bronchiectasis dilated airways with frequently thickened walls
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BronchiectasisBronchiectasis
Dilated airways with frequently Dilated airways with frequently thickened wallsthickened walls
Bronchiectasis: ClinicalBronchiectasis: Clinical
Note: Bronchiectasis may happen 2/2 COPD or may be a Note: Bronchiectasis may happen 2/2 COPD or may be a separate process with very similar symptomsseparate process with very similar symptoms
Clinical:Clinical: Cough (90 %)Cough (90 %) Daily sputum production (76%)Daily sputum production (76%) Dyspnea (72%)Dyspnea (72%) Hemoptysis (56%)Hemoptysis (56%) Recurrent pleurisy Recurrent pleurisy
PathophysiologyPathophysiology
2 Prerequisites:2 Prerequisites:
Infectious insultInfectious insult
Impairment of drainage, airway Impairment of drainage, airway obstruction, and/or a defect in host obstruction, and/or a defect in host defense. defense.
Pathophys ContinuedPathophys Continued
Infection: Infection: Bacterial, mycobacterial, esp. ABPABacterial, mycobacterial, esp. ABPA central airway central airway
bronchiectasisbronchiectasis
Airway obstruction: Airway obstruction: intraluminal tumor, foreign body, lymph nodes, COPDintraluminal tumor, foreign body, lymph nodes, COPD
Immunodeficiency:Immunodeficiency: ciliary dyskinesia, HIV, hypogammaglobulinemia, cystic ciliary dyskinesia, HIV, hypogammaglobulinemia, cystic
fibrosis (obstruction and immunodef.)fibrosis (obstruction and immunodef.)
Note: this table compares primary bronchiectasis with COPDNote: this table compares primary bronchiectasis with COPD
Exacerbation: Etiology +RxExacerbation: Etiology +RxColonization/infection: Colonization/infection: HemophilusHemophilus PseudomonasPseudomonas MAIMAI AspergillusAspergillus
Very difficult to distinguish colonization from acute infection with Very difficult to distinguish colonization from acute infection with these bugs.these bugs.
Psuedomonas colonized Psuedomonas colonized more bronchiectasis on CT; increased more bronchiectasis on CT; increased number of hospitalizations vs H. flu colonizationnumber of hospitalizations vs H. flu colonization
Effect of sputum bacteriology on the quality of life of patients with bronchiectasisEffect of sputum bacteriology on the quality of life of patients with bronchiectasis. . Wilson CB; Jones PW; O'Leary CJ; Hansell DM; Cole PJ; Wilson CB; Jones PW; O'Leary CJ; Hansell DM; Cole PJ;
Wilson R Eur Respir J 1997 Aug;10(8):1754-60Wilson R Eur Respir J 1997 Aug;10(8):1754-60. .
Treatment: Treatment: fluoroquinolonefluoroquinolone
PreventionPrevention
Antibiotics-Controversial:Antibiotics-Controversial:Consider Macrolide TIWConsider Macrolide TIWCipro qd X 7-14 D/ monthCipro qd X 7-14 D/ month
Bronchial Hygiene, physiotherapy, Bronchial Hygiene, physiotherapy, pulmonary rehabpulmonary rehab
?bronchodilators, and steroids?bronchodilators, and steroids SurgerySurgery
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