Bronchiectasis- This is a relatively rare disease of the respiratory system, in which the main problem is the deformation of the bronchi and the formation of pus in them. Deformed areas of the bronchi are also called bronchiectasis or bronchiectasis... In some cases, these names are also used in relation to pathology in general.
Bronchiectasis differs from other lung diseases in that bronchiectasis is the primary lesion. That is, first, the expansion and suppuration of the bronchi occurs in a certain part of the lung, and then the interstitial tissue can be affected ( proper respiratory alveoli). If bronchiectasis was formed against the background of other pathologies ( pneumonia, bronchitis, etc.), then the diagnosis of "bronchiectasis" is not made, but they speak of the so-called secondary bronchiectasis.
The prevalence of bronchiectasis ( primary lesion) is approximately 3-4 people per 100,000 population, but the data vary greatly from one region to another. Statistically, men suffer from this pathology 2.5 - 3 times more often than women, but there is no reasoned evidence why this happens. It was also noted that bronchiectasis more often develops in young people and becomes chronic. This is due to the fact that the deformation of the bronchi in this pathology is irreversible.
Lung anatomy
Human lungs are a paired organ located in the chest cavity. One lung is located on each side of the sternum. The right one consists of three parts ( top, middle and bottom) and exceeds the volume of the left lung, which consists of two lobes ( top and bottom). This is due to the fact that the left part of the chest volume is occupied by the heart. The upper border of the lungs ( top) rises a few centimeters above the clavicle, and the lower one is located on the diaphragm ( flat muscle that separates the chest and abdominal cavity). Between the two lungs, behind the sternum, there is a space called the mediastinum. The heart, thymus gland, esophagus are located here, as well as a number of important vessels and nerves. The lungs themselves are made up of the following parts:
- trachea;
- bronchial tree;
- pulmonary lobules;
- acini.
Trachea
The trachea is a hollow tube about 10-15 cm long that starts in the larynx and descends into the chest cavity. In fact, the trachea is not part of the lungs, but rather refers to the airways. Due to its large diameter, it ensures the passage of a large volume of air to the bronchi. Many pathologies of the trachea are closely related to the work of the lungs.The trachea contains 16 - 20 semicircular cartilages in its walls. These cartilages are positioned so that the back of the tube remains unprotected. They are connected to each other by a dense film of connective tissue. Thus, in the posterior wall, which is adjacent to the esophagus, there is no cartilage, and it is an elastic membrane. There are no muscles in the walls of the trachea. The inside is lined with mucous membrane, the cells of which can produce mucus. There are also villous cells that can clean the surface of the shell when foreign objects get on it ( dust particles, etc.).
At the lowest point, approximately at the level of II-V thoracic vertebrae, there is a bifurcation ( bifurcation) trachea. This is where the main bronchi originate, which carry air to the lungs.
Bronchial tree
The bronchial system in the lungs is often compared to a tree due to the gradual branching of the airways. The main bronchi begin from the bifurcation of the trachea and are sent to the thickness of the lung tissue. The right bronchus is slightly larger in diameter and does not deviate so much to the side. The left main bronchus departs from the bifurcation site with a large angle and has a smaller diameter.The bronchial tree consists of bronchi of a different order:
- Lobar bronchi ( first order) ... These structures extend directly from the main bronchus and are directed to each lobe of the lung. Thus, the main bronchus on the right is divided into 3, and on the left - into 2 lobar bronchi of the first order.
- Segmental bronchi ( second order) ... These bronchi begin from the lobar bronchus and carry air to various segments of the lung. Each second-order bronchus has its own segment. In total, there are 8 segments in the left lung, and 10 in the right lung. The segments, like the lobes, are separated from each other by layers of connective tissue.
- Bronchi of the third order and less ( up to the fifth order inclusive) ... Their diameter is only a few millimeters. If there were cartilaginous formations in the walls of the wider bronchi, here they disappear. But at this level, smooth muscle cells appear in the wall. They maintain the shape of the bronchus, preventing the walls from sticking together. Under certain conditions, smooth muscle spasm can occur. Then the lumen of the small bronchi will be completely closed, and the air will not flow further.
- Bronchioles. The next link is the so-called bronchioles. They are located directly inside the lung. At the end of each bronchiole is the so-called acinus, which is the main functional unit of the lung.
It is at the level of the bronchial tree that the main pathological changes occur in bronchiectasis. For various reasons, bronchi of the 3rd - 5th order change their shape. This is due to their overstretching and loss of normal muscle tone. As a result, pathological enlargements are formed, which, even on full exhalation and with spasm of smooth muscles, are not completely emptied. Favorable conditions are created here for the accumulation of mucus and the multiplication of various pathogenic ( disease-causing) microorganisms.
Pulmonary lobules
Lobules are small sections of the lungs that are ventilated by a single bronchus. They have the shape of a truncated cone with apex facing inward. The base of such a lobule lies on the edge of the lung and is in contact with the pleura ( membrane covering the lungs). In each lobule there is a branching of the bronchus entering it into 15 - 20 bronchioles.When the airway bronchus is blocked, the entire lobule collapses. Even if there is a small volume of air in it, it gradually dissolves. With a prolonged absence of ventilation in the collapsed segment, connective tissue is formed, which replaces the respiratory alveoli. This process is called pneumosclerosis and can sometimes be seen with bronchiectasis.
Acini
The acinus is the basic structural unit of the lung. It consists of air bubbles called alveoli. Air enters the acinus through the bronchioles. The alveoli are entangled in a dense network of capillaries - the thinnest vessels, the walls of which are highly permeable. This is where the so-called gas exchange takes place. Oxygen from the atmospheric air enters the vessels and combines with hemoglobin. In the cavity of the alveoli, carbon dioxide is released from the blood, which leaves the lungs when you exhale.The lungs are covered with a specific membrane called the pleura. The same shell passes to the inner surface of the chest, as if lining it. In this case, a small gap remains between the lungs and the walls of the chest, called the pleural cavity. It is hermetically sealed and is directly involved in the breathing process. The fact is that when inhaling, it is not the lungs themselves that expand, but only the walls of the chest. Due to the tightness of the pleural cavity, negative pressure is created in it, which leads to the expansion of the lungs and drawing air into them. Exhalation is a passive process that occurs when the respiratory muscles are relaxed.
With bronchiectasis, the following changes occur in the anatomy and physiology of the lungs:
- Expansion of the bronchi medium small caliber. The bronchi, deprived of the cartilaginous base, expand, losing their normal shape. They stop contracting with smooth muscle spasm. The main cause is the stretching of the connective tissue that is contained in the bronchial wall.
- Accumulation of mucus... In the dilated bronchioles, mucus begins to accumulate, which is normally excreted from the lungs. This is due to stagnant air and lack of muscle tone in the walls.
- Violation of the passage of air... In the enlarged area, blockage of the bronchus may occur. It is caused by sticking of the walls, swelling of the lung ( with inflammation) mucous membrane or accumulation of mucus ( or pus).
- Inflammation of the bronchus... When an infection enters the dilated bronchus, it actively multiplies. Most often, this is accompanied by an accumulation of pus, which cannot flow normally due to deformed walls. An inflammatory process develops, leading to swelling of the mucous membrane.
- Foci of pneumosclerosis... Prolonged inflammation leads to changes in the cellular structure of the tissue. Muscle cells die, and dense connective tissue forms in their place. As a result, a site of pneumosclerosis is formed, which is not involved in the breathing process.
Causes of bronchiectasis
The mechanisms and root causes of the development of bronchiectasis are currently not fully understood. The fact is that the appearance of bronchiectasis can be associated with many different factors, but none of them can be considered the main one. In general, all the causes of this disease can be divided into two groups. The first is the main factors influencing the appearance of primary bronchiectasis. The latter are responsible for the appearance of secondary bronchiectasis and are not directly related to bronchiectasis. It is believed that the reasons for the development of bronchiectasis can be:
- genetic factors;
- developmental anomalies of the lungs;
- postponed respiratory infections.
Genetic factors
Genetic factors are a collection of birth defects that subsequently lead to the formation of bronchiectasis in the lungs. The cause of these diseases is a defect in the DNA molecule, which carries information about all cells in the human body. Some genes also encode information about the cells that make up the bronchial walls. People who have these genes damaged or missing are at a higher risk of bronchiectasis. The role of genetic factors in the development of primary bronchiectasis has been proven by a number of specially conducted studies. In addition, this explains the early onset of the disease, which usually occurs between the ages of 5 and 25.People with congenital DNA defects may experience the following disorders:
- local immunodeficiency ( there are not enough cells in the mucous membrane to fight infection);
- weakness of smooth muscle cells in the walls of the bronchi;
- absence or insufficient number of smooth muscle cells;
- bronchomalacia ( insufficient strength or lack of cartilage tissue in the bronchial wall);
- weakness and increased elasticity of the connective tissue;
- increased secretion of viscous sputum by mucosal cells ( with cystic fibrosis).
The syndromes that are accompanied by the above disorders are:
- Schwachman-Daymond syndrome;
- cystic fibrosis;
- immobile cilia syndrome;
- Kartagener's syndrome;
- Williams-Campbell syndrome;
- Duncan's disease.
Lung developmental abnormalities
Lung anomalies are birth defects, which, however, are rarely the main cause of bronchiectasis ( only in 5 - 6% of cases). In this case, we are not talking about genetic factors, but directly about the development of the fetus in the womb. In rare cases, people are born with bronchiectasis, which then become inflamed and cause bronchiectasis. The factors leading to such mutations here affect the mother's body before pregnancy or directly during the period of gestation.Factors that cause impaired fetal development can be:
- alcohol abuse;
- taking certain medications ( with fetal impairment action);
- some infections during pregnancy ( cytomegalovirus, Epstein-Barr virus, etc.).
- the presence of chronic diseases of internal organs ( kidney disease, liver disease, etc.).
Previous respiratory infections
It's no secret that children are more susceptible to respiratory infections than adults. Especially often they get sick at the age of 1.5-2.5 years, when breastfeeding is usually stopped and the child's body does not receive the maternal antigens that protected him before. In most cases, respiratory diseases at this age do not leave serious consequences.However, in the presence of genetic defects or congenital developmental abnormalities, which were mentioned above, the disease does not pass without a trace. Infections carried over in childhood become, as it were, a trigger mechanism. With weakness of the bronchial wall, any pneumonia or bronchitis, accompanied by a strong cough, deforms the lumen of the bronchus. Bronchiectasis is formed, which does not disappear after the infection is cured.
Medical practice shows that almost all patients with bronchiectasis have suffered serious acute respiratory infections in childhood ( usually repeatedly). This allows such diseases to be categorized as causes of bronchiectasis.
Secondary bronchiectasis should be considered separately. They can form at any age and cannot be called bronchiectasis. Such defects of the bronchi are caused by other pathological processes in the lungs. There is a violation of the movement of air through the bronchi, partial destruction of lung tissue, massive sclerosis of the lungs ( replacement of normal tissue with connective tissue that does not perform a respiratory function). Secondary bronchiectasis remains after the underlying disease is cured. The accumulation of pus and inflammation in them can give symptoms similar to bronchiectasis. In the future, diagnosis and treatment are not very different. That is why bronchiectasis is often called bronchiectasis.
Secondary expansion of the bronchi and deformation of their walls can be observed with the following pathologies:
- lingering pneumonia;
- severe bronchitis;
- pneumosclerosis;
- pneumoconiosis ( occupational pathology that develops with prolonged inhalation of dust);
- neoplasms in the lungs and mediastinum;
- connective tissue diseases ( rheumatism, systemic lupus erythematosus, scleroderma, etc.);
- ingress of foreign bodies into the respiratory system.
Regardless of the origin of bronchiectasis ( primary or secondary) an important role in the clinical picture of bronchiectasis is played by pathogenic microorganisms. They enter the dilated bronchus with inhaled air and are fixed on the wall of the cavity. Due to violations in the structure of the mucous membrane, the infection does not die and is not removed from the body. It is actively multiplying and gradually affecting the surrounding tissues. Most often, pus is formed, which gradually fills the bronchiectasis cavity. It is the acute inflammatory process and the formation of pus that largely determine the symptoms characteristic of this disease. Thus, pathogenic microorganisms are also partly the cause of the development of bronchiectasis ( or rather, the cause of its exacerbations).
The inflammatory process in bronchiectasis can be caused by the following microbes:
- Streptococcus pneumoniae;
- Staphylococcus aureus;
- Haemophilus influenzae;
- Klebsiella pneumoniae;
- Mycoplasma pneumoniae;
- Escherichia coli;
- Chlamydia pneumoniae;
- Streptococcus haemolyticus;
- Legionella pneumophila;
- Moraxella catarralis.
Thus, there are many reasons for bronchiectasis. Usually, the development of this pathology requires the influence of several factors ( for example, genetic defects of the bronchial wall, previous respiratory diseases and the presence of an infectious focus). From a practical point of view, it is important to establish whether bronchiectasis is secondary, and which pathogen caused an exacerbation of the disease. It is not always possible to unambiguously establish the cause.
Types of bronchiectasis
There are several classifications of bronchiectasis, each of which has its own practical value. With their help, the doctor formulates a complete diagnosis and facilitates the patient's treatment in the future. In addition, many of these classifications reflect the clinical picture ( a set of symptoms and manifestations of the disease).Each case of bronchiectasis can be assessed according to the following criteria:
- the nature of the deformation of the bronchi;
- phase of the disease;
- the prevalence of the process;
- the severity of the disease;
- the origin of bronchiectasis.
The nature of the deformation of the bronchi
The nature of the deformation of the bronchi is considered the main classification criterion, as it directly describes the pathological process. To classify the disease according to this criterion, a special study is carried out - bronchography. It shows exactly how the shape of the bronchus has changed. This largely determines the nature of the course of the disease and its severity.There are the following forms of bronchial dilatation:
- Cylindrical... Cylindrical bronchiectasis occurs mainly with sclerosis of the bronchial walls. In this case, the lumen of the bronchus expands evenly over a sufficiently large extent. Most often this occurs against the background of other lung diseases ( secondary bronchiectasis). The cylindrical shape does not contribute to the accumulation of a large volume of pus, therefore, the general condition of patients, as a rule, is not too severe.
- Clear... A clear-cut expansion takes place if several round or oval cavities are sequentially located along one bronchus. A large volume of sputum or pus can accumulate here, which causes a more severe course of the disease. With bronchography, this form of bronchiectasis looks like beads or rosary ( hence the name).
- Baggy... Saccular bronchiectasis is a single spherical or oval expansion on one side of the bronchus. Often, this form occurs with congenital defects in the development of lung tissue. Sacks are blind bulges of the wall that can be large. A significant amount of sputum and pus accumulates here. The course of the disease in these patients is usually severe.
- Fusiform... Fusiform are such expansions when the diameter of the bronchiectasis gradually narrows, turning into a normal bronchus. This shape of the cavities does not contribute to the accumulation of pus and breathing difficulties.
- Mixed... Mixed forms are called forms in which the same patient has bronchiectasis of various forms. This is usually typical for secondary bronchiectasis against the background of tuberculosis, pneumosclerosis, or other processes associated with severe deformation of the lung tissue. The condition of patients largely depends on the number and size of bronchiectasis, but the prognosis as a whole remains unfavorable.
Disease phase
Since the formed bronchiectasis does not disappear over time, this disease is always considered chronic. The patient's condition changes periodically depending on the phase.During bronchiectasis, two phases are distinguished:
- Exacerbation phase... The exacerbation phase is characterized by the ingress of infection into the cavity of bronchiectasis. In most cases, a pronounced inflammatory process develops with an accumulation of pus. During this period, the symptoms of the disease are most striking. A rapid deterioration of the patient's condition may occur, up to urgent hospitalization. In the absence of adequate treatment, the inflammatory process goes beyond the dilated bronchus, pneumonia develops. The frequency of exacerbations can vary, from a few episodes per year to several over the course of one month. To improve the general condition of the patient, it is recommended to observe preventive measures for exacerbations.
- Remission phase... The remission phase is characterized by the absence of acute symptoms. The patient can feel completely healthy, go about his daily activities, do work. At the same time, bronchiectasis is preserved, but does not interfere with the breathing process. In the presence of multiple dilatations of the bronchi and concomitant pneumosclerosis in the remission phase, dry cough and signs of respiratory failure may be observed.
Prevalence of the process
When formulating a diagnosis, the doctor must indicate the localization of the pathological process. Congenital bronchiectasis, formed during intrauterine development, can be unilateral, affecting only one segment or lobe of the lung. The same can be said about the secondary dilatation of the bronchi. They are localized in the place where there was pneumonia or a focus of tuberculosis.With genetic weakness of the bronchial walls, bronchiectasis usually appear diffusely, in all parts of both lungs. Thus, in terms of prevalence, one can distinguish between unilateral or bilateral bronchiectasis, as well as single or multiple formations.
The severity of the disease
It is difficult to assess the severity of bronchiectasis as a whole. Here the doctor must compare a number of different criteria, of which the frequency of exacerbations and preservation of working capacity play the most important role. In general, the assessment of the severity of bronchiectasis is difficult to make objectively, since there is no clear framework.Bronchiectasis can be of the following severity:
- Light form... With a mild form of the disease, exacerbations are observed no more often than 1 - 2 times a year. Hospitalization is usually not required, and taking prescribed medications quickly helps. During the period of remission, the patient feels completely healthy and can do any job.
- Moderate form... With bronchiectasis of moderate severity, the disease is exacerbated 3 - 5 times during the year. At this time, the patient's condition deteriorates greatly, there is an abundant secretion of sputum ( up to 50 - 100 ml per day). The patient temporarily loses his ability to work, attacks of respiratory failure may occur. The disease does not immediately respond to medication, the symptoms disappear slowly. During the period of remission, a cough with sputum production may also persist. In the study, the respiratory function is somewhat reduced.
- Severe form... With a severe form of exacerbation of the disease, they are often observed. The patient suffers from a severe cough, and more than 200 ml of sputum with pus and blood impurities can be released per day. The skin is pale, blue and cold, indicating respiratory distress. Usually, the patient is hospitalized to stabilize the condition. The periods of remission are short, and the ability to work does not return completely.
- Complicated form... This form is taken out separately and characterizes the patient's condition during remission. If a patient, against the background of bronchiectasis, has developed complications such as pneumosclerosis or cor pulmonale, then his general condition practically does not return to normal. During the period of exacerbation, symptoms prevail, caused by an acute infectious process, and during the period of remission, respiratory or cardiovascular insufficiency.
Origin of bronchiectasis
By origin, as mentioned above, bronchiectasis are divided into primary and secondary. It is sometimes not possible to clearly define this. If secondary bronchiectasis is detected, treatment of the underlying pathology that caused their appearance should be carried out ( lingering pneumonia, tuberculosis, etc.). This will prevent future damage to other parts of the bronchi.Symptoms of bronchiectasis
Bronchiectasis has been identified as a separate disease, not only because of the typical structural disorders in the bronchi, but also because of the peculiar clinical picture. Most of the symptoms appear during the period of exacerbation of the disease, when an active inflammatory process begins in the cavities of bronchiectasis. Often, bronchiectasia can be confused with other respiratory diseases ( pneumonia, purulent bronchitis). The problem is that these pathologies often develop in parallel, which masks the typical picture of bronchiectasis. During the period of remission, patients may not have any complaints at all, and only complex examinations will reveal the disease. The most common complaints of patients with bronchiectasis are:
- cough;
- increased body temperature;
- fingers of Hippocrates;
- decreased ability to work;
- weight loss;
- developmental lag.
Cough
Cough is the main and leading symptom that is observed in all patients with bronchiectasis. It is caused by irritation of the bronchial mucosa and difficulty in the passage of air. Essentially, it is the body's defensive response to clear the airways. Irritation of the mucous membrane occurs due to the inflammatory process, accumulation of sputum and pus, deformation of the bronchus.During the period of exacerbation of the disease and during the period of remission, the cough is usually different. During remission, it is often dry. The phlegm, if he coughs up, then in small quantities, without any admixture of pus or blood.
During the period of exacerbation of bronchiectasis, the cough has the following features:
- The onset of coughing in the form of attacks. Despite the fact that the phlegm leaves quite easily, the person still cannot clear his throat. Each contraction of the respiratory muscles leads to the release of a new portion of pus from the cavity and causes a new attack.
- Profuse expectoration. Depending on the size and number of bronchiectasis, as well as on microorganisms that have entered the lungs, the volume of sputum coughing up per day may be different. On average, 50-200 ml is separated, but in rare cases the daily amount exceeds 0.5 l ( mainly with accumulation of pus).
- Impurities of pus in the sputum. As noted above, many microorganisms, getting into the cavity of bronchiectasis, lead to the accumulation of pus. Pus is formed from the waste products of microbes, when they die, when fluid is released from the mucous membrane of the bronchi, as well as when lung cells are destroyed. At the same time, the sputum has an unpleasant odor and a characteristic color ( white, yellowish or greenish). The color depends on the microorganism that multiplies in the lungs.
- Impurities of blood in the sputum. Impurities of blood in sputum are a fickle phenomenon, but it is noted periodically in every third patient. Blood usually appears as streaks. It enters the bronchial cavity in the process of purulent fusion of the walls. Small blood vessels ( arterioles), when damaged, blood gets into the sputum. After sclerosing the wall, the vessels in it overgrow, and pus no longer leads to its destruction. Therefore, in patients with pneumosclerosis, blood in the sputum rarely appears. In some cases ( in case of damage to a large vessel) cough may be accompanied by the release of scarlet blood. This is more often observed in patients with tuberculosis, since the causative agents of this disease are especially aggressive in destroying the lung tissue.
- The cough usually appears in the morning. This is due to the fact that a large volume of sputum accumulates in the bronchiectasis cavity during the night. After awakening, breathing becomes more frequent, irritation of the mucous membrane occurs and an attack of coughing occurs with copious secretion of sputum or pus.
- The cough occurs when the position of the body changes. This feature is explained by the presence of large bronchiectasis. They are not completely filled with pus. When the position of the body changes, part of the fluid flows into the lumen of the bronchus, makes breathing difficult and causes an attack of coughing.
- Sputum in bronchiectasis often contains two fractions. They are found if a small amount of the coughing up liquid is put into a transparent glass. After a while, the less dense fraction, mucus, will collect in the upper part in the form of a cloudy light layer. At the bottom, a column of opaque purulent sediment of white or yellowish color will clearly stand out.
At the first stages of the disease ( usually during childhood and adolescence) cough appears periodically, being the main symptoms during exacerbations. Over time, as the disease progresses, coughing becomes more frequent.
Wheezing
During the period of exacerbation of the disease, patients themselves may complain of wheezing in the lungs. They are explained by a large accumulation of pus and phlegm in the dilated bronchi. Wheezing with a deep breath is sometimes heard even at some distance from the patient. The patient himself feels them as vibrations of the chest, which temporarily disappear after a coughing fit.Dyspnea
This symptom is typical for the later stages of the disease. In childhood and adolescence, shortly after diagnosis, shortness of breath does not appear. As bronchiectasis increases in size, there is an increasing curvature of the airways. This makes it difficult for air to reach the alveoli. In the later stages, with the development of concomitant pneumosclerosis or cor pulmonale, shortness of breath becomes the main symptom that is present even during remission, when there is no cough or other manifestations of the disease. Attacks are more often triggered by physical exertion or an excess of emotions.Chest pain
The lungs do not have nerve endings, so they do not feel pain. Nevertheless, 30-40% of patients with bronchiectasis complain of recurrent chest pain. This symptom always appears during exacerbations, when there is an acute inflammation and accumulation of pus. If this process reaches the pleura, which is rich in nerve endings, patients complain of pain. Their nature can be different - from dull and aching attacks lasting several days ( during an exacerbation) to an acute flash during a deep breath.Increased body temperature
An increase in body temperature is a characteristic symptom of an exacerbation in bronchiectasis. Most often, it indicates the involvement of the lung parenchyma in the inflammatory process ( alveolar sacs) and the parallel development of pneumonia. This symptom occurs due to the ingress of toxic substances into the bloodstream. These substances are partially secreted by microbes in the focus of infection, partially penetrate into the bloodstream during the absorption of pus.Usually the temperature is kept at a subfebrile level ( 37 - 38 degrees) for several days or weeks. She reacts to the intake of antipyretic drugs, but rarely decreases to normal. Sometimes the rapid accumulation of pus leads to a temperature rise of up to 39 degrees. It subsides after coughing up a lot of pus. This is typical for bronchiectasis, but it is not observed in all patients.
Fingers of Hippocrates
The fingers of Hippocrates are called the expansion of the terminal phalanges of the fingers, which occurs as respiratory failure progresses. This symptom is rarely seen in patients younger than 40 to 45 years old. The mechanism of its appearance is not completely clear. It is believed that the nail phalanx of the toe becomes more porous due to prolonged lack of oxygen. This leads to its expansion. Fingers are most often affected ( here the symptom is seen more clearly), but some changes are also present on the toes. Over time, the fingers take on the shape of a drumstick.The toenails begin to rise in a domed manner. They are sometimes called watch-glass nails because of their appearance. These changes are irreversible and last until the end of life.
Decreased ability to work
A decrease in working capacity is observed in moderate and severe forms of the disease. The patient does not tolerate almost any physical activity, as it causes coughing or shortness of breath in him. If the work involves inhaling dust, caring for animals or being outdoors for a long time, then the patient is more likely to experience exacerbations. Due to breathing difficulties, the body does not receive enough oxygen, and the patient constantly feels overwhelmed, tired, experiences prolonged headache attacks and dizziness. During the period of exacerbations, this is also facilitated by intoxication due to the infectious process.Weight loss
Weight loss is most often observed after an exacerbation of the disease. This is due to the fact that during the purulent process, the patient has a fever, increased sweating and poor appetite. With frequent exacerbations, the patient looks emaciated. At the same time, the face may remain puffy ( swollen), and the chest is slightly expanded. This disproportion is also a typical symptom of bronchiectasis.Developmental delays
Developmental delay is observed in children with congenital bronchiectasis. They often suffer from respiratory infections. Decreased appetite and lack of oxygen prevent the cells of the body from dividing normally. With time ( from 3 - 4 years old) the child begins to noticeably lag behind in height and weight from their peers. At the same time, the level of mental development does not suffer, that is, the disease does not directly affect the central nervous system. However, after prolonged mental exertion, the child may have headaches. The level of attention and concentration is reduced. These signs, combined with chronic cough and periodic fever, should be suggestive of bronchiectasis.With the development of complications, patients may experience other symptoms, for example, pallor of the skin with pneumosclerosis, lower back pain with renal amyloidosis, swelling of the cervical veins with cor pulmonale. However, all these manifestations of the disease are not directly related to bronchiectasis.
In general, it can be noted that the combination of symptoms and the nature of the course of the disease makes it possible to suspect bronchiectasis at the first visit to the doctor. However, none of these symptoms confirm the diagnosis unequivocally. For this, it is necessary to conduct a number of special studies.
Diagnosis of bronchiectasis
Diagnostics of bronchiectasis is aimed at detecting deformed bronchi and clarifying the characteristics of the course of the disease in a particular patient. At the initial stages, the diagnosis is carried out by general practitioners or pediatricians ( if signs of pathology are found in children). If bronchiectasis is suspected, the patient is sent to a pulmonologist for the final formulation of the diagnosis. In general, bronchiectasis is difficult to diagnose, since it is accompanied by other pathological processes in the lungs. During an exacerbation, the patient is monitored and symptoms evaluated. It is much more difficult to detect bronchiectasis during the period of remission.
At the first stages of diagnosis, the following methods of examining the patient are used:
- General inspection... A general examination is performed to detect visible symptoms ( drum fingers, pale skin, etc.). In addition, with bronchiectasis, you can notice swelling or retraction of the skin in the intercostal spaces. This is due to the fact that areas with closed air cavities or without air at all are formed in the lung. In the process of breathing, the affected side lags somewhat behind, and the amplitude of respiratory movements ( how much the ribs rise as you inhale) can be reduced.
- Chest percussion... Chest percussion is tapping with the fingers of the entire projection of the lungs. With bronchiectasis of significant size in the affected area, the percussion sound is dulled. Under the fingers is a cavity with fluid or an area of lung fibrosis where air is not contained.
- Chest auscultation... Auscultation during remission of the disease reveals harder breathing and a characteristic hum over the dilated bronchi. It is created by passing air on a deep breath. During an exacerbation, various moist rales are heard, associated with a significant accumulation of pus and sputum.
In the diagnosis of bronchiectasis, the following instrumental research methods are used:
- functional tests;
X-rays of light
An X-ray machine is a device capable of creating X-ray radiation, which, having passed through the human body and hitting the film, forms an image on it.The resulting image is further referred to as a radiograph. It shows alternations of light and dark areas of varying intensity. They characterize the internal structure of the chest.
At the time of examination, the patient should be between the X-ray machine and the film so that the film is close to the patient's body, and the distance to the device is about 1 meter on average. The radiation dose for a single study is about 0.3 millisievert ( energy unit), which confirms the absolute safety of this diagnostic method. On modern devices, the dose received is so small that neither pregnancy nor the patient's youth can be considered absolute contraindications. Nevertheless, for these categories of people, the examination is prescribed only when necessary, and not in a planned manner.
On average, this x-ray takes a few minutes. The patient is not allowed to move for about 20 to 30 seconds. This is necessary to get a clear picture. With the classical method, the result will be ready the next day, since the film must be pre-processed in the laboratory. On monitor screens in digital form, the result can be obtained faster.
The study is usually performed in an upright position.(standing up)in multiple projections:
- straight when the direction of the rays is perpendicular to the frontal plane ( forehead plane), and the film is attached to the chest or back;
- lateral when the x-rays are coming from the side ( direction is determined by the affected side).
X-ray signs of bronchiectasis are:
- Deformation of the pulmonary pattern... The bronchi do not branch evenly over the entire area of the lungs. In some places, their walls are thickened, which is reflected in the picture in the form of blackouts.
- Local pneumosclerosis... On the radiograph, this complication resembles a white spot against the background of a darker lung tissue. This contrast is due to the lack of air in the sclerosed area. Often in the center of the darkening, a clearly demarcated cavity can be discerned ( dilated bronchus proper).
- Honeycomb pattern of the affected area... This symptom appears with multiple bronchiectasis. Small dilatations of the bronchi create a resemblance of a honeycomb with cells of irregular shape in the picture.
- A decrease in the volume of functional lung tissue... On the picture, it looks like a decrease in the volume of one of the lungs or an increase in the other ( the formation of a specific extension - emphysema). Such changes are characteristic of the late stage of the disease.
- The appearance of cysts... Bronchiectasis itself on the roentgenogram looks like cystic cavities. During an exacerbation, even the liquid level can be seen in them.
Functional tests
In bronchiectasis, it is of great importance to measure the function of external respiration ( FVD). This indicator may indicate the degree of functional insufficiency of the lungs affected by this pathology. The most accessible and widespread method is spirometry. This diagnostic procedure is carried out using a special device - a spirometer. Modern spirometers consist of several components - a tube, a transducer and a microcomputer. All the necessary information about the HPF is displayed on the screen of the device after the completion of the procedure.Special preparation for this study is not required. The procedure is usually performed in the morning on an empty stomach. 12 - 24 hours before the study, you must stop taking medications that may affect the results of the study. Having previously rested in the office, the patient should sit on a chair and breathe into the device tube for several minutes. Spirometry is absolutely safe and has no absolute contraindications. The doctor receives the results of the study instantly, reading the readings from the screen of the device.
The main indicators that are recorded with spirometry are:
- Tidal volume of the lungs- This is the amount of air that is inhaled and exhaled by the patient during a normal breathing rhythm. As pneumosclerosis progresses in patients with bronchiectasis, the tidal volume gradually decreases.
- Inspiratory reserve volume... This is the amount of air that the patient can inhale after a normal inhalation, making additional efforts. This indicator characterizes the elasticity of the lung tissue. With bronchiectasis and sclerosis, it is greatly reduced.
- Expiratory reserve volume... This volume is the reverse of the above. It characterizes the amount of air that the patient can exhale with effort. In patients with bronchiectasis, coughing attacks are often observed, since increased exhalation expels fluid from pathological cavities into the lumen of the bronchi.
- Lung vital capacity calculated by summing up the three previous indicators.
- Forced vital capacity of the lungs- the maximum expiratory volume after the deepest inhalation. It is he who characterizes how well the respiratory system works as a whole.
- Forced expiratory volume Is the amount of air that the patient can exhale in one ( the first) give me a sec. This indicator is also reduced in the presence of bronchiectasis.
- Tiffeneau Index Is an important practical indicator of lung function. It is the ratio between forced expiratory volume and forced vital capacity. This indicator serves as the main indicator for assessing the patency of the bronchi. With its decrease, we can say for sure about the presence of obstacles precisely at the level of the bronchial tree.
All of the above indicators, like many others, serve as important criteria in assessing the degree of respiratory impairment that occurs in the late stages of bronchiectasis. In the initial stages, the study of FVD may not detect any changes. This study is appointed rather in order to timely detect the broncho-obstructive syndrome accompanying the disease. It also indirectly reflects the degree of respiratory failure.
Bronchoscopy
Bronchoscopy is an instrumental method, which consists in examining the mucous membrane of the trachea and bronchi using a special camera. The device used for this procedure is called a fiberoptic bronchoscope. It is a flexible wire, at one end of which there is a miniature camera, and at the other end there is a small peephole and all kinds of image controls.Bronchoscopy is a rather difficult and unpleasant study for the patient. It lasts about 5-10 minutes, during which he has difficulty breathing. In addition, when a bronchoscope is inserted, nausea is felt, and when the larynx passes through, pain.
Bronchoscopy requires the following preparation steps:
- the study is carried out on an empty stomach;
- a few hours before the procedure, you should not even drink water;
- local anesthesia of the throat mucosa is carried out with the help of special sprays;
- the day before the procedure, the patient begins to receive sedatives ( in injections or tablets);
- the study is carried out after taking drugs that help cleanse the bronchi from phlegm and expand them;
- the patient should have a towel or napkins, as after the end of the procedure, hemoptysis is possible.
Bronchography
Bronchography is an x-ray of the lungs after a special contrast is injected into them. This contrast is distributed over the bronchial tree and makes it distinct in the resulting image. In most cases, the contrast is made on the basis of oily or water mixtures with the addition of iodine. The patient receives it some time before the X-ray. The introduction and distribution of contrast through the bronchi is accompanied by unpleasant sensations.To obtain a high-quality image, it is necessary to pre-clean the bronchi from sputum. To do this, the patient is given drugs that promote the discharge of sputum. Otherwise, the contrast will not be evenly distributed and will not show a clear outline of the bronchi.
This research method has a number of contraindications:
- individual intolerance to contrast components ( allergy);
- severe respiratory failure;
- pulmonary bleeding;
- chronic kidney disease ( it is through them that the contrast must leave the body after the procedure).
All of these methods are aimed at visualizing structural abnormalities in the lungs and collecting data on the functioning of the respiratory system. However, the diagnostic process is not limited to them. To collect complete information about the disease and prescribe the correct treatment, a number of additional studies are being carried out.
A complete examination program for patients with bronchiectasis includes the following procedures:
- bacteriological analysis of sputum;
- electrocardiography ( ECG);
- consultation of an ENT doctor.
General blood analysis
In the general analysis of blood, changes are observed mainly during the period of exacerbations. Typical for bronchiectasis is an increase in the level of leukocytes and a shift in the leukocyte formula to the left. Most often, this indicates the presence of an acute inflammatory process. With a prolonged and severe course of the disease, anemia may occur ( lowering the level of red blood cells).Blood chemistry
A biochemical blood test is more sensitive to pathological processes in the body than a general one. According to its results, one can judge not only the presence of inflammation, but also the development of some complications of bronchiectasis. Sometimes the results of the analysis indicate pathological changes in the body even before the onset of visible symptoms.Typical changes in the biochemical blood test are an increase in the level of the following substances:
- sialic acids;
- seromucoid;
- fibrin;
- haptoglobin;
- alpha globulins and gamma globulins.
General urine analysis
In the general analysis of urine, changes are usually not observed. The appearance in the urine of cells of columnar epithelium ( cylindruria) and proteins ( proteinuria) is characteristic only in the case of renal amyloidosis.Sputum bacteriological analysis
Sputum bacteriological analysis is recommended for all patients with bronchiectasis. In this case, the material for research is sputum or pus, which is separated with a cough. They contain a large number of microorganisms that have caused an exacerbation of the disease.When taking sputum for analysis, you should adhere to the following rules:
- it is advisable to take sputum in the morning, since at this time more of it leaves and you can get more live microorganisms;
- a bacteriological test should be done before starting antibiotics ( otherwise, there is a risk of getting a false negative result);
- in the presence of foci of infection in the upper respiratory tract ( sinusitis, frontal) it is necessary to prevent the ingress of microbes from these areas into the sample ( this can distort the analysis result).
The next step, which also needs to be carried out for patients with bronchiectasis, is the preparation of an antibioticogram. The resulting culture of microbes is tested for resistance to various antibiotics. As a result, after a few days, it is possible to obtain reliable information about which drug will be most effective for the treatment of this particular patient. Most often, repeated exacerbations of the disease are caused by the same type of microbes, therefore, the antibiogram is not always compiled ( to save time). However, identification of the pathogen on nutrient media or under a microscope must be carried out at each exacerbation.
Electrocardiography
Electrocardiographic study ( ECG) is assigned to assess the function of the heart. In the early stages of bronchiectasis, no pathological changes are usually observed. Minor failures can be noted only during severe exacerbations. In patients with multiple bronchiectasis and pneumosclerosis, the ECG should be taken at least once every six months. This will allow you to notice signs of the formation of cor pulmonale in the early stages and promptly begin treatment of this complication.ENT doctor consultation
Consultation with an ENT doctor is necessary to detect foci of infection in the upper respiratory tract. If there are any, the doctor must take steps to eliminate them. For example, with chronic sinusitis or frontal sinusitis, taking antibiotics does not always completely destroy the infection. Because of this, exacerbations of bronchiectasis are often observed and the prognosis for the future worsens. With chronic tonsillitis, the tonsils should be removed, and with sinusitis, a puncture should be done with washing the sinuses of the nose from pus. All this will reduce the likelihood of infection in bronchiectasis. The ENT doctor is engaged in the diagnosis and treatment of such problems.The purpose of these examinations is to diagnose complications and features of the course of the disease. The information received by the doctor helps to choose a faster and more effective treatment. These examinations will be most informative during the period of exacerbation, when there is an acute inflammatory process and the development of infection. During remission, no changes may be detected.
Treatment of bronchiectasis
The treatment of bronchiectasis can be approached in different ways. The approach depends mainly on the severity of the course and phase of the pathological process. With a mild course, it is only necessary to observe preventive measures in order to prevent frequent exacerbations. In a more serious condition of the patient, urgent hospitalization may be required, followed by treatment in a hospital setting. Specialists in the pulmonary or internal medicine department can provide appropriate treatment and care. In different cases, a variety of methods of treating bronchiectasis can be applied - from traditional methods of treatment to surgical removal of deformed bronchi. The data obtained in the course of diagnostic procedures are of great importance. It is on their basis that a patient's treatment plan is drawn up. In some cases, this process can be delayed for many years, since the disease periodically worsens. The patient should regularly visit the doctor and monitor his health.
In the process of treating bronchiectasis, the following methods are used:
- drug treatment;
- surgery;
- instrumental methods of treatment;
- prevention of exacerbations of the disease;
- adherence to proper nutrition;
- traditional methods of treatment.
Drug treatment
Medical or conservative treatment is the main treatment for bronchiectasis. Various groups of drugs can be used, each of which has its own effect. Sometimes patients with severe forms of the disease have to take medication constantly, even during the period of remission. During the period of exacerbation, the number of drugs increases.Drug treatment of bronchiectasis in the exacerbation phase pursues the following goals:
- cleansing the bronchi from phlegm ( its liquefaction and expectoration);
- improved respiratory function;
- destruction of pathogenic microbes;
- elimination of acute inflammatory process ( this will prevent the development of pneumosclerosis);
- decrease in body temperature;
- detoxification of the body ( cleansing of microbial toxins).
Groups of drugs used in the treatment of bronchiectasis
| Group of drugs | Mechanism of action | Drug name | Dosage and directions for use |
| Antibiotics | Suppresses the growth of microbes and destroys them. | Ciprofloxacin | 200 - 500 mg 2 - 3 times a day, depending on the severity of symptoms. |
| Levofloxacin | 250 - 500 mg 1 - 2 times a day. | ||
| Azithromycin | The daily dose for adults is 0.25 - 1 g, children are prescribed at the rate of 5 - 10 mg per 1 kg of body weight ( mg / kg / day). | ||
| Anti-inflammatory drugs | They have anti-inflammatory and antipyretic effects. | Paracetamol | Adults 0.3 - 0.5 g 3-4 times a day. Children from 9 to 12 years old - up to 2 g / day. Children under 9 years old at the rate of 60 mg / kg / day 3-4 times a day. |
| Aspirin | The daily dose for adults is from 0.25 to 1.0 g / day. The dosage for children depends on age and ranges from 0.05 to 0.3 g / day. | ||
| Ibuprofen | To reduce body temperature below 39 degrees, the dosage is 10 mg / kg / day, at a lower temperature ( 38 - 39 degrees) - 5 mg / kg / day. | ||
| Mucolytic drugs (mucolytics) | These funds contribute to the liquefaction of phlegm and facilitate its release from the bronchi. | Acetylcysteine | The daily dose for adults is 600 mg, for children under 2 years of age - 200 mg, and for older age - 400 mg. |
| Bromhexine | Patients from 14 years old are prescribed 8-16 mg 3-4 times a day. Children from 6 to 12 years old are prescribed 6 - 8 mg 3-4 times / day. Children under 6 years old - 2-4 mg with the same frequency. |
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| Ambroxol | Patients over 12 years old are prescribed 30 mg 2 to 3 times a day. Children from 5 to 12 years old - 15 mg 2 - 3 times / day. Children under 5 years old, 7 mg 2 - 3 times / day. ( dosage is indicated for tablets). |
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| Selective β2-adrenergic agonists
| They have a bronchodilating effect, facilitate the passage of air through the bronchi, facilitate the coughing up of sputum. | Salbutamol | The dosage depends on age, form of release, severity of symptoms. Before using these drugs, a mandatory consultation with a doctor is required, as serious side effects are possible. |
| Terbutaline | |||
| Fenoterol |
The choice of an antibiotic is made depending on the pathogen detected and its sensitivity to drugs. Before starting antibiotic therapy, it is advisable to draw up an antibioticogram. With the development of complications ( amyloidosis of the kidneys, cor pulmonale, pulmonary hemorrhage) some of the above drugs may be contraindicated. Therefore, self-medication during an exacerbation of bronchiectasis is strictly prohibited. The feasibility of using therapeutic aerosols and inhalations should also be discussed with your doctor. With intense formation of pus in bronchiectasis, they may be contraindicated.
Surgery
Surgical treatment of bronchiectasis is a radical method that allows some patients to be completely cured. It is resorted to only in cases where one or two bronchi are dilated, preferably within one pulmonary lobe. The location of bronchiectasis and their size are also of great importance. In some cases, the removal of even a single formation is associated with an unjustified risk. Therefore, not all patients can get rid of bronchiectasis surgically.Contraindications to surgical treatment are:
- multiple bilateral bronchiectasis;
- phase of exacerbation of the disease with the accumulation of pus;
- amyloidosis of the kidneys with signs of renal failure;
- pulmonary heart;
- deep location of bronchiectasis ( this complicates the surgical access);
- patient's age up to 14 - 16 years ( before that, the chest is actively growing and the position of bronchiectasis may change somewhat).
Instrumental methods of treatment
Instrumental methods of treatment are used mainly as supportive therapy or in severe disease. These include, for example, the endobronchial administration of certain drugs. Using the same bronchoscope, the doctor penetrates the bronchial tree and approaches as close as possible to the site of expansion. After that, an antibacterial agent or drugs to thin sputum are injected here. The effectiveness of such administration of drugs is much higher than when they are used in the form of tablets or injections.Physiotherapy is another instrumental method. It is carried out mainly during the period of remission of the disease and prevents exacerbation of the disease.
The main physiotherapy treatments are:
- microwave irradiation;
- electrophoresis with calcium chloride;
- inductometry ( exposure to high frequency magnetic field).
Prevention of exacerbations of the disease
As noted above, the prevention of exacerbations takes a significant place in the treatment of bronchiectasis. When the patient understands the essence of the pathological process in the body, he can easily observe all the necessary precautions so that his condition does not worsen.Prevention of exacerbations of bronchiectasis includes the following measures:
- avoiding hypothermia of the body;
- timely treatment of colds or other upper respiratory tract infections;
- timely treatment of caries and infectious processes in the oral cavity;
- limiting contact with patients who spread the infection by aerogenic ( when breathing) by;
- visiting a therapist or pulmonologist at least 3-4 times a year, even in the absence of exacerbations;
- to give up smoking;
- limiting dust inhalation ( if necessary - change of workplace);
- vaccination of children ( but not during an exacerbation) and the use of seasonal vaccines ( against flu).
In addition, within the framework of prevention ( and sometimes treatment of exacerbations) bronchiectasis, patients are often prescribed spa treatment. Fresh air increases resistance ( resilience) of the body, which reduces the likelihood of developing an infection. In case of exacerbations, one should resort to physiotherapy exercises and massage, which help cleanse the bronchi, release phlegm and facilitate breathing.
Compliance with proper nutrition
With the development of bronchiectasis, all patients are recommended preventive diet No. 13 according to Pevzner. It is especially important in the prevention of exacerbations. In general, this diet is used for infectious diseases.The essence of diet number 13 is reduced to the following basic postulates:
- high calorie content of food;
- consumption of foods rich in vitamins and minerals;
- consuming a lot of fluids;
- rational diet and proper culinary processing of products;
- limited consumption of fatty, salty, seasoned foods.
All patients need to consume foods rich in vitamins ( A, C, B1, B2) and minerals ( calcium, phosphorus, magnesium, zinc, etc.). Consumption of large amounts of fluids is one of the main mechanisms for reducing intoxication of the body, which occurs due to the death of microbes and the destruction of lung tissue. The total volume of liquid should be at least 1.5 - 2 liters per day. Reusable diet - up to 5 - 6 times a day in small portions. They eat well thermally and mechanically processed food, which is most often steamed and served warm. Preference is given to soups or mashed potatoes, as they are more easily absorbed by a weakened body.
The following foods are excluded from the nutritious diet:
- fatty meats;
- baking in large quantities;
- pasta;
- fried eggs;
- fatty broths;
- alcohol.
- low-fat varieties of meat, fish, poultry;
- dairy products;
- juices, fruit drinks;
- fresh fruits and berries, vegetables;
- honey, jam, jam;
- soft-boiled eggs or in the form of an omelet.
Traditional methods of treatment
Traditional methods of treating bronchiectasis are aimed at thinning sputum and making it easier to excrete. In most cases, these methods can be used in parallel with drug treatment. In the case of a serious condition of the patient or complications of the presence of complications, it is necessary to warn the attending physician about the alternative methods that the patient uses. With a pronounced purulent process in the bronchi, a number of folk remedies may be temporarily contraindicated. In the period of remission, you can continue the course.The following folk remedies are best for bronchiectasis:
- Flax seed crushed into powder and mixed with a garlic-honey mixture. For half a liter of the mixture, it is necessary to grind about 100 g of seeds. Take it 1 teaspoon half an hour before meals. This remedy strengthens the immune system, helps to defeat the infection and helps to thin the contents of the bronchi.
- Decoction of garlic. Cut one head of garlic into small pieces, preserving the juice, and mix with 250 ml of milk. The mixture is boiled for 3 to 5 minutes over low heat. Then the pieces of garlic are filtered through cheesecloth, and milk is drunk 1 tablespoon 3 times a day before meals.
- Carrot juice mixed with boiled milk and lime honey. For 50 grams of honey, 250 g of the remaining components are taken. The mixture is insisted, stirring occasionally, for 5 to 6 hours. Take it warmed up to 40 - 50 degrees 3 - 5 times a day until the cough is relieved.
- Infusion of aloe leaves... Infusion is made on moderate strength grape wine. For 4 large leaves you need 0.5 liters of wine. The leaves are scalded with boiling water, kneaded without loss of juice and placed in a vessel. Infusion in wine lasts 3 - 4 days in a dark place. After that, the agent is taken 1 tablespoon 3 times a day for 5 to 7 days.
Consequences of bronchiectasis
Bronchiectasis is a pathology that can cause a variety of complications. Often, the mechanism of these complications remains unclear. Their high prevalence is confirmed only statistically. This applies, for example, to renal amyloidosis, the development process of which is still unclear. In general, complications of bronchiectasis can affect not only the respiratory system, but also other organs. Often, during the period of remission of the underlying disease, it is the consequences and various complications that determine the serious condition of the patients. Some of them can also pose a serious threat to life. The main consequences and complications of bronchiectasis are:
- chronic respiratory failure;
- pneumosclerosis;
- pulmonary heart;
- amyloidosis of the kidneys;
- septicemia;
- pulmonary bleeding.
Chronic respiratory failure
Chronic respiratory failure is a major problem in all patients with bronchiectasis. Deformed areas of the bronchi and peribronchial sclerosis of the lung tissue impede the normal passage of air. Because of this, gas exchange is difficult in the alveoli. Venous blood, when passing through the lungs, is not enriched with oxygen to the desired level. With an appropriate analysis, a decrease in the partial pressure of oxygen in arterial blood can be detected.Respiratory failure progresses as pneumosclerosis develops. The more often the patient experiences exacerbations of bronchiectasis, the more the breathing process is disturbed. In the later stages of the disease, it is respiratory failure, not infection, that becomes the main problem.
Typical signs of respiratory distress are:
- shortness of breath on exertion;
- muscle weakness;
- increased fatigue;
- dizziness;
- blue tip of the nose, fingertips;
- cold intolerance.
Pneumosclerosis
Pneumosclerosis with bronchiectasis develops slowly. The process of proliferation of connective tissue begins around the affected bronchi. It is triggered by chronic inflammation and the aggressive effects of pus. Most often, in patients with bronchiectasis, focal proliferation of connective tissue is observed, which is limited to the segment in which the bronchiectasis is located.Pneumosclerosis is an irreversible process and is a major respiratory problem. Because of it, the respiratory volume of the lungs falls and chronic respiratory failure develops, which was mentioned above. There is no effective treatment for pneumosclerosis, therefore, patients with bronchiectasis should follow all the recommendations of doctors in order to prevent this formidable complication.
Pulmonary heart
The term "cor pulmonale" refers to the expansion of the right heart ( the right ventricle and, less commonly, the right atrium). The reason for this change is the increase in pressure in the vessels of the lungs. With single bronchiectasis without pneumosclerosis, cor pulmonale does not develop. The pressure increases significantly only when a large number of arterioles and capillaries in the lungs overgrow or become pinched as a result of deformation and degeneration of the tissue.With cor pulmonale, the thickness of the ventricular wall increases significantly. Because of this, symptoms that are not characteristic of bronchiectasis may periodically appear. Common complaints are chest pain, swelling of the neck veins, swelling in the ankle area, heart rhythm disturbances ( arrhythmias).
Amyloidosis of the kidneys
Amyloidosis or amyloid dystrophy of the kidneys is the accumulation of a pathological protein in their tissue - amyloid. Normally, there is no such substance in the body, but it can form against the background of chronic inflammatory processes. The so-called autoantigens begin to circulate in the blood, destroying the body's own cells. All degradation products and antibodies are deposited in the kidneys, which can lead to the formation of amyloid. In this case, the normal tissue of the organ is gradually impregnated with a pathological protein, and its functions are impaired.Patients with bronchiectasis are more likely to develop renal amyloidosis. At the first signs of this complication, treatment is urgently needed. A course of medical treatment and a special diet will help to avoid further progression of this disease.
Symptoms of renal amyloidosis, which are not characteristic of uncomplicated bronchiectasis, are:
- swelling in the arms, legs, face;
- increased blood pressure;
- hepatosplenomegaly ( enlargement of the liver and spleen);
Septicemia
Septicemia is the entry of pathogenic microorganisms into the bloodstream. In bronchiectasis, this can occur during a severe exacerbation. Microbes penetrate the bronchiectasis cavity, multiply there and sometimes lead to the destruction of the bronchial walls. As a result of vascular damage, the infection enters the bloodstream. First, it goes to the left parts of the heart, and from there it spreads throughout the body.Most often, with bronchiectasis, new foci do not appear in other organs. Nevertheless, such complications are possible with some particularly aggressive pathogens. The most common complaints are severe headaches, chills, and a sharp rise in temperature. With timely treatment with correctly selected antibiotics, the spread of the infection can be stopped.
Pulmonary bleeding
Pulmonary hemorrhage is a rare complication of bronchiectasis. They can occur against the background of a tuberculous infection or with massive formation of pus. In these cases, there is an active destruction of the lung tissue, which inevitably affects the vessels. If a more or less large vessel is damaged, bleeding begins. It is usually limited to blood in the sputum. In rare cases, blood is released in small droplets when breathing.Since large vessels are rarely damaged during bronchiectasis, bleeding most often does not require urgent measures to stop it. Blood ceases to stand out after a while ( minutes, rarely hours), and the total blood loss is insufficient to cause anemia, hypotension, or other serious disorders. However, some of the blood remaining in the lungs ( accumulated in the bronchioles and alveoli), is a favorable environment for the development of microbes. Severe pneumonia may follow episodes of pulmonary hemorrhage.
If, the examination showed that bronchiectasis developed in the lungs. It means that the treatment of bronchiectasis of the lungs is to be done. This is not an easy matter, but is it really a problem if you love life? Without treatment, bronchiectasis develop, develop into complications: emphysema, atrophic pharyngitis, bronchial asthma may develop.
Friends, hello! Svetlana Morozova with you. Do you know this gnawing feeling when you don't know what's wrong with you and suspect everything in the world? The hero of the book "Three in a boat, not counting a dog" sometimes wakes up in each of them - do you remember when he took a reference book of diseases in the library and found every one of them except for childbirth fever? So, let's talk about such a disease as bronchiectasis. She does not meet so often, and it is not possible to recognize her immediately. And we will take it and analyze it! Forward!
Treatment of bronchiectasis of the lungs: how will we treat it?
Let's start right away with the treatment. So where does it always start? Right, we go to the doctor. And then the following lies ahead:
- Antibiotic treatment. The first priority is to stop the multiplication of the infection. The medication regimen is always assigned on a case-by-case basis. Let me explain why. If the lesion is severe, then antibiotics must be taken daily, even during periods of remission. If bronchiectasis is developed easily enough, it is easier.
In this case, the method of administration can be different: in tablets, inhalers, aerosols, through intramuscular and intravenous injections. But the most effective is to administer the antibiotic using bronchoscopy. More on this a little further.
Breathing gymnastics
There are a couple of nuances here. First, you need to breathe in a special way, in jerks, that is, imitating a cough, with long exhalations. Secondly, during exercise, it is sometimes necessary to tap on the place where it is found that there is an accumulation of phlegm. Do not hit in the chest, but beat gently. Such manipulations are needed, again, to relieve sputum. And during the period of exacerbation, it is better not to do gymnastics.
So, the main positions, lying everywhere:
- IP: on the back. Legs should be slightly raised, you can put a roller / 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 our stomach, calmly, we try to stretch out the exhalation. With the help of our hands, we make sure that breathing is exactly abdominal.
- IP: on the back, arms along the body. On inhalation, we spread our arms to the sides, on exhalation, we draw our knees to the chest with our hands.
- IP: as in the previous one. To inhale, raise our hands behind our head, to exhale, raise a straight leg and at the same time lower our arms.
- IP: the same. With a breath, we spread our arms to the sides, trying to bend in the back. On exhalation, cross your straight arms as much as possible in front of you, slightly squeezing the chest.
- IP: on the side. Stretch your hand at the floor along the body, remove your free hand behind your head. On inhalation we lift it up, on exhalation we lower it to the chest, trying to press on the chest.
- IP: the same. We raise our free hand while inhaling, while exhaling, we simultaneously pull the knee to the chest and lower the hand, helping the knee.
- IP: on the stomach. To inhale, we take our hand behind our back, we reach for it with the upper part of the body. On exhalation, we return to the IP.
The exercises are all based on similar movements. Raise, pull up, push, breathe slowly and with an intensified exhalation. You can make any similar movements that come to mind. The main thing is that the pose is natural. Do not "reach the right ear with your left heel."
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 the breast fees from medicinal herbs. Probably, in childhood, everyone was given this when they cough. But with purulent sputum, some herbs are not allowed, so we consult a doctor about everything.
What recipes are considered the most effective:
- Garlic. The head of garlic must be chopped and mixed with a glass of milk. We boil the resulting mixture over low heat for 5 minutes, then filter and take a tablespoon three times a day before meals.
- Carrot. Namely her juice. Do it yourself or buy it - 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 up to interfere. When infused, we take 1 tbsp during the day. l. up to 6 times, preheated.
- Wine infusion. We take large leaves of aloe, 4-5 pcs., Scald with boiling water and knead. At the same time, we try not to squeeze out the juice. Then fill 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 to take with a wet cough. And this is licorice root, calendula, wild rosemary, marshmallow, coltsfoot, anise, sage.
We define the signs
Bronchiectasis is not always diagnosed immediately. It's all about disguise, so to speak. At first it looks like, then - like pneumonia, and all the time looks like bronchitis. Therefore, the picture is clarified only by complete 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 phlegm, it has a characteristic purulent color, with an unpleasant odor. Especially favorite time of day is morning. People stand up with a mouthful of exudate. That's when the morning doesn't start with coffee.
- If blood vessels are touched, 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. It manifests itself typically: pallor, weakness, weight loss. Children lag behind in physical development, puberty begins later.
- During the period of exacerbations, the temperature rises, the cough intensifies, and the sputum also becomes more. All signs of bronchopulmonary infection and intoxication.
- Insufficient breathing is especially pronounced in children: shortness of breath, cyanosis (cyanosis), the chest is changing. It is often enough to look at your hands. With respiratory failure, the nail phalanges of the fingers swell, become like "drumsticks". And nails are compared to "watch glass" - flat, round.
Oh, this infection
Most people find out that such a disease exists at all only when they or their children are diagnosed with it. So what is this disease?
The bronchi change shape, expand. Unfortunately, irreversible, 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 defective.
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 the 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 now ready-made bronchiectasis.
This differs from pneumonia in that the parenchyma of the lungs (superficial tissue) is not affected by inflammation, and atelectasis (deflated, flaccid, lost porosity areas of the lungs) are not formed.
It is not hard to imagine what will happen if you start the situation. Without treatment, bronchiectasis develop, develop into complications (COPD, emphysema, cardiac, renal, respiratory failure, atrophic pharyngitis), bronchial asthma may develop. By the way, there is an interdependent relationship. And asthma can occur due to bronchiectasis, and vice versa.
If treated properly, the prognosis is good. In 80% of cases, it is possible to achieve 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, in principle.
Don't get sick friends.
All the best!
The tale of the treatment bronchiectasis lung disease. I'll tell you about the symptoms, emphysema, atrophic farengitis, about the prognosis and treatment methods, and a bunch of interesting things. Go!
Hello friends! I'll tell you today about the organ that provides all our cells with the most necessary - oxygen. More precisely, about one of his ailments, which brings no less suffering than asthma. And most importantly, I will outline what the treatment consists of. bronchiectasis lung disease. This ailment can occur even in children, and getting rid of it is hefty difficult!
The tale of a tree that grows upside down
We have such a phenomenon in our body. The trunk of our tree is the trachea. Two massive knots depart from it - the main bronchi, which are then divided into many small branches. At the ends of them grow alveoli - small bubbles through which oxygen enters the blood.
Bronchiectasis disease is a deformation of the bronchi.
They stretch, their walls become thinner, and cannot work normally. A chronic inflammatory process develops in them, as a result of which pus accumulates. Since the organ is ill, various pulmonary infections join the main ailment.
You need to be alarmed if you have the following symptoms:
- persistent cough;
- separation of a fair amount of purulent sputum, especially in the morning;
- hemoptysis, and in the worst case, pulmonary hemorrhage.
Treatment of bronchiectasis of the lungs or what will happen to me?
The result of the disease can be anemia, respiratory failure, pulmonary emphysema.
Children develop poorly physically, lag behind their peers. A purulent inflammatory process leads to depletion of the body, and constant poisoning with decay products.
The lungs cannot work normally and shortness of breath occurs, and with a one-sided course of the process, the chest acquires an irregular shape.
There are three signs of chronic oxygen deprivation:
You can see for yourself that the problem is serious, and you cannot launch it.
Why is this happening?
History and treatment of bronchiectasis of the lungs, calculated over the years. The disease can be congenital and acquired. In the first case, the walls of the bronchi are deformed from birth. In the second, bronchiectasis develops from a young age, due to the fact that you often suffer from:
- tuberculosis;
- whooping cough;
- bronchitis;
- bronchopneumonia;
- atrophic pharyngitis;
- various chronic diseases of the nasopharynx.
A weak, not hardened child is susceptible to this! You can get sick for other reasons, mechanical and chemical in nature, due to which the bronchi change and their mucous membrane is disturbed.
This happens due to:
- ingress of foreign objects;
- the occurrence of vascular aneurysms, tumors;
- accidental reflux of stomach contents when;
- inhalation of poisonous gases and toxic substances;
- HIV infection.
The doctor diagnoses the disease as follows: he listens to moist rales in the lungs, when tapping, the sound is dull on the affected side, a change in the pulmonary pattern is visible on the X-ray.
An endoscope will detect viscous sputum, and bronchography will show the specific location of the lesion.
The diagnosis was made. What's next?
This is not a verdict yet. The main thing is to act. If left untreated, the prognosis is poor, the process can lead to extensive pulmonary hemorrhage, additional severe infections, disability and even death. Definitely, you will seriously complicate and shorten your life.
Classical methods serve two purposes:
- stop purulent-inflammatory process;
- cleaning the lungs from foreign contents.
The treatment regimen is as follows:
- You are prescribed antibiotics. They are all very powerful and should not be used without a specialist.
- Remove pus. This is done with a bronchoscopic drain. The procedure seems scary, but there is nothing to be afraid of. An experienced doctor conducts it very carefully. The tube, which is inserted through the nose or mouth, is much thinner in diameter, so breathing will not block. Before the introduction of the bronchoscope, you will certainly be given auxiliary medications that will facilitate the procedure.
- In order for the phlegm to go away well, expectorants are needed, both pills and herbal preparations, and inhalations. A good result is given by special breathing exercises and electrophoresis.
- If there is a possibility of surgical removal of the affected part, an operation is performed. It is not given to children under the age of seven, and rarely after forty-five, when severe complications develop. But in most cases, this is the only way to get rid of the disease completely.
And what about prevention?
Here's what you need to do:
- do not breathe dust, neither at home nor at work;
- treat upper respiratory tract infections on time;
Stop! Hardening does not mean hypothermia.
Pouring ice water is not for you, it is better to choose gentle methods, move more and walk more. It is necessary to observe the regime of sleep and rest, and by all means do gymnastics, both respiratory and general strengthening, in the fresh air.
I will say a few words about nutrition
To recover, you will need a lot of and, iron and others. There is no need to eat whole mountains of meat, fish and cottage cheese. It is necessary to consume food correctly and in the right quantities, in small portions and at least five times a day, for better digestibility.
Food should be light and tasty, because the psychological factor is no less important than any other.
Folk remedies are simple and can be of great help. Moreover, our ancestors have achieved serious success in thinning phlegm and expectorant effect.
So, expectorants:
- everyone's favorite plantain with honey (not recommended for high acidity of gastric juice);
- radish with honey (same warning);
- oregano, coltsfoot, chamomile (milder remedy);
- St. John's wort, calendula, clover;
- wild rosemary herb (read the contraindications carefully - it is poisonous);
- cranberries in combination with infusion of linden flowers, raspberry leaves, bay leaves and flax seed;
- melted badger fat with milk (can be replaced with lard);
- inhalation with various essential oils (mint, anise).
Afterword
Traditional medicine is a treasure. But we must remember that it does not replace traditional methods of treatment, especially for such dangerous diseases, one of which I spoke about today.
Treatment of bronchiectasis of the lungs exists, but it is impossible to completely recover from this ailment, but everything can be done so that it does not interfere with a normal life.
And to make it easier to determine the regime, understand its necessity and change your lifestyle for the better, read the articles of my blog. In them everyone will be able to find something that will certainly suit him and help him. This is the most important thing for me.
That's it for today.
Thank you for reading my post to the end. Share this article with your friends. Subscribe to my blog.
Definition
It is necessary to distinguish between bronchiectasis as an anatomical concept and bronchiectasis. Bronchiectasis (bronchus + Greek ectasis - expansion) is a persistent (irreversible) expansion of the bronchi with pronounced structural changes and functional inferiority of their walls. Bronchiectasis– This is a disease that arose in childhood, the morphological substrate of which is bronchiectasis, followed by their infection and the development of a chronic purulent inflammatory process in them (purulent endobronchitis).
In addition to bronchiectasis as an independent nosological form, also called primary bronchiectasis, secondary bronchiectases are isolated, which are a complication of other diseases of the bronchopulmonary system: chronic bronchitis (characterized by the development of bronchioectasis), chronic pneumonia, lung abscess, tuberculosis, tumors, foreign bodies and cicatricial processes in the bronchi. The cause of the development of secondary bronchiectasis can also be malformations of the lungs (cystic hypoplasia, tracheobronchomegaly, etc.), genetically determined diseases (cystic fibrosis, motionless cilia syndrome), as well as primary immunodeficiency states. With bronchiectasis as an independent nosological form of the disease, which caused the development of bronchiectasis, (see below) "remained in the anamnesis", and the main, and often the only manifestation of the pathological process is purulent endobronchitis in the cavities of the dilated bronchi. In secondary bronchiectasis, signs of a purulent inflammatory process in the cavities of the dilated bronchi are superimposed on the clinical picture of the underlying disease and, as a rule, do not have a dominant significance.
In the International Classification of Diseases X revision, bronchiectasis as an independent disease is designated by the code J 47. In this
The document also lists congenital bronchiectasis, which has the Q 33.4 code, which is used only in children in the first two years of life.
Social value
Prevalence bronchiectasis, according to referral data, ranges from 0.1 to 0.4%. It is impossible to establish the true prevalence of bronchiectasis, since bronchographic examination is necessary for its diagnosis. Its share among all COPD does not exceed 3-4%. Since the 60s of the last century, there has been a decrease in the incidence of bronchiectasis, which is explained by a decrease in the frequency of childhood infections, especially measles and whooping cough, and the success of treatment of acute bronchopulmonary diseases, primarily pneumonia in children, which are mainly associated with the development of bronchiectasis.
Bronchiectasis contributes to mortality structure, a
also temporary and permanent disability, although these questions have not been answered
zeal in literature. A lethal outcome can occur with an exacerbation of the disease, especially with severe perifocal pneumonia and impaired bronchial drainage with a delay in sputum separation, which sharply increases the syndrome of purulent intoxication. An unfavorable outcome can also occur with complications with metastatic brain abscess, purulent meningitis, septicopyemia, pulmonary hemorrhage, as well as with the development of secondary systemic amyloidosis and secondary COPD.
With an exacerbation of the disease, as well as with the development of complications, the patient is disabled. With frequent exacerbations of bronchiectasis (more than 2-3 times a year), in the presence of a syndrome of pronounced purulent intoxication in the periods between exacerbations, the release of a large amount of purulent sputum, periodically arising "temperature candles" (incomplete remissions), persistent disability is determined. Persistent disability also occurs with complications of pulmonary heart failure, secondary amyloidosis with kidney damage and the development of chronic renal insufficiency.
sti, as well as after extensive resections of the lungs with the development of severe respiratory failure.
Etiology and pathogenesis
The main causal factors diseases are considered pneumonia, less often
tuberculous bronchoadenitis, developing in childhood and leading to a violation of bronchial patency up to the development of obstructive atelectasis. The immediate causes of atelectasis can be compression of the child's thin and pliable bronchi by hyperplastic hilar lymph nodes or blockage of the bronchial lumen with viscous sputum. An additional (sometimes basic) value in the development of atelectasis is the collapse of the lung tissue due to disturbances in connection with pneumonia of the activity of surfactant - a special lipoprotein complex that provides the necessary level of surface tension of the alveolar membrane.
V the site of atelectasis, the drainage function of the bronchi is impaired, which leads to a delay in secretion, activation of infection and the developmentpurulent endobronchitis distal to the level of obstruction... The purulent process further spreads to all layers of the bronchial wall, causing degeneration of smooth muscles and cartilaginous elements and their replacement with scar tissue. As a result, the bronchi lose their normal elasticity and become functionally defective.
V conditions of functional inferiority of the bronchi to their expansion lead to the followingpathogenetic factors:
1. Increased intrabronchial pressure during coughing and stretching of the bronchi with accumulated sputum.
2. Increased, due to a decrease in lung volume due to atelectasis, negative intrathoracic pressure, especially in the inspiratory phase. The difference in pressure in the bronchi, which are associated with atmospheric air, and intrathoracic pressure has an expanding effect on the bronchi.
It is believed that these factors can cause the formation of bronchiectasis only in childhood (up to 10-12 years), when the normal formation of the bronchi has not yet been completed. The nature of bronchopulmonary inflammation is also important.
fections: bronchiectasis often develops after pneumonia associated with measles, whooping cough, viral-bacterial infection, in which there are pronounced lesions of the bronchial tree. Most authors also believe that congenital inferiority of the bronchial wall (insufficient development of smooth muscles, elastic and cartilaginous tissues) is a contributing factor for the formation of bronchiectasis.
Some authors admit the formation of bronchiectasis in early childhood only due to congenital inferiority of the bronchial wall (desontogenetic bronchiectasis). Such bronchiectasis, in the opinion of these authors, develop out of connection with previous pneumonia, impaired bronchial patency and purulent-destructive changes in the bronchial wall.
The resulting enlargement of the bronchi is worn persistent character and retaining
after elimination of bronchial obstruction ... Violation of sputum evacuation
leads to persistence of chronic inflammation in them, which periodically aggravates under the influence of unfavorable factors.
The progression of the pathological process in bronchiectasis occurs, first of all, along the path of the development of secondary diffuse bronchitis, which is initially reversible and can disappear after removal of the section of the lungs affected by bronchiectasis. If a radical operation is not performed or is performed with a delay, then chronic diffuse bronchitis is progressing... In some patients (in about 20% of cases) chronic obstructive bronchitis develops and COPD is formed with the development of respiratory failure, and then chronic cor pulmonale with its subsequent decompensation.
The progression of the process can also lead to the formation of new bronchiectasis as a result of the flow of purulent sputum into the intact bronchi with the development of purulent bronchitis with persistent impairment of bronchial patency. So, with a primary lesion of the basal segments as a result of this mechanism, a secondary lesion of the bronchi in the reed segments can develop.
The data presented here relate to the etiology and pathogenesis of bronchiectasis as such. In addition, the doctor needs to know in order to prescribe adequate antibiotic therapy the etiology of this exacerbation, which is judged by the results of laboratory studies, mainly by bacteriological research with an assessment of the antibiogram of the purulent contents of bronchiectasis. Exacerbations are more often caused by gram-negative flora (Klebsiella, Proteus, Pseudomonas, Haemophilus influenzae, etc.), somewhat less often - by staphylococcus, pneumococcus, streptococcus, or mixed microflora are found.
Classification
There is no official classification for bronchiectasis. Among the many options proposed, the most convenient for practical work is the classification of A.Ya. Tsygelnik, which is given by us with some additions. The classification provides the following characteristics.
1. The form of the disease:
a) lung (bronchitis); b) "dry" (bleeding); c) pronounced (classical).
2. Localization of the process by shares and segments.
3. Type of ectasia (according to bronchography): saccular, cylindrical, fusiform, mixed.
4. Phase of the process: exacerbation, remission.
5. Complications: pneumonia, hemoptysis, pulmonary hemorrhage, aspiration abscess in the unaffected area of the lung, metastatic brain abscess, pleural empyema, meningitis, septicopyemia, secondary chronic diffuse bronchitis, secondary systemic amyloidosis.
Examples of the formulation of a clinical diagnosis
1. Bronchiectasis, severe (classical) form, saccular bronchiectasis in the VIIVIII segments on the left, exacerbation phase. Secondary chronic purulent obstructive bronchitis, exacerbation phase. DN I.
2. Bronchiectasis, "dry" form, mainly cylindrical bronchiectasis in the X segment on the right, exacerbation phase. Complication: profuse pulmonary hemorrhage.
Clinic and diagnostics
Clinical signs diseases usually appear between the ages of 3-5 to 20 years. It is often possible to establish the true date of the onset of the disease only with the participation of the parents. The disease is 1.5-2 times more common in men.
In a significant number of patients, the disease first manifests itself as a cough with a small amount of sputum (bronchitic form of the disease), against this background, there is a tendency to colds and periodic exacerbations of the disease, which often occur under the diagnosis of ARVI, exacerbation of chronic bronchitis or chronic pneumonia.
With a pronounced (classical) form of the disease, the main complaint during an exacerbation is a cough with the separation of a significant amount (from 30-50 to 200-300 ml or more per day) of purulent sputum. Clinical signs are revealed cavity syndrome:
1) sputum separation with a full mouth, mainly in the morning;
2) dependence of sputum separation on body position; this is due to the fact that the pathologically altered mucous membrane in the dilated bronchi loses sensitivity and the cough reflex occurs only when sputum enters the unaffected bronchi;
3) sometimes an unpleasant odor from sputum, which indicates putrefactive decomposition of sputum during its stagnation in bronchiectasis.
When standing, the sputum is divided into two layers: the upper one, which is an opalescent liquid with a large admixture of saliva, and the lower one, consisting entirely of purulent sediment. It is the volume of this sediment that characterizes
the intensity of purulent inflammation. Unlike a lung abscess, elastic fibers in sputum with bronchiectasis are absent.
Some patients (about 30%) have hemoptysis and pulmonary hemorrhage. Hemoptysis is the secretion (coughing up) of blood with phlegm. Pulmonary hemorrhage is the discharge of pure blood from the airways or lungs when coughing. Distinguish between small (up to 100 ml), medium (up to 500 ml) and large, profuse (more than 500 ml) pulmonary bleeding. Hemoptysis and pulmonary hemorrhage can be observed in any form of the disease (on average in 25-30% of patients), and in the "dry" form of bronchiectasis, they are the only manifestation of the disease. Pulmonary bleeding usually occurs after heavy physical exertion or overheating. The immediate cause of bleeding and hemoptysis is the rupture of altered vessels in the wall of bronchiectasis.
With extensive lesions and with complications of the disease by secondary diffuse obstructive bronchitis (COPD), shortness of breath is observed. Chest pain of a pleural nature can be with an exacerbation of the disease due to reactive dry pleurisy. As a rule, with an exacerbation of the disease, symptoms of intoxication are revealed: general weakness, malaise, sweating.
An increase in body temperature during an exacerbation is more pronounced (up to 38.5-39 ° C) in the first years of the disease, which, apparently, is associated not only with suppuration in bronchiectasis, but also with pneumonia in the parenchyma preserved around them. In the future, the parenchyma around bronchiectasis is destroyed and exacerbation of the disease
levania are caused almost entirely by the suppurative process in the cavities of the
dilated bronchi; the temperature rise in these cases rarely exceeds
38 ° C.
In the remission phase of the disease, the cough and the amount of sputum secreted decrease, the manifestations of intoxication decrease, and the body temperature normalizes. However, there is a clear connection between the general condition of the patient and the temperature reaction with the state of the drainage function of the bronchi; in case of delay,
sputum intoxication increases, and the body temperature rises (temperature "candles").
With an objective examination in about 30-40% of patients,
there are changes in the terminal phalanges of the fingers in the form of "drumsticks" and nails in the form of "watch glasses". This symptom, associated with purulent intoxication, is more common with a long course of the disease.
Above the affected area of the lung, usually in the posterior lower parts, the dullness of the percussion sound is determined or, in the presence of dry cavities, the tympanic percussion sound (changes during percussion may be absent); more characteristic is listening in this area against the background of hard breathing sonorous and rather persistent medium- and large-bubble humid rales, which are compared with "machine-gun crackling". After coughing up sputum and especially after the elimination of the exacerbation of the disease, the amount of wet wheezing decreases until it disappears completely.
The auscultatory picture changes sharply when the bronchi are blocked with a viscous secretion. In such cases, breathing and wheezing over the affected section are not heard and begin to be determined only after sputum discharge or medical lavage of the bronchi.
With an exacerbation of bronchiectasis, leukocytosis, neutrophilic shift to the left, deviations of acute phase blood parameters are often observed; an increase in ESR is natural. With severe purulent intoxication, a number of patients develop hypo or normochromic anemia (posthemorrhagic or myelotoxic).
An X-ray of the chest organs, performed in frontal and lateral projections, reveals an area of reinforced and deformed pulmonary pattern, covering 1-2 segments or a whole lobe, less often more extensive in area, and the affected sections are reduced in size due to pneumofibrosis. Against the background of fibrosis, a cellular pulmonary pattern is often found. Contrary to the previously existing concepts, the cells do not correspond to the cavities of the dilated bronchi, but represent areas of emphysema against the background of pneumonia.
mosclerosis. Only in very rare cases, bronchiectasis can be directly detected on the roentgenogram in the form of thin-walled cavities, sometimes with a fluid level.
More reliably, structural changes in the affected area of the lungs can be judged by the data of multiaxial X-ray super-exposed and tomographic studies.
These changes are more often found in the lower lobe on the left and in the middle lobe on the right. On a direct radiograph, the lower left lobe, reduced in volume, is almost completely "hidden" behind the heart displaced to the left; its structure is clearly visible only on the left lateral radiograph. In the same way, a direct radiograph cannot be judged about changes in the lower lobe on the right, especially if it is reduced in volume (presented in the form of a small triangular darkening adjacent to the mediastinum). The middle lobe is clearly visible on the right lateral image in the form of a clearly delineated strip up to 2-3 cm wide, running obliquely from the root of the lung to the anterior costal-diaphragmatic sinus.
Radiography and tomography of the lungs can reveal only indirect signs of bronchiectasis, which, in combination with clinical data, make it possible to express a reasonable suspicion of the presence of this disease.
Of decisive importance for the diagnosis of bronchiectasis is
contrast examination of bronchi - bronchography ... Bronchography is performed on
after the exacerbation of the disease is removed, the amount of sputum being separated is maximally reduced, since the presence of a large amount of secretion in the bronchi prevents them from filling with a contrast agent and makes the research results uninformative.
Bronchography is performed in the morning on an empty stomach. In adults, the procedure is often performed under local anesthesia. The first stage: in a sitting position, anesthesia of the nose, nasopharynx (up to the glottis) is carried out with a 0.5% dicain solution. In this case, the patient must breathe correctly: inhale through the nose, exhale through the mouth. When inhaling into the nostril, which has the best permeability, it is first instilled, and then
Then a 0.5% solution of dicaine is poured in with a full pipette, which is evenly distributed over the mucous membrane and reaches the glottis. After 5-7 minutes, when anesthesia occurs (this is determined by the feeling of awkwardness in the throat), the catheter is advanced through the corresponding nostril to the glottis, and then, with a deep breath, it is pushed through the glottis into the trachea. This is determined by the appearance of a hoarse voice. 3-5 ml of a mixture consisting of 1-2 ml of a 0.5% solution of dicaine and 2-3 ml of a 10% solution of novocaine are poured into the trachea. After that, the cough goes away.
In the future, if there is a suspicion of bronchiectasis, the so-called undirected bronchography, which allows you to assess the state of the bronchial tree as a whole, to resolve the issue of the length of the pathological process and the volume of the forthcoming operation. For this purpose, the subsequent stages of the procedure are carried out on a lateroscope. The patient is placed on the side to be examined, the catheter is carried out to the middle of the trachea and 3-4 ml of the same mixture as before is injected through it.
After anesthesia of the bronchi of the lung under study, iodine-containing contrast agent iodolipol (iodized vegetable oil) in combination with norsulfazole is injected through the catheter. This drug is called sulfoiodol. For its preparation, 10 g of powdered non-crystalline norsulfazole is added to 30 ml of iodolipol. The mixture is thoroughly triturated to a completely homogeneous mass and 10-20 ml of sulfoiodol is injected into the respiratory tract with a syringe through the catheter. After 3-4 days, the study is carried out on the other side.
With directional or selective bronchography is carried out at the beginning an-
path, and then the introduction of contrast into the lobar or segmental (and even subsegmental) bronchus using a guided catheter. This technique makes it possible to more reliably detect bronchoconstriction (for example, tumor) or broncho-iron fistula in small bronchi.
Detected bronchiectasis can be saccular, cylindrical, fusiform and mixed; for bronchiectasis, the predominance of saccular bronchiectasis is characteristic. At the same time, inside the affected section
(lobes, segment, group of segments) all or almost all bronchi are affected, mainly of the 4th-6th order, the ends of which end blindly due to obliteration of smaller bronchi distal to bronchiectasis. Typical is the localization of bronchiectasis in the lower lobe on the left, reed segments and the middle and lower lobes on the right. The location of bronchiectasis in the upper lobes is not typical for bronchiectasis; such bronchiectasis are secondary and are usually associated with previous pulmonary tuberculosis.
For an objective judgment about the nature of bronchiectasis, it was proposed to compare the diameter of bronchiectasis at the widest point with a diameter of the preceding
unchanged bronchus causing bronchiectasis ... With cylindrical bronchiectasis, their diameter exceeds the diameter of the previous bronchus by 10-15 %, with fusiform - by 15-30 %, with saccular - more than 30%. Large bronchiectasis, located in a heap within the affected segment (segments), give a picture of a "bunch of grapes" on the bronchogram. Smaller bronchiectasis emanating from the bronchi 7-9 order, have the shape of a rosary or beads on the bronchogram.
Bronchography makes it possible not only to establish morphological changes in the bronchial tree, but also to evaluate functional disorders of the bronchi by the time of their release from iodolipol: in patients with bronchiectasis, it is sharply slowed down.
Thus, bronchographic examination is the main method for diagnosing bronchiectasis. ... It allows you to install the loca-
lization, prevalence and type of bronchiectasis, detect deforming bronchitis, violations of bronchial patency, assess functional disorders of the bronchial tree, and in some cases identify a foreign body or tumor in the bronchus.
Currently, as an alternative to bronchography, it is proposed CT scan, in which bronchiectasis is also detected. However, a negative result from this study is not sufficient to exclude bronchiectasis; in these cases, as well as with the planned radical operation, bronchography should be performed. In addition, according to re-
The results of computed tomography fail to clearly distinguish the type of bronchiectasis.
Diagnostic bronchoscopy It is used to assess the prevalence and nature of inflammation of the bronchial mucosa, sampling the contents of the bronchi for bacteriological, cytological and mycological research, biopsy of suspicious areas of the mucous membrane. With bronchoscopy, bronchiectasis located in the bronchi 4th-6th order and in the smaller bronchi, are not directly visible, since with fibrobronchoscopy only the bronchi are clearly visible 1-3rd order (principal, equity, segmental). However, with bronchoscopy, it is possible to reveal indirect signs of bronchiectasis: the discharge of pus from the mouths of those segmental bronchi, where there are suppurative bronchiectasis.
In uncomplicated bronchiectasis, the dysfunction of external respiration in a restrictive (restrictive) type is moderately expressed; with a complication of chronic diffuse bronchitis, ventilation disorders of a mixed or obstructive type are determined.
Bronchiectasis is characterized by steadily progressive, undulating course... The most common variants of disease progression and complications are listed above.
Differential diagnosis
Differential diagnosis of bronchiectasis must be carried out primarily with secondary bronchiectasis, which can develop in chronic bronchitis, chronic pneumonia, lung abscess, tuberculosis, tumors, foreign bodies and cicatricial processes in the bronchi. Secondary bronchiectasis is characterized by a connection with the above diseases, a small number of bronchiectasis within the affected segments, and in chronic bronchitis - diffuse localization in various parts of the lungs; predominantly cylindrical or spindle-shaped nature of the expansion of the bronchi and bronchioles, in connection with which the cavity syndrome is expressed moderately. To this-
We can add that bronchiectasis begins in childhood, secondary bronchiectasis usually develops in adults.
In differential diagnosis for suppurative syndrome it is necessary to bear in mind also acute and chronic abscess and cystic hypoplasia of the lung (congenital disease).
With "dry" (bleeding) bronchiectasis, the differential diagnosis is carried out with all diseases, which can give hemoptysis and pulmonary
Treatment of bronchiectasis is divided into for conservative and surgical... In patients with small in volume and unexpressed bronchial dilatation, mainly cylindrical, and, on the other hand, in the presence of contraindications for surgery, conservative therapy is the main method of treatment. Conservative therapy is also carried out to relieve exacerbation of the disease in preparation for surgery.
Conservative treatment carried out against the background of a certain therapeutic regimen with the use of adequate physical activity and breathing exercises with the complete exclusion of smoking and the elimination of the effects of other pollutants. Conservative treatment is based on sanitation of the bronchial tree, which is subdivided into passive and active. Passive debridement involves the administration of mucolytics and expectorants and postural (positional) drainage. When carrying out postural drainage, the patient takes a position that ensures the separation of secretions from the affected bronchi. So, with the most frequent localization of bronchiectasis in the basal segments of the patient in the prone position, the head end of the body hangs from the bed at an angle of 40-45%. The effectiveness of postural drainage increases significantly when combined with tapping on the chest.
However, active sanitation of the bronchial tree, which provides for the aspiration of the contents of the bronchi, their lavage and the subsequent introduction of medicinal substances into the bronchi. Of the various methods of local administration of medicinal substances discussed in the previous chapters of this manual, for bronchiectasis, endobronchial administration through a fibrobronchoscope is preferred. Before the administration of the drug, the bronchi are washed and the bronchial contents (lavage) are sucked out using an electric suction. In addition to the antibiotics mentioned in the previous chapter, dioxidine, nitrofuran preparations (furacilin, furagin), as well as an antiseptic of natural origin, chlorophyllipt, are used for endobronchial administration. However, fibrobronchoscopy is a stressful procedure, therefore, a combined debridement of the bronchial tree is usually performed. At the same time, about once a week, bronchoscopic sanitation is performed, and in the intervals between them, the antimicrobial drug is administered endobronchially through a rubber catheter. A good effect is also achieved when sanitizing the bronchial tree through a microirrigator (guided catheter). Other methods of endobronchial administration of drugs are less effective - inhalation and with the help of a laryngeal syringe.
With moderate exacerbation, you can limit yourself local administration of antibiotics... In severe exacerbation, accompanied by a significant increase in body temperature and severe purulent intoxication, en-
pre-bronchial methods combine with parenteral administration of antibiotics in therapeutic doses, taking into account their compatibility ... The selection of antibiotics for parenteral administration is carried out according to the same principles as for chronic pneumonia.
It should be borne in mind that the effectiveness of parenteral and oral administration of antibiotics is associated with their effect on perifocal pneumonia, to a lesser extent - on the course of bronchitis; also, treatment is practically ineffective in suppurating bronchiectasis. In this regard, the main importance in the treatment of bronchiectasis is the sanitation of the bronchial tree with endobronchial
by the other methods of administration of antimicrobial drugs. Etiotropic therapy is recommended to be carried out under the control of the clinical efficacy and sensitivity to antibiotics of the microflora isolated from the patient's sputum.
We consider it necessary to emphasize the frequent underestimation of the therapeutic role by doctors. postural (positional) drainage, which must be carried out at least 2 times a day (in the morning after waking up and in the evening before bedtime). The patient should be trained in the technique of finding the optimal position for emptying the bronchi from phlegm. The effect of postural drainage is enhanced by the simultaneous administration of expectorants and mucolytics, breathing exercises, chest massage.
In case of severe exacerbation of the disease, they are used detoxification means, passive immunotherapy is carried out. After the exacerbation has been removed, a differentiated pharmacological immunocorrection is recommended, depending on the specific deviations in the immune status.
From physical factors in case of bronchiectasis, an UHF electric field is recommended on the affected area in a low-thermal dosage. Treatment is carried out in the presence of confidence that there are no obstacles to the outflow of pus from bronchiectasis. Physiotherapy is contraindicated for hemoptysis and pulmonary hemorrhage.
A beneficial effect on the course of bronchiectasis has sanatorium treatment in the warm season in conditions close to the Mediterranean climate (North-West coast of the Caucasus near the cities of Anapa and Gelendzhik, South Coast of Crimea). Sanatorium treatment is indicated only in the phase of remission of the disease after the previous sanitation of the bronchial tree and in the absence of complications.
An important element of the medical complex is sanitation of the upper respiratory tract(treatment of sinusitis, tonsillitis, removal of adenoids). Since a lot of protein is lost with phlegm, its increased content should be provided in the daily diet.
Surgery(resection of the affected part of the lung) is the most radical method and can lead to complete recovery. With a one-sided process, radical surgical treatment is possible in most patients. In a bilateral asymmetric process, the operation is performed on the side of the larger lesion; after that, as a rule, it is possible to restrain the purulent-inflammatory process on the unoperated side. With a bilateral symmetric lesion, bilateral resection is indicated, usually of the lower lobes, sometimes, in addition, of the lingual segments. The operation is performed in two stages with an interval of 6-12 months.
Complete recovery with surgical treatment is not achieved in all patients; in about 20% of those operated on, residual bronchiectasis is subsequently determined. Mortality during lung resections in specialized institutions does not exceed 1-2%.
Contraindications for surgery are common processes when less than 3 lobes of the lung remain unaffected, the presence of COPD with severe respiratory failure and cor pulmonale, as well as renal amyloidosis. At the same time, the initial manifestations of renal amyloidosis (albuminuric stage), according to many authors, are not a contraindication for surgery, since they are reversible and are often eliminated after surgery.
Prognosis for recovery usually unfavorable. Practical recovery can occur only in patients with a small amount of damage and with a timely operation. In these cases, no "residual effects" remain in the bronchopulmonary system, and a slight decrease in lung tissue does not reduce respiratory function.
Forecast for life for the immediate and distant period of time is determined mainly by the degree of pulmonary heart failure (with a complication of COPD disease) and the presence of secondary systemic amyloidosis and associated functional renal failure. A serious threat to life can occur with pulmonary hemorrhage, the development of a metastatic abscess of the brain.
ha, meningitis, septicopyemia, with severe exacerbation of bronchiectasis, accompanied by impaired bronchial drainage.
Prognosis for work ability depends mainly on the degree of development of pulmonary heart failure and functional disorders of organs, primarily of the kidneys, associated with secondary amyloidosis. Persistent disability can also occur with a severe course of the disease, occurring with frequent exacerbations, a syndrome of severe purulent intoxication, shortness of breath, especially in cases where remission is not achieved with active treatment.
Prevention
Primary prevention of bronchiectasis is the complete treatment of pneumonia, acute bronchitis and acute respiratory viral infections in children.
Secondary prevention consists in preventing exacerbations of bronchiectasis and restraining its progression. For this purpose, patients are taken to dispensary observation, in the process of which medical and recreational activities are carried out. Patients are taught postural drainage, which is recommended 2-3 times a day. Expectorants and mucolytics are periodically used. In spring and autumn, adaptogens are prescribed, with an increase in the amount of sputum secreted - inhalation of phytoncides or antibiotics. In case of acute respiratory viral infections, a prophylactic course of antibiotics is recommended. With a pronounced exacerbation of the disease, a course of endobronchial sanitation is carried out on an outpatient basis, or the patient is sent for inpatient treatment.
Literature
1 Paleev N.R., Borokhov A.N., Ilchenko V.A. Bronchiectasis // Guide to Internal Medicine. Diseases of the Respiratory System / Ed. N.R.
Paleeva. - M .: Medicine, 2000 .-- S. 450-458.
2. Rice J. Diagnostic tools in pulmonology. Per. from English - M .:
Medicine, 1994 .-- 312 p.
3. Tsigelnik A.Ya. Bronchiectasis. - L .: Medicine, 1968. - 444 s.
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