Bronchorrhea Explained

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] __TOC__

Treatment

Treatment options for bronchorrhea vary depending on the inciting cause; they 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]

Notes and References

1. Lembo T, Donnelly T . A case of pancreatic carcinoma causing massive bronchial fluid production and electrolyte abnormalities . Chest . 108 . 4 . 1161–3 . 1995 . 7555132 . 10.1378/chest.108.4.1161.
2. Shimura S, Sasaki T, Sasaki H, Takishima T . Chemical properties of bronchorrhea sputum in bronchial asthma . Chest . 94 . 6 . 1211–5 . 1988 . 2903819 . 10.1378/chest.94.6.1211.
3. Gavelli G, Canini R, Bertaccini P, Battista G, Bnà C, Fattori R . Traumatic injuries: imaging of thoracic injuries . European Radiology . 12 . 6 . 1273–1294 . June 2002 . 12042932 . 10.1007/s00330-002-1439-6 . 1919039 .
4. Shimura S, Takishima T . Bronchorrhea from diffuse lymphangitic metastasis of colon carcinoma to the lung . Chest . 105 . 1 . 308–10 . 1994 . 8275762 . 10.1378/chest.105.1.308.
5. Mito K, Yamakami Y, Kashima K, Mizunoe S, Tokimatsu I, Ichimiya T, Hiramatsu K, Nagai H, Kadota J, Nasu M . [A case of suspected lung metastasis of pancreatic carcinoma with bronchorrhea similar to bronchioloalveolar carcinoma] . Nihon Kokyuki Gakkai Zasshi . 40 . 8 . 666–70 . 2002 . 12428395.
6. Book: Abbott. Mark S. Parker, Melissa L. Rosado de Christenson, Gerald F.. Teaching atlas of chest imaging. 2005. Thieme. New York. 978-1588902306.
7. Kitazaki T, Soda H, Doi S, Nakano H, Nakamura Y, Kohno S . Gefitinib inhibits MUC5AC synthesis in mucin-secreting non-small cell lung cancer cells . Lung Cancer . 50 . 1 . 19–24 . 2005 . 16009452 . 10.1016/j.lungcan.2005.05.005.
8. Kitazaki T, Fukuda M, Soda H, Kohno S . Novel effects of gefitinib on mucin production in bronchioloalveolar carcinoma; two case reports . Lung Cancer . 49 . 1 . 125–8 . 2005 . 15949598 . 10.1016/j.lungcan.2004.11.027.
9. Milton D, Kris M, Gomez J, Feinstein M . Prompt control of bronchorrhea in patients with bronchioloalveolar carcinoma treated with gefitinib (Iressa) . Support Care Cancer . 13 . 1 . 70–2 . 2005 . 15558327 . 10.1007/s00520-004-0717-z. 8562408 .
10. Takao, Motoshi. Successful treatment of persistent bronchorrhea by gefitinib in a case with Recurrent Bronchioloalveolar Carcinoma: a case report . World J Surg Oncol . 1 . 1 . 8 . 2003 . 12917017. 10.1186/1477-7819-1-8 . Inoue . K . Watanabe . F . Onoda . K . Shimono . T . Shimpo . H . Yada . I . 183862 . free .
11. 10.1111/j.1349-7006.2003.tb01464.x . Yano S, Kanematsu T, Miki T, Aono Y, Azuma M, Yamamoto A, Uehara H, Sone S . 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") . 94 . 5 . 453–8 . 2003 . 12824893 . Cancer Science. free . 11160214 .
12. Tamaoki J, Kohri K, Isono K, Nagai A . Inhaled indomethacin in bronchorrhea in bronchioloalveolar carcinoma: role of cyclooxygenase . Chest . 117 . 4 . 1213–4 . 2000 . 10767270 . 10.1378/chest.117.4.1213.
13. Homma S, Kawabata M, Kishi K, Tsuboi E, Narui K, Nakatani T, Nakata K . Successful treatment of refractory bronchorrhea by inhaled indomethacin in two patients with bronchioloalveolar carcinoma . Chest . 115 . 5 . 1465–8 . 1999 . 10334175 . 10.1378/chest.115.5.1465.
14. Tamaoki J, Chiyotani A, Kobayashi K, Sakai N, Kanemura T, Takizawa T . Effect of indomethacin on bronchorrhea in patients with chronic bronchitis, diffuse panbronchiolitis, or bronchiectasis . Am Rev Respir Dis . 145 . 3 . 548–52 . 1992 . 1546834 . 10.1164/ajrccm/145.3.548.
15. Nakajima T, Terashima T, Nishida J, Onoda M, Koide O . Treatment of bronchorrhea by corticosteroids in a case of bronchioloalveolar carcinoma producing CA19-9 . Intern Med . 41 . 3 . 225–8 . 2002 . 11929186 . 10.2169/internalmedicine.41.225. free .
16. Hudson E, Lester J, Attanoos R, Linnane S, Byrne A . Successful treatment of bronchorrhea with octreotide in a patient with adenocarcinoma of the lung . J Pain Symptom Manage . 32 . 3 . 200–2 . 2006 . 16939841 . 10.1016/j.jpainsymman.2006.05.003. free .
17. Krawtz S, Mehta A, Vijayakumar S, Stoller J . Palliation of massive bronchorrhea . Chest . 94 . 6 . 1313–4 . 1988 . 2461277 . 10.1378/chest.94.6.1313-b. free .