Internal Medicine

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

252 Bronchiectasis

specific therapy

Indications

■Treatment based on symptoms and underlying conditions

Treatment Options

■General therapies:

➣Inhaled beta-agonists or anticholinergics

➣Antibiotics for recurrent or persistent lower respiratory infec-

tions or hemoptysis using prolonged course (eg, oral broad-

spectrum antibiotic for 3 mo) or rotating course (eg, one of three

oral antibiotics for first wk of every mo)

➣IV antibiotics (2–3 wks) may be required forPseudomonas

➣Chest physical therapy with postural drainage

➣Inhaled tobramycin (28 d on/28 d off ) may be helpful with

chronicPseudomonas

➣Consider resection for single bronchiectatic area with recurrrent

infection

➣Bronchial artery embolization or, less commonly, resection for

massive or recurrent hemoptysis (see complications)

➣Therapies for specific underlying conditions (specialist referral

recommended):

➣Aerosolized recombinant DNase and tobramycin for cystic fibro-

sis

➣IV immunoglobulin for immunoglobulin deficiency

➣Replacement enzyme therapy for alpha-1-antitrypsin defici-

ency

Side Effects & Complications

■Chronic antibiotic therapy can lead to resistant organisms; thus

extended-spectrum antibiotics generally discouraged for rotating

regimens unless indicated by sputum microbiology

■Bronchial artery embolization may be complicated by ischemia

of spinal or thoracic nerves, pulmonary infarct, or mediastinal

hematoma

■Surgical complications associated with general anesthesia and tho-

racic surgery

Contraindications

■Relative: resectional therapy requires adequate pulmonary function

(specialist referral recommended)