Bronchoectasis

Bronchiectasis - cylindrical or saccular widening of segmental and subsegmental bronchi with chronic inflammation of the bronchial wall, in 50% of cases - two-sided, more often localized in the basal segments and lower lobes. At the heart of the development of bronchiectasises are congenital malformations of bronchial structures (cystic fibrosis, Kartagener syndrome, Williams-Campbell syndrome-cartilage deficiency), pneumonia or bronchitis in early childhood, defective mechanisms (gamma globulin deficiency, phagocytosis, alpha 1- Antitrypsin insufficiency), complication of other pulmonary and bronchial diseases (chronic bronchitis, aspiration of foreign bodies). There are primary and secondary bronchiectasises. Primary bronchiectasis is caused by congenital malformations with the onset of hypertrophy of bronchial mucosa, aggravating the disturbance of drainage function, hypercrinia with secondary infection. The cause of secondary acquired bronchiectasis can be any disruption of the drainage function of the bronchus, both functional and organic, with secondary hypercrinia, infection and destruction of the bronchus wall with a weakly expressed cartilaginous framework. Subsequently, peribronchitis occurs. Edema of the parenchyma and scar change of the lung tissue.

Symptoms, course. Characteristic cough, often with purulent sputum. In adults, the only symptom of "dry" bronchiectasis can be hemoptysis. Sometimes hard breathing is heard, more often wet, large bubbling rales. Often there are signs of chronic hypoxia - a symptom of tympanic sticks and nails in the form of hourglasses.

The diagnosis is based on radiographic examination of the lungs, revealing cavities, atelectasis and volume decrease in the proportion or lobes of the lung, tissue infiltration. Tomographic examination makes it possible to clarify the nature of changes in lung tissue, but the greatest information is provided by computed tomography. Clarification of the localization of bronchiectasis is achieved by bronchography, which is used to resolve the issue of the need for an operation and its volume.

Treatment. Conservative therapy aimed at improving the drainage function of the bronchi: inhalation of bronchodilators, respiratory gymnastics, chest massage by effleurage, courses of rehabilitation fibrobronchoscopy, especially seasonal ones. At exacerbations of the process hospitalization is shown. It is necessary to sanitize the oral cavity and the paranasal sinuses. Operative treatment for lesions of one lobe and two segments on one side and a maximum of a fraction on another are performed in two stages with an interval of 5-6 months. Absolute indications include recurrent severe bleeding. Operative treatment can be recommended for primary bronchiectasis, strictly localized, streets not older than 40 years.

The prognosis with the possibility of a full-fledged operational sanation with subsequent supporting courses of sanative fibrobronchoscopy and climatotherapy is favorable.