Резюме
定义
病史和体格检查
关键诊断因素
- cough
- sputum production
- crackles, high-pitched inspiratory squeaks and rhonchi
- dyspnea
- fever
其他诊断因素
- fatigue
- hemoptysis
- rhinosinusitis
- weight loss
- wheezing
- pleuritic chest pain
- clubbing
危险因素
- 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, age 60 or over
- prematurity
诊断性检查
首要检查
- high-resolution chest CT
- CXR
- CBC
- sputum culture and sensitivity
- serum alpha-1 antitrypsin phenotype and level
- serum immunoglobulins
- sweat chloride test
- rheumatoid factor
- specific IgE or skin prick test to Aspergillus fumigatus
- serum HIV antibody
- nasal nitric oxide (NNO)
- pulmonary function tests
需考虑的检查
- primary ciliary dyskinesia (PCD) testing
- cystic fibrosis transmembrane regulator (CFTR) protein gene mutation testing
- swallow study
- pH monitoring of esophagus
- 6-minute walk test
- tuberculosis testing
- diagnostic bronchoscopy with bronchoalveolar lavage
治疗流程
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
撰稿人
作者
Anne E. O'Donnell, MD
Professor of Medicine
Chief, Division of Pulmonary, Critical Care and Sleep Medicine
The Nehemiah and Naomi Cohen Chair in Pulmonary Disease Research
Georgetown University Medical Center
Washington
DC
利益声明
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. AEOD is the author of a reference cited in this topic.
鸣谢
Dr Anne E. O'Donnell would like to gratefully acknowledge Dr Pamela J. McShane and Dr Sangeeta M. Bhorade, previous contributors to this topic.
利益声明
PJM and SMB declare that they have no competing interests.
同行评议者
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
利益声明
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
利益声明
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
利益声明
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
利益声明
WK declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax. 2019 Jan;74(suppl 1):1-69.Full text Abstract
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.Full text Abstract
O'Donnell AE. Bronchiectasis - a clinical review. N Engl J Med. 2022 Aug 11;387(6):533-45. Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- COPD
- Asthma
- Pneumonia
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