Bronchiectasis
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Features
- Chronic productive cough with dyspnea and wheezing.
- Radiographic findings of dilated, thickened airways and scattered, irregular opacities.
INVESTIGATION
- CBC with differential count, ESR, CRP- to look for signs of infection.
- Chest x ray /HRCT to look for Tram line appearance/Signet ring
- Sputum microscopy and C/S to isolate any organism, particularly Pseudomonas
- Pulmonary function test to look for Obstructive pattern
- ECG and Echocardiography to rule out Cor pulmonale
- 6min walking test for functional assessment
- Sweat test if suspect cystic fibrosis
Management: General measures
- Stop smoking and avoid dust exposure.
- Pulmonary rehabilitation (Patient education, Nutrition, Psychological support, Physiotherapy, POSTURAL DRAINAGE)
- Arrange prophylactic influenza vaccine
Specific Therapy
- Inj-Augmentin/ Amoxiclave/ Calamox (Co-amoxiclave) 1.2gm I/Vx TDS.
- Inf-Novidat/ Cipval (ciprofloxacin) 200-400mg I/V x BD
- Mucolator (acetylcysteine) sachet PO x TDS 'OR' Cap-Erdozet (Erdosteine) 150-300mg PO x BD
- Atem (Ipratropium Br) nebulization or 2-4 puffs TDs
- Clenil (Beclomethasone) nebulization (2cc + 5cc N/S) TDS
- Tab-Deltacortel (prednisone) 5mg, 2 tab PO x TDS for 5 days.
- If the patient cannot tolerate oral therapy, then go for Inj Hyzonate (hydrocortisone) 250 mg IV x stat 100mg IV x TDS
- In case of Cor pulmonale add
- Inj-Lasix (Furosemide) 20-60 mg IV x B
- Tab- Viagra (sildenafil) 50-100mg PO x OD Consider LTOT therapy if indicated
- Massive hemoptysis may require embolization of bronchial arterie surgical resection. Surgical resection (lobectomy) is otherwise reserved for the few patients with localized bronchiectasis and adequate pulmonary function in whom conservative management fails.
- Lung transplant for cystic fibrosis