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Recurrent bronchopulmonary infection — Clinical Guidelines

Overview

Recurrent bronchopulmonary infections refer to repeated infections affecting the bronchi and lungs, often associated with underlying immune deficiencies or structural abnormalities. 1 2

Diagnosis

Elevated serum IgE levels 1 2

History of recurrent skin and lung infections 1 2

Connective tissue abnormalities, including coronary artery anomalies (tortuosity, ectasia, aneurysms) 1 2

Imaging studies such as coronary MDCT angiography for coronary abnormalities 1

Management

Antibiotics: Tailored to the specific pathogen identified in cultures 3

Supportive care: Including oxygen therapy and respiratory support as needed 3

Intravenous erythromycin lactobionate: 500 mg every 8 hours; consider 60-minute infusion for reduced venous irritation; inline filtration may mitigate venous complications 3

Special Populations

Elderly: Increased risk of complications like coronary artery aneurysms; close monitoring of cardiovascular health 1 2

Pediatrics: Early identification and management of underlying conditions like HIES crucial; regular imaging for coronary abnormalities 1 2

Key Recommendations

Evaluate patients with recurrent bronchopulmonary infections for underlying immune deficiencies, particularly hyper IgE recurrent infection syndrome (HIES), including coronary artery imaging 1 2 (Evidence: Moderate)

Implement inline filtration during intravenous erythromycin administration to minimize venous irritation 3 (Evidence: Weak)

Monitor elderly patients for coronary artery abnormalities and cardiovascular complications due to increased risk 1 2 (Evidence: Expert opinion)

References

1 Gharib AM, Pettigrew RI, Elagha A, Hsu A, Welch P, Holland SM et al.. Coronary abnormalities in hyper-IgE recurrent infection syndrome: depiction at coronary MDCT angiography. AJR. American journal of roentgenology 2009. link 2 Ling JC, Freeman AF, Gharib AM, Arai AE, Lederman RJ, Rosing DR et al.. Coronary artery aneurysms in patients with hyper IgE recurrent infection syndrome. Clinical immunology (Orlando, Fla.) 2007. link 3 Marlin GE, Thompson PJ, Jenkins CR, Burgess KR, LaFranier DA. Study of serum levels, venous irritation and gastrointestinal side-effects with intravenous erythromycin lactobionate in patients with bronchopulmonary infection. Human toxicology 1983. link

Recurrent bronchopulmonary infection