Bronchiectasis medical therapy: Difference between revisions

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Revision as of 13:57, 24 June 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The medical therapy is divided into medical treatment and physiologic strategies. The medical treatment consists of patient education, treatment of the acute exacerbations and prophylactic strategies, bronchodilator trial, and vaccination. The physiotherapy strategies focuses on airway clearance and pulmonary rehabilitation.

Bronchiectasis Medical Therapy

Medical Treatment

Patient Education

The patients should understand their diagnosis clearly.
Smoking cessation, regular exercise, and proper nutrition should be advised.
The patient should know how to self-manage acute exacerbations with a home supply of antibiotics.

Treatment of Acute Exacerbations and Prophylactic Strategies

The mainstay of treatment is antibiotic therapy.
Once the sputum specimen is collected and sent for culture, a targeted antibiotic therapy is recommended.
Colonization with a particular microorganism is graded as chronic if the same microorganism is detected in three or more consecutive cultures separated by at least 1 month over a period of 6 months.^[1]

Oral antibiotic therapy should be used first line for 10-14 days. Intravenous (IV) antibiotics may be needed if there has been: no response to oral antimicrobials, systemic deterioration or if pathogenic organisms sensitive only to IV agents are cultured. ^[1]

References

↑ ^1.0 ^1.1 McDonnell MJ, Ward C, Lordan JL, Rutherford RM (2013). "Non-cystic fibrosis bronchiectasis". QJM. 106 (8): 709–15. doi:10.1093/qjmed/hct109. PMID 23728208.

Template:WikiDoc Sources

[pmid23728208-1] 1.0 ^1.1 McDonnell MJ, Ward C, Lordan JL, Rutherford RM (2013). "Non-cystic fibrosis bronchiectasis". QJM. 106 (8): 709–15. doi:10.1093/qjmed/hct109. PMID 23728208.

[1]

@@ Line 4: / Line 4: @@
 ==Overview==
-Treatment of bronchiectasis is aimed at controlling [[infection]]s and bronchial secretions, relieving airway obstruction, and preventing [[Complication (medicine)|complication]]s.
+The medical therapy is divided into medical treatment and physiologic strategies. The medical treatment consists of patient education, treatment of the acute exacerbations and prophylactic strategies, bronchodilator trial, and vaccination. The physiotherapy strategies focuses on airway clearance and pulmonary rehabilitation.
+==Bronchiectasis Medical Therapy==
+===Medical Treatment===
+====Patient Education====
+*The patients should understand their diagnosis clearly.
+*Smoking cessation, regular exercise, and proper nutrition should be advised.
+*The patient should know how to self-manage acute exacerbations with a home supply of antibiotics.
+====Treatment of Acute Exacerbations and Prophylactic Strategies====
+*The mainstay of treatment is antibiotic therapy.
+*Once the sputum specimen is collected and sent for culture, a targeted antibiotic therapy is recommended.
+*Colonization with a particular microorganism is graded as chronic if the same microorganism is detected in three or more consecutive cultures separated by at least 1 month over a period of 6 months.<ref name="pmid23728208">{{cite journal| author=McDonnell MJ, Ward C, Lordan JL, Rutherford RM| title=Non-cystic fibrosis bronchiectasis. | journal=QJM | year= 2013 | volume= 106 | issue= 8 | pages= 709-15 | pmid=23728208 | doi=10.1093/qjmed/hct109 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23728208  }} </ref>
+*Oral antibiotic therapy should be used first line for 10-14 days. Intravenous (IV) antibiotics may be needed if there has been: no response to oral antimicrobials, systemic deterioration or if pathogenic organisms sensitive only to IV agents are cultured. <ref name="pmid23728208">{{cite journal| author=McDonnell MJ, Ward C, Lordan JL, Rutherford RM| title=Non-cystic fibrosis bronchiectasis. | journal=QJM | year= 2013 | volume= 106 | issue= 8 | pages= 709-15 | pmid=23728208 | doi=10.1093/qjmed/hct109 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23728208  }} </ref>
-==Medical Therapy==
-Common medical therapy for bronchiectasis includes prolonged usage of [[antibiotic|antibiotics]] to prevent detrimental infections,<ref>{{cite journal |author=Evans DJ, Bara AI,Greenstone M |title=Prolonged antibiotics for purulent bronchiectasis in children and adults |language=English |journal=The Cochrane Database of Systematic Reviews |volume= |issue=2 |pages= |year=2007 |pmid= |doi=10.1002/14651858.CD001392.pub2}}</ref> as well as eliminating accumulated fluid with postural drainage and chest physiotherapy. Surgery may also be used to treat localized bronchiectasis, removing obstructions that could cause progression of the disease.<ref>{{cite journal |author=Ötgün B, Karnak B, Tanyel K, Enocak M, Büyükpamukçu N|title=Surgical treatment of bronchiectasis in children. |language=English |journal=Journal of Pediatric Surgery |volume=39 |issue=10 |pages=1532-36 |year=2003 |pmid= |doi=}}</ref>
-Inhaled [[steroid]] therapy that is consistently adhered to can reduce sputum production and decrease airway constriction over a period of time will prevent progression of bronchiectasis. One commonly used therapy is [[Beclometasone dipropionate]], also used in [[asthma]] treatment.<ref>{{cite journal |author=Elborn JS, Johnston B, Allen F, Clarke J, McGarry J, Varghese G. |title=Inhaled steroids in patients with bronchiectasis |language=English |journal=Respir Med |volume=86 |issue=2 |pages=121-4 |year=1992 |pmid=1615177 |doi=}}</ref> Use of inhalers such as [[Salbutamol|Albuterol (Salbutamol)]], [[Fluticasone|Fluticasone (Flovent/Flixotide)]] and [[Ipratropium|Ipratropium (Atrovent)]]  may help reduce the likelihood of infection by clearing the airways and decreasing inflammation.<ref>{{cite web | last = Reports | first = Consumer | authorlink = | coauthors = | title = Ipratropium and Albuterol Inhalation - Drug Review | work = | publisher = Consumer Reports of U.S.| url = http://www.consumerreports.org/mg/drug-reports/ipratropium-and-albuterol-inhalation.htm | format = | doi =}}</ref>
-[[Mannitol]] dry inhalation powder, under the name Bronchitol, has been approved by the FDA for use in [[cystic fibrosis]] patients with Bronchiectasis. The original [[orphan drug]] indication approved in February 2005 allowed its use for the treatment of bronchiectasis. The original approval was based on the results of phase 2 clinical studies showing the product to be safe, well-tolerated, and effective for stimulating mucus hydration/clearance, thereby improving quality of life in patients with chronic obstructive lung diseases like bronchiectasis. Long-term studies are currently underway to ensure the safety and effectiveness of the treatment, and it is not yet available on the market for use.
 ==References==