Pocket Medicine

PULMONARYQ

BRONCHIECTASIS

Definition and epidemiology (NEJM 2002;346:1383)

•  Obstructive airways disease of bronchi and bronchioles, chronic transmural inflamm w/ airway dilatation and thickening, collapsibility, mucus plugging w/ impaired clearance

•  Frequency:  > ; in the U.S. more frequent in Asian Americans (Chest 2012;142:432)

Initial workup

•  H&P: cough, dyspnea, copious sputum production, ± hemoptysis, inspiratory “squeaks”

•  CXR: scattered or focal; rings of bronchial cuffing; “tram track” of dilated, thick airways

•  PFTs: obstructive pattern

•  Chest CT: dilation and thickening of airways; ± cystic changes, infiltrates, adenopathy

Treatment

•  Treat underlying condition; mucolytics & bronchodilators

•  Antibiotics: CF Pts often have multiple drug-resistant organisms (PseudomonasBurkholderia cepaciaS. aureus) and require IV antibiotics during exacerbations. Azithro shown to ↓ exacerb. in non-CF bronchiectasis (Lancet 2012;380:660; JAMA 2013;309:1251).

•  Emerging data on gene-based targeted therapies in CF (NEJM 2011;365:1663)