Flashcards in Bronchiectasis Deck (19):
5 aspects of the pathology of bronchiectasis?
"Subsegmental" bronchial thickening/dilation.
Cellular infiltration (lymphos/macs in bronchilar wall, PMNs in lumen).
Damage to lung parenchyma.
Hypertrophied bronchial arteries.
If you just look at the bronchiole wall in histology from a patient with bronchiectasis, what would you see?
Lymphocytic infiltrate of epithelium and submucosa.
4 steps in the vicious cycle of bronchiectasis?
Abnormal mucus clearance.
PMN inflammation (with proteases).
Airway destruction and distortion - "bronchiectasis".
Different diseases that cause bronchiectasis are thought to start at different spots - e.g. CF starts with abnormal mucus clearance.
Biofilms. They're a pain.
Yeah. Pseudomonas is a particularly big problem.
If you don't include CF patients, in what age groups is bronchiectasis most prevalent?
ages 55 and up.
And for some reason more common in women.
(It's becoming increasingly recognized...)
So, why does bronchiectasis suck?
Recurrent lung infections.
What's the clinical picture of someone you would suspect as possibly having bronchiectasis?
A patient without COPD who has...
-Persistent productive cough (months to years).
What pattern would PFTs on a patient with bronchiectasis reveal?
Low FEV1/FVC ratio -> obstructive disease.
(and... maybe other things depending on the underlying cause)
2 main patterns of bronchiectasis?
Focal vs. diffuse.
(focal is.. usually from infection, esp TB?)
2 main types of etiology of focal bronchiectasis?
Postinfectious - bacterial, viral, or mycobacteria.
Airway obstruction - foreign body, mass, etc.
5 etiologies of diffuse bronchiectasis?
Postinfectious - measles, perussis, mycobacteria.
Congenital - CF, Primary ciliary dyskinesia.
Immune-mediated -ABPA, Rheum arth, IBD, etc.
Allergic bronchopulmonary aspergillosis.
(there's non-required info on it at the end of Dr. Ochs' path lecture)
Specific therapy for bronchiectasis?
Depends upon the underlying cause:
Immunoglobulin for Ig deficiencies.
ABx for mycobacteria.
3 therapies to help airway clearance?
Vibratory PEP device (provides positive pressure... so airways don't collapse from Starling resistors during forced expiration?)
Chest physiotherapy - vest, and... pummeling.
Inhaled hyperosmolar agents (mannitol or saline).
..and bonchodilators / mucolytics (but there's not evidence for these working outside of asthma / CF).
Why would inhaling hypertonic saline help with mucus clearance?
By drawing more water into the airway, thinning mucus.
Antimicrobial therapy for bronchiectasis.
Not really any new info here. Culturing and determining sensitivity is nice, but sometimes you need to do empiric ABx. There's little data to support chronic ABx as prophylaxis.
Pseudomonas, MRSA, and non-TB mycobacteria are challenging.
Why do lung infections have some ABx options that wouldn't otherwise be feasible?
You can inhale things like tobramycin, gentamicin and they're not absorbed systemically.
What's nice about some macrolide ABx, other than their antimicrobial effects?
Can inhibit some destructive inflammtion (PMN elastase, and may interfere with biofilm formation.