035. Bronchiectasis diagnosis and treatment

Background: Bronchiectasis, with was once thought to be an orphan disease, is now being recognized with increasing frequency around the world. Patients with bronchiectasis have chronic cough and sputum production, and bacterial infections develop in that result in the loss of lung function. Bronchiectasis occurs in patients across the spectrum of age and gender, but the highest prevalence is in older women. The diagnosis of bronchiectasis is made by high-resolution CT scans. Bronchiectasis, which can be focal or diffuse, may occur without antecedent disease but is often a complication of previous lung infection or injury or is due to underlying systemic illnesses. Patients with bronchiectasis may have predisposing congenital disease, immune disorders, or inflammatory disease. The treatment of bronchiectasis is multimodality, and includes therapy with antibiotics, anti-inflammatory agents, and airway clearance. Resectional surgery and lung transplantation are rarely required. The prognosis for patients with bronchiectasis is variable given the heterogeneous nature of the disease. A tailored, patient-focused approach is needed to optimally evaluate and treat in individuals with bronchiectasis. Bronchiectasis is destruction and widening of the large airways. If the condition is present at birth, it is called congenital bronchiectasis.

Causes: Bronchiectasis is often caused by recurrent inflammation or infection of the airways. Sometimes it begins in childhood after a more severe lung infection or inhaling a foreign object. Cystic fibrosis causes about a third of all bronchiectasis cases in the United States. Certain genetic conditions can also cause bronchiectasis, including primary ciliary dyskinesia and immunodeficiency syndromes. The condition can also be caused by routinely breathing in food particles while eating.

Symptoms: Symptoms often develop gradually, and may occur months or years after the event that causes the bronchiectasis. The may include: (I) bluish skin color; (II) breath odor; (III) chronic cough with large amounts of foul-smelling sputum; (IV) clubbing of fingers; (V) coughing up blood; (VI) fatigue; (VII) paleness; (VIII) shortness of breath that gets worse with exercise; (IX) weigh loss and (X) wheezing.

Exams and tests: When listening to the chest with a stethoscope, the doctor may hear small clicking, bubbling, wheezing, rattling, or other sounds, usually in the lower lobes of the lungs. Test may include: (I) aspergillosis precipitin test; (II) aipha-1; (III) antitrypsin blood test; (IV) chest X-ray; (V) chest CT; (VI) sputum culture; (VII) complete blood count; (VIII) genetic testing, including sweat test for cystic fibrosis; (IX) PPD skin test to check for a prior tuberculosis infection and (X) serum immunoglobulin electrophoresis.

Treatment: Treatment is aimed at controlling infections and bronchial secretions, relieving airway obstruction, and preventing complications. Regular, daily drainage to remove bronchial secretions is a routing part of treatment. A respiratory therapist can show the patient coughing exercises that will help. Antibiotics, bronchodilators, and expectorants are often prescribed for infections, Surgery to resect the lung may be needed if medicine does not work or if the patient has, massive bleeding.

Prognosis: The outlook depends on the specific causes of the disease. With treatment, most people can lead normal lives without major disability.

Possible complications: (I) coughing up blood; (II) low oxygen levels; (III) recurrent pneumonia.

Prevention: The risk may be reduced if lung infections are promptly treated. Childhood vaccinations and a yearly flu vaccine help reduce the change of some infections. Avoiding upper respiratory infections, smoking, and pollution may also reduce your risk or infection.

Keywords: Bronchiectasis; spirometry; macrolides