Updated: 12/24/2021

Bronchiectasis

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  • Snapshot
    • 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.
  • Introduction
    • 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")
  • Presentation
    • Symptoms
      • persistent productive cough
        • production of thick sputum
    • Physical exam
      • wheezes and crackles
  • Imaging
    • Chest CT
      • indication
        • imaging modality of choice for confirming the diagnosis
      • findings
        • airway dilation ("tram tracks" and "signet-ring sign")
  • Differential
    • Pneumonia
      • differentiating factor
        • chest imaging will demonstrate a pulmonary infiltrate
  • DIAGNOSIS
    • Making the diagnosis
      • based on the clinical picture that is supported by chest CT findings
  • Treatment
    • 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
  • Complication
    • Antibiotic resistance
      • due to recurrent antibiotic use
    • Hemoptysis
      • due to superficial mucosal vessel injury secondary to recurrent infections

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