Last reviewed: March 2020
Last updated: April  2020

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
  • specific IgE or skin prick test to Aspergillus fumigatus
  • serum HIV antibody
  • nasal nitric oxide (NNO)
  • pulmonary function tests
More 1st investigations to order

Investigations to consider

  • bronchial biopsy and electron microscopy of cilia
  • cystic fibrosis transmembrane regulator (CFTR) protein gene mutation testing
  • swallow study
  • pH monitoring of oesophagus
  • 6-minute walk test
More investigations to consider

Treatment algorithm

Contributors

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

Disclosures

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), American Thoracic Society, and European Respiratory Society. AEOD is the author of a reference cited in this topic.

Dr Anne E. O'Donnell would like to gratefully acknowledge Dr Pamela J. McShane and Dr Sangeeta M. Bhorade, previous contributors to this topic.

Peer reviewersVIEW 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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