Bronchiectasis (or bronchiectasis) is an acquired disease accompanied by irreversible structural changes(expansion, deformation) and chronic purulent process in the bronchi. Most often this pathology affects the lower regions respiratory tract, and a violation of the structure of the bronchi can affect one segment or lobe of the lung, or be diffuse.
This disease occurs against the background of recurrent bronchopulmonary infection, and its main symptoms are cough and purulent sputum. According to statistics, bronchiectasis most often develops in childhood or young age (from 5 to 25 years) and affects about 1-1.5% of the population. In this article we will talk about the causes and symptoms of the pathology, as well as methods for diagnosing and treating the disease. Let's talk about the consequences.
Causes and classification
Frequent bronchitis increases the risk of developing bronchiectasis.The reasons for the development of bronchiectasis and the appearance of deformed areas of the bronchi have not yet been fully elucidated, but the factors that in most cases provoked this bronchopulmonary pathology have been established.
The causes of bronchiectasis (areas of bronchial deformation) include:
- congenital predisposition to bronchial dysplasia;
- frequent and;
- lung abscess;
- foreign bodies;
- expiratory stenosis of the trachea and bronchi;
- allergic bronchopulmonary aspergillosis;
- Mounier-Kuhn syndrome;
- Williams-Campbell syndrome;
- cystic fibrosis, etc.
The above-described diseases and conditions significantly worsen the mechanisms of sputum discharge from the respiratory tract, and infection with various infections (Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, etc.) is accompanied by filling of the bronchi with viscous secretions. Sputum accumulated in the bronchial tree can cause expansion and subsequent scarring (deformation) of the bronchi.
The examination reveals the following bronchiectasis:
- cylindrical;
- fusiform;
- saccular;
- mixed.
In the absence of infection, these areas of bronchial deformation may not manifest themselves in any way, but when a pathogenic microorganism is introduced, the cavities are completely filled with purulent contents and manifest themselves as long-lasting chronic inflammation. Thus, bronchiectasis begins to develop, which is aggravated by obstruction and difficult self-cleaning of the bronchial tree.
According to severity, pulmonologists distinguish four forms of this disease(according to Ermolaev):
- light;
- expressed;
- heavy;
- complicated.
Bronchiectasis is also classified according to its prevalence. pathological process:
- right-sided;
- left-handed.
For more detailed clarification of the localization of pathological foci, indicate lung segment. Most often, bronchiectasis is localized in the basal or lingular segment of the left lung or in the basal segment or middle lobe of the right lung.
Symptoms
The main complaint of patients during an exacerbation of bronchiectasis is a cough with purulent sputum. The amount of secretion may vary and depends on the stage of the disease. In some severe cases, about 30-300 (sometimes up to 1000) ml of purulent contents can be separated from the bronchi.
The sputum of a patient with bronchiectasis collected in a jar tends to separate over time. Upper layer contains impurities of saliva and is a viscous mucous liquid, and the lower one consists of purulent secretion. It is the amount of the lower layer that can determine the intensity of the inflammatory process.
The most abundant sputum is released in the morning (immediately after waking up) or during the so-called drainage positions of the body (turning onto the healthy side, tilting the body forward, etc.). As the disease progresses, the sputum acquires a putrid odor and becomes increasingly fetid. Many patients complain of frequent bad breath, shortness of breath, and increased coughing when trying to change body position.
When the disease worsens, purulent inflammation in the bronchi is accompanied by intoxication of the body, and the patient develops the following symptoms:
- weakness;
- fast fatiguability;
- sweating;
- increased body temperature (up to 38-39 °C);
- chills.
During auscultation (listening), the patient can hear hard breathing and a large number of wheezing, which are especially pronounced in the morning. Patients may also experience a decrease in body temperature to subfebrile levels after the discharge of a large portion of sputum.
As the disease progresses, coughing can lead to hemoptysis. Patients may complain of dull pain in the chest area and lesions paranasal sinuses nose
In the initial (mild) stages of the disease appearance patients are normal, but as the severity of bronchiectasis increases, the complexion acquires an earthy tint and it becomes puffy. Such patients have fingers shaped like drumsticks and nails shaped like watch glasses. Also, prolonged purulent intoxication of the body and hypoxemia can lead to the appearance of diffuse cyanosis.
Diagnostics
An informative method for diagnosing bronchiectasis is chest x-ray. Diagnostic examination for bronchiectasis always includes a complex of various measures:
- taking anamnesis;
- auscultation;
- physical examination;
- radiography;
- bronchography (main method);
- bronchoscopy;
- bacteriological examination of sputum;
- cytological examination of sputum;
- spirometry;
- peak flowmetry;
- CT scan.
As additional methods examinations of the patient may be prescribed:
- sweat chloride analysis;
- analysis to detect rheumatoid factor;
- testing for Aspergillus precipitins;
- immunological blood test, etc.
Treatment
The choice of treatment tactics for bronchiectasis depends on the stage and severity of the disease.
During the period of exacerbation, the main goal of therapy is aimed at eliminating purulent inflammation of the bronchial tree and sanitizing the bronchi. For this, the patient is prescribed antibacterial and antimicrobial drugs:
- semisynthetic penicillins: Oxacillin, Methicillin, etc.;
- cephalosporins: Cefazolin, Ceftriaxone, Cefotaxime, etc.;
- Gentamicin;
- sulfonamide drugs: Sulfadimethoxine, Biseptol, etc.
They can be administered intravenously, intramuscularly and endobronchially (during therapeutic bronchoscopy).
Also, for bronchoscopic drainage, in addition to antibiotics, proteolytic enzymes (Chymotrypsin, Ribonuclease, Trypsin), Dioxidin, mucolytics (Bromhexine, Acetylcysteine, etc.) can be used. At the beginning of the disease, these procedures are carried out 2 times a week, and then they can be used once every 6-7 days. This therapeutic bronchoscopy allows you to wash the walls of the bronchi, remove purulent secretions and deliver medicines directly into the foci of bronchiectasis.
For the most efficient removal of sputum, patients are prescribed:
- expectorants;
- massage;
- breathing exercises;
- drinking plenty of alkaline drinks;
- electrophoresis, etc.
After eliminating the inflammation, the patient is recommended to take medications for (Methyluracil, Retabolil or Nerabol, B vitamins and high doses ascorbic acid). In the stage of stable remission, it is highly desirable to conduct courses of sanatorium-resort treatment (Evpatoria, Yalta, Sochi, Alupka, etc.).
Radical surgical treatment of bronchiectasis is indicated in cases where, after resection of areas of lung tissue, it is possible to maintain sufficient respiratory function. Conditions accompanied by massive pulmonary hemorrhage may also be an indication for it. In such cases, bronchial embolization is performed and symptomatic treatment is carried out.
In case of unilateral bronchiectasis, the affected parts of the lung are removed during the operation (in extreme cases, a pneumectomy can be performed). In the case of bilateral damage to the bronchial tree, the possibility of performing surgical intervention is determined by analyzing data for each clinical case. The condition of patients after such operations in most cases improves significantly, and further clinical observation, anti-relapse treatment and preventive measures make it possible to achieve a complete recovery.
Prognosis and complications
Pneumothorax is one of the serious complications of bronchiectasis. Bronchiectasis lasts a long time and often worsens in the spring and autumn. Its relapses are provoked infectious diseases respiratory tract or hypothermia.
The lack of adequate therapy and prolonged severe course of bronchiectasis gives extremely unfavorable prognosis and leads to disability of the patient. It can be complicated by the following serious diseases and conditions:
- pulmonary hemorrhages;
- pleural empyema;
- amyloidosis of internal organs;
- metastatic brain abscesses.
With adequate treatment, the prognosis of this pathology can be favorable. Effective courses prophylaxis with anti-inflammatory drugs and Spa treatment can lead to persistent and long-term remissions, and surgical treatment (removal) of bronchiectasis in some cases guarantees complete relief from this disease.
Closely related to the group of suppurative processes in the lungs are bronchiectasis - dilation of the bronchi, resulting from combined damage to the bronchi and lung tissue. In some cases, this disease is the main, leading one, causing changes in the entire body, so it should be called bronchiectasis.
In other cases, dilatation of the bronchi does not represent an independent disease, but is only a consequence of various pathological processes in the bronchi and lungs - and for them the old name bronchiectasis or bronchiectasis can be retained, although in each specific case it is quite difficult to draw the line between bronchiectasis and bronchiectasis.
Bronchiectasis as an independent disease was first described in 1819 by Laennec, and from that time the clinical study of this disease began.
Causes of bronchiectasis
The very name “bronchiectasis” does not exhaust the essence of the pathological process, since in addition to changes in the bronchi there are changes in the lung tissue, and often the pleura.
A distinction should be made between acquired and congenital bronchiectasis. Acquired bronchiectasis is much more common than congenital bronchiectasis and usually occurs after focal pneumonia of various etiologies (influenza, measles, whooping cough, etc.), especially after repeated pneumonia over a period of several years. However, the presence of only residual effects after focal pneumonia is not enough to cause expansion of the bronchial walls; A factor contributing to the stretching of the bronchial wall is also chronic bronchitis, in which coughing impulses for months or even years contribute to the development of bronchiectasis.
The main pathogenetic factor is a decrease in the elasticity of the bronchial wall itself and an increase in its compliance; this is facilitated by an increase in expiratory pressure - in particular when coughing.
Chronic scarring inflammatory processes in the lungs around the bronchi, as well as organizing pleurisy, are important and influence.
Of course, a number of functional factors in the form of bronchospasms are also important in the development of bronchiectasis.
Consequently, the leading role in the occurrence of bronchiectasis belongs to a combination of two factors - residual effects after suffering focal pneumonia and the presence of bronchitis and peribronchitis, changing the elasticity of the bronchial walls.
Pathological anatomy
It is necessary to distinguish between 2 main forms of bronchial expansion - cylindrical and saccular; with cylindrical bronchiectasis there is a uniform expansion of the bronchus, the walls of which are mostly thickened and hypertrophied; the surrounding lung tissue is normal or fibrotic. Saccular bronchiectasis usually develops predominantly in altered lung tissue; they come in different sizes - up to a chicken egg; their walls are often sharply atrophied, the surrounding lung tissue is wrinkled and atrophied. The mucous membrane of the dilated bronchi is thickened, infiltrated, and later atrophic. The vessels of the submucosal tissue are often aneurysmically dilated and can serve as a source of bleeding.
In addition to the cylindrical and saccular forms of bronchiectasis, there are also mixed forms, called fusiform; their mucous membrane is more often atrophied, less often hypertrophied, sometimes ulcerations or polypous growths appear, which serve as a source of bleeding. Around bronchiectasis there are atelectatic or emphysematous areas of lung tissue; sometimes there are separate “bronchiectatic cavities” in the wrinkled lung tissue.
Symptoms of the disease
The initial stage of bronchiectasis is often almost asymptomatic, but then the main complaint of patients is a persistent cough, often in attacks. The sputum is often mixed with blood, and in some cases there may be periodic hemoptysis with the release of pure blood.
With so-called dry bronchiectasis, even in advanced cases, little sputum is usually produced, but hemoptysis often occurs, which forces patients to seek treatment. medical care. In addition to the listed complaints, patients with bronchiectasis complain of periodic increases fever, weakness, fatigue, sometimes shortness of breath.
Upon examination, fingers and even toes are usually found in the form of drumsticks and nails in the form of watch glass, which is more often observed in the stages of severe disease; in these cases there may be mild deformations of the chest, which is associated with the presence of pulmonary fibrosis. Slight cyanosis of the face and extremities may be observed. Percussion, with the exception of moderate tympanitis caused by the presence of concomitant pulmonary emphysema, does not produce characteristic changes; voice tremors most often not changed. From the outside of cardio-vascular system no special deviations from the norm are observed; during periods of exacerbation, the pulse usually quickens, shortness of breath increases, and cyanosis increases.
Diagnostics
The diagnosis of bronchiectasis is difficult. In addition to clinical data, x-ray examination and, in particular, bronchography should be widely used.
On the radiograph, in some cases, you can see tracks corresponding to the course of the bronchi, which, if there is a corresponding clinical picture makes it possible to assume the presence of cylindrical bronchiectasis. Saccular bronchiectasis often produces round or oval shadows, sometimes located side by side in the form of cells resembling a honeycomb.
The most accurate results are provided by bronchography, which has become widespread over the past 40 years. For this purpose, a contrast agent is injected into the bronchial tree - in particular, iodolipol (a solution of iodine in poppy oil), iodipine, brominol, etc.; these substances are well tolerated by patients and provide good contrast in the X-ray image. Cylindrical bronchiectasis on bronchography gives wider linear shadows than normal bronchi, and saccular bronchiectasis gives round or oval shadows filled with contrast agent.
Bronchography is one of the most precise methods diagnosis of bronchiectasis, a very valuable addition to clinical methods research and is certainly necessary in cases when it comes to the need for surgical intervention.
Examination of sputum reveals its mucopurulent nature, often mixed with blood. With “dry” bronchiectasis, sputum is in small quantities, but mixed with blood; in most cases there is a lot of sputum - sometimes up to 0.5 liters or more; often it is three-layered, with a smell.
In the blood - neutrophilic leukocytosis, especially during exacerbation of the disease, often a shift leukocyte formula left; ROE is usually accelerated.
Drumstick-shaped fingers were described by Hippocrates, and are still called Hippocratic fingers in French literature. It should be emphasized that drumstick-shaped fingers can also be observed in other chronic respiratory diseases, chronic cardiovascular failure, in prolonged septic endocarditis, and sometimes even in healthy people, but their presence is most typical for bronchiectasis.
Complications of bronchiectasis
One of the common complications of bronchiectasis is pulmonary emphysema; due to disruption of bronchial patency, stretching of the alveoli, obliteration of blood vessels, death of elastic elements of the lung tissue and disappearance of alveolar septa occur with the development of pneumosclerosis; There is a disturbance in gas exchange in the lungs, which leads to cyanosis and increased shortness of breath. Subsequently, due to the death of the alveoli and obliteration of the blood vessels of the small circle, pulmonary heart failure occurs with all the ensuing consequences.
Often in inflammatory process the pleura is involved, especially with peripheral bronchiectasis, and pleural adhesions develop, which cause pain and lead to a decrease in amplitude breathing movements, which, in turn, contributes to the stagnation of sputum and makes it difficult to remove.
A serious complication is the development of pleural empyema.
This is described severe complication, like a brain abscess, which appears to arise by embolic means, which, however, is not recognized by everyone.
Other complications, occurring in approximately 5-7% of cases, are the development of amyloidosis of internal organs - in particular, amyloid nephrosis; this complication often occurs unnoticed by the patient; it must always be kept in mind and carefully monitor the patient’s urine, since the first manifestation of amyloidosis is most often the appearance of protein in the urine.
Treatment of bronchiectasis
In the initial stages of the disease, when there are no pronounced symptoms of intoxication of the body, general hygienic measures are indicated: fresh, clean air for the patient, good nutrition with sufficient proteins and vitamins and limiting the amount of fluid administered. To facilitate expectoration of sputum, patients are recommended to take a position in which the contents of the dilated bronchi can best be emptied - position on the side, on the stomach, on the back with the foot end of the bed raised, knee-elbow position, etc. The use of antibiotics and sulfonamides during exacerbations and various symptomatic remedies.
In further periods of bronchiectasis, due to the significant development of infection in the bronchi and severe symptoms of intoxication, all the remedies indicated in the section for the treatment of abscesses and gangrene of the lungs should be used. The main measures should be aimed at fighting the infection and restoring bronchial patency - improving the outflow of the contents of the dilated bronchi; for this purpose, intratracheal administration of antibiotics and suction of pus from the bronchi using a bronchoscope are indicated.
If the development of amyloidosis is suspected, it is necessary to widely use hepatotropic drugs (campolon, antianemin) and vitamin B13.
In case of unilateral bronchiectasis and the general satisfactory condition of the patient, the question of surgical treatment is raised - prompt removal affected lobes or the entire lung. Experience recent years showed good and persistent therapeutic effect after lobectomies and pneumonectomies, especially in young people.
Prevention
To prevent the development of bronchiectasis, careful treatment of pneumonia is necessary until they are completely eliminated and the fight against chronic bronchitis using both medications, as well as various physiotherapeutic measures; climatic treatment is indicated in areas with a warm, dry climate, the fight against occupational hazards (“dust” professions), a complete ban on smoking, physiotherapy, general hardening of the body. Preventing infections in childhood also prevents bronchiectasis.
Bronchiectasis is chronic illness bronchopulmonary system, accompanied by multiple pathological dilation of the bronchi - bronchiectasis, in the mucous membrane of which a chronic inflammatory process develops, which is characterized by a long, recurrent and progressive course with purulent complications.
This disease occurs and is diagnosed, as a rule, between the ages of 5 and 25 years, but its development in mature and elderly people is not excluded.
According to statistics, for every sick woman there are three sick men.
Bronchiectasis is widespread (on average 15 per 1000 inhabitants). More common in people with bad habits. The incidence rate is slightly higher in areas with poor ecology.
Bronchiectasis develops due to various reasons. They may be due to genetic determination of the inferiority of the bronchial wall, adverse effects on the lungs of the fetus during intrauterine development. In the postnatal period, the bronchi begin to be affected by various respiratory infections, tuberculosis, cicatricial narrowing of the bronchi, exposure to foreign bodies, compression increased lymph nodes, as a result of which the blood supply to areas of the lung suffers, and their ventilation is also disrupted. The age of the patients is noteworthy. Most often, the disease manifests itself in childhood, when the child begins to often suffer from pneumonia, various colds. Initially, the cough in these infections is accompanied by sputum production. light color, and during subsequent exacerbations - gray or greenish in color. Often noted as a concomitant pathology chronic tonsillitis, sinusitis. With massive bronchiectasis, patients often have thickened terminal phalanges on the fingers and toes, which is a manifestation of hypoxia.
Symptoms of bronchiectasis
- Sputum discharge is greenish in color with a rotting smell when coughing. Comes off freely, in large quantities.
- The maximum amount of sputum is released simultaneously, usually in the morning. This is facilitated by a certain position of the patient in space. More than 200 ml of sputum can be released per day.
- Blood in the sputum (no more than 70% of patients).
- Shortness of breath on exertion (no more than 35% of patients).
- Chest pain that gets worse with inspiration.
- Cyanosis.
- Thickening of the terminal phalanges of the fingers and toes, convex nail plates, if the disease, having begun in early childhood, lasts for many years.
- Retarded physical development of patients who have been ill since early childhood.
- Accompanying fever with exacerbation of the disease.
Diagnosis of bronchiectasis
- General blood test: increase in the number of leukocytes at the time of exacerbation, shift in the leukocyte formula, increase in the erythrocyte sedimentation rate. If bronchiectasis occurs long time, anemia is possible.
- Biochemical study: increased content of sialic acids, fibrin, seromucoid, α2- and γ-globulins during exacerbation. If the course of the disease is complicated by renal amyloidosis and renal failure, as a rule, the level of creatinine and urea increases.
- Urinalysis: with the development of renal amyloidosis, protein and casts appear in the urine.
- Sputum examination: high percentage of neutrophils, wide microbial palette. Among microbes, haemophilus influenzae, streptococcus pneumoniae and pseudomonas aeraginosa are more often found, less often - staphylococcus aureus, anaerobic flora. A characteristic feature The presence of bronchiectasis is the detection of pseudomonas aeruginosa in the sputum.
- X-ray examination chest organs: in some cases, especially with mild cases, the data are not very informative.
- Bronchography: when performed, bronchiectasis is usually visible better than on a simple x-ray.
- CT scan: in terms of information content it is not inferior to bronchography.
- Fiberoptic bronchoscopy: allows you to exclude bronchial obstruction in case of damage in a limited area.
- Function Study external respiration: determines the type of ventilation disturbances that usually occur with complications of bronchiectasis. Signs of reversible bronchial obstruction are very typical.
Treatment of bronchiectasis
If the microbe that caused the disease is known, etiotropic drugs that act on a specific pathogen are used. In severe cases and constant separation of purulent sputum, treatment with antibacterial agents is carried out for a long time. Bronchial dilators are used to eliminate their obstruction and stimulate mucociliary clearance.
Against this background, the bronchi are improved with the use of expectorants and the adoption of a drainage position in bed for better discharge sputum. Very effective means rehabilitation of bronchiectasis is bronchoscopy with the introduction of antibacterial and antiseptics. With a mild course of the disease with long-term remissions, antibacterial agents used only during periods of exacerbation. Indication for surgical treatment bronchiectasis is a unilateral limited (segmental) lesion that cannot be treated conservative treatment. It is advisable to perform surgical treatment before complications appear: respiratory failure and chronic pulmonary heart disease.
Essential drugs
There are contraindications. Specialist consultation is required.
Dosage regimen (doses are given in terms of amoxicillin): orally for adults and children over 12 years of age or with a body weight of 40 kg or more for severe respiratory tract infections - 875 mg 2 times a day. or 500 mg 3 times/day. Maximum daily dose amoxicillin for adults and children over 12 years of age - 6 g. The maximum daily dose of clavulanic acid for adults and children over 12 years of age is 600 mg.
When administered intravenously, adults and adolescents over 12 years of age are administered 1 g (amoxicillin) 3 times a day, if necessary - 4 times a day. The maximum daily dose is 6 g.
The duration of treatment is up to 14 days.
Dosage regimen: the drug is administered intramuscularly and intravenously (stream or drip). For exacerbation of bronchiectasis for adults and children over 12 years of age, the dose is 1-2 g 1 time / day. or 0.5-1 g every 12 hours. The maximum daily dose is 4 g. A dose of more than 50 mg/kg body weight should be administered as an intravenous infusion over 30 minutes. The duration of treatment is determined individually.
Dosage regimen: the drug is taken orally 1 or 2 times a day. Do not chew the tablets and take a sufficient amount of liquid (from 0.5 to 1 glass); you can take them before meals or between meals. For exacerbation of bronchoectasis: 500 mg 1-2 times a day - 7-14 days.
Pills: adults and children over 12 years of age are prescribed 1 tablet. (30 mg) 3 times/day for the first 2-3 days. Then the dose of the drug should be reduced to 1 tablet. 2 times/day.
Extended release capsules: adults and children over 12 years of age are prescribed 1 caps. (75 mg) 1 time/day. in the morning or evening after eating, without chewing, with a sufficient amount of liquid.
Syrup 3 mg/1 ml: adults and children over 12 years of age are prescribed 2 scoops (30 mg) 2-3 times a day. in the first 2-3 days. Then 2 scoops 2 times a day. In severe cases of the disease, the dose is not reduced throughout the entire course of treatment. The maximum dose is 4 scoops (60 mg) 2 times a day.
Solution for oral administration and inhalation(1 ml = 20 drops): adults and children over 12 years of age are prescribed 4 ml (30 mg) 3 times a day in the first 2-3 days. Then the dose of the drug should be reduced to 4 ml 2 times a day. The oral solution can also be used in the form of inhalations: adults and children over 5 years of age are recommended to inhale 1-2 times a day, 2-3 ml (40-60 drops, which corresponds to 15-22.5 mg of ambroxol).
Bronchiectasis is a disease in the lower sections of the bronchi, which is characterized by their irreversible expansion at the time of exacerbation of purulent inflammation.
The disease, with permanent treatment, easily controlled and extremely rarely leads to the death of the patient. Otherwise, the risk of death increases several times. Men get sick 3 times more often than women. Also more susceptible to developing bronchiectasis smoking people and residents of cold and humid regions. This diagnosis is first detected at the age of 5-25 years.
Causes of the disease
The reasons for the initial development of bronchiectasis are not fully known. The following theories can be distinguished:
- Genetic mutations during the development of the bronchopulmonary system, in which the muscles of the bronchi, tissue elasticity and other mechanisms that maintain the bronchi in good shape do not develop sufficiently.
- Frequent pneumonia and bronchitis in childhood, which cause disturbances in the structure of the tissues of the bronchial tree.
- Lung abscess is a purulent disease of the lung tissue, which can result in disruption of the functioning of the small bronchi, causing pathological expansion in them.
- Foreign bodies in the bronchi can also cause changes in tissue structure, reducing their tone and elasticity.
The reasons for the development of exacerbation and the occurrence of a purulent process in the dilated bronchi are:
- The inability of the bronchi to cleanse themselves of natural mucus. This leads to stagnation and infection.
- Reduced immunity after suffering from colds and other illnesses
- Hypothermia
- Exacerbation of sore throat
For the first time, if not genetic mutations, dilatation of the bronchi and the development of bronchiectasis, begins after suffering bronchitis with obstruction of the airways. Blockage of the bronchial lumen causes a reflex cough and compensatory expansion of the affected bronchi to make breathing easier for the patient. After repeated exacerbations of such bronchitis, the elasticity of the tissues in the walls of the bronchi decreases, and their lumen does not return to its previous level and remains expanded. This is the beginning of bronchiectasis. Subsequently, the natural mucus in the bronchi is not able to evacuate, causing congestion in the lumen, to which infection is associated during predisposing factors.
Classification of the disease
There are several types of disease classifications based on different criteria.
According to the severity of the process:
- Mild - 1-2 exacerbations are possible during the year; during remission, patients have practically no complaints and can perform their work fully.
- Moderate severity - exacerbations up to 3-4 times a year, last longer and more severely. During the day, up to 100 ml of purulent sputum (yellow) may be released. During the period of remission, cough and sputum are constantly present, but it does not contain pus and is less in quantity than during exacerbations. Endurance to physical work decreases, lighter labor is required.
- Severe - exacerbations are quite long and frequent, and are difficult. There can be up to 5-6 exacerbations per year, sometimes more. The amount of sputum per day can reach up to 200 ml. The periods of remission are not long; patients continue to be bothered by many complaints and become completely incapacitated.
According to the phase of the disease:
- Remission
- Exacerbation
According to the prevalence of the process:
- Single sided shape
- Double sided form
According to the structure of the dilated bronchi:
- Saccular
- Cylindrical
- Varicose (spindle-shaped)
- Mixed
These types of bronchiectasis can be determined by bronchography ( x-ray examination bronchial tree).
By period of occurrence:
- Congenital
- Acquired
By stages during the exacerbation period:
- Stage of bronchitis (bronchitis stage)
- Expressed stage clinical manifestations
- Stage of complications (not present in every patient and not with every exacerbation)
- Stage of recovery (attenuation of the process)
Symptoms of the disease
- The symptoms of the disease are quite varied and have varying degrees of severity (depending on the severity of the process).
- At the stage of bronchitis, the patient is concerned about the following symptoms:
- Cough like bronchitis, especially severe in the morning
- Sputum (per day from 20 to 500 ml), purulent-serous in nature
- Shortness of breath during physical activity (the intensity of the exercise for the development of shortness of breath depends on the severity of the process).
The stage of pronounced clinical manifestations is characterized by the following symptoms:
The cough becomes paroxysmal
The sputum becomes purulent and is coughed up mouth full, especially in the morning or when the patient bends forward. It has a yellow color and an unpleasant putrid odor. Its quantity increases compared to the first period of the disease
Shortness of breath is pronounced even with the slightest exertion
Chest pain when breathing and coughing
Increased body temperature. In mild cases of the disease, the temperature reaches 37.5-37.8ºС, in severe cases it reaches 39-40ºС. In severe cases, when coughing up a large amount of sputum, the temperature can drop significantly.
Cyanosis ( Blue colour skin) on the lips occurs in severe cases of the disease.
The attenuation stage of the process is characterized by the following features:
Body temperature drops to normal levels
Sputum decreases in quantity and becomes serous in nature (almost transparent, without admixture of pus)
Cough becomes less intense
The severity of shortness of breath is less
During the period of remission in mild degree The severity of the disease does not bother the patient, with moderate severity of the disease the cough and sputum persist (not purulent and not as abundant as during an exacerbation), and in severe cases the cough is pronounced, the sputum persists, shortness of breath bothers us (to a lesser extent than during an exacerbation).
Diagnosis of bronchiectasis
To diagnose this disease, physical examination methods (percussion and auscultation) are used. laboratory diagnostics and instrumental methods.
During percussion, the pulmonologist hears dullness of the percussion sound or tympanitis
On auscultation - hard breathing and moist rales of large and small caliber
Complete blood count - increased white blood cells and accelerated ESR (erythrocyte sedimentation rate)
Sputum examination - culture to identify the pathogen and smears to study the composition
X-ray of the chest organs without contrast - dilated bronchi are detected (a symptom of tram rails)
Bronchography is an x-ray of the bronchi using a contrast agent. The shape of the expansion and its localization are determined
Bronchoscopy - examination of the bronchial tree using an endoscope with a special camera, during which the doctor examines the structure of the walls of the bronchi on a monitor
Computed tomography helps to clarify the localization of the process, the size of the dilated bronchi, etc.
Study of external respiration function - helps to determine the degree of respiratory failure and determine the possibility of reversibility of the process in the bronchi
Treatment of the disease
Used to treat bronchiectasis medicinal methods, surgical interventions, ethnoscience.
Conservative treatment
Antibiotics are prescribed first. Most often this is amoxiclav or augmentin, as well as ceftriaxone (1 g daily intramuscularly).
To improve sputum discharge, mucolytics are used. These drugs thin the mucus and ensure its easy and rapid removal. An example of such drugs is ACC (acetylcysteine) - 1 tablet or 1 sachet 3-4 times a day for at least 10 days. Ambroxol will also cope with the task - 1 tablet 3 times a day.
Bronchodilators are used to widen the bronchi, which are clogged with mucus or pus, to make breathing easier. These are Atrovent, Serevent, Ventolin and their analogues. They are used in the form of inhalations, 1-2 breaths 2-5 times a day.
In severe cases of the disease, glucocorticosteroids are used. Prednisolone is prescribed depending on the patient's weight and the severity of his illness.
To reduce body temperature, non-steroidal anti-inflammatory drugs are used - paracetamol, ibuprofen, nimide - 2-4 tablets per day.
Surgery
Indicated for any severity of the disease up to 40 years, in more late age only if available life-threatening complications. Surgical treatment involves removing the affected area of the bronchus along with the lung. This operation is performed if, after removing a fragment of an organ, breathing will be provided in full by the remaining bronchi.
Traditional treatment
Traditional methods of treatment are aimed at improving sputum discharge:
- Squeeze the juice from plantain leaves, mix it 1:1 with honey and take 1 teaspoon 2-3 times a day.
- You need to squeeze the juice out of the turnips and take 1 tablespoon 4-6 times a day. Can be used with honey.
- Mix black radish juice with honey in a ratio of 1:1 or 2:1 and take 1 tablespoon 3 times a day.
Traditional medicine, like independent method treatment of this disease is extremely dangerous and can lead to complications and death of the patient.
Exacerbations of bronchiectasis
Exacerbations of the disease include conditions such as:
- Pulmonary hemorrhage
- Respiratory failure
- Sepsis (general blood poisoning)
- Pleural empyema (purulent disease of the pleura)
- Pleurisy (inflammation of the pleura)
Bronchopneumonia (a combination of bronchitis and pneumonia)
Prevention
As a preventive measure, it is necessary to promptly treat infectious and viral diseases respiratory system, avoid hypothermia and strengthen the immune system.
You can find symptoms of all diseases on our website in the section
If the examination showed that bronchiectasis has developed in the lungs. This means that treatment for bronchiectasis of the lungs awaits. It's not a simple matter, but is this a problem if you love life? Without treatment, bronchiectasis develops and develops into complications: emphysema, atrophic pharyngitis, and may develop bronchial asthma.
Friends, hello! Svetlana Morozova is with you. Do you know this gnawing feeling when you don’t know what’s wrong with you and you suspect everything in the world? Sometimes the hero of the book “Three in a Boat, Not Counting a Dog” awakens in everyone - remember when he took a reference book of diseases in the library and discovered that he had every one of them, except for puerperal fever? So, let's talk about a disease such as bronchiectasis. It doesn’t occur very often, and it’s not easy to recognize it right away. And we’ll take it and sort it out! Forward!
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Treatment of bronchiectasis of the lungs: how will we treat it?
Let's start right away with 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 primary task is to stop the spread of infection. The medication regimen is always prescribed for each case separately. I'll explain why. If the lesion is severe, then antibiotics must be taken daily, even during periods of remission. If bronchiectasis is developed quite easily, it’s easier.
In this case, the method of administration can be different: in tablets, inhalers, aerosols, through intramuscular and intravenous injections. But the most effective way is to administer the antibiotic using bronchoscopy. More on this a little further.
Breathing exercises
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 exercises, sometimes you need to tap on the place where, as determined, there is an accumulation of sputum. Do not hit the chest, but lightly tap it. Such manipulations are again needed to relieve phlegm. And during the period of exacerbation, it is better not to do gymnastics.
So, the main positions, lying everywhere:
- IP: on the back. Your legs should be slightly elevated; you can place a bolster/pillow or place your legs on the armrest of the sofa. One hand lies on the stomach, the other on the chest. We breathe with our stomachs, calmly, and try to stretch the exhalation. Using our hands, we make sure that the breathing is abdominal.
- IP: on the back, arms along the body. As you inhale, spread your arms to the sides, and as you exhale, pull your knees to your chest with your hands.
- IP: as in the previous one. As you inhale, raise your arms behind your head, as you exhale, raise your straight leg and at the same time lower your arms.
- IP: same. Inhaling, we spread our arms to the sides, trying to bend our back. As you exhale, cross your straight arms in front of you as much as possible, slightly squeezing your chest.
- IP: on the side. Extend your arm near the floor along your body, and place your free hand behind your head. As you inhale, we lift it up, as you exhale, we lower it to the chest, trying to put pressure on the chest.
- IP: same. Raise your free hand up as you inhale, and as you exhale, simultaneously pull your knee to your chest and lower your hand, helping the knee.
- IP: on the stomach. As you inhale, move your hand behind your back and reach for it. top part torso. As we exhale, we return to IP.
The exercises are all based on similar movements. Lift, pull, press, breathe slowly and with intense exhalation. You can do any similar movements that come to mind. The main thing is that the pose is natural. Don’t “reach your left heel to your right ear.”
Treatment of bronchiectasis of the lungs: folk advice
Do not forget that folk remedies cannot be used instead of medicines. Only as an addition. Everyone knows chest infusions made from medicinal herbs. Probably everyone was given this when they coughed. But with purulent sputum, some herbs cannot be used, so we consult a doctor about everything.
Which recipes are considered the most effective:
- Garlic. The head of garlic should be chopped and mixed 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. linden honey, set aside in a dark corner for 6 hours. Sometimes we come to interfere. When it brews, take 1 tbsp throughout the day. l. up to 6 times, preheated.
- Wine infusion. Take large aloe leaves, 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 this, you can take the infusion according to Art. l. three times a day.
- Herbs. We need expectorant herbs that are taken for wet coughs. And this is licorice root, calendula, wild rosemary, marshmallow, coltsfoot, anise, sage.
Determining the signs
Bronchiectasis is not always diagnosed immediately. It's all about camouflage, so to speak. At first it looks like pneumonia, then it looks like pneumonia, and all the time it looks like bronchitis. Therefore, the picture can only be clarified full diagnostics, 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 unpleasant smell. My favorite time of day is morning. People get up with a mouthful of exudate. That's when the morning doesn't start with coffee.
- If they get hurt blood vessels, then blood appears in the sputum. This can range from completely innocent veins to hemoptysis, and even pulmonary hemorrhage.
- Almost everyone here has anemia. Manifests itself typically: pallor, weakness, weight loss. Children are lagging behind in physical development, puberty starts 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), rib cage changes. Often it is enough to look at your hands. For respiratory failure nail phalanges the fingers swell and become like “drumsticks”. And the nails are compared to “watch glasses” - flat, round.
Oh this infection
Most people only learn that such a disease exists when they or their children are diagnosed with it. So what is this disease?
The bronchi change shape and 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, 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 of age, when an aggressive infection constantly invades the fragile bronchi of children.
The medical history of patients with this diagnosis is almost always replete with records of weak, frequent colds, chronic bronchitis, bronchiolitis - and here is ready-made bronchiectasis.
This differs from pneumonia in that here the lung parenchyma (surface tissue) is not affected by inflammation, and atelectasis (deflated, flaccid, areas of the lungs that have lost porosity) do not form.
It’s not hard to imagine what will happen if the situation starts. Without treatment, bronchiectasis develops and develops into complications (COPD, emphysema, cardiac, renal, respiratory failure, atrophic pharyngitis), and bronchial asthma may develop. By the way, there is an interdependent relationship here. And asthma can occur due to bronchiectasis, and vice versa.
If treated as expected, the prognosis is good. In 80% of cases, it is possible to ensure that the exacerbation occurs no more than once a year. And sometimes, with the help of a good operation, they completely get rid of such a problem.
That's all, basically.
Don't get sick friends.
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