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A 7-month child with pulmonary tuberculosis infection involving the whole right upper lobe is described. He was referred to us after diagnosis of recurrent asthmatic bronchitis. In spite of the severity of bronchopulmonary involvement, the outcome was good after 5 months of antitubercular chemotherapy.

Pulmonary fibrosis is a chronic disorder characterized by inflammation, injury and fibrosis of the alveolar structures and consequent loss of functional alveolar-capillary units. It involves a number of unresolved terminologic, pathogenetic, diagnostic and therapeutic controversies. The key to understanding the disease is the recognition that inflammation is the first event. The staging of the patients, important for correct therapy decision, is made using methods that specifically evaluate the inflammation such as open lung biopsy, bronchoalveolar lavage, and Gallium 67 scanning. The most rational therapeutic approach is to suppress the inflammation and to prevent further injury and scarring. The drugs of choice for treatment are corticosteroids (prednisone particularly). It is suggested to use large doses during the initial portion of the therapeutic trial followed by a tapering of the dose. If the patient does not respond to corticosteroids other immunosuppressive agents can be considered, particularly cyclophosphamide. The frequency and duration of response to these regimens remains to be defined.

Bronchial hyperreactivity is a condition in which the airways show a much greater bronchoconstrictor response to provocative stimuli than normal. Non-specific bronchial hyperreactivity is a feature of asthmatic patients both allergic and non-allergic. It is proposed that bronchial hyperreactivity is due to the fact that the airways are narrower. In addition changes in the mass of muscle, and changes in the contractility of the muscle may contribute to bronchial hyperreactivity. Moreover bronchial hyperreactivity could be due to increased alpha-adrenergic or parasympathetic activity or to decreased beta-adrenergic or non adrenergic inhibitory activity. Bronchial hyperreactivity can be induced by factors such as infection, inflammation or exposure to allergens.

Bronchial hyperreactivity is studied for the evaluation of airways' response to stimuli that provoke bronchoconstriction in hyperreactive subjects. Exercise is often used, especially in children. This method in simple, sufficiently tolerated and reproducible. The inhalation of ultrasonically-nebulized distilled water is a simple, reproducible and rapid to perform in the majority of adult patients test; in childhood it is poorly inquired. Pharmacological tests (with histamine or methacholine) have a greater sensitivity and reproducibility. Aspecific bronchoprovocation with methacholine is a diagnostic method that allows the diagnosis of bronchial hyperreactivity in asymptomatic subjects with asthma, recurrent cough and recurrent bronchopneumonia.

Bronchial hyperreactivity is a common report in several respiratory tract diseases such as bronchial asthma, chronic bronchitis and cystic fibrosis. Atopic patients and children who suffered lung diseases in early life (laryngotracheobronchitis, bronchiolitis, bronchopulmonary dysplasia) may have also persistent abnormalities in pulmonary function that frequently include bronchial hyperreactivity. A review of the actual literature, specially concerning with the clinical aspects of bronchial hyperreactivity in children and with the possible etiopathogenetic mechanism is presented.