Bronchoectasis (bronchoectatic disease) is a pathological saccular or cylindrical enlargement of the bronchi and bronchioles, provoked by a deep destructive lesion of the walls of the bronchus and surrounding tissues. They can be located in one segment / lobe of the lung, or capture one or both of the lungs. Bronchiectasis is usually observed in the lower lobes of the lungs. Uniform the expansion of bronchial tubes is called cystic bronchiectasis, and the expansion of bronchial tubes is called cylindrical bronchiectasis.
Distinctive features of bronchiectasises: bronchi of subsegmental level expand, cylindrical and ampullar expansions fill the bronchial secret, capable of easy infection, which subsequently causes a purulent chronic inflammatory process. In the case of clogging of the lumen of the bronchi, edema of its wall develops and secondary formation of additional blood vessels is observed, which causes frequent concomitant hemoptysis (provoked by a coughing attack). In the case of further development of bronchiectasis, all lung tissue is involved in the pathological process
Bronchiectasis - Causes
The main cause of development of bronchiectasis is the following respiratory diseases: cystic fibrosis, tuberculosis , pneumonia, whooping cough , measles , bronchitis, etc. Particularly harmful are the respiratory infections that were transferred in early childhood, during the formation of the respiratory system.
The next group of causes that can cause this pathology is called congestion of bronchial tubes of traumatic, tubercular and tumor nature. In some cases, the development of bronchiectasis can be triggered by connective tissue diseases such as Sjogren's syndrome and rheumatoid arthritis.
Sometimes there are congenital bronchiectasises developing in the prenatal period in the case of violations of the bronchopulmonary system. There were cases when several members of the same family had bronchiectasis immediately.
In recent years, the emergence of postnatal development of bronchiectasis is given special importance to the factor of "congenital weakness" of the bronchial wall. This is confirmed by the fact that in people with this congenital anomaly pneumonia is often complicated by atelectasis followed by the development of bronchiectasis
Bronchiectasis - symptoms
In the zone of bronchiectasises, the mucous membrane is often ulcerated, cartilage and muscle fibers undergo destruction and jamming with connective tissue. The pathological process accompanies the stasis of secretion in the enlarged bronchi and the violation of the drainage function.
Often there are manifestations of chronic diffuse bronchitis. During the microscopic examination, infiltration of the bronchial wall with neutrophils, replacement of the ciliated epithelium with cylindrical or multilayered is noted. In pulmonary tissue, there are changes in the form of areas of fibrosis, atelectasis and foci of bronchopneumonia. In amyloidosis, characteristic changes in the liver, kidneys, and other organs are observed, and abscesses of a metastatic nature can be detected.
Symptoms with acquired and congenital bronchiectasis are often the same, and, as a rule, they can be differentiated even if they have morphological and roentgenological data is difficult. Symptomatology directly depends on the prevalence of bronchiectasis, the degree of bronchial dilatation, the activity of infection, the severity of the destruction of the bronchial walls and the duration of the pathological process.
With dry bronchiectasis, when the infection in the affected bronchi does not show itself and there is no sputum in the patients, the symptomatology is very weak or completely absent. Usually, the infectious process that develops periodically develops in the affected bronchi.
Exacerbation of chronic inflammation is facilitated by foci of infection in the nasopharynx and oral cavity. Patients with bronchiectasis first of all complain of a cough with purulent and / or mucopurulent discharge, which is most pronounced in the morning hours.
During periods of exacerbation, up to 200 ml of sputum per day may leave the patient. In case of prolonged stagnation of bronchial secretion, attachment of putrefactive processes is observed, which gives an unpleasant, often fetid smell to the phlegm.
Most patients have hemoptysis, while massive pulmonary hemorrhage is extremely rare. A significant number of patients complains of weakness, rapid fatigue, chest pain, increased irritability, headaches , dyspepsia and depression of the psyche. During the exacerbation there is an increase in ESR, an evening increase in body temperature, and leukocytosis with neutrophil shift.
In the initial period, the appearance of patients does not have any characteristic differences. However, as the disease progresses due to respiratory insufficiency and intoxication, the fingernails of the toes and hands often take the form of "watch glass", and the fingers themselves form the shape of drum sticks. The integuments acquire an earthy color, the puffiness of the face, the general hypotrophy reaching to exhaustion, is observed.
On roentgenograms, usually the severity of the roots, increased pulmonary pattern, in some cases, the reduction of the affected area of the lung in the volume (local pneumosclerosis, atelectasis). Carrying out bronchography specifies the presence and form of bronchiectasis and the extent of the lesion.
Differentiated diagnostics of bronchiectasis with such diseases as lung cancer , lung abscess, tuberculosis and chronic bronchitis are shown. In addition to cytological, bacteriological and radiologic studies, the greatest diagnostic value belongs to computed tomography and bronchography, which most accurately show the characteristic lesions of the bronchi
Bronchiectasis - treatment
Treatment of bronchiectasis is complex, with the use of bronchoscopic, therapeutic and, if necessary, surgical methods, which is carried out in a hospital or on an outpatient basis. Indications for hospitalization in the pulmonological or therapeutic department are pulmonary heart failure or exacerbation of the infectious process. With pulmonary hemorrhage, the patient should immediately be hospitalized in the surgical department.
Conservative treatment of bronchiectasis mainly consists in eliminating outbreaks and preventing the exacerbation of infection. First of all, it is antibacterial therapy and special medical measures aimed at improving the drainage function of the bronchi and on the emptying of bronchiectasias. Taking into account the sensitivity of the detected bacterial sputum flora, a triad of typical antimicrobial agents is prescribed: drugs of the nitrofuran series, sulfonamides and antibiotics.
The most effective are medical bronchoscopy with removal of purulent contents from the lumen of the bronchi and the subsequent introduction of mucolytic drugs (bromhexine, acetylcysteine), proteolytic enzymes (chymotrypsin, trypsin) and antibiotics. Initially, the procedures are carried out twice a week, and as the purulent discharge decreases, once a week.
In order to increase the general reactivity of the body, biogenic stimulants, immunostimulants, vitamins, anabolic hormones, physiotherapeutic procedures and blood transfusions (blood preparations) are prescribed.
Surgical treatment of bronchiectasis is carried out in case of increasing deterioration of the state due to ineffectiveness of therapeutic treatment and in case of development of pulmonary hemorrhage. In the case of a minor local process affecting one or both lobes, thoracoscopic or open resection of the lung is performed. In the case of a local bilateral process, two-stage intervention is performed - first on one lobe of the lung, and three months later on the second. Contraindications for the operative intervention is amyloidosis of internal organs, pulmonary heart failure and an extensive bilateral process.
The prognosis primarily depends on the prevalence, form, nature and frequency of exacerbations, the effectiveness of treatment and the presence of complications. Unfavorable prognosis with prevalent saccular bronchiectasis. Patients with a mildly pronounced pathological process under the condition of adequate conservative treatment (bronchial sanitation + bronchoscopy) may be able to maintain a limited capacity for a long time. After applying radical treatment, clinical recovery is observed in 75% of patients, in 15% there is a significant improvement in the condition
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