Bronquiectasia: tratamiento, causas, síntomas, diagnóstico y prevención

La bronquiectasia es una dilatación irreversible de las pequeñas vías respiratorias. En general, el enfermo ha sufrido una lesión pulmonar grave del tipo de neumonía (bacteriana, tuberculosa o por tos ferina) o aspirado un cuerpo extraño 10-20 años antes. Otros factores predisponentes son la fibrosis quística, la enfermedad por Mycobacterium avium-intracellulare, la aspergilosis broncopul-monar, el síndrome de los cilios inmóviles, la deficiencia de a1-antitripsina, la hipogammaglobulinemia, la artritis reumatoidea el síndrome de Sjogren y el síndrome de Kar-tagener.

La bronquiectasia se manifiesta por una tos productiva crónica (purulenta, no abundante, no maloliente que suele empeorar con el decúbito). Otros datos consisten en disnea, fiebre recurrente y pleuresía, hemoptisis y expectoración sólo en las infecciones respiratorias altas. Entre los signos más frecuentes se encuentran los crepitantes, ruidos metálicos, roncus y sibilancias.56 La auscultación pulmonar puede variar con la tos y la postura o mantenerse localizada en todo momento. A diferencia de otras enfermedades pulmonares crónicas, afecta a no fumadores, predomina en la mujer (70 %) y las anomalías en la radiografía de tórax (91 %) se caracterizan por infiltrados discontinuos, crónicos o recidivantes, o dilatación y engrosamiento de la vía respiratoria (líneas paralelas, sombras anulares cuando se corta el vaso de forma transversal), a veces con niveles hidroaéreos. Si persiste la duda, la TC de alta resolución resulta diagnóstica.

El tratamiento se basa en las vacunas contra el neumococo y la gripe, el tratamiento de la enfermedad de base (p. ej., reposición de gammaglobulina para la hipogam-maglobulinemia), fisioterapia respiratoria 3 o 4 veces al día, tratamiento antimicrobiano de las reagudizaciones o profilaxis57 (la amoxicilina, la tetraciclina o la trimeto-prima-sulfametoxazol constituyen los fármacos de primera línea, porque cubren Haemophilus influenzae y Streptococcus pneumoniae), broncodilatadores en aerosol y antiinflamatorios, oxígeno (PO2 < 55 o insuficiencia cardíaca derecha sintomática), embolización arterial en las hemoptisis con amenaza para la vida y cirugía si fracasa el tratamiento conservador o se observa una enfermedad localizada.

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