Bronchiectasis Dilated airways with frequently thickened walls
Bronchiectasis: Clinical Note: Bronchiectasis may happen 2/2 COPD or may be a separate process with very similar symptoms Clinical: Cough (90 %) Daily sputum production (76%) Dyspnea (72%) Hemoptysis (56%) Recurrent pleurisy
Pathophysiology 2 Prerequisites: Infectious insult Impairment of drainage, airway obstruction, and/or a defect in host defense.
Pathophys Continued Infection: Bacterial, mycobacterial, esp. ABPA central airway bronchiectasis Airway obstruction: intraluminal tumor, foreign body, lymph nodes, COPD intraluminal tumor, foreign body, lymph nodes, COPD Immunodeficiency: ciliary dyskinesia, HIV, hypogammaglobulinemia, cystic fibrosis (obstruction and immunodef.) ciliary dyskinesia, HIV, hypogammaglobulinemia, cystic fibrosis (obstruction and immunodef.)
Note: this table compares primary bronchiectasis with COPD
Characteristic central bronchiectasis 2/2 ABPA
Note characteristic location in the upper lobes and superior segments of lower lobes
Exacerbation
Exacerbation: Etiology +Rx Colonization/infection: Hemophilus Pseudomonas MAI Aspergillus Very difficult to distinguish colonization from acute infection with these bugs. Psuedomonas colonized more bronchiectasis on CT; increased number of hospitalizations vs H. flu colonization Psuedomonas colonized more bronchiectasis on CT; increased number of hospitalizations vs H. flu colonization Effect of sputum bacteriology on the quality of life of patients with bronchiectasis. Wilson CB; Jones PW; O'Leary CJ; Hansell DM; Cole PJ; Wilson R Eur Respir J 1997 Aug;10(8): Treatment:fluoroquinolone
Prevention Antibiotics-Controversial: Consider Macrolide TIW Cipro qd X 7-14 D/ month Bronchial Hygiene, physiotherapy, pulmonary rehab ?bronchodilators, and steroids Surgery
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