19 Bronchiectasis
19.1 What this covers
- Presentation: think of nonsmoker with COPD, hemoptysis
- NOTE: MAC (some debate if it’s a chicken or egg came first)
- Unknown why it’s uncommon in patients who are obese
19.2 Learning objectives
- Presentation: think of nonsmoker with COPD, hemoptysis
- NOTE: MAC (some debate if it’s a chicken or egg came first)
- Unknown why it’s uncommon in patients who are obese
- CT Diagnosis: [ ] criteria? Airway > vessel. Should be 1.5x to make clear dx.
- In addition to the radiographic findings, to have the clinical syndrome they should have symptoms attributable to it
- Fundamentally, mucus is good and is antimicrobial properties secretions. However mucus plus bacteria equals sputum, which if persistent does indicate a problem.
- More than two anabiotic prescriptions for respiratory infections within six months, or airflow obstruction in a non-smoker should both prompt evaluation for bronchiectasis with CT scan
19.3 Bottom line / summary
- Presentation: think of nonsmoker with COPD, hemoptysis
- NOTE: MAC (some debate if it’s a chicken or egg came first)
- Unknown why it’s uncommon in patients who are obese
- CT Diagnosis: [ ] criteria?
- Should be 1.5x to make clear dx.
19.4 Approach
- Bronchiectasis
19.5 Red flags / when to escalate
- TODO: List red flags that require urgent escalation.
19.6 Common pitfalls
- If MAC excluded (to avoid monotherapy), can use chronic azithromycin.
19.7 References
TODO: Add landmark references or guideline citations.
19.8 Source notes
19.8.1 Bronchiectasis
20 Bronchiectasis
Presentation: think of nonsmoker with COPD, hemoptysis
NOTE: MAC (some debate if it’s a chicken or egg came first)
Unknown why it’s uncommon in patients who are obese
CT Diagnosis: [ ] criteria? Airway > vessel. Should be 1.5x to make clear dx.
In addition to the radiographic findings, to have the clinical syndrome they should have symptoms attributable to it
Fundamentally, mucus is good and is antimicrobial properties secretions. However mucus plus bacteria equals sputum, which if persistent does indicate a problem.
More than two anabiotic prescriptions for respiratory infections within six months, or airflow obstruction in a non-smoker should both prompt evaluation for bronchiectasis with CT scan
20.1 Treatment
Mechanical: Acapella valve, manual percussive therapy, aerobic exercise Pharm: ALbuterol, hypertonic saline. Mucolytics (e.g. NAc) maybe only in CF, not in others.
If MAC excluded (to avoid monotherapy), can use chronic azithromycin.
Exacerbations: add antibiotics guided by sputum culture.