BRONCHIECTASIS

Done by Enkhjin Batbold

Class 330
Signs and symptoms

■ Cough with sputum, often lasting months to years

■ Blood-streaked sputum or hemoptysis from airway damage associated with acute
infection
■ Dyspnea, pleuritic chest pain, wheezing, fever, weakness, fatigue, andweight loss
■ Rarely, episodic hemoptysis with little to no sputum production (ie, dry
■ bronchiectasis)
Exacerbations of bronchiectasis

■ Increased sputum production over baseline

■ Increased viscidity of sputum
■ A foul odor of the sputum (occasional)
■ Low-grade fever (rare)
■ Increased constitutional symptoms (eg, fatigue, malaise)
■ Increased dyspnea, shortness of breath, wheezing, or pleuritic pain
Physical examination
Diagnosis

■ Chest radiographs
 Increased pulmonary markings
 Honeycombing
 Atelectasis
 Pleural changes
■ HRCT
 Cylindrical bronchiectasis
 Varicose bronchiectasis
 Cystic bronchiectasis
■ Sputum analysis
Tests to identify underlying illnesses

■ Quantitative immunoglobulin levels

■ Quantitative serum alpha1-antitrypsin (AAT) levels, to rule out AAT deficiency
■ Aspergillus precipitins and serum total IgE levels, to diagnose ABPA
■ Autoimmune screening tests
■ Vitamin D deficiency
■ Pulmonary function test results may be normal or abnormal
Management

■ Bronchodilators
■ Corticosteroid therapy
■ Dietary supplementation
■ Oxygen (reserved for hypoxemic patients with severe disease)
■ Hospitalization for severe exacerbations
■ Surgical therapies
Antibiotic therapy

Acceptable antibiotic regimens for mild to

moderately ill outpatients include 7- 10 days of any For patients with moderate-to-severe symptoms, the
of the following: following antibiotics may be indicated:

■ Amoxicillin ■ An aminoglycoside (eg, gentamicin,

■ Tetracycline tobramycin) and
■ Trimethoprim-sulfamethoxazole ■ An antipseudomonal synthetic
■ A newer macrolide (eg, azithromycin   or
penicillin, a third-generation
clarithromycin   ) cephalosporin, or a fluoroquinolone
■ A second-generation cephalosporin ■ Tobramycin, for patients infected
with mucoid Pseudomonas species
■ A fluoroquinolone
Surgical intervention