Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- chronic cough
- sputum production
- crackles, high-pitched inspiratory squeaks and rhonchi
- dyspnea
- fever
Outros fatores diagnósticos
- fatigue
- hemoptysis
- rhinosinusitis
- weight loss
- wheezing
- pleuritic chest pain
- clubbing
Fatores de risco
- cystic fibrosis (CF)
- 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
- prematurity
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- thin section chest CT
- chest x-ray
- CBC
- sputum culture and sensitivity
- serum alpha-1 antitrypsin phenotype and level
- serum immunoglobulins
- sweat chloride test
- autoantibody tests
- specific IgE or skin prick test to Aspergillus fumigatus
- serum HIV antibody
- pulmonary function tests
Investigações a serem consideradas
- primary ciliary dyskinesia (PCD) confirmatory testing
- CFTR protein gene mutation testing
- modified barium swallow
- pH monitoring of esophagus and/or esophageal manometry
- 6-minute walk test and ABG
- tuberculosis testing
- diagnostic bronchoscopy with bronchoalveolar lavage
Algoritmo de tratamento
initial presentation
acute exacerbation: mild to moderate underlying disease
acute exacerbation: severe underlying disease or not responding/resistant to initial antibiotics
3 or more exacerbations per year despite maintenance therapy
first or new isolation of Pseudomonas aeruginosa at outpatient review
Colaboradores
Autores
B. Shoshana Zha, MD, PhD
Assistant Professor
Division of Pulmonology, Critical Care, Allergy, and Sleep Medicine
Director, Bronchiectasis and Pulmonary NTM Program (INTEGRATE)
Department of Medicine
University of California, San Francisco
San Francisco, CA
Declarações
BSZ is a member of the advisory committee for Bronchiectasis Clinical Care Network. BSZ is a paid consultant for Genentech and Boehringer Ingelheim, and she has received grant funding from the American Thoracic Society (ATS) and Cystic Fibrosis Foundation. BSZ has also presented on the topic at national conferences and is a faculty member for the ATS bronchiectasis education center.
Meghan Marmor, MD
Assistant Professor
Division of Pulmonary, Allergy and Critical Care Medicine
Department of Medicine
Stanford School of Medicine
Palo Alto, CA
Divulgaciones
MM has given industry sponsored talks for Insmed and Electromed. MM serves on writing committees for the Bronchiectasis Clinical Care Network.
Agradecimientos
Dr B. Shoshana Zha and Dr Meghan Marmor would like to gratefully acknowledge Dr Anne E. O'Donnell, Dr Pamela J. McShane, and Dr Sangeeta M. Bhorade, previous contributors to this topic.
Divulgaciones
AEOD has received scientific consulting fees from the following companies: Bayer, Xellia, Horizon, Grifols, Insmed, and Electromed. AEOD is the Principal Investigator for trials sponsored by the following companies (research funding provided directly to Georgetown University): Bayer, Insmed, Aradigm, Parion, Zambon. AEOD has been a faculty member at the annual meetings of CHEST (American College of Chest Physicians), the American Thoracic Society, and the European Respiratory Society. PJM and SMB declare that they have no competing interests.
Revisores por pares
Philip W. Ind, BA (Cantab), MB BChir, MA (Cantab), FRCP
Emeritus Professor of Practice (Respiratory Medicine)
National Heart and Lung Institute
Imperial College London
London
UK
Divulgaciones
PWI declares that he has no competing interests.
Meg Coleman, MBBS, BSc, MRCP
Respiratory Consultant
Honorary Senior Clinical Lecturer
Imperial College Hospitals NHS Trust and National Heart and Lung Institute
London
UK
Divulgaciones
MC has received honoraria from Pfizer and Gilead for delivering educational sessions.
Amanda Messinger, MD, MS
Assistant Professor
Section of Pediatric Pulmonary and Sleep Medicine
Department of Pediatrics
Children's Hospital Colorado
University of Colorado Denver School of Medicine
Aurora, CO
Divulgaciones
AM declares that she has no competing interests.
Ware Kuschner, MD
Associate Professor of Medicine
Stanford University
Stanford
Staff Physician
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto, CA
Divulgaciones
WK declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017 Sep 9;50(3):1700629.Texto completo Resumen
Chang AB, Fortescue R, Grimwood K, et al. European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J. 2021 Aug;58(2):2002990.Texto completo Resumen
Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax. 2019 Jan;74(suppl 1):1-69.Texto completo Resumen
Hill AT, Barker AF, Bolser DC, et al. Treating cough due to non-CF and CF bronchiectasis with nonpharmacological airway clearance: CHEST Expert Panel Report. Chest. 2018 Apr;153(4):986-93.Texto completo Resumen
Smith D, Du Rand I, Addy CL, et al. British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease. Thorax. 2020 May;75(5):370-404.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- COPD
- Asthma
- Pneumonia
Más DiferencialesGuías de práctica clínica
- ACR appropriateness criteria: chronic dyspnea - noncardiovascular origin
- ACR appropriateness criteria: tracheobronchial disease
Más Guías de práctica clínicaFolletos para el paciente
Bronchiectasis: what is it?
Bronchiectasis: what are the treatment options?
Más Folletos para el pacienteVideos
Expiratory wheeze
Early inspiratory crackles
Más vídeos
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad