Bronchiectasis

Август 2, 2022

Содержание

3. Bronchiectasis - involve the lung in a focal or a diffuse manner . (1) Cylindrical or
4. Bronchiectasis with predominant involvement of the : Upper lung fields: Cystic fibrosis (CF) Postradiation fibrosis corresponding
5. The incidence of bronchiectasis increases with age. Bronchiectasis is more common among women than among men.
6. The most common clinical presentation is a persistent productive cough with ongoing production of thick, tenacious
7. Physical findings: 1. crackles 2. wheezing 3.clubbing of the digits(some patients).
8. Pulmonary function tests: mild to moderate airflow obstruction, overlapping with that seen at presentation with other
9. Airway dilation (detected as parallel "tram tracks" or as the "signet-ring sign" -a cross-sectional area of
12. 1. Control of active infection 2. Minimlize the risk of repeated infections by improvements in secretion
13. Numerous approaches used to enhance secretion clearance include: hydration mucolytic administration， aerosolization of bronchodilators and hyperosmolar
14. In select cases, surgery can be considered， with resection of a focal area of suppuration. In
15. Outcomes of bronchiectasis can vary widely with: the underlying etiology the frequency of exacerbations the specific
16. Trying to decrease the risk of recurrent infections by: Reversal of an underlying immunodeficient state (e.g.
17. Administration of an oral antibiotic (e.g. ciprofloxacin) daily for 1-2 weeks per month. Use of a
29. ARDS
30. ARDS is an acute, diffuse, inflammatory form of lung injury that is associated with a variety
34. A variety of conditions may present as acute hypoxemic respiratory failure with bilateral alveolar opacities. Acute
36. Скачать презентацию

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Bronchiectasis - involve the lung in a focal or a diffuse

manner .
(1) Cylindrical or tubular (the most common form)
(2) Varicose, or cystic.

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Bronchiectasis with predominant involvement of the :
Upper lung fields:
Cystic fibrosis (CF)

Postradiation fibrosis corresponding to the lung region encompassed by the radiation port.
Tuberculosis
Midlung fields:
Infection by nontuberculous mycobacteria (NTM), most commonly the Mycobacterium avium-intracellulare complex (MAC),
Congenital causes of bronchiectasis - the dyskinetic/ immotile cilia syndrome.
Lower lung fields:
Chronic recurrent aspiration (e.g. due to esophageal motility disorders like those in scleroderma)，
End stage fibrotic lung disease (e.g. traction bronchiectasis from idiopathic pulmonary fibrosis),
Recurrent immunodeficiency-associated infections (e.g. hypogammaglobulinemia).
Central airways:
1. Allergic bronchopulmonary aspergillosis (ABPA), in which an immune-mediated reaction to Aspergillus damages the bronchial wall.
2. Congenital causes of central airway-predominant bronchiectasis resulting from cartilage deficiency include tracheobronchomegaly (Mounier-Kuhn syndrome) and Williams-Campbell syndrome.

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The incidence of bronchiectasis increases with age.
Bronchiectasis is more common among

women than among men.
Bronchiectasis resulting from MAC infection classically affects nonsmoking women >50 years of age.

EPIDEMIOLOGY

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The most common clinical presentation is a persistent productive cough with

ongoing production of thick, tenacious sputum.
Acute exacerbations of bronchiectasis are usually characterized by changes in the nature of sputum production, with increased volume and purulence.

CLINICAL MANIFESTATIONS

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Physical findings:
1. crackles
2. wheezing
3.clubbing of the digits(some patients).

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Pulmonary function tests: mild to moderate airflow obstruction, overlapping with that

seen at presentation with other conditions, such as chronic obstructive pulmonary disease (COPD).

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Airway dilation (detected as parallel "tram tracks" or as the "signet-ring

sign" -a cross-sectional area of the airway with a diameter at least 1.5 times that of the adjacent vessel).
Bronchial wall thickening in dilated airways.
Lack of bronchial tapering (including the presence of tubular structures within 1 cm from the pleural surface).
Inspissated secretions (e.g. the "tree-in-bud" pattern.

CT findings

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1. Control of active infection
2. Minimlize the risk of repeated

infections by improvements in secretion clearance and bronchial hygiene so as to decrease the microbial load with in the airways.
Treatment of acute exacerbations: Antibiotics targeting the causative or presumptive pathogen (with Haemophilus influenzae and P. aeruginosa isolated commonly) should be administered in acute exacerbations, for a minimum of 7-14 days.
In many cases, the etiology of bronchiectasis is not determined. In case series, as many as 25-50% of patients referred for bronchiectasis have idiopathic disease.
MAC strains are the most common NTM pathogens, and the recommended regimen for HIV-negative patients includes a macrolide combined with rifampin and ethambutol.

TREATMENT

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Numerous approaches used to enhance
secretion clearance include:
hydration
mucolytic administration，
aerosolization of bronchodilators

and hyperosmolar agents (e.g. hypertonic saline)
chest physiotherapy (e.g. postural drainage…)

BRONCHIAL HYGIENE

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In select cases, surgery can be considered， with resection of a

focal area of suppuration.
In advanced cases, lung transplantation can be considered .

REFRACTORY CASES

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Outcomes of bronchiectasis can vary widely with:
the underlying etiology
the frequency

of exacerbations
the specific pathogens involved (in infectious cases). With worse outcomes associated with P. aeroginosa colonization.

PROGNOSIS

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Trying to decrease the risk of recurrent infections by:
Reversal of an

underlying immunodeficient state (e.g. by administration of gamma globulin for immunoglobulin-deficient patients).
Vaccination of patients with chronic respiratory conditions (e.g. influenza and pneumococcal).
Smoking cessation.
After resolution of an acute infection in patients with recurrences (e.g.> 3 episodes per year), the use of suppressive antibiotics to minimize the microbial load and reduce the frequency of exacerbations has been proposed.

PREVENTION

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Administration of an oral antibiotic (e.g. ciprofloxacin) daily for 1-2 weeks

per month.
Use of a rotating schedule of oral antibiotics (to minimize the risk of development of drug resistance).
Administration of a macrolide antibiotic daily or three times per week
Inhalation of aerosolized antibiotics (e.g.tobramycin inhalation solution) by select patients on a rotating schedule (e.g. 30 days on, 30 days off), with the goal of decreasing the microbial load without eliciting the side effects of systemic drug administration.
Intermittent administration of IV antibiotics (e.g. "clean-outs") for patients with more severe bronchiectasis and/or resistant pathogens.

Possible suppressive treatments

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ARDS

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ARDS is an acute, diffuse, inflammatory form of lung injury that

is associated with a variety of etiologies. Recognizing and promptly treating ARDS is critical to reduce the associated high mortality.
ARDS should be suspected in patients with progressive symptoms of dyspnea, an increasing requirement for oxygen, and alveolar infiltrates on chest imaging within 6 to 72 hours of an inciting event.

ARDS

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A variety of conditions may present as acute hypoxemic respiratory failure

with bilateral alveolar opacities.
Acute cardiogenic pulmonary edema
Bilateral pneumonia
Diffuse alveolar hemorrhage
Inflammatory or autoimmune conditions
Acute eosinophilic pneumonia — AEP occurs in previously healthy individuals and is characterized by cough, fever, dyspnea, and sometimes chest pain. It can be distinguished from ARDS on BAL specimens by the identification of a large number of eosinophils, typically 35 to 55 percent of all recovered cells. Peripheral eosinophilia may or may not be present [
Pulmonary vasculitis
Cryptogenic organizing pneumonia (COP) — COP may be suspected in patients who present with the symptoms of nonresolving
Acute interstitial pneumonitis (AIP; Hamman-Rich syndrome)
Acute exacerbation of idiopathic pulmonary fibrosis (AEIPF)
Disseminated malignancy — Cancer can disseminate through the lungs (invasive cancer) or lymphatics (lymphangitic spread) so rapidly that the ensuing respiratory failure may be mistaken for ARDS

Differential Diagnosis

Bronchiectasis

Содержание

Bronchiectasis - involve the lung in a focal or a diffuse

Bronchiectasis with predominant involvement of the :Upper lung fields:Cystic fibrosis (CF)

The incidence of bronchiectasis increases with age.Bronchiectasis is more common among

The most common clinical presentation is a persistent productive cough with

Physical findings:1. crackles 2. wheezing3.clubbing of the digits(some patients).

Pulmonary function tests: mild to moderate airflow obstruction, overlapping with that

Airway dilation (detected as parallel "tram tracks" or as the "signet-ring

1. Control of active infection 2. Minimlize the risk of repeated

Numerous approaches used to enhancesecretion clearance include:hydration mucolytic administration，aerosolization of bronchodilators

In select cases, surgery can be considered， with resection of a

Outcomes of bronchiectasis can vary widely with:the underlying etiology the frequency

Trying to decrease the risk of recurrent infections by:Reversal of an

Administration of an oral antibiotic (e.g. ciprofloxacin) daily for 1-2 weeks

ARDS

ARDS is an acute, diffuse, inflammatory form of lung injury that

A variety of conditions may present as acute hypoxemic respiratory failure

Похожие презентации

Bronchiectasis with predominant involvement of the :
Upper lung fields:
Cystic fibrosis (CF)

The incidence of bronchiectasis increases with age.
Bronchiectasis is more common among

Physical findings:
1. crackles
2. wheezing
3.clubbing of the digits(some patients).

1. Control of active infection
2. Minimlize the risk of repeated

Numerous approaches used to enhance
secretion clearance include:
hydration
mucolytic administration，
aerosolization of bronchodilators

Outcomes of bronchiectasis can vary widely with:
the underlying etiology
the frequency

Trying to decrease the risk of recurrent infections by:
Reversal of an