Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cough
  • sputum production
  • crackles, high-pitched inspiratory squeaks and rhonchi
  • dyspnoea
  • fever

Other diagnostic factors

  • fatigue
  • haemoptysis
  • rhinosinusitis
  • weight loss
  • wheezing
  • pleuritic chest pain
  • clubbing

Risk factors

  • cystic fibrosis
  • host immunodeficiency
  • previous infections
  • congenital disorders of the bronchial airways
  • primary ciliary dyskinesia
  • alpha-1 antitrypsin deficiency
  • connective tissue disease
  • inflammatory bowel disease
  • aspiration or inhalation injury
  • focal bronchial obstruction
  • tall, thin, white females, aged 60 or over

Diagnostic investigations

1st investigations to order

  • CXR
  • high-resolution chest CT
  • FBC
  • sputum culture and sensitivity
  • serum alpha-1 antitrypsin phenotype and level
  • serum immunoglobulins
  • sweat chloride test
  • rheumatoid factor
  • Aspergillus fumigatus skin prick test
  • serum HIV antibody
  • nasal nitric oxide (NNO)
  • pulmonary function tests
Full details

Investigations to consider

  • bronchial biopsy and electron microscopy of cilia
  • cystic fibrosis transmembrane regular (CFTR) protein gene mutation testing
  • swallow study
  • sputum pH monitoring
  • 6-minute walk test
Full details

Treatment algorithm

ONGOING

Contributors

Authors VIEW ALL

Professor of Medicine

Chief, Division of Pulmonary, Critical Care and Sleep Medicine

Georgetown University Hospital

Washington

DC

Disclosures

AEOD has been compensated by the following companies for consultation regarding new drug development and clinical trials: Bayer, Xellia, Novartis, Insmed. AEOD has been or is the Principal Investigator for trials sponsored by the following companies (research funding provided directly to Georgetown University): Bayer, Insmed, Aradigm, Gilead. AEOD is the Principal Investigator for the Bronchiectasis Research Registry, sponsored by the COPD Foundation (research funding provided directly to Georgetown University). AEOD is the author of a reference cited in this monograph.

Dr Anne E. O'Donnell would like to gratefully acknowledge Dr Pamela J. McShane and Dr Sangeeta M. Bhorade, previous contributors to this monograph. PJM and SMB declare that they have no competing interests.

Peer reviewers VIEW ALL

Consultant Physician

Honorary Senior Lecturer

Imperial College Healthcare Trust

Hammersmith Hospital

London

UK

Disclosures

PWI declares that he has no competing interests.

Associate Professor of Medicine

Stanford University

Stanford

Staff Physician

US Department of Veterans Affairs

Palo Alto Health Care System

Palo Alto

CA

Disclosures

WK declares that he has no competing interests.

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