Other Chronic Bronchial Diseases Bronchiectasis

Bronchiectasis is both a chronic airway infection and a disease of chronic lung inflammation. Bronchiectasis might be more common outside the United States (Tsang and Tipoe, 2004). Clinical course can be progressive or indolent. Cough is the predominant symptom, and some patients have significant hemoptysis or shortness of breath, or both. Malodorous (fetid) breath is a characteristic symptom. Bronchiectasis not associated with a genetic disorder is designated non-cystic fibrosis bronchiectasis.

Antibiotics are given over the long term, using antipseu-domonal antibiotics either orally or as aminoglycosides nebulized for inhalation. Macrolide antibiotics such as azithromycin appear to have antibiotic and anti-inflammatory effects in treating bronchiectasis. A Cochrane review found a small but significant benefit for prolonged antibiotic therapy in the treatment of patients with purulent bronchiectasis (Evans et al., 2003). Sputum cultures should be monitored for the presence of fungal (aspergillus) and mycobacterial organisms as well, because they can complicate the polymi-crobial mix of organisms in these patients (Morrissey and Evans, 2003). Bronchodilators, oxygen, and even noninvasive pulmonary ventilation may be tried when bronchial obstruction becomes a major component of pulmonary impairment. Surgical resection of affected lung segments can be helpful in patients with localized disease (Greenstone, 2002).

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