bronchiectasis

Bronchiectasis - permanent local bronchiectasis with a change in the structure of their walls. The form of bronchiectasis is different, more common cylindrical and saccular bronchiectasis. They may be limited (in one segment or lobe of the lung) or common (whole lung capture and even both lungs). Most bronchiectasis seen in the lower lobes of the lungs.

There are congenital and acquired bronchiectasis. Congenital bronchiectasis occur in violation of bronchopulmonary system in utero; sometimes they are combined with other malformations - reverse arrangement of internal organs, swept the sky, splitting his upper lip. Acquired bronchiectasis develops, usually after various bronchopulmonary diseases (primarily from pneumonia and tuberculosis) and the syndrome of bronchial obstruction of any genesis. Changes in bronchial walls usually begin with an inflammatory process and end the destruction of muscle and connective tissue skeleton, thickening and often ulceration of the mucosa. Increasing intrabronchial pressure is caused by narrowing of the bronchial tubes, the accumulation in them a secret, long cough. In the event of bronchiectasis in children matters and violation of postnatal development of bronchopulmonary system. It is often associated with a history of early childhood (when is not over the formation of bronchopulmonary system), pneumonia, measles, whooping cough and others. Sometimes the cause of bronchiectasis in children are aspirated foreign bodies . Another possible way of occurrence of bronchiectasis - mechanical bronchiectasis atelectasis in the development of lung parenchyma or decrease the volume, followed by the addition of a secondary infection.

The clinical picture of congenital and acquired bronchiectasis is often the same, and to differentiate them, it is usually difficult. Symptoms are mainly determined by the extent and prevalence of bronchiectasis, severity of destruction of the bronchial wall, active infection, duration of the pathological process. In the so-called dry bronchiectasis, when manifestations of infection in the affected bronchi and are not expressed in patients with no sputum, clinical symptoms are often absent; it may sometimes be pulmonary hemorrhage. However, in most cases, the affected bronchi develops periodically escalating infectious process. Patients complain of cough with mucopurulent or purulent sputum, sometimes abundant, • «full mouth" (children under 7 years old are usually swallow phlegm). Often, there is a certain regularity of occurrence of productive cough attacks - he worried sick in the morning, on rising, and in the evening, in bed; in the rest of the day the cough may be absent. In exacerbations of infection the number of sputum increases and reaches 50-100 ml per day or more. In some cases, sputum becomes unpleasant, sometimes fetid odor, contains an admixture of blood. When defending this phlegm is divided into three layers: the bottom of thick pus accumulates in the middle - a dull greenish serous fluid, the top - mucopurulent foam. Exacerbation of infection accompanied by a rise in body temperature, especially in the evenings, leukocytosis with neutrophilic shift, increased ESR. Often there are shortness of breath , increasing as the disease progresses, the development of chronic bronchitis and emphysema, weight loss, appetite loss, cyanosis of the lips. As a result of purulent intoxication and respiratory failure nails take the form of time windows and terminal phalanges of the fingers - a form of drum sticks, children up to 2 years, these symptoms are rare. In chronically ill percussion often reveal boxed shade or dullness, auscultation - hard breathing, scattered dry rales , sometimes wet in a limited area of the lung. Some patients with pulmonary hemorrhage occurs periodically. In the long-term course and progression of the disease may develop amyloidosis of internal organs, pulmonary heart with the outcome of cardiopulmonary diseases.

In the differential diagnosis of bronchiectasis with chronic bronchitis, pneumonia, lung abscess, tuberculosis and lung cancer frequently used tomography and bronchoscopy; It helps to establish the diagnosis bronchography.

Treatment of patients with bronchiectasis is complex, with therapeutic, bronchoscopic, and if necessary - surgical methods.

Indications for hospitalization in a specialized therapeutic or pulmonology department are exacerbation of purulent process, severe general condition of the patient. In pulmonary hemorrhage patient should be urgently hospitalized in a specialized surgical department. In the same department routinely send patients who have surgical treatment of bronchiectasis.

Conservative treatment consists mainly in the prevention of infection and elimination of its outbreaks. To this end, it is important to ensure good evacuation of the bronchial tree from the pathological content with breathing exercises, percussion and vibration massage and postural (positional) drainage. Postural drainage is carried out by giving the body position of the patient, in which under the action of gravity vultures facilitates expectoration and coughing content bronchiectasis. For example, the bronchiectasis in the lower lobe of the right lung of the patient is placed on the left side, lift the foot end of the bed. In order to liquefy the thick and viscous mucus prescribe iodine preparations atsetiltsisteinovuyu acid, alkali and inhalation of proteolytic agents. To combat infection used broad-spectrum antibiotics (ampicillin, tetracycline), and sulfa drugs (Biseptol); optimally determining sensitivity to them microflora. The most effective antibiotics directed at the affected bronchi conducted through the nose for the catheter (catheter position, if necessary monitored by fluoroscopy).

Of great importance is sanitation bronchus during bronchoscopy: bronchial aspirated pathological contents, then washed with a warm solution of antiseptics and antibiotics. Pronounced positive effect of this treatment is usually temporary.

Radical treatment of bronchiectasis is possible only surgically. By surgery is usually resorted to when conservative therapy is ineffective, or in the development of pulmonary hemorrhage. Contraindications to it are extensive bilateral bronchiectasis, pulmonary heart disease, amyloidosis of internal organs. Typical operations for bronchiectasis involves removing the affected segments of shares (sometimes the entire lung). With bilateral lesions of the operation can be performed first on one, then on another light at intervals of several weeks or months. In some cases, bronchiectasis spend palliative surgery is to remove only the affected areas of the lung. Prior to surgery in patients with signs of acute purulent process and secrete large amounts of mucus necessary preoperative preparation with therapeutic and bronchoscopic techniques.

The prognosis for bronchiectasis depends on their form, extent, frequency and nature of the exacerbations of the inflammatory process, presence of complications, treatment efficiency. In common saccular bronchiectasis, frequent exacerbations of infection poor prognosis. Patients with less severe disease process with occasional conservative treatment, which includes for the purpose of bronchoscopy bronchus readjustment may retain a limited ability to work for a long time. After radical surgery clinical recovery occurs in 60-70% of patients, 10-15% of patients showed a significant improvement.

Prevention acquired bronchiectasis is the full and timely treatment of inflammatory bronchopulmonary diseases, especially in early childhood. To prevent infection with pathological changes of the bronchi must be carried out radical treatment of dental caries, sinusitis and other foci of chronic infection; Avoid contact with sick acute respiratory infections and other infectious diseases. Contraindicated inhalation of tobacco smoke, the use of tranquilizers and antitussives. Are important health-building, tempering measures that increase the body's resistance.