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Thursday, November 20, 2014
ABPA and bronchiectasis
I`m a 28 yr old male based in South Africa. I`ve had a persistent dry cough for the last 13 months. The cough would be associated with wheezes, shortness of breath and bronchitis. Nine hospitalizations later, I`ve been diagnosed with asthma; asthmatic bronchopulmonary aspergillosis; and focal bronchiectasis on the right upper lobe. I`m on sporozole and corticosteroids at the moment. The cough seems to be getting better, although it hasn`t gone away completely as yet. Is surgery the way to go to cure the bronchiectasis? what other alternatives are there to treat it?
Bronchiectasis has several forms, local (affecting only a specific part of the lung) and more generalized. In the focal type of bronchiectasis, then surgery can be used if there is either recurrent infections that impact that area of the lung that becomes a problem or if the area starts bleeding. In generalized bronchiectasis surgery is not a good option, because lung that is still affected is left behind. For allergic bronchopulmonary aspergillosis, the treatment is controlling the inflammation that we measure by IgE levels in your blood and also by determining lung function and symptoms you are having. Other causes of bronchiectasis that need to be evaluated including tuberculosis (you should have a skin test), hypogammaglobulinemia (you should have your immunoglobulin proteins measured to make sure that one is not low), autoimmune (you may have blood tests like ESR, CRP, ANA done). Cystic fibrosis can also cause bronchiectasis and should be considered if appropriate.
The treatment focuses on clearance of mucus from your airway using a flutter valve, postural percussion and drainage or other mechanical devices like a vest. If you have any sign of infection, then treatment with appropriate antibiotics early in the course is important. Likewise, getting annual influenza and H1N1 vaccines are important.
Clay B Marsh, MD
Vice Dean of Medicine Administration
Professor of Molecular Virology, Immunology & Medical Genetics
Professor of Veterinary Biosciences
Associate Vice President of Health Sciences Research Administration
College of Medicine
The Ohio State University