Bronchiectasis

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Bronchiectasis

• Dilated airways with frequently thickened walls

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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

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Pathophysiology

• 2 Prerequisites
• Infectious insult
• Impairment of drainage, airway obstruction,
  and/or a defect in host defense.

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Pathophys Continued

• Infection
• Bacterial, mycobacterial, esp. ABPA? central
  airway bronchiectasis
• Airway obstruction
• intraluminal tumor, foreign body, lymph nodes,
  COPD
• Immunodeficiency
• ciliary dyskinesia, HIV, hypogammaglobulinemia,
  cystic fibrosis (obstruction and immunodef.)

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• Note this table compares primary bronchiectasis
  with COPD

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Characteristic central bronchiectasis 2/2 ABPA
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Note characteristic location in the upper lobes
and superior segments of lower lobes
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Exacerbation
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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
• 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 Aug10(8)1754-60.
• Treatment
• fluoroquinolone

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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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Citations

• All material from Uptodate.com unless otherwise
  noted