Bronchiectasis Flashcards
What is bronchiectasis
abnormal and permanent dilation of the bronchi
clinical picture of bronchiectasis
cough, with or without sputum, dyspnea, hemoptysis, recurrent pneumonia and musical chest exam
pathogenesis of bronchiectesis
airway injury from infection or toxins
impaired bronchial hygiene
cycle of pooled secretions, infection, and more secretions
causes of bronchiectesis
Infections (pertussis, measles, S. aureus, klebsiella pseudlomans, viral, fungal, mycobacteria)
CF
cilia dyskinesia
alpha1 anti-trypsinase deficiency?
immunoglobin deficiency
rehumatic diseases (RA, Sjogrens, SLE, IBD (celiacs and ulcerative colitis)
Kartegener’s syndrome
situs inversis, bronchiectasis, chronic sinusitis
forms of ciliary dyskinesia
kartegener’s syndrom, autosomal dominant polycystic kidney disease
radiography of bronchiectasis
Chest X-ray normal or only very subtle changes
bronchography no longer used
CT
patterns of bronchiectasis
upper lobe: more often for CF
focal bronchiectasis: pneumonia or obstruction; diffuse: systemic problems
diagnosis form bronchiectasis
consider Xray, pulmonary function tests, sputum analysis
high resolution CT. if normal, consider GERD or aspiration
if focally abnormal, do bronchoscopy
if diffusely abnormal, look for CF, Ig assays, ciliary studies, semen analysis, rheumatic disease tests, and HIV
treatment for bronchiectasis- general approach
bronchiol hygiene and antibiotics
bronchiol hygiene
directed cough; high freq chest wall compression
hydration and mucolytic agents; maybe bronchodilors and inhaled steroids. GERD and aspiration risks. exercise
Antibiotics for bronchiectasis
use liberally
macrolides have some anti-inflammatory effects too. may be used daily or just 3X/wk (azithromycin).
inhaled antibiotics also good, esp. aminoglycosides in CF pts (gentamicin and tobramicin).
additional issues with bronchiectasis
mycobacterium, aspergillis, hemoptasis that may be massive and fatal.
