Bronchorrhea

Bronchorrhea is the production of more than 100 mL per day of watery sputum.^[1] Chronic bronchitis is a common cause, but it may also be caused by asthma,^[2] pulmonary contusion,^[3] bronchiectasis, tuberculosis, cancer, scorpion stings, severe hypothermia and poisoning by organophosphates and other poisons. Massive bronchorrhea may occur in either bronchioloalveolar carcinoma, or in metastatic cancer that is growing in a bronchioloalveolar pattern.^[1][4][5] It commonly occurs in the setting of chest wall trauma, in which setting it can cause lobar atelectasis.^[6]

Treatment

Treatment options include

• gefitinib - epidermal growth factor receptor tyrosine kinase inhibitor^{[7][8][9][10][11]}
• indomethacin^[12][13][14]
• corticosteroids^[15]
• octreotide^[16]
• radiation therapy^[17]
• bronchoscopy as is often done in the post traumatic setting.^[6]

References

1. Lembo T, Donnelly T (1995). "A case of pancreatic carcinoma causing massive bronchial fluid production and electrolyte abnormalities". Chest. 108 (4): 1161–3. doi:10.1378/chest.108.4.1161. PMID 7555132.
2. Shimura S, Sasaki T, Sasaki H, Takishima T (1988). "Chemical properties of bronchorrhea sputum in bronchial asthma". Chest. 94 (6): 1211–5. doi:10.1378/chest.94.6.1211. PMID 2903819.
3. Gavelli G, Canini R, Bertaccini P, Battista G, Bnà C, Fattori R (June 2002). "Traumatic injuries: imaging of thoracic injuries". European Radiology. 12 (6): 1273–1294. doi:10.1007/s00330-002-1439-6. PMID 12042932.
4. Shimura S, Takishima T (1994). "Bronchorrhea from diffuse lymphangitic metastasis of colon carcinoma to the lung". Chest. 105 (1): 308–10. doi:10.1378/chest.105.1.308. PMID 8275762.
5. Mito K, Yamakami Y, Kashima K, Mizunoe S, Tokimatsu I, Ichimiya T, Hiramatsu K, Nagai H, Kadota J, Nasu M (2002). "[A case of suspected lung metastasis of pancreatic carcinoma with bronchorrhea similar to bronchioloalveolar carcinoma]". Nihon Kokyuki Gakkai Zasshi. 40 (8): 666–70. PMID 12428395.
6. Abbott, Mark S. Parker, Melissa L. Rosado de Christenson, Gerald F. (2005). Teaching atlas of chest imaging. New York: Thieme. ISBN 978-1588902306.
7. Kitazaki T, Soda H, Doi S, Nakano H, Nakamura Y, Kohno S (2005). "Gefitinib inhibits MUC5AC synthesis in mucin-secreting non-small cell lung cancer cells". Lung Cancer. 50 (1): 19–24. doi:10.1016/j.lungcan.2005.05.005. PMID 16009452.
8. Kitazaki T, Fukuda M, Soda H, Kohno S (2005). "Novel effects of gefitinib on mucin production in bronchioloalveolar carcinoma; two case reports". Lung Cancer. 49 (1): 125–8. doi:10.1016/j.lungcan.2004.11.027. PMID 15949598.
9. Milton D, Kris M, Gomez J, Feinstein M (2005). "Prompt control of bronchorrhea in patients with bronchioloalveolar carcinoma treated with gefitinib (Iressa)". Support Care Cancer. 13 (1): 70–2. doi:10.1007/s00520-004-0717-z. PMID 15558327.
10. Takao, Motoshi; Inoue, K; Watanabe, F; Onoda, K; Shimono, T; Shimpo, H; Yada, I (2003). "Successful treatment of persistent bronchorrhea by gefitinib in a case with Recurrent Bronchioloalveolar Carcinoma: a case report". World J Surg Oncol. 1 (1): 8. doi:10.1186/1477-7819-1-8. PMC 183862. PMID 12917017.
11. Yano S, Kanematsu T, Miki T, Aono Y, Azuma M, Yamamoto A, Uehara H, Sone S (2003). "A report of two bronchioloalveolar carcinoma cases which were rapidly improved by treatment with the epidermal growth factor receptor tyrosine kinase inhibitor ZD1839 ("I[res]sa")". Cancer science. 94 (5): 453–8. doi:10.1111/j.1349-7006.2003.tb01464.x. PMID 12824893.
12. Tamaoki J, Kohri K, Isono K, Nagai A (2000). "Inhaled indomethacin in bronchorrhea in bronchioloalveolar carcinoma: role of cyclooxygenase". Chest. 117 (4): 1213–4. doi:10.1378/chest.117.4.1213. PMID 10767270.
13. Homma S, Kawabata M, Kishi K, Tsuboi E, Narui K, Nakatani T, Nakata K (1999). "Successful treatment of refractory bronchorrhea by inhaled indomethacin in two patients with bronchioloalveolar carcinoma". Chest. 115 (5): 1465–8. doi:10.1378/chest.115.5.1465. PMID 10334175.
14. Tamaoki J, Chiyotani A, Kobayashi K, Sakai N, Kanemura T, Takizawa T (1992). "Effect of indomethacin on bronchorrhea in patients with chronic bronchitis, diffuse panbronchiolitis, or bronchiectasis". Am Rev Respir Dis. 145 (3): 548–52. doi:10.1164/ajrccm/145.3.548. PMID 1546834.
15. Nakajima T, Terashima T, Nishida J, Onoda M, Koide O (2002). "Treatment of bronchorrhea by corticosteroids in a case of bronchioloalveolar carcinoma producing CA19-9". Intern Med. 41 (3): 225–8. doi:10.2169/internalmedicine.41.225. PMID 11929186.
16. Hudson E, Lester J, Attanoos R, Linnane S, Byrne A (2006). "Successful treatment of bronchorrhea with octreotide in a patient with adenocarcinoma of the lung". J Pain Symptom Manage. 32 (3): 200–2. doi:10.1016/j.jpainsymman.2006.05.003. PMID 16939841.
17. Krawtz S, Mehta A, Vijayakumar S, Stoller J (1988). "Palliation of massive bronchorrhea". Chest. 94 (6): 1313–4. doi:10.1378/chest.94.6.1313-b. PMID 2461277.