lesion or with evidence of healing.

Many cases of bronchial tuberculosis have been mistakenly diagnosed and treated as asthma for a long time. We believe that if the cases described until recently as "asthma and tuberculosis" were to be studied in the light of our present knowledge, a complete revision of the subject would follow. We want to have it well understood that we do not deny the existence of "tuberculous asthma" and also that asthma and tuberculosis may coexist independently in the same patient; but we want to insist that many of the supposed asthmatics which become tuberculous are really cases of bronchial tuberculosis of chronic evolution without parenchymal lesion. Since in such cases the asthmatoid syndrome predominates, the non-specialist physician is prone to neglect thorough study of the patient's respiratory tract because he considers them as genuine asthmatics. All asthmatics should be periodically studied radiologically, and no physician should content himself with a mere clinical examination.