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For further information, see CMDT Part 9-07: Bronchiectasis
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Essentials of Diagnosis
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Chronic productive cough with dyspnea and wheezing
Radiographic findings of dilated, thickened airways and scattered, irregular opacities
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General Considerations
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A congenital or acquired disorder of large bronchi characterized by abnormal dilation and destruction of bronchial walls
May be localized or diffuse
May be caused by recurrent inflammation or infection
Cystic fibrosis causes 50% of all cases
Causes
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Chronic cough with production of copious, purulent sputum
Recurrent pneumonia
Hemoptysis
Pleuritic chest pain
Dyspnea and wheezing
Weight loss and anemia common
Persistent basilar crackles commonly found on examination
Clubbing
Obstructive pulmonary dysfunction with hypoxemia seen in moderate or severe disease
Haemophilus influenzae is the most common organism recovered from noncystic fibrosis patients with bronchiectasis
Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus aureus are commonly identified; nontuberculous mycobacteria are seen less commonly
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Differential Diagnosis
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Sputum smear and culture for bacterial, mycobacterial, and fungal organisms
Quantitative pilocarpine iontophoresis sweat test for sodium and chloride levels
Quantitative immunoglobulins
Alpha-1-antiprotease level
Excluding patients with humoral immunodeficiencies, most patients have panhypergammaglobulinemia, reflecting an immune response to chronic airway infection
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Antibiotics should be used in acute exacerbations
Empiric therapy for 10–14 days with
Amoxicillin or amoxicillin clavulanate (500 mg every 8 hours orally)
Ampicillin or tetracycline (250–500 mg four times daily orally)
Trimethoprim-sulfamethoxazole (160/800 mg every 12 hours orally)
Ciprofloxacin (500–750 mg twice daily orally)
Sputum smears and cultures should guide therapy where possible
Preventive or suppressive antibiotics are frequently given to patients with increased purulent sputum, although this practice is not guided by clinical trial data
Long-term macrolide therapy (azithromycin 500 mg three times a week orally for 6 months or 250 mg/day for 12 months) has been found to decrease the frequency of exacerbations compared to placebo
High-dose (3 g/day) amoxicillin orally or alternating cycles of amoxicillin or amoxicillin clavulanate, ampicillin or ...