Investigations for secondary causes

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Investigations for secondary causes 2016-04-24T04:59:08+00:00

Investigations for secondary causes

Spirometry (FEV1, FVC, PEF) and TLCO

for the measurement of severity of disease

presence of bronchodilator response (reversibility)

Sputum sample (microbiology and culture)

identify the presence of bacteria or organisms in the sputum

include mycobacterial culture

persistent Staphylococcus aureus may indicate ABPA or CF

surveillance of sputum microbiology helps guide antibiotic therapy

Pathology

immunodeficiency screening – IgG, IgA, IgM and IgG subclass levels (derived from a venous blood sample)

connective tissue and vasculitis screening – rheumatoid factor, anti-CCP antibodies, antinuclear antibodies, antineutrophil cytoplasmic antibodies

identifying ABPA – Aspergillus in sputum, total IgE, Aspergillus RAST, Aspergillus precipitins (IgG)

Vaccine responses:

Immune deficiency may be identified by impaired vaccine response to pneumoccocal vaccination and Haemophilus influenzae type B

Bronchoscopy indicated when:

response to treatment is poor

HRCT indicative of mycobacterial infection

disease is localised (to exclude obstruction)

unexplained haemoptysis

Exhaled nasal nitric oxide

indicated if considering primary ciliary dyskinesia. This should be considered in cases of dextrocardia, chronic childhood sinusitis or upper respiratory tract infections

ciliary tests should be considered in adults with a history of chronic upper respiratory tract infections or otitis media

Sweat test

to exclude cystic fibrosis – CF needs to be excluded in all patients presenting at < 40 years of age and those > 40 years of age where no other cause is evident and there is persistent isolation of Staphylococcus aureus in the sputum, features of malabsorption, male primary infertility or upper lobe bronchiectasis

See TSANZ Bronchiectasis Guidelines

References