Bronchiectasis diagnosis, treatment. Bronchiectatic disease - etiology, pathogenesis, clinic, diagnosis
Bronchiectasis is a localized suppurative process in pathologically dilated bronchi, accompanied by their functional impairment. There is a concept of bronchiectasis primary and secondary. Under secondary bronchiectasis understand the pathological expansion of the bronchi as a complication or manifestation of other diseases. Primary bronchiectasis has no apparent connection with any pathological processes in the bronchi and is the main morphological substrate of bronchiectasis.
Classification:
- According to the clinical course and severity, 4 forms of the disease are distinguished: mild, severe, severe and complicated.
- According to the prevalence of the process - unilateral and bilateral bronchiectasis with indication of localization by segments.
- There are phases of exacerbation and remission.
Etiology, pathogenesis, pathological anatomy
Currently, there is no accurate data on the pathogens that cause the development of bronchiectasis. Staphylococci, pneumococci, Haemophilus influenzae, etc. are the cause of exacerbation of the inflammatory process in already formed bronchiectasis. It is known that bronchiectasis develops most often in patients who have had acute infectious diseases of the bronchopulmonary system in childhood: pneumonia, measles, whooping cough, etc., or in those suffering from chronic obstructive bronchitis, leading to a change in the bronchial wall.
The leading factor in the pathogenesis of bronchiectasis is the formation of obstructive atelectasis as a result of impaired patency of large and medium bronchi, due to a delay in viscous secretion. The overlap of the lumen of the bronchus can also occur with cicatricial stenosis, a growing tumor, hyperplasia of the lymph nodes.
Obstruction of the bronchus leads to the development of a suppurative process distal to the site of blockage and irreversible changes in the walls of the bronchus. There is a restructuring of the mucous membrane, degeneration of cartilage and smooth muscles occurs, fibrous tissue develops. Degenerative processes in the bronchial wall can be aggravated by impaired pulmonary circulation and innervation. Finally, the possibility of genetically determined inferiority of the bronchial tree should also be taken into account: insufficient development of smooth muscles, elastic and cartilaginous tissue in the bronchial wall. As a result, the action of "bronchodilating forces" is manifested: an increase in intrabronchial pressure during coughing, forced breathing and accumulation of secretions, an increase in pressure in the pleural cavity due to a decrease in lung volume due to the development of atelectasis. All this leads to a persistent expansion of the lumen of the bronchi with a violation of the cleansing function. This, in turn, contributes to the periodic exacerbation of the suppurative process in bronchiectasis.
A certain pathogenetic role is played by foci of chronic infection in the nasopharynx: sinusitis, sinusitis, adenoids, chronic tonsillitis, which contribute to infection of the upper and lower respiratory tract. In the pathogenesis of bronchiectasis, primary ciliary dyskinesia is of great importance, characterized by dysfunction of the cilia of the ciliated epithelium. The movements of the cilia become chaotic, which leads to a violation of the upward flow of mucus and the purification of the respiratory tract from bacteria. The disease is manifested by bronchiectasis, sinusitis and otitis media.
The leading symptom of bronchiectasis is the expansion of the bronchi. Distinguish bronchiectasis cylindrical, saccular, varicose and mixed. The walls of the bronchi can be thinned, the mucous membrane is uneven. In the walls of the bronchi, histologically, chronic inflammation with peribronchial and perivascular sclerosis is detected. Bronchial epithelium in bronchiectasis metaplasia into a stratified squamous epithelium with the disappearance of the normal ciliary cover. In the parenchyma of the lung, areas of atelectasis are detected. They are reduced in size, dense, airless. In these areas, sclerosis of the parenchyma occurs. In bronchiectasis not associated with atelectasis, areas of the lung in the affected area are usually normal.
Symptoms
Bronchiectasis is more common in men. The main complaints in patients are cough with sputum, shortness of breath and fever. The cough is persistent and is accompanied by purulent sputum. The daily amount of sputum ranges from a few spittles to 300-400 ml or more. Sputum is separated more often in the morning, a putrid smell occurs only in seriously ill patients. When settling, sputum is divided into two layers: upper mucous with an admixture of saliva, lower purulent. The amount of pus determines the severity and intensity of the suppurative process in the bronchi. Hemoptysis is a rare symptom, it is observed in adult patients with bronchial deformity.
Dyspnea occurs in patients during physical exertion, it appears mainly with a bilateral process and indicates partial obstruction of the bronchi. Shortness of breath may be due to developing respiratory and pulmonary heart failure.
In many patients, subfebrile temperature can be observed even during remission. During an exacerbation, the temperature can rise to high numbers, especially with a common process in severe patients. Some patients complain of chest pain. The pains are dull and aggravated by coughing. Sometimes pain in the chest can be associated with the involvement of the pleural sheets in the pathological process. During the period of exacerbation of bronchiectasis, there are signs of intoxication: general weakness, sweating, headaches, fatigue, decreased performance.
The condition of patients can be satisfactory, moderate and severe. Accordingly, the physical data also change. In patients with a mild course, percussion and auscultation determine a normal lung tone and vesicular breathing. The most characteristic symptom may be dry buzzing rales. In severe patients, cyanosis of the mucous membranes, emaciation, deformity of the fingers ("drumsticks") are possible. The mobility of the chest is limited, on palpation over the affected area there is a weakening of voice trembling, on percussion dullness of the percussion tone, on auscultation or weakened or hard vesicular breathing, small and medium bubbling wet and scattered buzzing rales. Bronchophony is weakened.
Clinical course
During bronchiectasis, two periods are distinguished: the initial period and the period of clinically pronounced manifestations. The initial period is characterized by a relatively satisfactory condition of patients, long-term remissions with rare exacerbations. The pathological process in the bronchi is clearly localized, most often in the basal segments of the left lung or in the middle lobe of the right lung. The duration of this period can be 14-18 years.
The period of clinically pronounced manifestations develops with the spread of bronchiectasis to the unaffected sections of the bronchi, the process becomes bilateral, diffuse. It is during this period that the condition of patients worsens, coughing intensifies, and the separation of purulent sputum increases. Often during this period, a clinic of obstructive bronchitis develops, which leads to the development of respiratory failure and cor pulmonale.
The course of bronchiectasis can be complicated by focal nephritis, amyloidosis of the kidneys and intestines, and chronic gastritis may develop, especially with frequent ingestion of purulent sputum. Perhaps the development of pleural empyema and abscesses in the lungs.
Diagnostics
In sputum, microscopy reveals a large number of neutrophils, and bacteriological examination reveals a diverse microflora (Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeroginosa, sometimes Staphylococcus aureus, anaerobic and other microorganisms.
In a functional study of the lungs in patients with bronchiectasis, mixed ventilation disorders are found. As the disease progresses, obstructive disorders begin to predominate.
The main method for diagnosing bronchiectasis is bronchography with full contrast of both lungs. Bronchography should be performed after careful drainage of the bronchi and a decrease in the suppuration process. On bronchograms, bronchial expansions of 4-6 orders of various forms and non-filling of the distal bronchi behind bronchiectasis with a contrast agent are revealed. Bronchoscopy allows assessing the severity of the suppuration process, conducting endobronchial sanitation and monitoring the effectiveness of the treatment.
An x-ray examination in patients with bronchiectasis reveals an enhanced pulmonary pattern, a decrease in volume and thickening of the shadow of the affected part of the lung (obstructive atelectasis). Atelectasis are in the form of triangles adjacent to the mediastinum. Quite often, a “middle lobe syndrome” is also detected: a reduced in volume and compacted middle lobe is detected on a lateral radiograph in the form of a darkening band 2–3 cm wide, running from the root to the anterior costophrenic sinus. In some patients, on the side of the lesion, limitation of the mobility of the dome of the diaphragm and obliteration of the pleural sinus are found.
Currently, high-resolution CT is widely used, which allows obtaining sections with a thickness of 1.0-1.5 mm and improves the non-invasive diagnosis of bronchiectasis.
Differential diagnosis of bronchiectasis usually does not cause difficulties in the presence of high-quality bronchograms, which reveal pathological expansion of the bronchi of typical localization: the middle lobe and basal segments on the right, reed segments on the left.
- The initial stage of bronchiectasis in clinical manifestations resembles chronic bronchitis. Unlike bronchiectasis, chronic bronchitis in most patients manifests itself in middle age.
- With an exacerbation of chronic bronchitis, scattered dry buzzing and wheezing rales are heard more often, with an exacerbation of bronchiectasis, localized fine and medium bubbling rales are heard. Bronchography and CT are crucial for differential diagnosis.
- In the period of clinical manifestations in the presence of persistent cough with hemoptysis, intoxication and high fever, bronchiectasis should be differentiated from pulmonary tuberculosis and central cancer.
Treatment
Treatment of patients with bronchiectasis should be aimed at the rehabilitation of the bronchial tree, especially during the period of exacerbation, facilitating sputum discharge and eliminating bronchial obstruction.
In the period of exacerbation until the results of bacteriological examination, ampicillin is prescribed orally at 250-500 mg every 6 hours or amoxicillin orally at 500 mg 3 times a day, or ceflacor 500 mg 3 times a day, or ciprofloxacin 500 mg orally 2 times a day. After clarifying the pathogen, treatment is carried out in accordance with its sensitivity to antibiotics.
Bronchoscopy is the main method of removing purulent sputum from the bronchi and local exposure to pyogenic microflora. During bronchoscopy, solutions of antiseptics, antibiotics, mucolytics (acetylcysteine in the form of a 10% solution of 2 ml) and proteolytic enzymes (trypsin, chymotrypsin, 10-20 mg in saline) are injected into the affected bronchi. Initially, the procedure is carried out 2 times a week, with a decrease in purulent sputum - 1 time in 5-7 days. The same agents can be administered after lavage through a transnasal catheter and percutaneous microtracheostomy.
To liquefy sputum, mucolytics are prescribed (acetylcysteine 600 mg orally 1 time per day, Bromhexine 8 mg orally 4 times a day, Ambroxol 30 mg orally 3 times a day). Bronchodilators are prescribed for exacerbation of bronchiectasis, accompanied by obstructive syndrome.
The discharge of purulent sputum can be enhanced by breathing exercises, vibration massage, inhalation of mucolytic drugs (acetylcysteine, bisolvan) and proteolytic enzymes (trypsin, chymotrypsin, ribonuclease) in the form of aerosols. Patients are prescribed ascorbic acid, vitamins B1, B6, methyluracil, pentoxyl, anabolic hormones (nerobol, retabolil), and general strengthening procedures are carried out. Of great importance is a complete, protein-rich diet.
Of the methods of physiotherapy, patients with bronchiectasis are prescribed UHF in low-thermal doses on the chest, followed by electrophoresis of calcium chloride, trypsin, and heparin. In a complicated course - the development of pneumonia - galvanization of the chest in the affected area is indicated.
In the complex of treatment of patients with bronchiectasis, sanitation of the upper respiratory tract should be provided.
Surgical treatment is carried out only according to strict indications (ineffectiveness of conservative treatment with limited damage, severe pulmonary bleeding, persistent atelectatic changes in the lungs). With unilateral bronchiectasis, the affected areas of the lung are removed while preserving the unaffected sections. As an extreme option, a pulmonectomy can be performed.
With bilateral bronchiectasis, the degree and symmetry of bronchial damage is taken into account. An asymmetric lesion is an indication for the removal of festering sections of the bronchial tree. With a relatively symmetrical lesion, bilateral resection is possible, which is carried out in two stages with an interval of 6-12 months. Operations usually improve the condition of patients, their working capacity is restored.
With the development of complications, mainly obstructive bronchitis with respiratory failure and cor pulmonale, surgical treatment is contraindicated. Focal nephritis, renal amyloidosis are relative contraindications to lung resection. Only with the development of renal failure, surgical treatment becomes impossible. With the rapid progression of the disease, despite intensive treatment, lung transplantation is indicated.
Rehabilitation
Rehabilitation of patients with bronchiectasis can be carried out in a suburban rehabilitation department, in local sanatoriums, in the climatic resorts of the Crimea. It is advisable to send patients to the northern resorts with one- and two-sided localization of the process in the remission phase, without the release of a large amount of purulent sputum in the warm season. Aeroionotherapy, air baths, therapeutic exercises, walks stabilize the condition of patients. Patients after surgery undergo rehabilitation, mainly in the out-of-town rehabilitation department.
Ability to work
With an exacerbation of bronchiectasis, patients should undergo a course of inpatient treatment and subsequent outpatient treatment for 5 to 7 days. Development of complications: chronic obstructive bronchitis with respiratory and cardiopulmonary insufficiency requires long-term treatment up to 1.5 - 2 months in the pulmonology department. Accession of other complications and decompensation of the cor pulmonale lead to invalidization of patients. Surgical treatment, which improves the condition of patients, contributes to the restoration of their ability to work.
Recovery Criteria
Complete recovery from bronchiectasis is possible only in childhood and adolescence. In the majority of patients, various methods of treatment (operative and conservative) contribute to the improvement of the condition: reduction or disappearance of cough and purulent sputum, reduction of shortness of breath, disappearance of signs of intoxication, normalization of external respiration. With bronchoscopy, a decrease in signs of inflammation is revealed, with a control X-ray examination, which should be carried out only according to strict indications (the presence of atelectasis or "middle lobe syndrome" in the initial study), it is possible to establish a decrease or disappearance of obstructive atelectasis zones.
Forecast
The prognosis for severe and complicated forms of bronchiectasis is unfavorable. Patients most often die from cor pulmonale decompensation and developing pulmonary complications. The prognosis improves significantly in cases of timely surgical treatment. In the postoperative period, relapses are possible due to post-resection movements of the bronchi, which violate the drainage function. Unsatisfactory results of operations are also possible, mainly due to incorrect determination of the volume of surgical treatment and leaving the affected areas of the bronchi.
Prevention
Prevention of bronchiectasis should begin with young children who often suffer from pneumonia. Timely and rational treatment of pneumonia, restorative therapy during the recovery period, hardening procedures and physical education can prevent the progression of bronchial damage. In adults, preventive measures should be aimed at combating chronic infection; obligatory dispensary observation, exclusion of smoking, elimination of occupational hazards.
Bronchoectatic disease: etiology, pathogenesis, clinic, diagnosis, treatment.
Bronchiectasis (bronchiectasis) is an acquired disease characterized, as a rule, by a localized chronic suppurative process (purulent endobronchitis) in irreversibly altered (dilated, deformed) and functionally defective bronchi, mainly in the lower parts of the lungs.
Etiology.
Reasons for development bronchiectasis to date cannot be considered sufficiently clarified. Microorganisms that cause acute respiratory processes in children, which can be complicated by the formation of bronchiectasis (causative agents of pneumonia, measles, whooping cough, etc.), can be considered an etiological factor only conditionally, since in the vast majority of patients these acute diseases end in complete recovery. Infectious pathogens that cause exacerbations of the suppurative process in already altered bronchi (staphylococcus aureus, pneumococcus, Haemophilus influenzae, etc.) should be considered as the cause of exacerbations, and not bronchiectasis. A very significant, and perhaps decisive, role in the formation of bronchiectasis is played by a genetically determined inferiority of the bronchial tree (congenital "weakness" of the bronchial wall, insufficient development of smooth muscles, elastic and cartilaginous tissue, insufficiency of protective mechanisms that contribute to the development and chronic course of infection, etc.). At present, it is still difficult to assess the significance of the factor under consideration in specific patients, and the allocation of a special group of so-called dysontogenetic bronchiectasis associated with postnatal bronchial dilatation in children with congenitally defective bronchopulmonary tissue is still controversial.
Pathogenesis.
The most important role in the pathogenesis of bronchiectasis is played by impaired patency of large (lobar, segmental) bronchi, causing a violation of their drainage function, retention of secretion and the formation of obstructive atelectasis. In children, the cause of the formation of atelectasis may be compression of the compliant, and possibly congenitally defective, bronchi by hyperplastic hilar lymph nodes or prolonged blockage of their dense mucous plug in acute respiratory infections (banal or hilar pneumonia) or tuberculosis. Decreased surfactant activity, either congenital or associated with an inflammatory process or aspiration (for example, amniotic fluid in a newborn), can also contribute to atelectasis.
Obturation of the bronchus and retention of bronchial secretions inevitably lead to the development suppurative process distal to the site of obstruction, which, being the second most important factor in the pathogenesis of bronchiectasis, apparently causes progressive irreversible changes in the walls. A decrease in the resistance of the bronchial walls to the action of the so-called “bronchodilating forces” (an increase in endobronchial pressure due to coughing, distension with accumulated secretions, negative intrapleural pressure, which increases due to a decrease in the volume of the atelectatic part of the lung) leads to a persistent expansion of the bronchial lumen. Irreversible changes in the affected section of the bronchial tree retain their significance even after the restoration of bronchial patency, as a result of which a periodically aggravated suppurative process chronically flows in the dilated bronchi with a persistently impaired cleansing function.
There is a long-noted pathogenetic relationship between bronchiectasis and upper respiratory diseasesways(paranasal sinuitis, chronic tonsillitis, adenoids), which are observed in about half of patients with bronchiectasis, especially in children. This connection is probably due to the general insufficiency of the protective mechanisms of the respiratory tract, as well as the constant mutual infection of the upper and lower respiratory tract, leading to a kind of vicious circle.
Classification.
Depending on the forms of bronchial dilatation distinguish between bronchiectasis:
cylindrical,
saccular,
fusiform
mixed.
Between them there are many transitional forms, the assignment of which to one or another type of bronchiectasis is often arbitrary. Bronchiectasias are also divided into atelectatic and non-atelectasis.
By clinical course and severity based on the classification of V. R. Ermolaev (1965), there are 4 forms (stages) of the disease:
expressed
complicated
By prevalence process, it is advisable to distinguish between one- and two-sided bronchiectasis, indicating the exact localization of changes in segments. Depending on the patient's condition at the time of the examination, the phase of the process should be indicated: exacerbation or remission.
Basic complaint patients is a cough with more or less significant amount of purulent sputum. The most abundant expectoration of sputum is noted in the morning (sometimes with a “full mouth”), as well as when the patient takes the so-called drainage positions (turning to the “healthy” side, tilting the body forward, etc.). An unpleasant, putrid odor of sputum, which in the past was considered typical of bronchiectasis, is now found only in the most severe patients. The daily amount of sputum can range from 20-30 to 500 ml or even more. During periods of remission, sputum may not be separated at all. The sputum collected in a jar is usually divided into two layers, the upper of which, which is a viscous opalescent liquid, contains a large admixture of saliva, a. the lower entirely consists of a purulent sediment. The volume of the latter characterizes the intensity of the suppurative process to a much greater extent than the total amount of sputum.
Hemoptysis and pulmonary bleeding are rare, mainly in adult patients. Occasionally, they are the only manifestation of the disease in the so-called "dry" bronchiectasis, characterized by the absence of a suppurative process in the dilated bronchi.
Shortness of breath during physical exertion worries almost every third patient. It is not always associated with a deficiency of functioning lung parenchyma and often disappears after surgery. Chest pain associated with pleural changes is observed in a significant proportion of patients.
The temperature rises to subfebrile figures, as a rule, during periods of exacerbations. High fever, decreasing after expectoration of profuse stagnant sputum, is sometimes observed in more severe patients. Also, mainly during periods of exacerbations, patients complain of general malaise, lethargy, decreased performance, depression of the psyche (usually in the presence of fetid sputum and an unpleasant odor when breathing).
The appearance of most patients is not very characteristic. Only in severe cases are there some delay in physical development and delayed puberty in children and adolescents. Cyanosis, as well as club-shaped deformity of the fingers (“drumsticks”), which was considered in the past as a typical symptom of bronchiectasis, have been rare in recent years.
Diagnostics.
At physical examination sometimes there is a slight percussion dullness and limitation of the mobility of the diaphragm in the affected area. Auscultatory here are defined coarse and medium bubbling rales, decreasing or disappearing after coughing, as well as hard breathing. During remission, there may be no physical symptoms.
On survey radiographs bronchiectasis can be suspected by characteristic cellularity against the background of an enhanced pulmonary pattern, better defined on the lateral ones, as well as by such signs as a decrease in volume and thickening of the shadow of the affected parts of the lung.
The main method confirming the presence and specifying l calcification of bronchiectasis, is bronchography with obligatory full contrasting of both lungs, which is carried out in stages or simultaneously (mainly in children under anesthesia) after careful sanitation of the bronchial tree and the maximum possible relief of the suppurative process. Bronchographically, in the affected area, one or another form of bronchial expansion of the 4th-6th orders is noted, their convergence and non-filling of the branches located peripherally with a contrast agent, as a result of which the bronchi of the affected lobe are compared with a "bundle of rods" or "a chopped broom".
Bronchoscopy is important for assessing the severity of suppuration (endobronchitis) in certain segments of the lung, as well as for endobronchial sanitation and monitoring the dynamics of the process.
Functional examination of the lungs detects predominantly restrictive and mixed ventilation disorders in patients with bronchiectasis. With a long course of the process and its complication with diffuse bronchitis, obstructive disorders begin to predominate, becoming irreversible and indicating missed opportunities for surgical treatment.
Prevention.
Prevention of bronchiectasis should be aimed primarily at the prevention and rational treatment of pneumonia in early childhood, which is an independent problem of pediatrics. In all likelihood, it is with certain achievements of the latter that the decrease in recent years in the total number of patients with bronchiectasis and the alleviation of the course of the latter are associated.
Differential diagnosis.
Differential diagnosis is carried out with chronic bronchitis, tuberculosis and lung abscess, abnormal development of the lung.
Conservative treatment plays an important role in the treatment of patients with bronchiectasis. The main element of conservative treatment is the sanitation of the bronchial tree, which, on the one hand, provides for the emptying of the latter from purulent sputum, and, on the other hand, the local effect of antimicrobial agents on pyogenic microflora. Along with sanitation by lavage with the help of installations in the affected bronchi through a transnasal catheter or with bronchoscopy of solutions of antiseptics, antibiotics, mucolytic agents, etc., auxiliary agents that promote the discharge of purulent sputum have also retained significant importance: the so-called postural drainage, breathing exercises, vibration chest massage, etc. The right regimen, restorative procedures, complete, protein-rich nutrition, etc. bring great benefits.
An important element in the treatment of bronchiectasis, especially in children, is the sanitation of the upper respiratory tract, usually carried out by otorhinolaryngologists, whose participation in the examination and treatment is mandatory.
Radical surgical intervention consists in resection of the affected area, but is not always indicated and cannot cure all patients with bronchiectasis. The optimal age for intervention should be considered 7-14 years, since at a younger age it is not always possible to accurately establish the scope and boundaries.
The content of the article
Bronchiectasis is a chronic disease, which is based on a persistent pathological expansion of the lumen of the medium and small bronchi. The disease can affect the bronchi of both or one lung or be local for a short segment or lobe of the lung in nature with destruction of the elastic and muscular components of the bronchial wall.Etiology, pathogenesis of bronchiectasis
Etiological factors are repeated diseases of the bronchial system: bronchitis, catarrhs of the upper respiratory tract, chronic pneumonia, tuberculosis, etc. Great importance in their development is attached to: 1) congenital and hereditary factors; 2) blockage of the lumen of the bronchus by a tumor, purulent plug, foreign body; 3) an increase in intrabronchial pressure. Depending on the predominance of one or another factor, bronchiectasis occurs, combined with atelectasis of a part of the lung or without it. In the presence of an inflammatory process, the elastic properties of the bronchial wall change. This is also facilitated by inflammatory processes in the lungs, in which intrapulmonary bronchial nerve nodes can be affected. The wall of the bronchus loses its tone, becomes easily extensible, a violation of the drainage function of the bronchi causes a cough, which is accompanied by an increase in intrabronchial pressure. As a result of these factors, bronchiectasis is formed.Classification of bronchiectasis
There are unilateral and bilateral bronchiectasis, and depending on the form of bronchial expansion - cylindrical, saccular and mixed.There are three stages in the development of bronchiectasis:
I - changes in the small bronchi. The walls of the bronchi are lined with cylindrical epithelium, the cavities of the dilated bronchi are filled with mucus, there is no suppuration;
II - the attachment of inflammation in the walls of the bronchi. The dilated bronchi contain pus. The integrity of the epithelium is broken, in some places it is exfoliated. In the submucosal layer develops scar connective tissue;
III - a suppurative process from the bronchi passes to the lung tissue with the development of pneumosclerosis.
Clinic of bronchiectasis
Men get sick more often. The left lung is affected 2-3 times more often than the right. Most often, bronchiectasis develops in the lower lobe of the left lung. 30% of patients have a bilateral lesion.In the anamnesis, frequent bronchitis and pneumonia are noted, and after recovery, cough and subfebrile body temperature remain. At first, the cough is dry. There may be no manifestations of the disease, but a productive cough persists, from 30-50 to 500 ml of sputum is secreted per day. Cough is most pronounced in the morning (bronchial toilet), may increase with a change in body position, which depends on the location of bronchiectasis. For a long time, sometimes for years, the general condition of patients does not suffer significantly. A frequent symptom is hemoptysis, which is associated with a destructive process in the bronchi and destruction of the vessel wall, and occasionally pulmonary bleeding becomes the leading manifestation of the disease. With the development of pneumonia around bronchiectasis, body temperature sometimes rises to 38-39 ° C. With the so-called dry form of bronchiectasis, repeated hemoptysis is the only sign of the disease.
Frequent exacerbations of the disease may be accompanied by general symptoms: the face becomes puffy, body weight decreases, acrocyanosis appears, thickening of the terminal phalanges of the fingers in the form of drumsticks and changes in nails (the shape of watch glasses) are characteristic.
Sometimes, during examination, there is a sinking of the corresponding half of the chest, narrowing of the intercostal spaces. With percussion, a slight dullness of sound over the area of the lung with localization of bronchiectasis is determined. Ascultatively, moist fine bubbling rales are detected, sometimes - hard breathing with a bronchial tinge.
Diagnostics. During the period of exacerbation, a general blood test reveals hyperleukocytosis with a shift of the leukocyte formula to the left, hypochromic anemia. In the remission phase, elevated ESR and lymphocytosis persist. When two lobes of the lung are involved in the process, the vital capacity of the lungs decreases, pulmonary ventilation is disturbed according to the obstructive type. X-ray examination reveals areas of pneumosclerosis, increased pulmonary pattern. Bronchography data are informative, which allows to identify bronchiectasis, to establish their localization. Bronchiectasis can be complicated by bleeding, pleural empyema, spontaneous pneumothorax, abscess and gangrene of the lung, sepsis.
Diagnosis of bronchiectasis
Diagnosis with a pronounced clinical picture does not cause difficulties. The leading diagnostic method should be considered radiopaque polypositional bronchography. In the affected areas of the lung, bronchi are enlarged, close to each other, devoid of small branches. With cylindrical bronchiectasis, the bronchi of the 3rd-4th order are dilated evenly and do not have narrowing towards the periphery, they end blindly. Saccular bronchiectasis is characterized by uneven expansion of the bronchi, ending in a spherical swelling. Bronchoscopy has only an auxiliary value and is used for differential diagnosis.If, the examination showed that bronchiectasis developed in the lungs. So, the treatment of bronchiectasis of the lungs is to be. It's not easy, but is it really a problem if you love life? Without treatment, bronchiectasis develops, develops into complications: emphysema, atrophic pharyngitis, bronchial asthma may develop.
Friends, hello! Svetlana Morozova is with you. Do you know that gnawing feeling when you don't know what's wrong with you and suspect everything in the world? In everyone, the hero of the book “Three in a Boat, Not Counting the Dog” sometimes wakes up - do you remember when he took a reference book of diseases in the library and found every one of them, except for puerperal fever? So, let's talk about such a disease as bronchiectasis. She is not seen very often, and it is not possible to recognize her immediately. We'll take it and find out! Forward!
Friends, read the article below, there will be a lot of interesting things in it! And those who want to: restore their health, remove chronic ailments, start eating themselves properly and much more, starting today, go to this one and get FREE video tutorials from which you will learn:
- Cause of infertility in modern, married couples.
- How to feed a child?
- How does a piece of meat become our flesh?
- Why do you need protein?
- Causes of cancer cells.
- Why is cholesterol necessary?
- Causes of sclerosis.
- Is there an ideal protein for humans?
- Is vegetarianism allowed?
Treatment of bronchiectasis of the lungs: how will we treat?
Let's start with the treatment. So where does it always start? That's right, let's go to the doctor. And then there is the following:
- Treatment with antibiotics. The first priority is to prevent the spread of the infection. The medication regimen is always prescribed for each case separately. I'll explain why. If the lesion is severe, then in this case antibiotics should be taken daily, even during periods of remission. If bronchiectasis is developed quite easily, it is easier here.
At the same time, the method of administration can be different: in tablets, inhalers, aerosols, through intramuscular and intravenous injections. But the most effective is to administer an antibiotic using bronchoscopy. More on this a little further.
Gymnastics for breathing
There are a couple of nuances here. Firstly, you need to breathe in a special way, in jerks, that is, simulating a cough, with long exhalations. Secondly, during exercise, sometimes you need to tap on the place where, as it is established, there is an accumulation of phlegm. Do not beat on the chest, but lightly beat. Such manipulations are needed again to alleviate sputum. And during the period of exacerbation, it is better not to do gymnastics.
So, the main positions, lying everywhere:
- IP: on the back. The legs should be slightly raised, you can put a cushion / pillow or put your feet on the armrest of the sofa. One hand rests on the stomach, the other on the chest. We breathe in the stomach, calmly, we try to stretch the exhalation. With the help of hands, we make sure that the breath is exactly abdominal.
- IP: on the back, arms along the body. On the inhale we spread our arms to the sides, on the exhale we pull the knees to the chest with our hands.
- IP: as in the previous one. On the inhale we raise our hands behind the head, on the exhale we raise the straight leg and at the same time we lower our hands.
- IP: same. With an inhalation, we spread our arms to the sides, trying to bend in the back. As you exhale, cross your straight arms in front of you as much as possible, squeezing your chest a little.
- IP: on the side. Stretch your hand near the floor along the body, remove your free hand behind your head. On the inhale we lift it up, on the exhale we lower it to the chest, trying to put pressure on the chest.
- IP: same. We raise our free hand up while inhaling, while exhaling, we simultaneously pull the knee to the chest and lower the hand, helping the knee.
- IP: on the stomach. On inspiration, we take our hand behind our back, we reach for it with the upper body. On exhalation, we return to the IP.
The exercises are all based on similar movements. Raise, tighten, push, breathe slowly and with a forced exhalation. You can do any similar movements that come to mind. The main thing is that the posture is natural. Do not "reach your left heel to your right ear."
Treatment of bronchiectasis of the lungs: folk advice
Do not forget that folk remedies should not be used instead of drugs. Only as an addition. Everyone knows breast fees from medicinal herbs. Probably, in childhood, everyone was given this when they coughed. But with purulent sputum, some herbs are not allowed, so we consult a doctor about everything.
What recipes are considered the most effective:
- Garlic. Chop the head of garlic and mix with a glass of milk. Boil the resulting mixture over low heat for 5 minutes, then filter and take a tablespoon three times a day before meals.
- Carrot. Namely, its juice. Whether you make it yourself or buy it doesn't matter. Mix a glass of juice with a glass of milk and add 2 tbsp. l. lime honey, set aside in a dark corner for 6 hours. Sometimes we get in the way. When it is infused, we take 1 tbsp during the day. l. up to 6 times, preheated.
- Wine infusion. We take large leaves of aloe, 4-5 pieces, scald with boiling water and knead. We try not to squeeze out the juice. Then pour the leaves with wine and let it brew for 4 days. After that, you can take the infusion according to Art. l. three times per day.
- Herbs. We need expectorant herbs that are taken for wet coughs. And this is licorice root, calendula, wild rosemary, marshmallow, coltsfoot, anise, sage.
We define signs
Not always bronchiectasis is diagnosed immediately. It's all about disguise, so to speak. At first it looks like, then like pneumonia, and all the time it looks like bronchitis. Therefore, the picture is clarified only by a complete diagnosis, including X-ray, bronchoscopy, bronchography, determination of respiratory function (peak flowmetry, spirometry).
The main symptoms are:
- Cough. Very wet, frequent. There is a lot of sputum, it has a characteristic purulent color, with an unpleasant odor. My favorite time of day is morning. People get up with a mouthful of exudate. That's when the morning does not start with coffee.
- If the blood vessels are affected, then blood appears in the sputum. It can be both completely innocent streaks, and hemoptysis, and up to pulmonary hemorrhage.
- Almost everyone has anemia here. Manifested typically: pallor, weakness, weight loss. Children lag behind in physical development, puberty begins later.
- During exacerbations, the temperature rises, the cough intensifies, and there is also more sputum. All signs of bronchopulmonary infection and intoxication.
- Respiratory failure is especially pronounced in children: shortness of breath, cyanosis (cyanosis), chest changes. Often enough to look at the hands. With respiratory failure, the nail phalanges of the fingers swell, become like “drumsticks”. And the nails are compared with “watch glasses” - flat, round.
Oh that infection
Most people only become aware of the existence of such a disease when they or their children are diagnosed with it. So what is this disease?
The bronchi change shape, expand. Unfortunately, irreversibly, forever. Such changes in the bronchial trunk are called bronchiectasis, which I have mentioned so many times today. Purulent sputum accumulates in them, the respiratory function becomes inferior.
In rare cases, the cause of bronchiectasis is the underdevelopment of the bronchopulmonary system from birth. But most often the disease begins in childhood, from 5 to 25 years old, when an aggressive infection constantly invades fragile bronchi in children.
The medical history of patients with such a diagnosis is almost always replete with records of weak, frequent colds, chronic bronchitis, bronchiolitis - and here are ready-made bronchiectasis.
This differs from pneumonia in that here the parenchyma of the lungs (surface tissue) is not affected by inflammation, and atelectases (deflated, flaccid, areas of the lungs that have lost porosity) do not form.
What will happen if you start the situation, it is not hard to imagine. Without treatment, bronchiectasis develops, develops into complications (COPD, emphysema, cardiac, renal, respiratory failure, atrophic pharyngitis), bronchial asthma may develop. By the way, there is an interdependence here. And asthma can occur due to bronchiectasis, and vice versa.
If treated properly, the prognosis is good. In 80% of cases, it can be achieved that the exacerbation will be no more than 1 time per year. And sometimes with the help of a good operation they completely get rid of such a problem.
That's all, basically.
Don't worry friends.
It's time to make the right choice for your health. Before it's too late - act! Now 1000 year old recipes are available for you. 100% natural Trado complexes is the best gift for your body. Start restoring your health today!
All the best!
The disease is bronchiectasis- an acquired disease characterized, as a rule, by a localized chronic suppurative process (purulent endobronchitis) in irreversibly altered (dilated, deformed) and functionally defective bronchi, mainly in the lower parts of the lungs (N. V. Putov, 1984). Bronchiectasis does not include bronchiectasis that develops a second time as a result of an infectious process that damages the bronchial wall (chronic purulent bronchitis, chronic pneumonia, tuberculosis, etc.).
Classification of bronchial etiology (N. V. Putov, 1984)
I. Form of bronchial dilatation: 1. Cylindrical. 2. Saccular. 3. Fusiform. 4. Mixed.
II. The state of the parenchyma of the affected lung: 1. Atelectatic. 2. Not associated with atelectasis.
III. Clinical course (form): 1. Easy. 2. Expressed. 3. Heavy. 4. Complicated.
IV. Phase. 1. Aggravation. 2. Remission.
V. Prevalence of the process: 1. Unilateral. 2. Bilateral. With an indication of the exact localization of changes by segments.
In mild form, patients experience 1-2 exacerbations during the year; during periods of long remissions, they feel practically healthy and quite efficient.
With a pronounced form of exacerbation, they are more frequent and prolonged, 50-200 ml of sputum is secreted per day. Outside of exacerbation, patients continue to cough, separating 50-100 ml of sputum per day. Moderate disturbances of respiratory function are observed; load tolerance and performance are reduced.
The severe form of bronchiectasis is characterized by frequent and prolonged exacerbations, accompanied by a noticeable temperature reaction. They produce more than 200 ml of sputum, often with a fetid odor. Remissions are short-term, observed only after long-term treatment. Patients remain able-bodied and during remissions.
With a complicated form of bronchiectasis, various complications join the signs inherent in the severe form: cor pulmonale, pulmonary heart failure, focal nephritis, amyloidosis, etc.
The independence of bronchiectasis as a separate nosological form can now be considered proven by the following circumstances. The infectious-inflammatory process in bronchiectasis occurs mainly within the bronchial tree, and not in the lung parenchyma. In addition, a convincing confirmation is the operation, in which the removal of bronchiectasis leads to the recovery of patients.
Etiologybronchial disease:
- 1. Genetically determined inferiority of the bronchial tree (congenital "weakness" of the bronchial wall, insufficient development of smooth muscles, elastic and cartilage tissue, insufficiency of protective mechanisms), which leads to a violation of the mechanical properties of the walls of the bronchi during their infection.
- 2. Conditional etiological factor - microorganisms that cause acute respiratory processes (pneumonia, whooping cough, etc.) in children. Finally, the causes of bronchiectasis remain insufficiently clarified.
Pathogenesisbronchiectasis includes factors leading to the development of bronchiectasis, and factors leading to their infection.
Lead to the development of bronchiectasis:
- a) obstructive atelectasis that occurs when bronchial patency is impaired (the development of atelectasis is facilitated by a decrease in surfactant activity, compression of the bronchi by hyperplastic hilar lymph nodes in the case of hilar pneumonia, tuberculous bronchodenitis; prolonged blockage of the bronchi with a dense mucous plug in acute respiratory infections);
- b) a decrease in the resistance of the walls of the bronchi to the action of bronchodilating forces (an increase in intrabronchial pressure during coughing, stretching of the bronchi with an accumulating secret, an increase in negative intrapleural pressure due to a decrease in the volume of the atelectatic part of the lung);
- c) the development of an inflammatory process in the bronchi, if it progresses, leads to degeneration of cartilage plates, smooth muscle tissue with replacement by fibrous tissue and a decrease in bronchial resistance.
The following mechanisms lead to infection of bronchiectasis:
- a) violation of expectoration, stagnation and infection of the secret in the dilated bronchi;
- b) dysfunction of the system of local bronchopulmonary protection and immunity.
In turn, the suppurative process in the bronchi contributes to the further expansion of the bronchi. Subsequently, the blood flow through the pulmonary arteries decreases, and the network of bronchial arteries hypertrophies, through extensive anastomoses, blood is discharged from the bronchial arteries into the pulmonary artery system, which leads to the development of pulmonary hypertension. Men are more often ill.
Clinical symptoms bronchial disease:
1. Main complaints: cough with discharge of purulent sputum of an unpleasant odor, especially in the morning ("full mouth"), as well as when taking a drainage position in an amount of 20-30 to several hundred milliliters; possible hemoptysis; general weakness; anorexia; increase in body temperature.
2. On examination: pallor of the skin and visible mucous membranes, with the development of DN - cyanosis, shortness of breath; thickening of the terminal phalanges ("drumsticks") and nails ("watch glasses"); lag of children in physical and sexual development.
3. Physical examination of the lungs: lag of lung mobility on the side of the lesion; auscultatory - hard breathing and dullness of percussion sound, coarse and medium bubbling rales over the lesion.
Laboratory data
1. OAK: signs of anemia, leukocytosis, shift of the leukocyte formula to the left and an increase in ESR (in the acute phase). 2. Urinary OA: proteinuria. 3. BAC: decrease in albumin content, increase in ag- and y-globulins, as well as sialic acids, fibrin, seromucoid, haptoglobin in the acute phase. 4. OA of sputum: purulent; when settling - two or three layers; in sputum there are many neutrophils, elastic fibers, erythrocytes can be found.
Instrumental Research
Radiography of the lungs: a decrease in the volume of the affected part of the lung, a mediastinal shift towards the lesion, a high position of the diaphragm, amplification, deformation, cellularity of the lung pattern, sometimes intense darkening of a sharply reduced lobe. Bronchography: cylindrical or saccular dilatations of the bronchi of the IV, VI order, their convergence, deformation, lack of contrast distally located branches. Bronchoscopy: purulent bronchitis is detected, the source of bleeding is specified. Spirography: restrictive or mixed type of respiratory failure.
Survey program
1. OA of blood, urine. 2. BAC: total protein, protein fractions, seromucoid, sialic acids, fibrin, haptoglobin, urea. 3. General sputum analysis, for BK, elastic fibers, atypical cells. 4. Spirography. 5. Bronchoscopy with sputum examination for flora and its sensitivity to antibiotics. 6. Radiography of the lungs. 7. Bronchography.
Diagnosis example
Bronchiectasis, severe course, in the acute phase; cylindrical oronchiectasis in the lower lobes of both lungs.
Diagnostic Handbook of Therapist. Chirkin A. A., Okorokov A. N., 1991
