Bronchiectasis Flashcards
clinical syndrome of bronchiectasis (BE)
very productive cough, waxing and waning, constitutional sx (fatigue, anorexia, weight loss)
pathology of BE
dilation of the airways, mucous plugging
irreversible (unlike asthma)
histo path of BE
dilated airways, lots of inflammation, destroyed bronchiole wall, PMNs/lymphos/plasmas/eos, squamous metaplasia, ulcerations
epi of BE
more in older, females more in older ages, less common in blacks, more in asian/ pacific islander
describe vicious cycle of BE
tissue damage, impaired sputum clearance, bacterial colonization, chronic inflammation, back to tissue damage and around
list some causes of BE
50% idiopathic; many have distant etiology- infection (like TB), toxic damage
systemic disease, obstructive airway disease, APBA
CF and PCD
manifestations of PCD
neonate respiratory distress, chronic wet cough from birth, BE by adulthood, otitis media w/ hearing loss, reduced fertility, 50% have situs inversus
8 clinical signs of bronchiectasis
audible secretions, sputum inspection, finger clubbing, crackles, wheezes, skeletal abnormalities (tall thin, pectus, scoliosis), situs inversus w/ PCD, respiratory failure
list some investigations into BE
PFTs for obstruction/air trapping (restriction in severe disease), radiography
for inflammation- blood counts, ESR, CRP
sputum microbio
typical antibiotic for BE w/ pseudomonas
azithromycin- macrolides have proven efficacy against pseudomonas in BE
tx strategies for BE
airway clearance, antibiotics, airway hydration, bronchodilation, macrolides, vaccination, surgery
macrolide benefit for BE
anti-inflammatory in addition to anti microbial
reduce exacerbations and improve QOL
when to use IV antibiotics
during exacerbation, resistance G- organisms, failure oral antibiotics, previous history, hemoptysis
