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Bronchiectasis II
MEDICATIONS DRUG(S) OF CHOICE: • Bronchodilators
• Dependent on pulmonary function tests
• May be helpful for patients with associated asthma or aspergillosis
• Beta-adrenergic agonists (e.g., albuterol) given by metered dose inhaler with use of a spacer (reservoir device)
• Antibiotics
• Dependent on culture results, use at exacerbations
• Ampicillin: 250-500 mg orally q 6 hours (50 mg/kg/day in divided doses q 6-8 hours in children less than 20 kg)
or
• Trimethoprim-sulfamethoxazole: DS q12h
• Tetracycline: 250-500 mg orally q 6 hours
• Aminoglycosides via nebulizer
• Steroids
• Consider for patients with bronchopulmonary aspergillosis. IgE level guides steroid dosing.
Contraindications:
• Tetracycline: not for use in pregnancy or children < 8 years.
Precautions:
• Tetracycline: may cause photosensitivity; sunscreen recommended.
Significant possible interactions:
• Tetracycline: avoid concurrent administration with antacids, dairy products, or iron.
• Broad-spectrum antibiotics: may reduce the effectiveness of oral contraceptives; barrier method recommended.
ALTERNATIVE DRUGS: • For chronic persistent infection, long-term high dose of amoxicillin 3 g every 12 hours may be useful. It does not provide relief for everyone and has more side effects.
• Other broad-spectrum antimicrobials including anti-pseudomonals if required. Choice would depend on pathogen and susceptibility.
• Inhaled corticosteroids if reversible obstruction present
• Oxygen - if PO2 < 60 mm Hg
• Nicotine replacement, consider to aid smoking cessation
FOLLOW UP PATIENT MONITORING: • Frequent followup for progress of illness, prevention of infection, smoking cessation, and to check on physiotherapy
• At some point in followup, need to discuss with patient the possibility of mechanical ventilation and cardiopulmonary resuscitation in the future. The patient, family and provider should determine if this type of treatment is appropriate.
PREVENTION/AVOIDANCE: • Treat all pneumonias adequately
• Immunizations for viral illnesses (i.e., influenza)
• Immunization for pneumococcal pneumonia
• Routine childhood immunizations, e.g., pertussis, measles, Hib
• Genetic counseling if inherited etiology
POSSIBLE COMPLICATIONS: • Recurrent pulmonary infections
• Pulmonary hypertension
• Secondary amyloidosis
• Cor pulmonale
• Brain abscess
• Massive hemoptysis
• Atelectasis
• Lung abscess
EXPECTED COURSE AND PROGNOSIS: • Chronic. Surgery may be curative if disease localized.
• Average life expectancy - 55 years
MISCELLANEOUS ASSOCIATED CONDITIONS: • Sinusitis
• Cor pulmonale
• Kartagener syndrome
• Cystic fibrosis
AGE-RELATED FACTORS:
Pediatric: Cystic fibrosis and other congenital disorders
Geriatric: Elderly more likely to need hospitalization for treatment
Others: N/A
PREGNANCY: N/A
SYNONYMS: N/A
ICD-9-CM: 494 bronchiectasis
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SEE ALSO (Enter the keywords below
into our search box or click on the link):
Aspergillosis
Bronchiolitis obliterans & organizing pneumonia
Cystic fibrosis
Lung abscess
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