Bronchiectatic pulmonary disease causes. The course of bronchiectasis. Symptoms of bronchiectasis

One of serious illnesses respiratory system is considered bronchiectasis. During this pathology, the bronchi in several areas undergo sustained expansion due to the destruction of the walls, consisting of muscle and elastic layers. The disease is common and accounts for 15-35% of lung-related diseases.

What is bronchiectasis?

At its core, bronchiectasis is an acquired disease, distinctive feature which is a chronic localized suppurative process. It is also known as purulent endobronchitis. During this pathology, irreversible changes in the bronchi occur in the form of expansions and deformations. As a result, their functionality is gradually lost, including in the lower parts of the lungs.

Bronchiectasis is an independent disease in which inflammatory processes and fibrosis in bronchopulmonary tissues are possible. But this disease often acts as a secondary manifestation of other diseases or a complication. Often primary and secondary bronchiectasis manifests itself in the form of a transitional form that combines the most characteristic features. In contrast, infection and inflammation do not affect the pulmonary parenchyma, but the corresponding sections located in the bronchial tree.

Causes of the disease

The exact reasons that provoke the occurrence and development of bronchiectasis are not fully understood. Often the presence of microorganisms associated with acute respiratory processes is conventionally considered as an etiological factor. The vast majority of diseases caused by infectious agents, is cured. Therefore, they cause exacerbations, but are in no way associated with bronchiectasis.

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Acute tracheitis

The formation of bronchiectasis is determined by the genetic inferiority of the elements and tissues of the bronchi. Underdeveloped smooth muscles, cartilage and elastic tissue are often observed. This is due to congenital weakness of the bronchial walls. In addition, the protective mechanisms that provoke the development of infection and its transition to a chronic form do not work enough.

Symptoms of bronchiectasis

The difference between one or another bronchiectasis is the form acquired by the bronchi during expansion. It can be cylindrical, saccular, spindle-shaped and mixed. The specific type of disease is determined arbitrarily due to the large number of transitional or intermediate forms.

According to the clinical course and severity of the disease, bronchiectasis can be mild, severe, severe or complicated. The spread of the process indicates the presence of unilateral or bilateral bronchiectasis. At the same time, changes localized by segments are indicated. The patient's health condition during examination is characterized by remission or exacerbation. The disease most often affects men (60-65% of all cases). The onset of the disease is difficult to determine. Primary symptoms similar to colds. Therefore, establishing initial manifestations pulmonary changes are possible only on the basis of a thorough history and questioning.

Often the trigger for the occurrence of bronchiectasis is pneumonia suffered in the first years of life. Patients complain of a cough that causes purulent sputum. The most abundant sputum is expectorated in the morning and when the patient is in the drainage position. In severe cases, sputum becomes putrid smell. The amount of sputum produced during the day reaches 500 ml or more.

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Acute and chronic lung abscess

Less commonly, the disease manifests itself in the form of pulmonary hemorrhage and hemoptysis. These symptoms are typical for adult patients. Sometimes they indicate the presence of dry bronchiectasis, when there is no suppuration in the dilated bronchi. Every third patient suffers from shortness of breath that occurs during physical exertion. Patients experience pain in the chest area due to changes affecting the pulmonary pleura.

During exacerbation, the temperature rises. It is accompanied by severe fever. This is typical for the patient's serious condition. During exacerbations, there are often complaints of general malaise. The patient becomes lethargic, his performance decreases, and a depressed mental state sets in, caused by discomfort from the stench of sputum.

Diagnostics

During a physical examination, slight percussion dullness of the diaphragm and limitation of its mobility in the affected area become noticeable. By auscultation, it is possible to detect large and medium-sized bubbling rales, which decrease after coughing or disappear completely. The presence of hard breathing is determined in the same way.

Survey radiographs reveal characteristic cellularity in the enhanced pulmonary pattern. The affected parts of the lung are identified by their reduced volume and thickened shadow. At the same time, there is a displacement of the interlobar boundaries - moorings in the direction of the affected lobes. More accurate results obtained by performing bronchography, which involves complete contrasting of the lungs. The bronchial tree undergoes comprehensive sanitation with simultaneous relief of suppuration. To determine the degree of suppuration, a bronchoscopic examination of certain segments of the lung is performed. At the same time, the dynamics of the inflammatory and suppurative process is monitored.

Bronchiectasis (bronchiectasis) is an acquired disease, characterized, as a rule, by a localized chronic suppurative process (purulent endobronchitis) in irreversibly changed (dilated, deformed) and functionally defective bronchi, mainly in the lower parts of the lungs.

The independence of bronchiectasis (bronchiectasis) as a separate nosological form was disputed by some authors until recent years. Indeed, bronchial dilatation itself, as an X-ray morphological phenomenon, can be observed in a wide variety of pathological processes, accompanied by long-term inflammation and fibrosis in the broncho lung tissue. Bronchiectasis that occurs as a complication or manifestation of another disease is usually called secondary Unlike primary bronchiectasias, which are the main morphological substrate of the pathological process and cause the appearance of a rather characteristic symptom complex in the patient. At the same time, it should be remembered that the so-called primary bronchiectasis, strictly speaking, is not primary and usually develops as a consequence of acute infections of the bronchopulmonary system suffered in childhood. The connection between bronchiectasis and acute pneumonia prompted some authors to consider this condition as a form of chronic pneumonia [Uglov F. G., 1977, etc.]. This point of view seemed to be confirmed by the presence of transitional forms between limited deforming bronchitis, which was considered characteristic of chronic pneumonia, and pronounced saccular dilatations of the bronchi.

Although these arguments cannot be completely ignored, there are a number of convincing arguments in favor of the fact that the infectious-inflammatory process that determines the clinical manifestations of bronchiectasis is determined by the condition of the corresponding department bronchial tree and occurs mainly within the latter, and not in the pulmonary parenchyma (which would justify the term “pneumonia”). This is evidenced by the data of morphological studies, which have shown that the phenomena of chronic inflammation in the respiratory part of the lung tissue in acquired bronchiectasis may be almost absent, as well as clip-radiological observations, indicating that exacerbations in bronchiectasis occur predominantly according to the type exacerbation of purulent bronchitis without infiltration in the pulmonary parenchyma. A very convincing confirmation of this same position is the operation, in which the removal of only the dilated bronchi leaving the corresponding pulmonary parenchyma led to the recovery of patients [Isakov Yu. F. et al., 1978].

All of the above, as well as the clear clinical delineation of bronchiectasis, has led to the fact that in the literature there is a strong tradition of identifying bronchiectasis as an independent nosological form.

The discussion about the independence of bronchiectasis as a nosological form also has a purely practical side. The diagnosis of “chronic pneumonia” in patients with bronchiectasis often seems to reassure both the doctor (therapist, pediatrician) and the patient (parents), as a result of which consultation with a specialist surgeon and bronchological examination are not carried out in time, and the optimal timing for the operation is missed.

What provokes / Causes of Bronchiectasis:

Reasons for development bronchiectasis cannot be considered sufficiently clarified to date. Microorganisms that cause acute respiratory processes in children, which can be complicated by the formation of bronchiectasis (pathogens of pneumonia, measles, whooping cough, etc.), can be considered etiological factor only conditionally, since in the vast majority of patients these acute diseases end full recovery. Infectious pathogens that cause exacerbations of the suppurative process in already changed bronchi (staphylococcus, pneumococcus, Haemophilus influenzae, etc.) should be considered as the cause of exacerbations, and not bronchiectasis.

A very significant, and possibly decisive, role V In the formation of bronchiectasis, genetically determined inferiority of the bronchial tree plays a role (congenital “weakness” of the bronchial wall, insufficient development of smooth muscles, elastic and cartilaginous tissue, insufficiency of protective mechanisms contributing to the development and chronic course infections, etc.). At present, it is still difficult to assess the significance of the factor under consideration in specific patients, and the identification of a special group of so-called dysontogenetic bronchiectasis associated with postnatal bronchial dilatation in children with congenitally defective bronchopulmonary tissue [Struchkov V.I., 1967] is still controversial .

Pathogenesis (what happens?) during Bronchiectasis:

The most important role in the pathogenesis of bronchiectasis is played by disruption of the patency of large (lobar, segmental) bronchi, causing disruption of their drainage function, retention of secretions and the formation of obstructive atelectasis. According to A. Ya. Tsigelnik (1968), shared by many researchers, not a single process in the lungs results in the development of bronchiectasis with such frequency and regularity as is observed with obstructive atelectasis. This important position is confirmed by the natural development of bronchiectasis against the background of atelectasis associated with obstruction of the bronchial tube by an aspirated foreign body, cicatricial stenosis, slowly growing tumor, etc. In children, the cause of the formation of atelectasis may be compression of the pliable, and possibly congenital - full-fledged bronchi with hyperplastic hilar lymph nodes or long-term blockage of their dense mucous plug in acute respiratory infections (banal or hilar pneumonia) or tuberculous bronchoadenitis [Kolesov A. P., 1951; Libov S. L. and Shiryaeva K. F., 1973; Klimansky V.A., 1975, etc.]. Atelectasis may also be contributed to by a decrease in surfactant activity, either congenital or associated with an inflammatory process or aspiration (for example, amniotic fluid in a newborn).

Obstruction of the bronchus and retention of bronchial secretions inevitably lead to the development suppurative process distal to the site of obstruction, which, being the second most important factor in the pathogenesis of bronchiectasis, apparently causes progressive irreversible changes in the walls of the bronchi (restructuring of the mucous membrane with complete or partial death of the ciliated epithelium, providing bronchial drainage, degeneration of cartilaginous plates, smooth muscles with their replacement with fibrous tissue, etc.). A decrease in the resistance of the bronchial walls to the action of the so-called “broncho-dilating forces” (increased endobronchial pressure due to coughing, distension by accumulating secretions, negative intrapleural pressure, increasing due to a decrease in the volume of the atelectatic part of the lung) leads to persistent expansion of the lumens bronchi. Irreversible changes in the affected part of the bronchial tree retain their significance even after restoration of bronchial patency, as a result of which a periodically aggravated suppurative process occurs chronically in the dilated bronchi with a persistently impaired cleansing function.

The above ideas cannot at all claim to be a complete explanation of the pathogenesis of bronchiectasis. Thus, obstruction of a large bronchus at the onset of the disease is, as a rule, difficult to prove, since by the time of examination the violation of its patency is usually not detected, and atelectasis is also not always detected. It is quite possible that an important pathogenetic role in the genesis of bronchiectasis plays violationtion patency of smaller bronchi, located dis- than the developing expansions, which, indeed, is observed in all patients. The degree and nature of obstruction of these bronchi explain the changes observed in bronchiectasis in the respiratory part of the lung, which can vary from atelectasis (with complete blockage) to emphysema (with a valve mechanism). Disruption of communication between the respiratory sections of the lung and the bronchi, where bronchiectasis is formed, leads to disruption of the coughing mechanism due to the impossibility of jerky expiratory air movements directed from the periphery to the center, and this, in turn, creates conditions for stagnation of sputum, expressed predominantly in the lower parts of the bronchial tree, since from the upper parts the secretion can flow freely due to gravity.

Thus, the mechanism presented above to a certain extent explains both the predominantly lower lobe localization of bronchiectasis and the possibility of their combination with various changes in the pulmonary parenchyma (atelectasis, emphysema, or their combinations). Something like a barrier between the dilated bronchi and the respiratory sections of the lung tissue, formed by a violation of the patency of small bronchial branches, creates at a certain stage the relative independence of the suppurative process in bronchiectasis from the pulmonary parenchyma. This, in all likelihood, gives the peculiar features of bronchiectasis, as if distinguishing it from pneumonia.

There is a long-noted pathogenetic connection between bronchiectasis and upper respiratory diseases ways(paranasal sinuitis, chronic tonsillitis, adenoids), which are observed in approximately half of patients with bronchiectasis, especially in children. This connection may be explained by general insufficiency protective mechanisms of the respiratory tract, as well as constant mutual infection of the upper and lower respiratory tract, leading to a kind of vicious circle.

Has a certain significance in the pathogenesis of bronchiectasis, apparently expiratory stenosis of the bronchi and trachea which in our institute is found in 54% of patients with bronchiectasis [Gerasin V. A., 1981].

Of interest pulmonary circulation disorders, developing with bronchiectasis. As shown by angiographic studies performed at our institute by Yu. F. Neklasov and A. A. Noskov, the lumen of the bronchial arteries of the submucosal layer increases in bronchiectasis by 5 times, in the lumen of arterio-arterial anastomoses - by 10-12 times. This leads to a pronounced discharge of arterial blood into pulmonary arteries, in which retrograde blood flow and first regional and then general pulmonary hypertension occur, which largely explains the formation of the pulmonary heart and the paradoxically favorable hemodynamic effect after pulmonary resection in some patients.

PATHOLOGICALANATOMY

With atelectatic bronchiectasis, the affected areas of the lung are sharply reduced in size, dense, and airless. In the absence of atelectasis, they may be normal size or even increased. In both cases, the amount of carbon pigment is usually reduced, which indicates a violation of ventilation already at an early age. On a section, among the correspondingly changed parenchyma, more or less dilated bronchi are visible, sometimes ending blindly almost under the pleura. Their walls are thickened and sometimes worn away, the mucous membrane is folded and uneven. The hilar lymph nodes are usually hyperplastic. Histologically, predominantly in the walls of the bronchi, a picture of chronic inflammation with peribronchial and perivascular sclerosis is detected. Often, especially with cylindrical bronchiectasis in children, the bronchi are surrounded, as it were, by a muff of lymphoid tissue. Bronchial epithelium in bronchiectasis can metaplase into multirow or stratified squamous epithelium with the disappearance of the normal ciliary cover. In places, in foci of acute inflammation, the epithelial cover is replaced by granulation tissue, which gave rise to the term “abscess bronchiectasis,” which leads to confusion, since true abscess formation in the parenchyma of the affected part of the lung is almost never observed in bronchiectasis. Changes in the parenchyma are characterized by atelectasis, more or less pronounced sclerosis and emphysema.

Symptoms of Bronchiectasis:

Depending on the forms of bronchial dilatation bronchiectasis is distinguished: a) cylindrical, b) saccular, c) spindle-shaped and d) mixed. Between them there are many transitional forms, the assignment of which to one or another type of bronchiectasis is often arbitrary. Bronchiectasis is also divided into atelectatic and not associated with atelectasis, which is undoubtedly convenient in practical terms.

By clinical course and severity Based on the classification of V. R. Ermolaev (1965), there are 4 forms (stages) of the disease: a) mild, b) severe, c) severe and d) complicated. By prevalence process, it is advisable to distinguish between unilateral and bilateral bronchiectasis, indicating the exact localization of changes by segment. Depending on the patient’s condition at the time of examination, the phase of the process should be indicated: exacerbation or remission.

Among patients with bronchiectasis, men predominate, accounting for about 60-65%. Usually the disease is recognized between the ages of 5 and 25 years, but it can be difficult to establish the time of onset of the disease, since the first exacerbations of the process are often considered as a “cold” and do not leave a trace in the patient’s memory. Careful collection of anamnesis with mandatory questioning of parents makes it possible to establish the initial manifestations of pulmonary pathology in the first years or even the first months of life in most patients. The starting point of the disease is often pneumonia suffered at an early age.

Over the past decades, the clinic of bronchiectasis has undergone significant changes associated with a decrease in the number of severe and an increase in milder, so-called “minor” forms of the disease.

Basic complaint patients have a cough with the release of more or less significant amounts of purulent sputum. The most abundant expectoration of sputum is observed in the mornings (sometimes with a “full mouth”), as well as when the patient takes the so-called drainage positions (turning to the “healthy” side, bending the body forward, etc.). The unpleasant, putrid odor of sputum, which in the past was considered typical of bronchiectasis, is now found only in the most severely ill patients. The daily amount of sputum can range from 20-30 to 500 ml or even more. During periods of remission, sputum may not be separated at all. Sputum collected in a jar is usually divided into two layers, the upper of which, which is a viscous opalescent liquid, contains a large admixture of saliva, and. the lower ones consist entirely of purulent sediment. The volume of the latter characterizes the intensity of the suppurative process to a much greater extent than the total amount of sputum.

Hemoptysis and pulmonary hemorrhage are observed rarely, mainly in adult patients. Occasionally, they are the only manifestation of the disease in so-called “dry” bronchiectasis, characterized by the absence of a suppurative process in the dilated bronchi.

Shortness of breath during physical activity worries almost every third patient. It is not always associated with a deficiency of functioning pulmonary parenchyma and often disappears after surgery. Chest pain associated with pleural changes is observed in a significant proportion of patients.

The temperature rises to subfebrile levels, as a rule, during periods of exacerbations. High fever, decreasing after expectoration of copious stagnant sputum, is sometimes observed in more severe patients. Also, mainly during periods of exacerbations, patients complain of general malaise, lethargy, decreased performance, mental depression (usually in the presence of foul-smelling sputum and an unpleasant odor when breathing).

The appearance of most patients is not very characteristic. Only in severe cases is there some delay in physical development and slow motion puberty in children and adolescents. Cyanosis, as well as club-shaped deformation of the fingers (“drumsticks”), which was considered in the past typical symptom bronchiectasis have become rare in recent years.

Diagnosis of Bronchiectasis:

At physical examination Sometimes there is slight dullness to percussion and limited mobility of the diaphragm in the affected area. Auscultation also reveals large- and medium-bubble wheezing, which decreases or disappears after coughing, as well as hard breathing. During remission, physical symptoms may be absent.

On sightseeing radiographs bronchiectasis can be suspected by characteristic cellularity against the background of an enhanced pulmonary pattern, which is better determined on lateral films and observed in 27-80% of patients, as well as by such signs as a decrease in volume and thickening of the shadow of the affected parts of the lung. In this case, the interlobar boundaries (moorings) shift towards the affected lobe, the shadows of the wrinkled (atelectasis) lower lobes often appear as triangles adjacent to the lower part of the mediastinum, and on the left such a triangle can cover the border of the heart, smoothing its waist and creating a false impression of mitral configuration. The reduced volume and compacted middle lobe appears on a lateral radiograph in the form of a characteristic shading strip 2-3 cm wide, running from the root to the anterior costophrenic sinus (“middle lobe syndrome”). Important indirect symptoms indicating a decrease in the affected parts of the lung are displacement of the mediastinal shadow towards the lesion with exposure of the opposite (usually right) edge of the spine, high standing and limited mobility of the corresponding dome of the diaphragm, obliteration of its sinuses, increased transparency of the unaffected parts of the lungs due to vicarious emphysema.

The main method confirming the presence and clarifyingLocalization of bronchiectasis, is bronchography with mandatory full contrasting of both lungs, which is carried out step by step or simultaneously (mainly in children under anesthesia) after careful sanitation of the bronchial tree and the maximum possible relief of the suppurative process. Bronchographically, in the affected part, one or another form of expansion of the bronchi of the 4th-6th order is noted, their convergence and non-filling of the branches located peripheral to bronchiectasis with a contrast substance, as a result of which the bronchi of the affected lobe are compared to a “bundle of rods” or “ chopped off broom."

Bronchoscopic examination is important for assessing the severity of suppuration (endobronchitis) in certain segments of the lung, as well as for endobronchial sanitation and monitoring the dynamics of the process.

Pulmonary function test detects predominantly restrictive and mixed ventilation disturbances in patients with bronchiectasis. With a long course of the process and its complication with diffuse bronchitis, obstructive disorders begin to predominate, becoming irreversible and indicating missed opportunities for surgical treatment.

Differential diagnosis of bronchiectasis if present good bronchograms usually does not cause difficulties and is based on a characteristic history and typical localization of the bronchial dilatations (basal pyramid and lingular segments on the left, middle lobe and basal segments on the right). Isolated bronchiectasis in the upper lobes and in the apical segments of the lower lobes, as a rule, are secondary, associated with a previous lung abscess, tuberculosis, or represent a congenital anomaly.

The course of bronchiectasis is characterized by periodic exacerbations (mainly in spring and autumn), followed by more or less long-term remissions. Often, having suffered one or two pneumonias in early childhood, patients feel practically healthy for a number of years until puberty, and from the age of 14-18, exacerbations occur more or less regularly.

In most patients, the pathological process occurs per-HIV-regional and more or less clearly localized. The basal segments of the left lung and the middle lobe on the right are most often affected. The process may remain limited over many years. The predominance of widespread bilateral lesions in patients of older age groups indirectly confirms the possibility of gradual spread of bronchiectasis to initially unaffected parts of the lung. Long and severe course bronchiectasis is often accompanied by the development diffuse obstructivebronchitis, which, along with the above-mentioned features of the pulmonary circulation, can ultimately lead to the development of respiratory failure and cor pulmonale. With such a course, other complicatedopinions(focal nephritis, amyloidosis of the kidneys and other organs, aspiration abscess in an unaffected area of ​​the lung, pleural empyema, etc.). However, as already mentioned, in currently bronchiectasis is characterized on average by a much milder course than in the past.

Treatment of Bronchiectasis:

Conservative treatment plays an important role in the treatment of patients with bronchiectasis. As the main method, it is indicated for a group of patients with minor and clinically poorly manifested changes in the bronchi, which is becoming increasingly numerous, as well as for patients with a widespread and insufficiently clearly localized process for whom radical surgery cannot be performed. In the first case, such treatment makes it possible to prevent or quickly stop exacerbations and, thus, maintain a state of clinical well-being indefinitely for a long time, and sometimes, mainly in children, to achieve practical recovery, while in the second the goal of conservative therapy is possible prevention progression of the disease and development of complications. AuxiliaryAn important, but absolutely obligatory role is played by the conservativenew treatment in preparing patients for bronchoscopy and radical surgery.

The main link of conservative treatment is the sanitation of the bronchial tree, which involves, on the one hand, emptying the latter of purulent sputum, and on the other hand, the local effect of antimicrobial agents on the pyogenic microflora. Along with sanitation by lavage with the help of installations into the affected bronchi through a transnasal catheter or during bronchoscopy, solutions of antiseptics, antibiotics, mucolytic agents, etc., also retained significant importance aids, facilitating the discharge of purulent sputum: the so-called postural drainage, breathing exercises, vibration massage of the chest, etc. A correctly chosen regimen, restorative procedures, nutritious, protein-rich nutrition, etc. are of great benefit.

An important element in the treatment of bronchiectasis, especially in children, is the sanitation of the upper respiratory tract, usually carried out by otolaryngologists, whose participation in examination and treatment is mandatory.

Radical surgical intervention is not always indicated and cannot cure all patients with bronchiectasis. The optimal age for intervention should be considered 7-14 years, since at a younger age it is not always possible to accurately determine the volume and boundaries of the lesion [Pugachev A. G. et al., 1970; Isakov Yu. F. et al., 1978, etc.].

Indications for pulmonary resection in so-called “minor forms” should be made with some caution, only after a thorough assessment of the dynamics of the disease under the influence of conservative treatment and repeated bronchographic studies. In all patients with sufficiently pronounced and localized bronchiectasis, the affected parts of the lung can be removed only on the condition that after resection the respiratory function will be ensured by a sufficient volume of complete lung tissue.

At unilateral bronchiectasis you can achieve maximum radicalism by leaving unaffected parts of the lung or, in as a last resort by resorting to pneumonectomy.

At bilateral bronchiectasis with asymmetrical lesions of the bronchial tree, in which one of the lungs has small dilatations of the bronchi of individual segments, palliative resection of the lung on the side of the larger lesion is permissible. The condition of patients after such operations usually improves significantly, and with mandatory follow-up and anti-relapse treatment, it is often possible to achieve clinical well-being, and changes on the non-operated side, as a rule, do not progress.

With more or less symmetrical damage to the bronchi For both lungs, bilateral resection is indicated, which most surgeons prefer to perform in two stages with an interval of 6-12 months. The possibility of such resection is determined by the volume of unchanged lung tissue. For extensive bilateral bronchiectasis with damage to the upper pulmonary segments surgical treatment usually not shown.

Lung resections have little prospect and in patients with bronchoectasia, complicated by obstructive bronchitis, accompanied by persistent respiratory failure and, especially, pulmonary heart disease. Changes in the kidneys observed in a number of patients, such as focal nephritis or initial manifestations of amyloidosis, are often reversible during careful preoperative preparation and are not always a contraindication to intervention. You should refrain from surgery only if you have persistent renal failure.

With age, especially after 45 years, the number of patients subject to surgery becomes significantly smaller due to the progression of the pathological process and the appearance of complications.

FORECAST

In the natural course, the prognosis of pronounced, severe, and even more complicated forms of bronchiectasis should be considered as very serious. Thus, according to V.R. Ermolaev (1965), 24.5% died within a period of 5 to 10 years, and progression of the disease was observed in 45.2% of patients who were not subjected to surgical treatment.

Postoperative mortality in patients with bronchiectasis currently does not exceed 1%, however complete cure After surgery, unfortunately, this is not achieved in all patients. Thus, according to the All-Russian Research Institute of Pulmonology (B.V. Medvensky), in the long term after the intervention, only a little more than half of those operated on do not present any complaints, while unsatisfactory results were noted in 12% of cases. The rest show more or less significant improvement. Failures can be associated with incorrect determination of the volume of the lesion and resection of the lungs and leaving altered areas of the bronchial tree, with technical errors of the operator and postoperative complications. Sometimes relapses depend on post-resection movements of the bronchi and their position, which is unfavorable for the drainage function.

Prevention of Bronchiectasis:

Prevention of bronchiectasis should be aimed primarily at the prevention and rational treatment of early pneumonia childhood, which represents independent problem pediatrics. In all likelihood, the decrease in the total number of patients with bronchiectasis in recent years and the improvement in the course of the latter are associated with certain achievements of the latter.

Which doctors should you contact if you have Bronchiectasis:

Pulmonologist

Therapist

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Other diseases from the group Respiratory diseases:

Bronchiectasis is an acquired or congenital disease. When it occurs, suppuration occurs in the bronchi. Long-term treatment is required.

In bronchiectasis there are dangerous changes in the bronchi: deformation, expansion. They are accompanied functional disability and the active development of a chronic purulent inflammatory process in the bronchial tree.

If the bronchi have changed, they are called bronchiectasis (bronchiectasis). The main manifestation of bronchiectasis will be persistent cough. This symptom is accompanied by the release of a large amount of purulent sputum.

In some cases, even hemoptysis and the development of serious pulmonary hemorrhage are possible. Over time, the disease causes respiratory failure and anemia. When a child is sick, he runs the risk of falling behind in physical development.

The diagnostic algorithm provides:

1. physical examination of the patient;
2. chest x-ray;
3. auscultation of the lungs;
4. sputum analysis;
5. bronchoscopy;
6. bronchography;
7. study of respiratory function (external respiration function).

Bronchiectasis is treated by stopping the purulent inflammatory process inside the bronchi. Additional sanitation of the bronchial tree is also carried out. Sometimes treatment with folk remedies is allowed.

Bronchiectasis is detected in 0.5-1.5 percent of the population. The pathology develops mainly in childhood and young age (from 5 to 25 years).

The disease occurs in the form of recurrent bronchopulmonary infection.

Damage to the bronchi may be widespread or affect only one specific segment.

Classification of bronchiectasis

There is a generally accepted classification of bronchiectasis. So, it is customary to distinguish the disease by:

• type of bronchial deformation (mixed, saccular, fusiform, cylindrical);
• according to the extent of the pathological process (unilateral, bilateral);
• by phase of the course (exacerbation, remission);
• according to the prerequisites of development (primary, it is called congenital, secondary - acquired);
• according to the current state of the parenchyma of the studied part of the lung (atelectatic, not accompanied by atelectasis);
• according to clinical form (mild, severe, severe and complicated form).

If the degree of bronchiectasis is mild, it is characterized by no more than 1-2 exacerbations during the year. Remissions in this case are long-lasting. During this period, patients feel absolutely healthy, their performance is not impaired.

The severe form of the disease is characterized by exacerbation every season. In one day, purulent sputum can be released in a volume of 50-200 ml. During remission, a cough with strong sputum discharge, moderate shortness of breath, and a decrease in usual ability to work persist.

Patients with severe bronchiectasis suffer from exacerbations that are too frequent and prolonged. They experience temperature reactions and short-term remissions. The volume of secreted sputum increases to 200 ml, it has an unpleasant putrefactive odor. During the period of remission, the patient maintains normal work activity.

The most serious and dangerous form of the disease is complicated. It is also characterized by signs of secondary complications:

1. pulmonary heart;
2. cardiopulmonary failure;
3. amyloidosis of the kidneys, liver;
4. nephritis.

In addition, the long course of the disease is always complicated by the following problems: pulmonary hemorrhage, lung abscess, iron deficiency anemia, pleural empyema.

The prerequisites for primary bronchiectasis are congenital malformations of the bronchial tree. It's about about underdevelopment or dysplasia of the bronchial wall.

Congenital bronchiectasis is diagnosed much less frequently than acquired bronchiectasis.

Secondary bronchiectasis occurs due to frequent infections in the bronchi and lungs that were suffered in childhood:

1. bronchopneumonia;
2. pulmonary tuberculosis;
3. chronic deforming bronchitis;
4. lung abscess.

Sometimes the disease can develop as a result of foreign bodies entering the lumen of the bronchi.

The chronic inflammatory process of the bronchial tree provokes irreversible pathological changes in the muscular and mucous layer of the bronchi, in the peribronchial tissue. The affected walls of the bronchi become pliable and expand. Past pneumonia, bronchitis, tuberculosis or lung abscess leads to wrinkling of the pulmonary parenchyma, stretching and deformation of the walls of the bronchi.

The destructive process can also capture and affect nerve endings, capillaries, and arterioles that feed the bronchi.

With cylindrical and fusiform bronchiectasis, the medium and large bronchi are affected. When saccular bronchiectasis is noted, the smaller bronchi are affected. With uninfected bronchiectasis, a few and small areas become inflamed. Moreover long time this condition does not produce any symptoms.

After infection and the development of the inflammatory process, the bronchi become filled with purulent sputum. It supports chronic inflammation in the modified bronchi. This is the whole mechanism of development of bronchiectasis.

The maintenance of the purulent inflammatory process is facilitated by:

1. bronchial obstruction;
2. complicated self-cleaning of the bronchial tree;
3. chronic purulent process in the nasopharynx;
4. decreased protective mechanisms of the bronchopulmonary system.

The main symptom of the disease is a constant cough, accompanied by active discharge of purulent sputum. The discharge usually has an unpleasant, foul odor. Especially copious discharge observed in the morning or with improper drainage position of the body. In the first case, the patient will note a feeling of a full mouth. In the second case, sputum is collected when the patient lies on the affected side for a long time, and his head is slightly lowered.

The amount of purulent exudate can sometimes reach several hundred milliliters. During the day, a cough torments the patient as the bronchial tubes fill with sputum. If a person coughs very hard, rupture may occur. blood vessels in places of thinning of the bronchial walls. This process is accompanied by profuse hemoptysis. When did the injury occur? large vessels, there is bleeding in the lungs.

Chronic purulent inflammatory process of the bronchial tree causes:

• exhaustion;
• intoxication of the body.

A patient with bronchiectasis has a high risk of developing anemia, general weakness, and pale skin. The sick child has a serious delay in physical and sexual development and a sharp loss of weight.

When develops respiratory failure, the situation is aggravated by cyanosis, shortness of breath, thickening of the terminal phalanx of the fingers. Such modifications are called “drumsticks”. Bronchiectasis can cause deformation of the chest, and the nails take on the appearance of “watch glass.”

The symptoms of bronchiectasis, their frequency and duration depend entirely on the clinical form of the disease. Exacerbations proceed similarly to bronchopulmonary infections.

Rising general temperature body, the amount of purulent sputum produced increases. Even after an exacerbation, a wet cough and sputum may persist for a long time.

A physical examination of the lungs will help to identify a lag in their mobility during breathing, dullness of percussion sound on the affected side. The auscultatory picture of the disease is characterized by:

1. weakened breathing;
2. a large number of different-sized moist rales.

Such wheezing occurs in the lower parts of the lungs. Their intensity decreases after coughing. The bronchospastic component is sometimes accompanied by dry wheezing.

On the lateral and direct projection of a chest X-ray, bronchiectasis will make itself felt by the deformation and cellularity of the pulmonary pattern. There is a decrease in the volume of the affected lobe or segment, and areas of atelectasis.

With help endoscopic examination bronchi (bronchoscopy procedure) can diagnose abundant and viscous purulent secretion. I manage to take required amount material for cytology, bacterial analysis, establish the cause of bleeding, carry out sanitation of the bronchial tree. Cleansing is necessary for the subsequent diagnostic stage - bronchography.

Bronchography should be understood as contrast X-ray examination affected bronchi. This diagnosis is the most reliable for this disease. Bronchography will help clarify:

• severity and prevalence of bronchiectasis;
• their shape and exact location.

The procedure is performed under local anesthesia (in adult patients) and general anesthesia(in children).

By inserting a soft elastic catheter into the bronchial tree, the doctor will fill the bronchi contrast agent, and then conduct x-ray control and a series of photographs. During bronchography, it is possible to identify: the convergence of the bronchi, their deformation, the nature of the expansion, the lack of contrast of the bronchial branches, which are located distal to bronchiectasis.

Peak flowmetry and spirometry are used to assess the degree of respiratory failure.

Treatment of bronchiectasis

When bronchiectasis worsens, the main task therapeutic measures there will be sanitation of the bronchi, suppression of purulent inflammation. For these purposes, the following is carried out:

1. antibiotic therapy;
2. bronchoscopic drainage.

Treatment with antibiotics can be carried out intravenously, intramuscularly, or endobronchially. To get rid of the chronic inflammatory process in the bronchi, the doctor will prescribe cephalosporins: Cefazolin, Ceftriaxone, Cefotaxime. Semi-synthetic penicillins are also shown: Gentamicin, Ampicillin, Oxacillin.

Treatment of bronchiectasis requires drainage of the bronchial tree. To do this, the patient lies down on the bed, lifting the foot end of the head to facilitate the drainage of exudate.

To speed up and improve the removal of sputum, it is necessary to take, drink an alkaline liquid, massage the sternum, perform breathing exercises, and inhalation. It is recommended to take the course medicinal electrophoresis on the chest.

Often, when an illness occurs, they resort to lavage of the bronchi. The procedure is called bronchoalveolar lavage. Additionally, purulent secretions are suctioned using a bronchoscope.

Therapeutic bronchoscopy will help not only wash the bronchi and remove pus, but also introduce drugs into them:

1. mucolytics;
2. bronchodilators.

It is also possible to use ultrasonic sanitation of the bronchial tree.

Mucolytics are additionally taken orally. They can be replaced with equivalent folk remedies.

Not the last role is given to nutrition. The patient's diet must contain sufficient amounts of protein, microelements and vitamins. The menu includes a lot of meat, fish, vegetables, cottage cheese, and fruits.

Outside of exacerbation of the pathology, it is allowed to do breathing exercises, take expectorant herbs, and undergo a course of sanatorium-resort rehabilitation. After consultation with the doctor, you can practice treatment with folk remedies.

When there are no serious contraindications, surgical treatment of the disease is permitted, even if the goal has not been achieved before. The doctor removes the affected lobe of the lungs. Often the operation is performed for health reasons. For example, you can’t do without it if you have incessant bleeding.

Prognosis and prevention

Surgical intervention usually helps to completely and permanently get rid of the problem. Regular courses of anti-inflammatory treatment will help achieve long-term remission.

Bronchiectasis worsens after hypothermia, a cold, or in damp, cold weather. If there is no appropriate treatment, a complicated version of the disease can cause death or disability.

Preventive measures boil down to dispensary observation see a pulmonologist, if there is a history of Chronical bronchitis, pneumosclerosis. It will also be necessary to completely eliminate harmful factors and harden the body. It won’t hurt to sanitize the paranasal sinuses and oral cavity in a timely manner. Then bronchiectasis will bypass the person.

The video in this article fully reveals the essence and nature of bronchiectasis.

A tale about treatment bronchiectasis lung diseases. I’ll tell you about symptoms, emphysema, atrophic pharyngitis, prognosis and treatment methods, and a bunch of interesting things. Go!

Hello friends! Today I’ll tell you about the organ that gives all our cells the most necessary thing - oxygen. More precisely, about one of his illnesses, which brings no less suffering than asthma. And most importantly, I will outline what the treatment consists of bronchiectasis lung diseases. This disease can occur in children, and it is very difficult to get rid of it!

A story about a tree that grows upside down

We have such a phenomenon in our bodies. The trunk of our tree is the trachea. Two massive branches depart from it - the main bronchi, which are then divided into many small branches. At their ends alveoli grow - small bubbles through which oxygen enters the blood.

Bronchiectasis the disease is a deformation of the bronchi.

They stretch, their walls become thinner, and cannot work normally. They develop a chronic inflammatory process, which results in the accumulation of pus. Since the organ is sick, various pulmonary infections are added to the main ailment.

You should be alarmed if you have the following symptoms:

1. persistent cough;
2. separation of a fair amount of purulent sputum, especially in the morning;
3. 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, and emphysema.

Children develop poorly physically and lag behind their peers. The purulent inflammatory process leads to exhaustion of the body, and constant poisoning decomposition products.

The lungs cannot work normally and shortness of breath occurs, and with a one-sided course of the process, the chest takes on an irregular shape.

There are three signs of chronic oxygen deficiency:

You can see for yourself that the problem is serious, and you can’t let it go.

Well, why is this happening?

The history and treatment of bronchiectasis of the lungs spans years. The disease can be congenital or 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 nasopharynx.

A weak, unseasoned child is susceptible to this! You can also get sick for other reasons, mechanical and chemical in nature, due to which the bronchi change and their mucous membrane is disrupted.

This happens due to:

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• ingress of foreign objects;
• the occurrence of vascular aneurysms, tumors;
• accidental reflux of stomach contents during;
• inhalation of poisonous gases and toxic substances;
• HIV infections.

The doctor diagnoses the disease as follows: listens for moist rales in the lungs, when tapping - dullness of sound on the affected side, an x-ray shows a change in the pulmonary pattern.

The endoscope will detect viscous sputum, and bronchography will show the specific location of the lesion.

The diagnosis has been 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 may progress to extensive pulmonary hemorrhage, additional severe infections, disability and even death. Definitely, you will seriously complicate and shorten your life.

Classic methods are aimed at two goals:

1. stop purulent-inflammatory process;
2. clearing the lungs of foreign contents.

The treatment regimen is as follows:

1. You are prescribed antibiotics. All of them are very strong and should not be used unless prescribed by a specialist.
2. Remove pus. This is done using bronchoscopic drainage. The procedure seems scary, but there is nothing to be afraid of. Experienced doctor conducts it very carefully. The tube, which is inserted through the nose or mouth, is much thinner in diameter than the passage, so it will not block breathing. Before inserting the bronchoscope, you will certainly be given auxiliary medications that will make the procedure easier.
3. In order for sputum to clear well, you need expectorants, both tablets and herbal mixtures, and inhalations. Good result gives special breathing exercises and electrophoresis.
4. If possible surgical removal the affected part, surgery is performed. It is not given to children under seven years of age, and rarely after forty-five, when they develop severe complications. But in most cases, this is the only way to get rid of the disease completely.

What about prevention?

Here's what you need to do:

• do not inhale dust, either at home or at work;
• treat upper respiratory tract infections in a timely manner;

Stop! Hardening does not mean hypothermia.

Pouring ice water not for you, it is better to choose gentle methods, move more and walk. It is necessary to observe a sleep and rest schedule, and be sure to do gymnastics, both breathing and general strengthening, in the fresh air.

I’ll say a few words about nutrition

To restore you will need a lot of iron and others. There is no need to eat whole mountains of meat, fish and cottage cheese. You need 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 psychological factor no less important than any other.

Folk remedies are simple and can provide significant help. Moreover, our ancestors achieved serious success in diluting sputum and having an 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 (a milder remedy);
• St. John's wort, calendula, clover;
• wild rosemary herb (read the contraindications carefully - it is poisonous);
• cranberries in combination with an infusion of linden flowers, raspberry leaves, bay leaves and flax seeds;
• melted badger fat with milk (can be replaced with lard);
• inhalations 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 talked about today.
Treatment for bronchiectasis of the lungs exists, but it is impossible to completely recover from this disease, but everything can be done so that it does not interfere with a normal life.

To make it easier to decide on a regimen, understand its necessity and change your lifestyle for a better one, read the articles on my blog. In them, everyone can find something that will certainly suit and help them. For me this is the most important thing.

Don't smoke please

That's all for today.

Thank you for reading my post to the end. Share this article with your friends. Subscribe to my blog.

Bronchiectasis (bronchiectasis, panbronchitis, panbronchiolitis) can irreversibly deform the human bronchi. As a result of defective development, an inflammatory process begins in the bronchial branch. Infectious diseases are not pathogenic agents. Among the sick, a larger percentage are young men.

The disease may not appear for a long time, worsening in spring and autumn. Patients often complain of:

• purulent (foul-smelling) profuse cough that occurs in the morning;
• weakness;
• there is hemoptysis, and if the cough is intense, then this condition can develop into pulmonary hemorrhage;
• severe shortness of breath with lungs;
• moist wheezing that can be heard over the lungs, and if you clear your throat, the wheezing decreases.

Important! Symptoms depend on the type and stage of bronchiectasis; this pathology can hide itself for a long time, but be expressed in an acute form.

A characteristic symptom of bronchiectasis is that the terminal phalanges of the fingers thicken and become like drumsticks,

and the shape of the nails looks like “watch glass”

Causes of bronchiectasis development

Most diseases affecting the bronchi are associated with infectious pathogens. In this case, the primary ones come from congenital defects in the development of the bronchi - any anomaly that occurs in this area can lead to pathology. Congenital disease a more common occurrence, acquired bronchiectasis has a lower percentage of complications.

Acquired bronchial disease can affect the body only due to infections associated with bronchopulmonary system, the infection should be experienced in childhood in the form of a mild abscess, initial stage tuberculosis, different types bronchitis. There are often cases when pathology develops due to foreign objects entering the bronchial tubes (lumen).

Types of bronchiectasis

There are many types of the disease, each of which has its own course:

1. Depending on the modification of the bronchi - saccular, cylindrical pathology, fusiform and mixed.
2. According to the scale of the expansion of the inflammatory process, taking into account the period of the segment, the lobes are unilateral and bilateral.
3. According to the structure of the course of the disease, there are remission and aggravated forms.
4. Depending on the causal relationship - congenital and acquired.
5. Clinical forms are characterized by mild, severe, severe and complicated.

Important! Severe and complicated form of bronchiectasis in Lately put on the same level due to the period of spread and scale of action of the pathology, therefore clinical forms three are most often distinguished.

At mild stage bronchiectasis exacerbations do not exceed two cases per year, long-term remissions are not accompanied by complications, these periods are difficult to identify the disease, since the person feels completely healthy.

With a more complex manifestation, panbronchitis manifests itself every season, exacerbations last longer, and purulent sputum can reach 200 ml in 24 hours. Remission occurs with wet cough, shortness of breath persists, due to lethargy and general malaise, working ability decreases.

Remissions in complex forms of pathology are short-term, exacerbations occur with high fever. More sputum is produced, it has unpleasant aroma. After a while they join secondary pathologies formed as a result of panbronchiolitis: problems with the functioning of the heart and lungs, nephritis, as well as amyloidosis of the kidneys and liver. With prolonged treatment, pulmonary hemorrhage may occur and a lung abscess may occur. This is considered a complicated form, coming from a complex one.

Treatment of bronchiectasis

It is necessary to contact a specialist at the initial stage, when shortness of breath occurs, since the symptoms of various pathologies can come from problems with the lungs. In the laboratory, the ailments are determined, the microbe is known. In this case, etiotropic drugs are prescribed; they do not harm the liver and only affect the pathogen.

Important! If a large amount of purulent sputum discharge and expectoration of blood are detected, then treatment can last about six months with the use of antibacterial agents.

Drugs are prescribed that expand the lumens of the bronchi, they eliminate further distribution deformation. There is also expectoration of excess mucus, this is part of the body’s healing. Bronchoscopy performs rehabilitation of bronchiectasis; during therapy, antibacterial and antiseptics, they do not harm humans.

If bronchiectasis found in a mild form, but remission is visible, antibacterial agents allowed to be used exclusively during periods of exacerbation. It rarely comes to surgical intervention, only in the case of definitive segmental damage, in which it is impossible conservative treatment. Surgical intervention is also used in case of acute problems with the heart and bronchi.

Treatment is carried out with the presumptive use of the following antibiotics:

1. Bactericidal – Amoxiclav.
2. Ceftriaxone is an antibiotic that has wide range actions.
3. A group of drugs - fluoroquinolones, which guarantee an antibacterial effect.
4. Ambroxol, as well as other expectorants.
5. Acetylcysteine ​​is a mucolytic antibiotic.

If a disease is suspected, tests are ordered

1. X-rays.
2. Changes general analysis sputum.
3. Fluorography.

Important! Why do you need a sputum level test? Bronchiectasis leads to expectoration, frequent coughs, in which sputum is produced in large quantities. The higher the sputum level, the worse condition sick.

The condition of the sputum depends on the stage of the disease: mucous, mucous, bloody. In the severe stage, the sputum gives off a cadaverous odor and is greenish in color.

Thanks to the explanations of fluorography, it is possible to understand whether the patient has bronchiectasis even at the initial (mild) stage.