Disorders of the Bronchi Part 2

Question 1

What is constrictive bronchiolitis?

Answer 1

Rare chronic and irreversible disease that worsens over time

Question 2

What is the etiology of constrictive bronchiolitis?

Answer 2

Most common: inhalation injury (smoke/chemicals)
RA, connective tissue disease
Drug reactions
Transplant rejection (heart, lung, bone marrow)
Post-infectious: RSV, pneumonia, bronchitis

Question 3

What are potential inhaled toxins that may cause constrictive bronchiolitis?

Answer 3

Acetaldehyde (cannabis, e-cig smoke)
Formaldehyde (adhesives, building materials, e-cig smoke)
Metal oxides (welding)
Sulfur dioxide (fossil fuels)
Ammonia
Chlorine
Nitrogen oxides
Mustard gas

Question 4

Signs and symptoms of constrictive bronchiolitis?

Answer 4

Asymptomatic
SOB
Dry cough
Wheezing
Fatigue

Question 5

How is constrictive bronchiolitis diagnosed?

Answer 5

variety of CXR findings:
-normal
-hyperinflation
-attenuation of vascular markings
-reticular/reticulonodular markings
Chest CT: bronchiectasis, wall thickening, ground glass opacities
LFT: fixed* obstruction
Biopsy may be needed if diagnosis is unclear

Question 6

How is constrictive bronchiolitis treated?

Answer 6

reduce exposure to agent
Corticosteroids (inhaled/systemic)
Inhaled bronchodilator
O2 therapy
Lung transplant

Question 7

Define bronchiectasis?

Answer 7

Congenital or acquired disorder of the large bronchi characterized by permanent, abnormal dilation and destruction of the bronchial walls
-recurrent inflammation/infection of the airways
-Can be localized or diffuse

Question 8

What are the etiologies of bronchiectasis?

Answer 8

50% - CF
Lung infection
Abnormal lung immune defense
Localized airway obstruction

Question 9

What are the signs/symptoms of bronchiectasis?

Answer 9

Characteristic finding: copious amounts of foul smelling, purulent sputum
Exacerbations and remissions are common (mimics COPD)
Chronic cough
Hemoptysis
Pleuritic chest pain
Dyspnea
Wheezing
Persistent basilar crackles
Hypoxia if severe

Question 10

What are the imaging results of bronchiectasis?

Answer 10

CXR: dilated, thickened bronchi (**tram-tracks); scattered irregular opacities, atelectasis, and focal consolidations

Chest CT is the diagnostic study of choice

Question 11

What are the sputum C&S findings if there is an infectious etiology of bronchiectasis?

Answer 11

H. flu is the most common organism
Others:
S. pneumoniae
S. aureus
P. aeruginosa (rapid decline)

Question 12

What is the treatment for bronchiectasis of a bacterial infection?

Answer 12

Empiric ABx treatment for 10-14 days:
-amoxicillin, Augmentin, ampicillin, tetracycline, T/S, cipro

If chronic, copious sputum production, consider prophylaxis:
-Azithromycin 500mg po 3x/week

In CF patients with an increased risk of P.aeruginosa
-inhaled aminoglycosides

Question 13

What are other treatments for bronchiectasis besides ABx for bacterial?

Answer 13

Chest physiotherapy with postural drainage and chest percussion
Inhaled bronchodilators
Surgical resection if localized

Question 14

What are the complications of bronchiectasis?

Answer 14

Mucus plugs/obstructing bronchial lesion: may need bronchoscopy
Hemoptysis/bronchial hemorrhage
Cor pulmonale (right heart failure)

Question 15

How can bronchiectasis be prevented?

Answer 15

Immune globulin replacement if immune deficient
Alpha 1 antitrypsin replacement if deficient
Vaccinations: Pneumococcal, influenza, COVID, RSV
CF: antimicrobial prophylaxis

Question 16

What is the definition of a bronchial carcinoid tumor?

Answer 16

Tumor which develops from uncontrolled growth of neuroendocrine cells in the lungs

Question 17

What percentage of carcinoid tumors occur in the lungs?

Answer 17

10%
Comprise 1-6% of all lung cancers

Question 18

What do bronchial carcinoid tumors look like?

Answer 18

Pedunculated or sessile growths in the central bronchi

Question 19

What are the risk factors for a bronchial carcinoid tumor?

Answer 19

Men=women
Age<60
African American race
NOT related to smoking/environmental exposures

Question 20

What are the typically signs and symptoms of bronchial carcinoid tumors?

Answer 20

Hemoptysis
Cough
Wheezing
Recurrent Pneumonia

Question 21

What is a rare manifestation of bronchial carcinoid tumors?

Answer 21

Carcinoid syndrome:
In 5% of carcinoid tumors due to serotonin production
-Flushing
-Abdominal cramps/diarrhea
-Palpitations
-Wheezing
-Hypotension
*mimics anaphylaxis
*these symptoms can occur no matter where the tumor is located

Question 22

How are bronchial carcinoid tumors diagnosed?

Answer 22

Serum serotonin
24 hour urinary 5-hydroxyindoleacetic acid (5-HIAA)
Bronchoscopy with biopsy: pink-purple tumor in the central airway
CT scan

Question 23

What is the prognosis for bronchial carcinoid tumor?

Answer 23

Slow growing and rarely metastasize
Complications - bleeding & airway obstruction
Usually just followed with CT scans but can be excised if symptomatic
If mets: cannot resect, chemo & radiation
Often not the patients cause of death