Bronchiectasis Flashcards
Upper lung involvement
Cystic fibrosis
Post radiation fibrosis
Lower lung field involvement
- Chronic recurrent aspiration
- End stage fibrotic lung disease
- Recurent immunodeficiency - associated infections
Example of chronic recurrent aspiration
Due to Esophageal motility disorders like in scleroderma
Example of end stage lung fibrotic disease
Traction bronchiectasis from idiopathic pulmonary fibrosis (IPF)
Example of recurrent immunodeficiency - associated infections
Hypogammaglobulinemia
Affects the midlung
- Infection NTM
Most commonly Mycobacterium avium-intracellulare complex MAC - Dyskinetic /immotile cila syndrome
Involvement of the central airways
- Allergic bronchopulmonary aspergillosis (ABPA)
- Cartilage deficiency
A. Tracheobronchomegaly (mounier-kuhn syndrome)
B. Williams-Campbell syndrome
What is the percentage of bronchiectasis have idiopathic disease
25-50%
More common in men or women in general
What about in MAC infection
- Women
2. Nonsmoking women >50 years of age
Most widely cited mechanism of infectious bronchiectasis
“vicious cycle hypothesis”
Refers to dilated airways arising from parenchymal distortion as a result of lung fibrosis
Traction bronchiectasis
Organism that has a propensity for colonizing damaged airways and evading host defense mechanisms
Pseudomonas aeruginosa
Most common clinical presentation
Persistent producrive cough with ongoing production of thick, tenacious sputum
Imaging modality of choice
Chest CT
How long do take the antibiotics
Minimum of 7-10 days
Perhaps for as long as 14 days
NTM should be considered if with symptoms, radiographic findings who have:
- At least to sputum culture positive
- At least 1 BAL culture positive
- Biopsy and one sputum culture positive
- Pleural fluid culture positive
Recommended regimen for HIV negative infectes with macrolide-sensitive MAC
Macrolide
Ethambutol
Rifampin
Decline of function in nonCF bronchiectasis was similar to that in COPD with FEV1 declining by
50-55ml per year
Organisms for single severe infection that can result in significant airway damage and poor secretion clearance
- Bordetella pertussis
2. Mycoplasma pneumonia
Examples of traction bronchiectasis
- Post radiation fibrosis
2. Idiopathic pulmonary fibrosis
Proposed mechanism for noninfectious bronchiectasis
Immune-mediated reactions that damage the bronchial walls
E.g. assoc with autoimmune (Sjögrens and RA)
Diagnosis for bronchiectasis
Clinical plus radiographic features
- persistent chronic cough and sputum production
FEV1 declines by how much per year in healthy individuals
20-30ml
