bronchiectasis Flashcards
what is the most common organism in non-CF pts with bronchiectasis?
H. influenza
______ makes up 1/2 the cases of bronchiectasis
cystic fibrosis
which organism is associated with accelerated course, more frequent exacerbations and more rapid decline in lung function?
pseudomonas
what is the overall result of bronchiectasis?
retained secretions colonized with pathogenic organisms resulting in COPIOUS amounts of purulent sputum
what is the vicious cycle of bronchiectasis?
inflammatory release leading to destruction loss of ventilatory function can't clear out mucous become colonized now infected
what are the main symptoms of bronchiectasis?
cough and copious amount of mucopurulent sputum lasting months to years
what is the most common clinical presentation of bronchiectasis?
crackles/rhonchi most common
may have scattered wheezing
clubbing
what is the gold standard for diagnosing bronchiectasis?
HRCT
if you do a sputum analysis, what may you see in bronchiectasis?
dittrich plugs (small white/yellow concentrations)
if you do a gram stain and culture, what may you see in bronchiectasis?
pseudomonas or E. coli
what does CXR show in pt with bronchiectasis?
increased pulmonary markings ring-like structures atelectasis dilated and thickened airways mucus pluggings TRAM LINES - train tracks
CBC for bronchiectasis may show what?
leukocytosis
polycythemia
what will you see on spirometry for pt with bronchiectasis?
reduced or normal FVC
low FEV1
low FEV1/FVC
how to manage bronchiectasis?
antibiotics chest physiotherapy bronchodilators smoking cessation adequate nutrition immunizations
what is the mainstay of treatment in bronchiectasis?
antibiotics
what are acceptable outpatient abx choices?
amoxicillin tetracycline bactrim macrolide second-generation cephalosporin fluroquinolone
what are examples of bronchial hygiene?
flutter device intrapulmonic percussive ventilation devices incentive spirometry vest system nebulizers
what kind of disorder is CF?
autosomal recessive genetic disorder
what is the median age of diagnosis for CF? median survival age?
dx: 6-8 months
survival: 36.5 y/o
CF is a disease of ______ gland function
exocrine
what is the primary cause of death in pts with CF?
end-stage lung disease
what is the pathophysiology of CF?
defect in the CFTR gene results in abnormal chloride transport channels
results in thick viscous mucus secretions in the respiratory tract, pancreas, and GI tract causing plugging
what is the presentation for CF?
chronic hacking cough (recurrent bronchiolitis in infants)
GI manifestations (meconium ileus in babies)
male reproductive tract (infertility, undescended testes)
sinus infection
what are other respiratory manifestations for CF pts?
sputum production decreased exercise tolerance recurrent hemoptysis chronic rhinosinusitis symptoms hyperresonance to percussion apical crackles nasal polyps digital clubbing
what criteria is needed to diagnose CF?
clinical symptoms consistent with CF in at least one organ system AND
evidence of CFTR dysfunction by either:
elevated sweat chloride 60 or greater
genotyping (presence of two disease-causing mutations in CFTR)
abnormal nasal potential difference
what is the primary test for diagnosing CF?
sweat chloride test
what vaccines to manage CF?
influenza and PNA
what bronchodilators to treat CF?
B-agonists and anticholinergics
what agents to promote clearance of secretions in CF?
enzymes
inhaled hypertonic saline
inhaled N-acetylcysteine
what antiinflammatory therapy to treat CF?
macrolides
ibuprofen
corticosteroids (inhaled and/or systemic)
