Summary
Definition
History and exam
Key diagnostic factors
- cough
- sputum production
- crackles, high-pitched inspiratory squeaks and rhonchi
- dyspnea
- fever
Other diagnostic factors
- fatigue
- hemoptysis
- 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, age 60 or over
Diagnostic investigations
1st investigations to order
- CXR
- high-resolution chest CT
- 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
Investigations to consider
- bronchial biopsy and electron microscopy of cilia
- cystic fibrosis transmembrane regulator (CFTR) protein gene mutation testing
- swallow study
- pH monitoring of esophagus
- 6-minute walk test
Treatment algorithm
Contributors
Authors
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
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.
Acknowledgements
Dr Anne E. O'Donnell would like to gratefully acknowledge Dr Pamela J. McShane and Dr Sangeeta M. Bhorade, previous contributors to this topic.
Disclosures
PJM and SMB declare that they have no competing interests.
Peer reviewers
Philip W. Ind, BA (Cantab), MB BChir, MA (Cantab), FRCP
Consultant Physician
Honorary Senior Lecturer
Imperial College Healthcare Trust
Hammersmith Hospital
London
UK
Disclosures
PWI declares that he 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
Disclosures
WK declares that he has no competing interests.
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