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Bronchiectasis (Obstructive) Cheat Sheet by

ACNP Cheatsheet
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Bronch­iec­tasis (Obstr­uctive)

Pathop­hys­iology
Perm­anent, abnormal dilation and dest­ruc­tion of the bron­chial walls. Cilia are damaged.
• Onset is usually early in childhood. Infe­ction in a patient with airway obstru­ction or impaired defense or drainage mechanism precip­itates the disease.
• Cause is identified in fewer than half of patients. Less common today due to modern antibi­otics.
Causes
CF is the most common (50% of cases). Infection, alpha1 antitr­ypsin, post-i­nfe­ctious (TB, asperg­illis), rheumatic diseases (RA, Sjogrens), toxins, humoral immuno­def­iciency (abnormal lung defense), and airway obstru­ction.
Symptoms
Chronic cough with large amounts of muco­pur­ulent, foul-s­melling sputum.
• Rhino sinusitis. Dyspnea, pleurisy, wheezing, crackles, clubbing.
Hemo­ptysis due to rupture of blood vessels near bronchial wall surfaces; usually mild and self-l­imited but sometimes can be brisk and present as an emergency.
• Recurrent or present pneumonia. More likely to have larger volume of sputum, recurrent fever, hemopt­ysis, and Pseudo­monas than chronic bronch­itis.
Diagnosis
CT is the study of choice. Bronch­oscopy only in certain cases. CT shows dilated central bronchi that are larger than the adjacent pulmonary artery branches, as well as thic­kening of the bronchial walls.
Pulmonary Function Tests
• Obstru­ctive pattern.
CXR
• Abnormal in most cases with nonspe­cific findings.
Treatment
• Antibi­otics for acute exacer­bations (infec­tions are signaled by change in qualit­y/q­uantity of sputum, fever, chest pain).
• Bronchial hygiene with hydration, chest PT (postural drainage, chest percus­sion) to help remove mucus, and inhaled bronch­odi­lators.
• The goal is to prevent compli­cat­ions.
Cort­ico­ste­roids and macrolide to reduce airway inflam­mat­ion.
 

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