Pathogenesis of Bronchiectasis

Mucoid impaction of the bronchi (MIB) is a specific form of proximal bronchiectasis characterized by obstruction and dilation of bronchi usually presented with thick mucoid plug. MIB mostly occurs as the manifestation of a hypersensitivity state in patients with bronchial asthma or in association with allergic bronchopulmonary aspergillosis (ABPA) and clinical overlap between MIB and ABPA can occur. MIB with no history of allergic background is not common and is less reported in the literature. In the following report we discuss a 39-year-old man with no previous history of allergy and atopy who initially presented with fever and shortness of breath. Further assessments demonstrated that the patient had a chronic endobronchial lesion and consolidation of the left lower lobe of the lung. A tissue biopsy reveals no malignant cells. Despite antibiotic therapy, the patient's symptoms persisted, and lobectomy was performed due to no clinical improvement. Even though gross pathology suggested endoluminal impaction, the patient didn't meet the ABPA diagnostic criteria.

Chronic rhinosinusitis (CRS) and bronchiectasis commonly co-occur, but most prior studies were not designed to evaluate temporality and causality.

In a sample representing the general population in 37 counties in Pennsylvania, and thus the full spectrum of sinonasal and relevant lung diseases, we aimed to evaluate the temporality and strength of associations of CRS with non–cystic fibrosis bronchiectasis.

We completed case-control analyses for each of 3 primary bronchiectasis case finding methods. We used electronic health records to identify CRS and bronchiectasis with diagnoses, procedure orders, and/or specific text in sinus or chest computerized tomography scan radiology reports. The controls never had any indication of bronchiectasis and were frequency-matched to the 3 bronchiectasis groups on the basis of age, sex, and encounter year. There were 5,329 unique persons with bronchiectasis and 33,363 without bronchiectasis in the 3 analyses. Important co-occurring conditions were identified with diagnoses, medication orders, and encounter types. Logistic regression was used to evaluate associations (odds ratios [ORs] and 95% CIs) of CRS with bronchiectasis while adjusting for confounding variables.

In adjusted analyses, CRS was consistently and strongly associated with all 3 bronchiectasis definitions. The strongest associations for CRS (ORs and 95% CIs) were those that were based on the text of sinus computerized tomography scan reports; the associations were generally stronger for CRS without nasal polyps (eg, OR = 4.46 [95% CI = 2.09-9.51] for diagnosis-based bronchiectasis). On average, CRS was identified more than 6 years before bronchiectasis.

Precedent CRS was strongly and consistently associated with increased risk of bronchiectasis.

La patología de las vías respiratorias de medio calibre (bronquios segmentarios y subsegmentarios) es común y se presenta con síntomas respiratorios poco específicos, como tos, infecciones de repetición y en ocasiones hemoptisis. La dilatación permanente del árbol bronquial se conoce como «bronquiectasia» y representa un reto diagnóstico. El análisis de la distribución regional de las bronquiectasias en los diferentes lóbulos pulmonares es la guía diagnóstica más útil. El objetivo de este trabajo es describir los hallazgos de imagen de las bronquiectasias y sus diferentes tipos, revisar las situaciones más comunes y proponer un algoritmo diagnóstico basado en su distribución anatómica. Las bronquiectasias son un hallazgo frecuente, resultado de un amplio espectro de enfermedades. Los estudios de imagen desempeñan un papel esencial en su detección, clasificación y orientación diagnóstica hacia la patología subyacente

Diseases that involve the medium caliber airways (segmental and subsegmental bronchi) are common and present clinically with nonspecific respiratory symptoms such as cough, recurrent respiratory infections and occasionally, hemoptysis. The abnormal and irreversible dilation of bronchi is known as “bronchiectasis”. The diagnosis can be challenging and the analysis of the regional distribution of the bronchiectasis is the most useful diagnostic guide. The objective of this manuscript is to describe the main imaging findings of bronchiectasis and their classification, review the diseases that most commonly present with this abnormality, and provide an approach to the diagnosis based on their imaging appearance and anatomic distribution. Bronchiectasis is a frequent finding that may result from a broad range of disorders. Imaging plays a paramount role in diagnosis, both in the detection and classification, and in the diagnosis of the underlying pathology.

To assess whether there is a correlation between a proposed MDCT severity score of bronchiectasis and pulmonary function tests.

20 patients presented with clinically or CT known bronchiectasis evaluated clinically and with multidetector CT of the chest and relevant pulmonary function tests.

By correlating severity of airway obstruction represented by the FEV1 severity (decreased forced expiratory volume in one second) with our proposed CT score of bronchiectasis, we found that CT score correlates with the severity of PFTs, and airflow obstruction in bronchiectasis which is primarily linked to severity of extent of bronchiectasis, severity of bronchial wall thickening and the degree of mosaic attenuation (the extent of decreased attenuation of lung parenchyma) which implies an association of obliterative bronchitis with bronchiectasis. On the other hand there was no statistically significant relationship between the severity of bronchial dilatation and FEV1. Also there was no statistically significant relationship between the extent of mucous plugging in relation to FEV1 severity.

MDCT is sensitive for showing, detecting, scoring and evaluating bronchiectasis, and with the recent advances in MDCT, it becomes the modality of choice and the cornerstone in the evaluation of bronchiectasis.

Patients with refractory asthma frequently have elements of laryngopharyngeal reflux (LPR) with potential aspiration contributing to their poor control. We previously reported on a supraglottic index (SGI) scoring system that helps in the evaluation of LPR with potential aspiration. However, to further the usefulness of this SGI scoring system for bronchoscopists, a teaching system was developed that included both interobserver and intraobserver reproducibility.

Five pulmonologists with expertise in fiber-optic bronchoscopy but novice to the SGI participated. A training system was developed that could be used via Internet interaction to make this learning technique widely available.

By the final testing, there was excellent interreader agreement (κ of at least 0.81), thus documenting reproducibility in scoring the SGI. For the measure of intrareader consistency, one reader was arbitrarily selected to rescore the final test 4 weeks later and had a κ value of 0.93, with a 95% CI of 0.79 to 1.00.

In this study, we demonstrate that with an organized educational approach, bronchoscopists can develop skills to have highly reproducible assessment and scoring of supraglottic abnormalities. The SGI can be used to determine which patients need additional intervention to determine causes of LPR and gastroesophageal reflux. Identification of this problem in patients with refractory asthma allows for personal, individual directed therapy to improve asthma control.