Bronchiectasis and Bronchiolitis for NP
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Bronchiectasis and Bronchiolitis for the Nurse Practitioner Exam
Bronchiectasis
Pathophysiology
- Chronic Inflammation and Infection:
- Bronchiectasis is a permanent dilation of the bronchi caused by recurrent infections and chronic inflammation. The damage impairs mucociliary clearance, leading to mucus accumulation, bacterial colonization, and further airway damage.
- Etiologies:
- Common causes include recurrent infections (e.g., pneumonia, tuberculosis), cystic fibrosis, immunodeficiencies, and airway obstructions.
Clinical Features
- Chronic Productive Cough:
- Persistent cough with production of large amounts of thick, purulent sputum.
- Recurrent Respiratory Infections:
- Frequent infections with pathogens like Pseudomonas or Haemophilus species.
- Hemoptysis:
- Blood-streaked sputum may occur due to inflammation and erosion of bronchial blood vessels.
Diagnosis
- High-Resolution CT (HRCT):
- Diagnostic imaging shows dilated airways with thickened bronchial walls ("tram tracks" or "signet ring" appearance).
Management
- Airway Clearance:
- Chest physiotherapy and postural drainage are key to managing mucus stasis.
- Antibiotics:
- Used for acute exacerbations and tailored to sputum culture results. Chronic suppressive therapy may be required in severe cases.
- Bronchodilators:
- May be used in patients with associated airway obstruction.
Bronchiolitis
Pathophysiology
- Small Airway Inflammation:
- Bronchiolitis involves inflammation of the bronchioles, commonly due to viral infections or exposure to toxic inhalants.
- Types:
- Acute Viral Bronchiolitis: Affects children and is often caused by RSV, influenza, or adenovirus.
- Bronchiolitis Obliterans: A chronic, irreversible condition resulting in fibrosis and bronchiolar obstruction, often following lung transplantation or chemical exposure.
Clinical Features
- Cough and Dyspnea:
- A persistent dry cough and progressive shortness of breath.
- Wheezing:
- Often present in viral bronchiolitis due to airway narrowing.
Diagnosis
- High-Resolution CT (HRCT):
- Shows air trapping and mosaic attenuation.
Management
- Supportive Care:
- Hydration, oxygen, and antipyretics are the mainstays of treatment for viral bronchiolitis.
- Bronchodilators:
- May provide relief in some patients, although their efficacy is limited.
Key Points
- Bronchiectasis is characterized by chronic cough with purulent sputum due to permanent bronchial dilation from recurrent infections. Management includes airway clearance and antibiotics.
- Bronchiolitis is small airway inflammation, often viral in children or chronic (bronchiolitis obliterans) in adults. Management is supportive for acute viral cases, with HRCT and PFTs aiding diagnosis.