Bronchiectasis: Difference between revisions
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| − | == |
+ | == Background == |
* Permanent dilatation of the small airways, causing persistent microbial infection |
* Permanent dilatation of the small airways, causing persistent microbial infection |
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| − | == |
+ | === Etiologies === |
* Focal |
* Focal |
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*** Chronic infection |
*** Chronic infection |
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**** Granulomatous |
**** Granulomatous |
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| − | ***** Tuberculosis |
+ | ***** [[Tuberculosis]] |
| − | ***** Histoplasmosis |
+ | ***** [[Histoplasmosis]] |
| − | ***** MAC/NTM |
+ | ***** [[MAC]]/[[NTM]] |
| − | **** Bacterial: |
+ | **** Bacterial: [[Staphylococcus aureus]], [[Klebsiella]], [[Pseudomonas]] |
**** Viral |
**** Viral |
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*** Obstruction |
*** Obstruction |
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**** Tumour |
**** Tumour |
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*** Right middle lobe syndrome |
*** Right middle lobe syndrome |
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| − | *** Swyer-James-MacLeod syndrome (postinfective obliterative bronchiolitis) |
+ | *** [[Swyer-James-MacLeod syndrome]] (postinfective obliterative bronchiolitis) |
** Congenital |
** Congenital |
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*** Bronchopulmonary sequestration |
*** Bronchopulmonary sequestration |
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| − | *** Williams-Campbell syndrome (cartilage deficiency) |
+ | *** [[Williams-Campbell syndrome]] (cartilage deficiency) |
| − | *** Mouner-Kuhn syndrome (tracheobronchmegaly) |
+ | *** [[Mouner-Kuhn syndrome]] (tracheobronchmegaly) |
* Diffuse |
* Diffuse |
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** Genetic |
** Genetic |
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| − | *** Cystic fibrosis |
+ | *** [[Cystic fibrosis]] |
| − | *** Primary ciliary dyskinesia/Kartagener's syndrome |
+ | *** [[Primary ciliary dyskinesia]]/Kartagener's syndrome |
| − | *** Alpha-1 antitrypsin deficiency |
+ | *** [[Alpha-1 antitrypsin deficiency]] |
| − | *** Young |
+ | *** [[Young syndrome]] |
| − | ** Infectious: |
+ | ** Infectious: [[non-tuberculous mycobacterium]]/[[MAC]] |
| − | ** Immunodeficiency: |
+ | ** Immunodeficiency: [[hypogammaglobulinemia]] |
| − | ** Inflammatory: |
+ | ** Inflammatory: [[allergic bronchopulmonary aspergillosis]] |
** Autoimmune or immune-mediated |
** Autoimmune or immune-mediated |
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| − | *** Rheumatoid arthritis |
+ | *** [[Rheumatoid arthritis]] |
| − | *** Sjögren |
+ | *** [[Sjögren syndrome]] |
| − | *** Inflammatory bowel disease |
+ | *** [[Inflammatory bowel disease]] |
| − | ** Bronchiolitis obliterans after transplant |
+ | ** [[Bronchiolitis obliterans]] after transplant |
** Recurrent aspiration |
** Recurrent aspiration |
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** Near drowning |
** Near drowning |
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** Toxic inhalation |
** Toxic inhalation |
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** Miscellaneous |
** Miscellaneous |
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| − | *** Yellow nail syndrome |
+ | *** [[Yellow nail syndrome]] |
*** Postradiation traction bronchiectasis |
*** Postradiation traction bronchiectasis |
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| − | *** IPF |
+ | *** [[IPF]] |
| − | |||
| − | == Epidemiology == |
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| − | |||
| − | == Risk Factors == |
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== Clinical Manifestations == |
== Clinical Manifestations == |
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| − | |||
| − | === History === |
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* Chronic cough (98%) |
* Chronic cough (98%) |
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* Hemoptysis (27%) |
* Hemoptysis (27%) |
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* Recurrent pleurisy (20%) |
* Recurrent pleurisy (20%) |
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| − | |||
| − | === Signs & Symptoms === |
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== Investigations == |
== Investigations == |
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* Labs |
* Labs |
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| − | ** 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 |
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** Sweat chloride testing +/- genetic testing to rule out CF |
** Sweat chloride testing +/- genetic testing to rule out CF |
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== Management == |
== Management == |
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| − | === Acute |
+ | === 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 |
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| − | === Chronic === |
+ | === Chronic Management === |
* Chest physiotherapy it most important |
* Chest physiotherapy it most important |
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** Pulmonary rehabilitation |
** Pulmonary rehabilitation |
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** GERD treatment |
** GERD treatment |
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| + | |||
| + | == Further Reading == |
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| + | |||
| + | * 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] |
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[[Category:Respirology]] |
[[Category:Respirology]] |
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Revision as of 06:15, 26 May 2021
Background
- Permanent dilatation of the small airways, causing persistent microbial infection
Etiologies
- Focal
- Acquired
- Chronic infection
- Granulomatous
- Bacterial: Staphylococcus aureus, Klebsiella, Pseudomonas
- Viral
- Obstruction
- Foreign body
- Tumour
- Right middle lobe syndrome
- Swyer-James-MacLeod syndrome (postinfective obliterative bronchiolitis)
- Chronic infection
- Congenital
- Bronchopulmonary sequestration
- Williams-Campbell syndrome (cartilage deficiency)
- Mouner-Kuhn syndrome (tracheobronchmegaly)
- Acquired
- Diffuse
- Genetic
- Cystic fibrosis
- Primary ciliary dyskinesia/Kartagener's syndrome
- Alpha-1 antitrypsin deficiency
- Young syndrome
- Infectious: non-tuberculous mycobacterium/MAC
- Immunodeficiency: hypogammaglobulinemia
- Inflammatory: allergic bronchopulmonary aspergillosis
- Autoimmune or immune-mediated
- Bronchiolitis obliterans after transplant
- Recurrent aspiration
- Near drowning
- Toxic inhalation
- Miscellaneous
- Yellow nail syndrome
- Postradiation traction bronchiectasis
- IPF
- Genetic
Clinical Manifestations
- Chronic cough (98%)
- Daily sputum (78%)
- Rhinosinusitis (73%)
- Dyspnea (62%)
- Hemoptysis (27%)
- Recurrent pleurisy (20%)
Investigations
- Labs
- CBC, quantitative 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
- High-resolution CT
- 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 Management
- 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
Further Reading
- British Thoracic Society Guideline for bronchiectasis in adults. Thorax. 2019;74:1-69. doi: 10.1136/thoraxjnl-2018-212463
References
- ^ Bethany Milliron, Travis S. Henry, Srihari Veeraraghavan, Brent P. Little. Bronchiectasis: Mechanisms and Imaging Clues of Associated Common and Uncommon Diseases. RadioGraphics. 2015;35(4):1011-1030. doi:10.1148/rg.2015140214.
