Drs. Aram Karkar and Yassmin Behzadian, along with other medical professionals, discuss bronchiectasis, including its causes, diagnostic work-up, treatment options, and the impact of the EMBRACE trial on treatment guidelines. They also highlight the effectiveness of azithromycin in managing bronchiectasis.
The Lady Windermere Syndrome can lead to mycobacterium infections in older women by suppressing the cough reflex.
Chronic inflammation affects mucus clearance and leads to structural airway changes in bronchiectasis pathogenesis.
Deep dives
Understanding Bronchiectasis and Lady Windermere Syndrome
Bronchiectasis is a chronic lung disease characterized by the abnormal dilation of airways. The Lady Windermere Syndrome refers to a presentation seen particularly in older women without underlying lung disease who suppress their cough reflex, making them susceptible to mycobacterium infections. This syndrome, although debated in terms of mechanism, is part of the bronchiectasis spectrum.
Pathogenesis and Diagnosis of Bronchiectasis
Bronchiectasis pathogenesis is best described by the Vicious Cycle Hypothesis, involving chronic inflammation impacting mucus clearance and leading to structural airway changes. High-resolution CT scan is key for diagnosing non-CF bronchiectasis, showing specific features like bronchial dilatation and lack of tapering. Blood work and sputum samples help identify causative factors and organisms.
Management and Treatment of Non-CF Bronchiectasis
The management of non-CF bronchiectasis focuses on treating underlying causes and enhancing mucus clearance. Strategies include airway clearance techniques, antibiotics for exacerbations, and in some cases, surgery. Research like the Embrace trial supports the use of chronic antibiotic therapy in patients with recurrent exacerbations.
What is bronchiectasis? In this episode, we discuss the etiologies of bronchiectasis, the diagnostic work-up of choice and the treatments available for patients with this disease. We also discuss the EMBRACE trial that has led to change in guidelines for treatment of bronchiectasis.
Podcast written by: Drs. Aram Karkar and Yassmin Behzadian (Internal Medicine residents), Reviewed by: Dr. Sophie Corriveau and Dr. Michael Nicholson (Respirologists) and Dr. Leslie Martin and Dr. Jeff Yu (General Internists) Sound Editing by: Nafis Hossain