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Idiopathic Bronchiectasis Less Common Than Predicted: Quality Improvement Project FREE TO VIEW

Diego Maselli, MD; Paola Faverio, MD; Alejandro Arango, MD; Juan Fernandez, MD; Stefano Aliberti, MD; Sara Lonni, MS; Mauricio Jalife Bucay, MD; Clinton Ezekiel, MD; Marcos Restrepo, MD
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University of Texas Health Science Center at San Antonio, San Antonio, TX

Chest. 2013;144(4_MeetingAbstracts):586A. doi:10.1378/chest.1704998
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SESSION TITLE: Cystic Fibrosis/ Bronchiectasis Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Bronchiectasis is a heterogeneous disease that represents a diagnostic challenge for clinicians, particularly regarding the possible etiological factors. Our aim was to determine the frequency of identifiable causes of bronchiectasis in a pre-intervention quality improvement (QI) project.

METHODS: We performed a QI project on patients referred to a subspecialty clinic at two tertiary teaching outpatient clinics in San Antonio, TX, USA. This QI project included a pre-interventional assessment of the tests and methodologies used by clinicians in their practice to identify causes of bronchiectasis. All patients required a chest computerized tomography (CT) to confirm the bronchiectasis diagnosis. Etiological factors were identified through past medical history and symptoms collection and, when required, specific diagnostic tests as performed in the patient care practice.

RESULTS: We identified 32 patients (median [IQR] age 56 [52-72] years, 21 males) with a clinical and radiological diagnosis of bronchiectasis. A definitive or presumptive cause of bronchiectasis was identified in 27 patients (84%), while 5 (16%) remained idiopathic. The most common causes found were: post-infective (n=17, 53%), rheumatoid arthritis (n=3, 9%), interstitial lung diseases (n=2, 6%), common-variable immunodeficiency (CVID) (2, 6%) and other causes (n=3, 9%, including Wegener granulomatosis, allergic broncho-pulmonary aspergillosis and Kartagener’s syndrome). The most common diagnoses found among post-infective etiologies were: recurrent pneumonias (n=10), and past tuberculosis (n=5). Patients with post-infective causes presented concomitant obstructive airways diseases (COPD and asthma in 6/17, 35%) and immunosuppressive state (4/17, 24%).

CONCLUSIONS: A definitive or presumptive cause of bronchiectasis was identified in the majority of our patients (84%). The most common etiology was determined to be post-infective. Further developments of our QI project comprehend the use of a diagnostic protocol in patients with bronchiectasis to try to improve the identification of specific etiological factors. Studies on larger samples are needed to better evaluate the importance of each factor and to evaluate the impact on patients’ management.

CLINICAL IMPLICATIONS: A dedicated diagnostic protocol for the workup bronchiectasis can achieve a definitive or presumptive diagnosis in the majority of cases.

DISCLOSURE: The following authors have nothing to disclose: Diego Maselli, Paola Faverio, Alejandro Arango, Juan Fernandez, Stefano Aliberti, Sara Lonni, Mauricio Jalife Bucay, Clinton Ezekiel, Marcos Restrepo

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