Chronic suppurative lung disease in adults

Abstract

Chronic suppurative lung disease (CSLD), characterized by a bronchiectasis-like syndrome in the absence of bronchial dilatation, is well described in the pediatric literature. In some patients, it may be a precursor of bronchiectasis. In adults, this syndrome has not been well described. We present four adult patients without obvious causative exposures who presented with prolonged cough and purulent sputum.Sputum cultures revealed a variety of Gram negative bacteria, fungi and mycobacteria. High resolution CT scanning did not reveal bronchiectasis. Evaluation revealed underlying causes including immunodeficiency in two, and Mycobacterium avium infection. One patient subsequently developed bronchiectasis. All patients improved with therapy. CSLD occurs in adults and has characteristics that distinguish it from typical chronic bronchitis. These include the lack of causative environmental exposures and infection with unusual pathogens. Evaluation and treatment of these patients similar to bronchiectasis patients may lead to clinical improvement. J Thorac Dis 2016;8(9):E974-E978 jtd.amegroups.com level were normal. He was now producing a half cup of yellow-green sputum daily, thus it was felt that he was a good candidate for azithromycin at 250 mg 3 times a week, as would be indicated for bronchiectasis patients. Three months later, he reported an "80% improvement" in his cough, which was then productive of only scant clear sputum and he has continued to do well with azithromycin and an airway clearance regimen. Case 2A 66-year-old male with a history of life-long asthma which was reasonably well controlled without systemic steroids, was referred for a several year history of daily cough of approximately a tablespoon of yellow sputum. His respiratory symptoms periodically worsened, and he experienced six exacerbations requiring antibiotics in the year prior to his referral. He had a 12-pack-year smoking history, discontinued more than 20 years previously. Physical examination was significant for a wet cough, rhinitis and diminished breath sounds at the lung bases. Spirometry testing showed borderline low FEV 1 /FVC ratio of 71% and sagging of the expiratory loop, but an FEV 1 of 111% of predicted and no bronchodilator response. Blood work showed an elevated IgE level at 590 kU/L. Other immunoglobulins, alpha-1 antitrypsin level and a cystic fibrosis (CF) mutation screen were normal. Sputum cultures showed Aspergillus fumigatus, Bordetella bronchiseptica, Pseudomonas aer uginosa and Mycobacterium avium complex (MAC). Aspergillus IgG and IgE were elevated, although the IgE elevation was borderline (0.47 kU/L, upper limit of normal 0.32 kU/L), suggesting the possibility of allergic bronchopulmonary aspergillosis. An HRCT from approximately 3 years prior to his referral, but after the onset of symptoms, demonstrated some areas of bronchial wall thickening but no bronchiectasis (Figure 2A). A HRCT after his referral demonstrated bronchiectasis, bronchial wall thickening and mucus impaction in his left lower lo...

Advances in bronchiectasis: endotyping, genetics, microbiome, and disease heterogeneity

“…77 The same or similar phenomenon almost certainly exists in adults. 78 Changes in the microbiome could also contribute to an exacerbation, there are changes in the microbiome as a consequence of antibiotic exposure, and after removal of the antibiotic exposure the microbiome can return to the prior state or remain altered (for better or for worse). In addition, there may be species interactions that may influence their virulence and pathogenicity.…”

Survey of Home Cleaning Practices With Noninvasive Ventilation Equipment

“…However, these authors studied patients with obstructive sleep apnea on continuous positive airway pressure therapy, whose infection risks likely differ from the current patient population. For some home NIV patients with impaired respiratory protective mechanisms, such as those with neuromuscular disease and a weak cough, 23 or those who are at risk of infective exacerbations, such as patients with suppurative lung disease, 24 insufficient cleaning of equipment may potentially further increase the risk of respiratory infection. One fifth of participants also reported using only water to clean their tubing, machines, and humidifier chambers, whereas almost 2 fifths reported using a dry cloth to clean their machine surfaces.…”