Extreme bronchorrhea

Specialty: Respiratory.

• massive bronchial hypersecretion
• profuse mucoid expectoration

Why it occurs

• Mucinous type lung adenocarcinoma (formerly called bronchioloalveolar carcinoma, which autonomously secretes large volumes of fluid mucus)
• Generalized infected or cystic bronchiectasis (chronic bronchial dilations with purulent hypersecretion associated with bacterial colonization by Pseudomonas aeruginosa)
• Chronic industrial or heavy smoker bronchitis in the severe exacerbation phase (hyperplasia and hypertrophy of the submucosal glands of the airway)
• Bronchoesophageal or tracheoesophageal fistula (continuous passage of saliva and gastric contents to the bronchial tree that stimulates massive production of mucus and reactive secretion)
• Extrinsic allergic alveolitis in the acute phase (hypersensitivity pneumonitis with profuse alveolar exudate)

Initial workup

Collection and quantification of expectoration in 24 hours; Sputum cytology (search for neoplastic cells); Sputum culture for common bacteria, mycobacteria and fungi, including antibiogram; High-resolution chest computed tomography (CT) (to document bronchiectasis or bronchioloalveolar dissemination pattern); Flexible bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy.

Standard management

• Carbocisteine — mucolytic, 750 mg orally every 8 hours to decrease mucus viscosity
• Dornasa alpha — inhaled, 2.5 mg once daily to hydrolyze extracellular DNA in purulent sputum of patients with cystic fibrosis or severe bronchiectasis
• Clarithromycin — macrolide, 500 mg orally every 12 hours, used not only for its antibacterial effect but also for its long-term immunomodulatory and anti-mucus secretion properties
• Inhaled atropine or glycopyrrolate (exceptionally prescribed and under monitoring to reduce refractory glandular secretion).