Bronchiectasis - Revision history

Aidan at 15:19, 22 March 2022

2022-03-22T15:19:24Z

@@ Line 70: / Line 70: @@
 ** Bronchoscopy
 ** Swallowing assessment to rule out aspiration
 == Management ==

Aidan at 10:15, 26 May 2021

2021-05-26T10:15:47Z

← Older revision		Revision as of 10:15, 26 May 2021
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	== ~~Definition~~ ==		== Background ==

	* Permanent dilatation of the small airways, causing persistent microbial infection		* Permanent dilatation of the small airways, causing persistent microbial infection

	== ~~Etiology~~ ==		=== Etiologies ===

	* Focal		* Focal
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	*** Chronic infection		*** Chronic infection
	**** Granulomatous		**** Granulomatous
	***** Tuberculosis		***** [[Tuberculosis]]
	***** Histoplasmosis		***** [[Histoplasmosis]]
	***** MAC/NTM		***** [[MAC]]/[[NTM]]
	**** Bacterial: S. aureus, Klebsiella, Pseudomonas		**** Bacterial: [[Staphylococcus aureus]], [[Klebsiella]], [[Pseudomonas]]
	**** Viral		**** Viral
	*** Obstruction		*** Obstruction
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	**** Tumour		**** Tumour
	*** Right middle lobe syndrome		*** Right middle lobe syndrome
	*** Swyer-James-MacLeod syndrome (postinfective obliterative bronchiolitis)		*** [[Swyer-James-MacLeod syndrome]] (postinfective obliterative bronchiolitis)
	** Congenital		** Congenital
	*** Bronchopulmonary sequestration		*** Bronchopulmonary sequestration
	*** Williams-Campbell syndrome (cartilage deficiency)		*** [[Williams-Campbell syndrome]] (cartilage deficiency)
	*** Mouner-Kuhn syndrome (tracheobronchmegaly)		*** [[Mouner-Kuhn syndrome]] (tracheobronchmegaly)
	* Diffuse		* Diffuse
	** Genetic		** Genetic
	*** Cystic fibrosis ~~(CF)~~		*** [[Cystic fibrosis]]
	*** Primary ciliary dyskinesia/Kartagener's syndrome		*** [[Primary ciliary dyskinesia]]/Kartagener's syndrome
	*** Alpha-1 antitrypsin deficiency		*** [[Alpha-1 antitrypsin deficiency]]
	*** Young's syndrome		*** [[Young syndrome]]
	** Infectious: ~~Non~~-tuberculous mycobacterium/MAC		** Infectious: [[non-tuberculous mycobacterium]]/[[MAC]]
	** Immunodeficiency: ~~Hypogammaglobulinemia~~		** Immunodeficiency: [[hypogammaglobulinemia]]
	** Inflammatory: ~~Allergic~~ bronchopulmonary aspergillosis ~~(ABPA)~~		** Inflammatory: [[allergic bronchopulmonary aspergillosis]]
	** Autoimmune or immune-mediated		** Autoimmune or immune-mediated
	*** Rheumatoid arthritis		*** [[Rheumatoid arthritis]]
	*** Sjögren's syndrome		*** [[Sjögren syndrome]]
	*** Inflammatory bowel disease		*** [[Inflammatory bowel disease]]
	** Bronchiolitis obliterans after transplant		** [[Bronchiolitis obliterans]] after transplant
	** Recurrent aspiration		** Recurrent aspiration
	** Near drowning		** Near drowning
	** Toxic inhalation		** Toxic inhalation
	** Miscellaneous		** Miscellaneous
	*** Yellow nail syndrome		*** [[Yellow nail syndrome]]
	*** Postradiation traction bronchiectasis		*** Postradiation traction bronchiectasis
	*** IPF		*** [[IPF]]

	== Epidemiology ==

	== Risk Factors ==

	== Clinical Manifestations ==		== Clinical Manifestations ==

	=== History ===

	* Chronic cough (98%)		* Chronic cough (98%)
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	* Hemoptysis (27%)		* Hemoptysis (27%)
	* Recurrent pleurisy (20%)		* Recurrent pleurisy (20%)

	=== Signs & Symptoms ===

	== Investigations ==		== Investigations ==

	* Labs		* Labs
	** CBC, immunoglobulins, and HIV testing to rule out immunodeficiency		** CBC, quantitative immunoglobulins, and HIV testing to rule out immunodeficiency
	** Sputum culture for bacteria, mycobacteria, and fungi; consider BAL		** Sputum culture for bacteria, mycobacteria, and fungi; consider BAL
	** Sweat chloride testing +/- genetic testing to rule out CF		** Sweat chloride testing +/- genetic testing to rule out CF
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	== Management ==		== Management ==

	=== Acute ~~exacerbation~~ ===		=== Acute Exacerbation ===

	* Send sputum cultures every time		* Send sputum cultures every time
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	* Consider prednisone if asthma or ABPA		* Consider prednisone if asthma or ABPA

	=== Chronic ===		=== Chronic Management ===

	* Chest physiotherapy it most important		* Chest physiotherapy it most important
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	** Pulmonary rehabilitation		** Pulmonary rehabilitation
	** GERD treatment		** GERD treatment

			== Further Reading ==

			* British Thoracic Society Guideline for bronchiectasis in adults. ''Thorax''. 2019;74:1-69. doi: [https://doi.org/10.1136/thoraxjnl-2018-212463 10.1136/thoraxjnl-2018-212463]

	[[Category:Respirology]]		[[Category:Respirology]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-15T12:14:50Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 12:14, 15 July 2020
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	== Risk Factors ==		== Risk Factors ==

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	=== History ===		=== History ===

Maintenance script: Imported from text file

2020-07-04T01:17:25Z

Imported from text file

New page

== Definition ==

* Permanent dilatation of the small airways, causing persistent microbial infection

== Etiology ==

* Focal
** Acquired
*** Chronic infection
**** Granulomatous
***** Tuberculosis
***** Histoplasmosis
***** MAC/NTM
**** Bacterial: S. aureus, Klebsiella, Pseudomonas
**** Viral
*** Obstruction
**** Foreign body
**** Tumour
*** Right middle lobe syndrome
*** Swyer-James-MacLeod syndrome (postinfective obliterative bronchiolitis)
** Congenital
*** Bronchopulmonary sequestration
*** Williams-Campbell syndrome (cartilage deficiency)
*** Mouner-Kuhn syndrome (tracheobronchmegaly)
* Diffuse
** Genetic
*** Cystic fibrosis (CF)
*** Primary ciliary dyskinesia/Kartagener's syndrome
*** Alpha-1 antitrypsin deficiency
*** Young's syndrome
** Infectious: Non-tuberculous mycobacterium/MAC
** Immunodeficiency: Hypogammaglobulinemia
** Inflammatory: Allergic bronchopulmonary aspergillosis (ABPA)
** Autoimmune or immune-mediated
*** Rheumatoid arthritis
*** Sjögren's syndrome
*** Inflammatory bowel disease
** Bronchiolitis obliterans after transplant
** Recurrent aspiration
** Near drowning
** Toxic inhalation
** Miscellaneous
*** Yellow nail syndrome
*** Postradiation traction bronchiectasis
*** IPF

== Epidemiology ==

== Risk Factors ==

== Clinical Presentation ==

=== History ===

* Chronic cough (98%)
* Daily sputum (78%)
* Rhinosinusitis (73%)
* Dyspnea (62%)
* Hemoptysis (27%)
* Recurrent pleurisy (20%)

=== Signs & Symptoms ===

== Investigations ==

* Labs
** CBC, immunoglobulins, and HIV testing to rule out immunodeficiency
** Sputum culture for bacteria, mycobacteria, and fungi; consider BAL
** Sweat chloride testing +/- genetic testing to rule out CF
** Alpha-1 antitrypsin levels (<11 in deficiency)
** Nasal brush/biopsy to rule out ciliary dyskinesia
* Imaging
** High-resolution CT
*** Signet-ring sign (airway >1.5x blood vessel) is best sign
*** Tram-tracking
* Other
** PFTs
** Bronchoscopy
** Swallowing assessment to rule out aspiration

== Management ==

=== Acute exacerbation ===

* Send sputum cultures every time
* Cover empirically with usual pneumonia treatment x 14 days
* Add Pseudomonas or MRSA coverage if needed
* Consider prednisone if asthma or ABPA

=== Chronic ===

* Chest physiotherapy it most important
* Mucous (questionable utility outside of CF)
** Hypertonic saline
** Mannitol
** DNAse/Pulmozyme is BAD outside of CF
** Mucomyst
* Antiinflammatory
** Consider inhaled bronchodilators if responsive
** Consider azithromycin 500mg po MWF
* Inhaled antimicrobials, if colonozed with Pseudomonas and more than 3 exacerbations annually
** Inhaled tobramycin
** Inhaled colistin
** Possibly inhaled ciprofloxacin
* Surgery: resection or transplantation can sometimes be considered
* Supportive
** Annual flu vaccine
** Smoking cessation
** Pulmonary rehabilitation
** GERD treatment

[[Category:Respirology]]