My study case is related to a bronchiectasis patient from Fairfax Inova Hospital. Bronchiectasis is an abnormal and permanent dilation of airways in which the bronchial walls become inflamed, the mucociliary elevator is impaired, and the mucus accumulates leading to increased susceptibility to infection. It can be classified according to morphological forms such as cylindrical bronchiectasis form where the bronchi are enlarged and cylindrical (least severe), varicose bronchiectasis form where the bronchi are irregular distorted with zones of dilation and constriction and saccular or cystic form (severe one) where dilated bronchi form clusters of cysts (all three forms may be present in the same patient). This disease may involve many areas
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Then, he should do some physical examinations, starting by radiology testing such as chest x-ray where findings could involve thickening of the airway walls with airway dilation. Those airways filled with mucous plugs can also cause scattered elongated, tubular opacities. In the same order, radiographic can make the difference between bronchiectasis due to cystic fibrosis which develops predominantly in the upper lobes, and bronchiectasis due to an endobronchial obstruction which causes more focal x-ray abnormalities. In addition, pulmonary function tests can establish the patient baseline, make the difference between obstructive and restrictive bronchiectasis and monitoring disease progression. Specific tests for suspected causes could be performed such as: sweat electrolyte tests and CFTR gene mutation analysis to diagnose cystic fibrosis (including in adults > 40 years without an identifiable cause of bronchiectasis, especially if they have upper lobe involvement, malabsorption, or male infertility) or α-1-Antitrypsin test to evaluate for α-1-antitrypsin deficiency if high resolution CT shows lower lobe emphysema. Not the least obtaining specimens of airway secretions for bacterial …show more content…
Breath sounds was wheezing on both lungs bilateral and SpO2 of 94 %. Patient appears with no sign of distress. He was able to take his medication without further instruction. Patient bed side spirometry conducted in 2016 reveals a combined obstructive and restrictive of the respiratory tract. In addition of those symptoms patient was also in mild protein caloric malnutrition.
Given that the patient has hospital acquired pneumonia in the past, the emergency room physician decided to admit him to be able to monitor his bronchiectasis exacerbations, to continue nebulizer treatment, to perform some sputum culture, to refer him to a nutritionist and perform HRCT
Then, he should do some physical examinations, starting by radiology testing such as chest x-ray where findings could involve thickening of the airway walls with airway dilation. Those airways filled with mucous plugs can also cause scattered elongated, tubular opacities. In the same order, radiographic can make the difference between bronchiectasis due to cystic fibrosis which develops predominantly in the upper lobes, and bronchiectasis due to an endobronchial obstruction which causes more focal x-ray abnormalities. In addition, pulmonary function tests can establish the patient baseline, make the difference between obstructive and restrictive bronchiectasis and monitoring disease progression. Specific tests for suspected causes could be performed such as: sweat electrolyte tests and CFTR gene mutation analysis to diagnose cystic fibrosis (including in adults > 40 years without an identifiable cause of bronchiectasis, especially if they have upper lobe involvement, malabsorption, or male infertility) or α-1-Antitrypsin test to evaluate for α-1-antitrypsin deficiency if high resolution CT shows lower lobe emphysema. Not the least obtaining specimens of airway secretions for bacterial …show more content…
Breath sounds was wheezing on both lungs bilateral and SpO2 of 94 %. Patient appears with no sign of distress. He was able to take his medication without further instruction. Patient bed side spirometry conducted in 2016 reveals a combined obstructive and restrictive of the respiratory tract. In addition of those symptoms patient was also in mild protein caloric malnutrition.
Given that the patient has hospital acquired pneumonia in the past, the emergency room physician decided to admit him to be able to monitor his bronchiectasis exacerbations, to continue nebulizer treatment, to perform some sputum culture, to refer him to a nutritionist and perform HRCT