Internal Medicine

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

Bronchiectasis Bronchiolitis 253

follow-up

During Treatment

■Regular office visits if on rotating antibiotics

Routine

■Depending on severity of symptoms and airway obstruction

complications and prognosis

Complications

■Hemoptysis:

➣If nonmassive (>500 mL/d), antibiotics and bronchoscopic eval-

uation should be considered

➣If massive, patient should be positioned bleeding side down with

attention to airway management, and bronchial artery emboliza-

tion or, rarely, lobectomy considered

Prognosis

■Overall, good; minority has severe physical and social problems as

result of bronchiectasis

■Decreased pulmonary function and cor pulmonale associated with

increased mortality

■After bronchial artery embolization for hemoptysis, rebleeding may

occur in 50% as long as 3 y after procedure

Bronchiolitis........................................

STEPHEN C. LAZARUS, MD

history & physical

Difficult to identify early because involvement of peripheral airways

produces few symptoms

History

■Bronchiolitis:

➣Common in infants and small children: usually due to virus

(especially RSV); begins as acute viral illness; cough, dyspnea,

fever later

➣Uncommon in adults: industrial, environmental exposures to

poorly soluble irritants (nitrogen dioxide, phosgene) from silo

gas, jet and missile fuel, fires; may occur withMycoplasma,

Legionella, viruses