Bronchiectasis Flashcards
- Uncommon
- Results from infectious process
- Leads to permanent distortion of one or more of the conduction airways
- Categorized as COPD due to airway collapse causing obstruction
What disease is this?
Bronchiectasis
Etiology of Bronchiectasis
- Cystic Fibrosis (50% of cases)
- Primary infections
- Aspiration
- Congenital anatomic defects
- connective-tissue disorders
- Alpha1-antitrypsin (AAT) deficiency
- Autoimmune disease
- Toxic gas exposure
- Haemophilus Influenza: most common organism in non-CF patients with bronchiectasis
-
P. aeruginosa, S. pneumonia, and S. aureus also commonly identified
- Pseudomonas associated with accelerated course, more frequent exacerbations and more rapid decline in lung function
Abnormal dilation of proximal and medium-large sized bronchi (>2mm in diameter)
Can be congenital but most often acquired
Infection ->imparied drainage -> airway obstruction
muscular and elastic components of the bronchial wall and often peribronchial alveolar tissue damaged from the inflammatory process
Overall result = retained secretions colonized with pathogenic organisms resulting in copious amounts of purulent sputum
What disease is this the pathology of?
Bronchiectasis
What is the vicious cycle of Bronchiectasis?
- Infection: with acute inflammation and recruitment of inflammatory cells
- Release: of inflammatory cytokines peroxidases, proteinases elastase
- Destruction: of mucociliary and cartilagenous supporting structure
- Loss: of ventilatory function
- Impariment: mucociliary clearance sputum retention
Bronchiectasis: Presentation
- Cough and daily mucopurulent sputum lasting months to years
- Blood-streaked/hemoptysis due to airway damage
- Pleuritic chest pain
- dyspnea
- wheezing
- weight loss
- fever
- Crackles/rhonchi with infection
- May have scattered wheezing due to secretions in airways
- clubbing
- cyanosis, wasting
Bronchiectasis: Work up
- ***GOLD STANDARD: High resolution CT (HRCT)
- Sputum Analysis: may reveal Dittrich plugs (small white/yellow concentrations)
- Gram stain & culture: may reveal Pseudomonas or E.coli
- Plain CXR obtained in all patients: increased pulmonary markings, ring-like structures, atelactasis, dilated and thickened airways (tram lines), mucus plugging (finger-in-glove) appearance.
- OR
- CXR MAY BE NORMAL
- CBC: Leukocytosis with left shift, polycythemia can be present due to chronic hypoxia
- Quantitative serum alpha1-antitrypsin level to r/o AAT deficiency
- Pilocarpine iontophoresis (sweat test) to r/o cystic fibrosis
- Autoimmune screening
Bronchiectasis Diagnostic Evaluation
Spirometry:
obstructive pattern
reduced or normal forced FVC (may be low in advanced dz)
Low FEV1
Low FEV1/FVC
Bronchiectasis Management
- improve symptoms
- reduce complications
- control exacerbations
- reduce morbidity and mortality
- antibiotics and chest physiotherapy
- bronchodilators
- corticosteroids
- oxygen
- surgical intervention
- Smoking cessation is essential
- adequate nutrition: pts w/CF
- immunizations (influenza/pneumococcus)
- all other immunizations UTD
What is the mainstay of treatment for Bronchiectasis?
Antibiotics
**In acute exacerbations use broad-spectrum abx
Acceptable outpt choices for antibiotics:
- amoxicillin
- tetracycline
- trimethoprim-sulfamethoxazole
- macrolide (azithromycin or calrithromycin)
- second-generation cephalosporin
- fluoriquinolone
-
Severe illness requiring hospitalization
- IV abx
What is one of the most important parts of treatment fro bronchiectasis?
- bronchial hygeine
- postural drainage with percussion and vibration loosens and mobilizes secreations
- Devices: flutter device, intrapulmonic percussive ventilation devices, and incentive spirometry
- “Vest” system is relatively new pneumatic compression device/vest work periodically throughout the day
- Nebulizers with concentrated (7%) sodium chloride solution beneficial
Management for severe disease
- lung resection
- transplant
