Internal Medicine

0521779407-B02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Bronchiectasis 251

➣Aspergillusprecipitins or specific immunoglobulins for ABPA

➣Light or electron microscopic exam of respiratory epithelium or

sperm for primary ciliary dyskinesia

Other Specific Tests

■PFTs:

➣Spirometry to evaluate severity of airway obstruction

➣Bronchoscopy: not routine, but may be indicated if aspirated

foreign bodies or obstructing lesions suspected

differential diagnosis

Underlying Conditions

■Bronchial obstruction/ bronchopulmonary sequestration

■Necrotizing infections/tuberculosis

■Atypical mycobacterial infection (as primary cause or associated

condition)

■Cystic fibrosis

■Immunodeficiency (immunoglobulin deficiency or phagocyte dys-

function)

■HIV infection

■Allergic bronchopulmonary aspergillosis (ABPA)

■Alpha-1-antitrypsin deficiency

■Primary ciliary dyskinesia

■Aspiration

■Rheumatoid arthritis

■Congenital cartilage deficiency

■Tracheobronchomegaly

■Unilateral hyperlucent lung

■Yellow nail syndrome

management

What to Do First

■Establish underlying condition, if possible

■Evaluate degree of airway obstruction with spirometry and response

to bronchodilator

General Measures

■Smoking cessation

■Influenza and pneumococcal vaccines

■Inhaled beta-agonists or anticholinergics