Review Topic
  • A 68-year-old man presents to his primary care physician for a cough. He has been coughing for the past 2 months and is associated with mucopurulent and tenacious sputum production, which has progressively worsened. Medical history is significant for chronic obstructive pulmonary disease. He smokes 1 pack of cigarettes daily for the past 45 years. On physical exam, the patient has wheezes and crackles bilaterally to auscultation. A radiograph of the chest is unremarkable; however, a CT scan of the chest demonstrates stigmata of bronchial dilatation.
  • Definition
    • a suppurative lung disease that leads to irreversible dilation of the bronchi
  • Etiology
    • Mycobacterium avium complex pulmonary infection
    • allergic bronchopulmonary aspergillosis
    • idiopathic
    • autoimmune disease (e.g., rheumatoid arthritis, systemic lupus erythematosus, and ulcerative colitis)
    • α1-antitrypsin deficiency
    • immunodeficiency (e.g., HIV and lymphoma)
    • cystic fibrosis
    • smoking and chronic obstructive pulmonary disease
  • Pathogenesis
    • conditions that lead to the persistent presence of bacteria in the airway (e.g., immunodeficiency and impaired mucus clearance) cause a host-mediated inflammatory response, which in turn, significantly damages the airway
      • this continues the persistent presence of bacteria and chronic inflammatory response ("the vicious cycle hypothesis")
  • Symptoms
    • persistent productive cough
      • production of thick sputum
  • Physical exam
    • wheezes and crackles
  • Chest CT
    • indication
      • imaging modality of choice for confirming the diagnosis
    • findings
      • airway dilation ("tram tracks" and "signet-ring sign") 
  • Making the diagnosis
    • based on the clinical picture that is supported by chest CT findings
  • Pneumonia
    • differentiating factor
      • chest imaging will demonstrate a pulmonary infiltrate
  • Conservative
    • airway clearance techniques
      • indication
        • to improve secretion clearance and bronchial hygiene
          • this decreases the amount of bacteria in the airway in order to decrease the risk of developing another infection
      • examples
        • mucolytics
        • bronchodilators
        • chest physiotherapy (e.g., postural drainage)
  • Medical
    • antibiotics
      • indication
        • to treat the underlying infection in acute exacerbations
  • Antibiotic resistance
    • due to recurrent antibiotic use
  • Hemoptysis
    • due to superficial mucosal vessel injury secondary to recurrent infections

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