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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