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Clinical manifestation and diagnosis of bronchiectasis Aleš Rozman University Clinic of Respiratory...
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![Page 1: Clinical manifestation and diagnosis of bronchiectasis Aleš Rozman University Clinic of Respiratory Diseases and Allergy, GOLNIK, Slovenia Portorož – 9th.](https://reader035.fdocuments.us/reader035/viewer/2022062802/56649e8f5503460f94b92ee2/html5/thumbnails/1.jpg)
Clinical manifestation and diagnosis of bronchiectasis
Aleš RozmanUniversity Clinic of Respiratory Diseases and Allergy,
GOLNIK, Slovenia
Portorož – 9th May 2009
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Bronchiectasis:
- refers to a permanent abnormal dilatation of
the bronchi and bronchioli, caused by recurrent
infections which destruct muscular and elastic
components of bronchial walls.
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1. Epidemiology
• approximately 40 /100.000 (est.)
• more in women
• more in elderly population
• more in societies with pure access to health care
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2. Etiologies
infection of the airway + susceptibility
Susceptibility:
1.airway obstruction
2.defect in host defence
3.impaired drainage
4.other
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2. Etiologies – airway obstruction
Innate:• bronchomalacia• tracheobronchomegaly• bronchial cyst• ectopic bronch• pulmonary sequestration• Yellow nail sy.
Acquired• foreign body aspiration (children, ...)• (benign) tumour• hilar adenopathy (TBC, sarcoidosis)• chronic bronchitis• polychondritis• mucus impaction (ABPA, ...)
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2. Etiologies – defect in host defense
Innate:• IgG deficiency (agammaglobulinemia, subclass deficiency,...)• IgA deficiency• chronic granulomatous disease (dysf. NADPH oxidase)
Acquired• AIDS / HIV• malnutrition
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2. Etiologies – impaired drainage / other
Impaired drainage:• CF• Young’s sy.• PCD• Kartagener’s sy.
Other:• RA, Sjoegren’s sy• alpha – 1 antitrypsin deficiency• GIT disorders (UC, Crohn, GERD)• infections in childhood (pertussis, measles, bacterial pneumonia, TBC, adenovirus, ...)• inhalation of toxic fumes and dusts (NO2, lipoid pneumonia, acids,...)
Kartagener’s sy.
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3. Clinical findings
1. cough and mucopurulent sputum - months / years
2. dyspnea, wheezing, chest pain
3. recurrent “bronchitis” and frequent antibiotic courses
Cough 98%
Daily sputum 78%
Rhinosinusitis 73%
Dyspnea 62%
Hemoptysis 27%
Pleurisy 20%
Crackles 75%
Wheezing 22%
Digital clubbing 2%
*King PT et al. Respir Med 2006; 100: 2183.
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4. Diagnosis
The purpose of evaluation:1. radiographic confirmation2. potentially treatable causes?3. functional assessment
Evaluation:• history / examination• laboratory testing• radiographic imaging• pulmonary function testing• other testing
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4. Diagnosis – laboratory testing
1. CBC, differential BC
2. immunoglobulin quantitation (levels of IgG, IgM, IgA)
3. sputum culture (bact. / TBC / fungi)
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4. Diagnosis - CXR
dilated airwaysthickened airway walls
irregular periph. opacities (mucus)
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4. Diagnosis – Chest CT
dilated bronchi
bronchial wall thickening
“tree – in – bud” pattern
cysts
lack of tapering
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Cylindrical bronchiectasis
4. Diagnosis – Chest CT
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Varicose bronchiectasis
4. Diagnosis – Chest CT
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Cystis / saccular bronchiectasis
4. Diagnosis – Chest CT
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Traction bronchiectasis (fibrosis)
4. Diagnosis – Chest CT
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4. Diagnosis - distribution
1. central (perihilar) – ABPA
2. predominant upper lobe – CF, Young sy, post -
TBC
3. middle /lower lobe – PCD
4. lower lobe – “idiopathic”
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4. Diagnosis - distribution
Post – TBC
bronchiectasis with
aspergilosis
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4. Diagnosis – lung function
• FEV1 – low
• FVC – normal or low
• TI – low (obstruction)
• hiperresponsive ness – often present
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4. Diagnosis – other tests
• bronchial biopsy (ciliary ultrastructure)
• bronchoscopy – obstructing lesion?
• aspergillus precipitins / antibodies
• serum IgE
• Ig subclasses
• alpha 1 – antitrypsin (concentracion / phenotype)
• RF
• ....
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5. Summary
1. clinical findings (cough & sputum)2. radiographic confirmation3. identification of treatable causes4. functional assessment
are important for proper treatment plan.
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P.S. – have you known...
... that the largest subgroup represent elderly women.
The prevalence of urinary incontinence is 47%, compared with 10 – 12% in general population.
* Prys-Picard CO, Niven R. Urinary incontinence in patients with bronchiectasis. Eur Respir J 2006; 27: 866 - 7.
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Thank you.University Clinic Golnik,
Slovenia