Document Detail


Severe bronchiectasis.
MedLine Citation:
PMID:  14716069     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Bronchiectasis is primarily the result of airway injury and remodeling attributable to recurrent or chronic inflammation and infection. The underlying etiologies include autoimmune diseases, severe infections, genetic abnormalities, and acquired disorders. Recurrent airway inflammation and infection may also be the result of allergic or immunodeficiency states such as allergic bronchopulmonary mycoses or HIV/AIDS. Bronchiectasis should be included in the differentiation diagnosis of any patient with chronic respiratory complaints such as cough and sputum production. Early clinical manifestations may be subtle. Hallmarks of severe bronchiectasis include fetid breath, chronic cough, and sputum production. The associated chronic respiratory infections and airway sepsis are punctuated by episodes of acute exacerbation. Prompt recognition and treatment of bronchiectasis may allow for prevention of disease progression and irreversible loss of lung function. This review of severe non-cystic fibrosis bronchiectasis describes the current pathophysiology, clinical presentations, and management of bronchiectasis. We review how impaired airway clearance and the inability to resolve infection and inflammation creates a vicious cycle of recurrent injury. The common clinical features of bronchiectasis and findings are presented and illustrated by radiographic images. The common species and significance of various organisms often recovered from the distal airways including: tuberculous and environmental mycobacteria, aspergillus, and bacteria such as Pseudomonas aeruginosa will be covered. Management strategies including sputum surveillance, sputum clearance, antimicrobial therapy including antifungal and antimyobacterial agents as well as the evidence for the use of inhalational and anti-inflammatory therapies such as corticosteroids are also discussed. Recommendations for the work-up and therapy of complications including hemoptysis and respiratory failure are presented.
Authors:
Brian M Morrissey; Samuel J Evans
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinical reviews in allergy & immunology     Volume:  25     ISSN:  1080-0549     ISO Abbreviation:  Clin Rev Allergy Immunol     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2004-01-12     Completed Date:  2004-09-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9504368     Medline TA:  Clin Rev Allergy Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  233-47     Citation Subset:  IM    
Affiliation:
Division of Pulmonary/Critical Care Medicine, University of California, Davis School of Medicine, Davis, CA, USA. bmmorrissey@ucdavis.edu
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MeSH Terms
Descriptor/Qualifier:
Bronchiectasis* / diagnosis,  epidemiology,  physiopathology,  therapy
Environmental Microbiology
Humans
Inflammation / complications,  immunology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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