Watch the video. https://www.youtube.com/watch?v=z6pab8YQgQA

1. Bronchiectasis
Investigations and Management
Presented by Aavash Mishra

2. Investigations
❖Sputum Culture
❖CBC, Hemoglobin, ESR, CRP
❖Screening
❖CXR
❖HRCT
❖Fibreoptic bronchoscopy
❖PFT (Obstructive)

3. DD of Copious Sputum
Bronchiectasis
Alveolar Cell Carcinoma
Lung abscess
Empyema
Necrotising Pnuemonia

4. Screening
❖Sweat chloride level
❖Immunoreactive trypsinogen
❖Saccharin swallow Test
❖Immunoglobin electrophoresis
❖Genetic analysis

5. Chest X Ray
❖Tram Track Appearance
❖Linear Atelectasis
❖Pneumonia ??

6. HRCT
❖Signet Ring
❖dilated bronchi with thickened walls
❖diameter bronchus> diameter of artery

7. Management
❖Patient and family education
❖Immunization
❖Diet
❖Manage Other diseases
❖Antibiotics
❖Physiotherapy
❖Treat Complications
❖Surgery

8. Medications
❖ Amoxicillin 500 mg TDS/ Clarithromycin 500 mg BDS
❖ Duration = 14 days
❖Beta-Lactamase +ve/ Pseudomonas
-Amoxicillin-Clavulanate
-Cephalosporin (2G/3G)
-Doxycycline
-Fluoroquinolone
❖IV Antibiotics in Hospitalized
❖Inhaled Antibiotics (tobramycin)
❖Oral/ Inhaled Steroids

9. Management of Exacerbations
● Start with FQ (Levofloxacin)
● If sputum cultures -ve= Amoxicillin/Macrolide
● If sputum culture +ve= Amoxicillin- Clavulunate, 3G Cephalosporin, Azithromycin/Clarithromycin,
Doxycycline, Fluroquinolones
● Pseudomonas= Ciprofloxacin 500-750 mg twice daily
● If resistant= start IV antibiotics
Ceftazidime, Aztreonam, Fluroquinolone, Aminoglycoside

10. Preventive Therapy
If recurrent exacerbations = Macrolide
Threshold= 2-3 exacerbations/ year

11. Physiotherapy
● Bronchial Hygiene
● Bronchial Exercise
● Postural Drainage
● Devices that increase airway pressure
● Aerosolized DNAse

12. Surgery
❖Excision of bronchiectatic areas
❖Management of Hemoptysis

13. Prevention of Bronchiectasis
❖Treat Measles, Whooping cough, TB, Pneumonia
❖Recognize Bronchial obstruction