The Pulm PEEPs podcast will be providing regular episodes delving into the world of pulmonary and critical care medicine. Our mission with this platform is to provide learners of all levels multiple formats to engage in pulmonary and critical care education that you can access anytime, anywhere. We will be bringing you case reports of classic teaching cases that we have encountered accompanied by infographics on high-yield points from each case, roundtable chats with experts and leaders in the field of PCCM, and series of Top ICU and Top Pulmonary consults.
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The Pulm PEEPs podcast will be providing regular episodes delving into the world of pulmonary and critical care medicine. Our mission with this platform is to provide learners of all levels multiple formats to engage in pulmonary and critical care education that you can access anytime, anywhere. We will be bringing you case reports of classic teaching cases that we have encountered accompanied by infographics on high-yield points from each case, roundtable chats with experts and leaders in the field of PCCM, and series of Top ICU and Top Pulmonary consults.
110. Pulm PEEPs at CHEST 2025 – Widened Airways and Narrowed Differentials
PulmPEEPs
30 minutes 11 seconds
2 weeks ago
110. Pulm PEEPs at CHEST 2025 – Widened Airways and Narrowed Differentials
For today’s podcast we have a special episode. We were extremely grateful to be invited to present live at CHEST 2025 this year. Kristina Montemayor, and Pulm PEEPs Associate Editors Luke Hedrick, Tom Di Vitantonio, and Rupali Sood hosted a session entitled “Widened Airways and Narrowed Differentials”. It is a great session around bronchiectasis. Enjoy!
Meet Our Guests
Dr. Doreen Addrizzo-Harris is a Professor of Medicine at NYU where she is also Associate Director of Clinical and Academic Affairs for the pulmonary and critical care division. In addition to that, she’s the director of the bronchiectasis and NTM program and also serves as a program director for the pulmonary and critical care fellowship.
Case Snapshot
60-year-old with CLL (in remission) → recurrent “pneumonias,” diffuse (not single-lobe), later dx’d with CVID; serial CTs: upper-lobe–predominant bronchiectasis, tree-in-bud, mucus impaction; multiple AFB+ cultures (MAC, later M. abscessus); recurrent bacterial flares (MSSA/MRSA).
CT Images
Key Learning Points
Imaging pearls
* Tree-in-bud = small airways (bronchiolar) impaction/inflammation, not a diagnosis. Differential guided by distribution + chronicity:
* Use all three (2020 guideline frame): clinical symptoms, compatible CT, microbiology (≥2 sputum cultures or 1 bronch +, etc.).
* Not every positive culture = disease needing drugs. If you defer pharmacologic therapy, follow closely (symptoms, sputum, PFTs, interval CT if change).
* Bug matters: MAC, M. abscessus, kansasii etc. “Low-virulence” species (e.g., M. gordonae) can still flag underlying airway disease.
* Regimens (MAC, macrolide-susceptible): azithro + ethambutol + rifampin (intermittent for nodular-bronchiectatic; daily ± IV amikacin for fibro-cavitary/advanced).
* Macrolide is the backbone; the others protect against resistance.
* M. abscessus: check for inducible macrolide resistance (prolonged in-vitro testing).
* Monitoring: sputum q1–3 mo; labs (CBC/CMP), vision (ethambutol), hearing (aminoglycosides). Treat ~12 months beyond culture conversion.
* Anti-inflammatory macrolide for bronchiectasis is contraindicated if macrolide-susceptible NTM is present—risk of resistance.
Bronchiectasis management essentials
* It’s a syndrome: symptoms/exacerbations plus CT changes.
* Airway clearance is foundational (exercise + devices ± hypertonic saline/DNase when indicated). Expect CT and symptom gains with adherence.
* Exacerbations often need ~14 days of pathogen-directed antibiotics (short courses may fail). Take the “easy win” when a conventional pathogen explains the flare.
Workup framework (start with a core bundle, then target)
PulmPEEPs
The Pulm PEEPs podcast will be providing regular episodes delving into the world of pulmonary and critical care medicine. Our mission with this platform is to provide learners of all levels multiple formats to engage in pulmonary and critical care education that you can access anytime, anywhere. We will be bringing you case reports of classic teaching cases that we have encountered accompanied by infographics on high-yield points from each case, roundtable chats with experts and leaders in the field of PCCM, and series of Top ICU and Top Pulmonary consults.
