Obstructive diseases: Bronchiectasis, APBA, and cystic fibrosis

Question 1

What is allergic bronchopulmonary aspergillosis

Answer 1

Hypersensitivity of lungs to fungal antigens that colonize bronchial tree and only happens in people with asthma and history of atopic disorders

Question 2

How do you know if a patient with asthma is suffering from allergic bronchopulmonary aspergillosis

Answer 2

They will have recurrent episodes of brown flecked sputum and transient infiltrates on chest XRAY

Question 3

What are the diagnostic tests for allergic bronchopulmonary aspergillosis

Answer 3

Peripheral eosinophilia, skin test reactive to aspergillus with antibodies in blood test to aspergillis and elevated IgE (discussed in asthma chapter)

Pulmonary infiltrates on chest x-ray

Question 4

What is the treatment for allergic bronchopulmonary aspergillosis

Answer 4

Only oral steroids (prednisone), not inhaled steroids

If recurrent, use itraconazole orally

Question 5

What is bronchiectasis

Answer 5

Uncommon disease from chronic dilation of large bronchi that cannot be reversed, but don’t see it today often because of better control of infections that would cause this

Question 6

What are the causes of bronchiectasis

Answer 6

Most common: CF

Others: Infections, immune deficiency, foreign bodies, tumors, ABPA, rheumatoid arthritis

Question 7

What is the presentation of someone with suspected bronchiectasis

Answer 7

Recurrent very high volume purulent sputum with possible hemoptysis, dyspnea, and wheezing. Will not see clubbing

Cannot be diagnosed without imaging,

Question 8

What is the best initial test and most accurate test for bronchiectasis

Answer 8

Initial: Chest X-ray showing thickened bronchi

Best: High resolution CT scan

Check sputum too to see cause of bacterial etiology

Question 9

What is the treatment for bronchiectasis

Answer 9

1. ) Chest physiotherapy with postural drainage to dislodge bronchi that are plugged up
2. ) Treat infections same coverage as COPD but MAC as well
3. ) Surgical resection of focal lesions if present

Question 10

Things I do not know about cystic fibrosis

Answer 10

1. ) Neutrophils in CF dump DNA into airway secretions which is responsible for clogging
2. ) One symptoms is recurrent pancreatitis, intestinal obstruction, and biliary cirrhosis
3. ) Men are infertile with azoospermia 95% of time, and vas deferens missing 20% of times. Women also infertile with thick cervical mucus blocking sperm entry
4. ) pilocarpine sweat test establishes diagnosis > 60

Question 11

What is the treatment for cystic fibrosis

Answer 11

1. ) Antibiotics always - inhaled aminoglycosides are exclusive to this disease
2. ) Inhaled recombinant human deoxyribonuclease breaking down massive amounts of DNA in respiratory mucus
3. ) Pneumo and influenza vaccines
4. ) Lung transplantation