Bronchiectasis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Along with treatment of bronchiectasis, it is important to treat the underlying condition if one is present. The medical therapy is divided into medical treatment and physiologic strategies. The medical treatment consists of patient | Along with treatment of bronchiectasis, it is important to treat the underlying condition if one is present. The medical therapy is divided into medical treatment and physiologic strategies. The medical treatment consists of patient education, treatment of the acute exacerbations, prophylactic treatment, vaccination, and other therapies. The physiotherapy strategies focuses on airway clearance and [[pulmonary]] rehabilitation. | ||
==Bronchiectasis Medical Therapy== | ==Bronchiectasis Medical Therapy== | ||
===Medical Treatment=== | ===Medical Treatment=== | ||
====Patient Education==== | ====Patient Education ==== | ||
*The patients should understand their diagnosis clearly. | *The patients should understand their diagnosis clearly. | ||
*Smoking cessation, regular exercise, and proper nutrition should be advised. | *Smoking cessation, regular exercise, and proper nutrition should be advised. | ||
| Line 15: | Line 14: | ||
====Treatment of Acute Exacerbations==== | ====Treatment of Acute Exacerbations==== | ||
*Exacerbations can be defined as patients reporting four or more of the following symptoms: change in sputum production, increased dyspnea, increased cough, fever over 38 °C, increased wheezing, decreased exercise tolerance, fatigue, malaise, lethargy, reduced pulmonary function, changes in chest sounds or radiographic changes consistent with a new infectious process. | *Exacerbations can be defined as patients reporting four or more of the following symptoms: change in sputum production, increased dyspnea, increased cough, [[fever]] over 38 °C, increased wheezing, decreased exercise tolerance, [[fatigue]], [[malaise]], [[lethargy]], reduced [[pulmonary]] function, changes in chest sounds or radiographic changes consistent with a new infectious process. | ||
*The mainstay of treatment is [[antibiotic]] therapy. | |||
*The mainstay of treatment is antibiotic therapy. | |||
*Once the sputum specimen is collected and sent for culture, a targeted antibiotic therapy is recommended. | *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> | *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> | *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> | ||
*Here are suggested antibiotics with specific culture growth | *Here are suggested antibiotics with specific culture growth | ||
:*H. influenza type B | :*H. influenza type B | ||
::*Amoxicillin | ::*[[Amoxicillin]] 1g tds × 2/52, [[Doxycycline]] 100mg bd × 2/52 | ||
::* If β-lactamase-positive strain, Augmentin | ::* If β-lactamase-positive strain, [[Augmentin]] 625mg tds × 2/52 | ||
:*P. aeruginosa | :*P. aeruginosa | ||
::*Ciprofloxacin | ::*[[Ciprofloxacin]] 750mg BD × 2/52 | ||
::*If no response or resistant to above, consider IV alternatives for 2/52: Ceftazidime | ::*If no response or resistant to above, consider IV alternatives for 2/52: Ceftazidime 2g tds × 2/52 IV, Tazocin 4.5g tds IV or Meropenem 1g tds IV | ||
:*S. pneumoniae | :*S. pneumoniae | ||
::*Amoxicillin | ::*[[Amoxicillin]] 1g tds × 2/52 | ||
:*M. catarrhalis | :*M. catarrhalis | ||
::*Augmentin 625 mg tds × 2/52 or Ciprofloxacin 500 mg BD × 2/52 | ::*[[Augmentin]] 625 mg tds × 2/52 or [[Ciprofloxacin]] 500 mg BD × 2/52 | ||
:*S. aureus | :*S. aureus | ||
::*Flucloxacillin 1 g qds × 2/52 | ::*[[Flucloxacillin]] 1 g qds × 2/52 | ||
====Prophylactic Treatment==== | ====Prophylactic Treatment==== | ||
| Line 42: | Line 40: | ||
====Other Therapies==== | ====Other Therapies==== | ||
*Inhaled mannitol and nebulized hypertonic 7% saline have demonstrated effectiveness in increased airways clearance and sputum yield.<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> | *Inhaled [[mannitol]] and nebulized [[hypertonic]] 7% saline have demonstrated effectiveness in increased airways clearance and sputum yield.<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> | ||
*Inhaled corticosteroids show a significant decrease in sputum production and cough.<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> | *Inhaled [[corticosteroids]] show a significant decrease in sputum production and cough.<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> | ||
*Macrolides exhibit anti-bacterial and immunomodulatory effects.<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> | *Macrolides exhibit anti-bacterial and immunomodulatory effects.<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> | ||
*The combination of a long-acting beta2-agonists (LABA) with a conventional inhaled corticosteroids (IC) improved the quality of life. | *The combination of a long-acting beta2-agonists ([[LABA]]) with a conventional inhaled corticosteroids (IC) improved the quality of life. | ||
== Physiotherapy Strategies== | == Physiotherapy Strategies== | ||
| Line 59: | Line 57: | ||
====Pulmonary Rehabilitation==== | ====Pulmonary Rehabilitation==== | ||
*Exercise training | |||
*Nutritional counseling | |||
*Education of the patient's disease and how to manage it | |||
*Techniques on how to conserve energy | |||
*Strategies on breathing | |||
*Psychological counseling | |||
==References== | ==References== | ||
Revision as of 13:28, 25 June 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Along with treatment of bronchiectasis, it is important to treat the underlying condition if one is present. The medical therapy is divided into medical treatment and physiologic strategies. The medical treatment consists of patient education, treatment of the acute exacerbations, prophylactic treatment, vaccination, and other therapies. 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
- Exacerbations can be defined as patients reporting four or more of the following symptoms: change in sputum production, increased dyspnea, increased cough, fever over 38 °C, increased wheezing, decreased exercise tolerance, fatigue, malaise, lethargy, reduced pulmonary function, changes in chest sounds or radiographic changes consistent with a new infectious process.
- 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]
- Here are suggested antibiotics with specific culture growth
- H. influenza type B
- Amoxicillin 1g tds × 2/52, Doxycycline 100mg bd × 2/52
- If β-lactamase-positive strain, Augmentin 625mg tds × 2/52
- P. aeruginosa
- Ciprofloxacin 750mg BD × 2/52
- If no response or resistant to above, consider IV alternatives for 2/52: Ceftazidime 2g tds × 2/52 IV, Tazocin 4.5g tds IV or Meropenem 1g tds IV
- S. pneumoniae
- Amoxicillin 1g tds × 2/52
- M. catarrhalis
- Augmentin 625 mg tds × 2/52 or Ciprofloxacin 500 mg BD × 2/52
- S. aureus
- Flucloxacillin 1 g qds × 2/52
Prophylactic Treatment
- National guidelines recommend that patients suffering from three or more exacerbations per year, should be considered for long-term antibiotics.[1]
Vaccination
- There has been some evidence to support that the yearly influenza vaccine reduces morbidity, mortality, and healthcare costs with high-risk patients.
Other Therapies
- Inhaled mannitol and nebulized hypertonic 7% saline have demonstrated effectiveness in increased airways clearance and sputum yield.[1]
- Inhaled corticosteroids show a significant decrease in sputum production and cough.[1]
- Macrolides exhibit anti-bacterial and immunomodulatory effects.[1]
- The combination of a long-acting beta2-agonists (LABA) with a conventional inhaled corticosteroids (IC) improved the quality of life.
Physiotherapy Strategies
Airway Clearance
- Postural Drainage
- Autogenic Drainage
- Active Cycle of Breathing Techniques
- Positive Expiratory Pressure (PEP)
- Oscillatory PEP devices
- High-frequency chest wall percussion
Pulmonary Rehabilitation
- Exercise training
- Nutritional counseling
- Education of the patient's disease and how to manage it
- Techniques on how to conserve energy
- Strategies on breathing
- Psychological counseling