Difference between revisions of "Bronchiectasis"
ClaireLewis (talk | contribs) (Created page with "==Background== *Uncommon disease caused by chronic infection and inflammation *Characterized by dilation and destruction of larger bronchi **Mucus build up attracts bacteria/m...") |
ClaireLewis (talk | contribs) (→Management) |
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*Antibiotics | *Antibiotics | ||
**Some patients may be on chronic [[macrolides]] or other antibiotics | **Some patients may be on chronic [[macrolides]] or other antibiotics | ||
| − | **If no CF and no prior culture data, treat against H. influenzae, M. catarrhalis, S. aureus, and S. pneumoniae (e.g. [[amoxicillin | + | **If no CF and no prior culture data, treat against H. influenzae, M. catarrhalis, S. aureus, and S. pneumoniae (e.g. [[amoxicillin-clavulanate]], [[azithromycin]], [[TMP-SMX]]) |
**If CF or more severe exacerbation, broaden antibiotics, knowing that many CF patients develop highly resistant polymicrobial infections and likely require multiple antibiotics (e.g. [[tobramycin]], [[aztreonam]], [[Zosyn]], [[cefepime]] | **If CF or more severe exacerbation, broaden antibiotics, knowing that many CF patients develop highly resistant polymicrobial infections and likely require multiple antibiotics (e.g. [[tobramycin]], [[aztreonam]], [[Zosyn]], [[cefepime]] | ||
**Consider inhaled antibiotics to reduce sputum bacterial load | **Consider inhaled antibiotics to reduce sputum bacterial load | ||
*Treat massive [[hemoptysis]] | *Treat massive [[hemoptysis]] | ||
| − | |||
==Disposition== | ==Disposition== | ||
Latest revision as of 15:34, 11 October 2019
Contents
Background
- Uncommon disease caused by chronic infection and inflammation
- Characterized by dilation and destruction of larger bronchi
- Mucus build up attracts bacteria/microbes--> bacteria multiply--> additional lung infection/inflammation-->more airway damage--> over time, enlarged/widened airways make it harder to breath and clear mucus
- Commonly caused by cystic fibrosis, immune defects, recurrent pneumonias, or (less commonly), congenital or idiopathic
Clinical Features
- Chronic cough productive of thick, often purulent sputum
- Dyspnea
- Crackles/rhonchi, wheezing
- +/- pleuritic chest pain
- +/- hemoptysis, due to airway neovascularization, can be massive
- If advanced;
- Hypoxia, clubbing
- Pulmonary hypertension, right-sided heart failure
- Acute exacerbation results from new/worsened infection, may have fever and constitutional symptoms
Differential Diagnosis
Acute dyspnea
Emergent
- Pulmonary
- Airway obstruction
- Anaphylaxis
- Angioedema
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute exacerbation
- Cystic fibrosis exacerbation
- Cardiac
- Other Associated with Normal/↑ Respiratory Effort
- Other Associated with ↓ Respiratory Effort
Non-Emergent
- ALS
- Ascites
- Uncorrected ASD
- Congenital heart disease
- COPD exacerbation
- Fever
- Hyperventilation
- Interstitial lung disease
- Neoplasm
- Obesity
- Panic attack
- Pleural effusion
- Polymyositis
- Porphyria
- Pregnancy
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
- URI
Evaluation
- Evaluate for alternative causes of symptoms
- CXR
- Thickening of airway walls and/or airway dilation
- Linear perihilar densities, indistinctness of central pulmonary arteries
- "Tram-track sign"; thickened, dilated airways perpendicular to x-ray beam
- Elongated, tubular opacities due to mucus plugs
- CT chest
- Sensitive and specific
- Airway dilation, signet ring sign (thickened, dilated airway adjacent to smaller artery
- Lack of normal bronchial tapering-->visible medium bronchi extending out closer to pleura
- "Tram-track" sign
- Infectious workup
- Consider sputum for TB
- Diagnosis of cause generally outside ED scope but may include workup for cystic fibrosis, immunodeficiency, ciliary dysmotility
Management
- Bronchodilators
- Supplemental O2 PRN
- Chest PT
- Mucolytics (e.g. NAC mucomyst, hypertonic saline nebs)
- Antibiotics
- Some patients may be on chronic macrolides or other antibiotics
- If no CF and no prior culture data, treat against H. influenzae, M. catarrhalis, S. aureus, and S. pneumoniae (e.g. amoxicillin-clavulanate, azithromycin, TMP-SMX)
- If CF or more severe exacerbation, broaden antibiotics, knowing that many CF patients develop highly resistant polymicrobial infections and likely require multiple antibiotics (e.g. tobramycin, aztreonam, Zosyn, cefepime
- Consider inhaled antibiotics to reduce sputum bacterial load
- Treat massive hemoptysis