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

Please rate topic.

Average 4.7 of 12 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Evidences (1)
Topic COMMENTS (4)
Private Note