How to treat bronchiectasis. Maintaining proper nutrition. Treatment of bronchiectasis of the lungs or what will happen to me

Bronchiectasis is characterized by regional dilatation of the bronchi with a predominant localization of the process in the lower parts of the lungs, manifested by symptoms purulent bronchitis, and often hemoptysis. The disease occurs in both adults and children, but more often it develops in childhood or adolescence.

Men are affected somewhat more often than women. Great importance in the origin of bronchiectasis is given to factors that disrupt the patency of the bronchi and promote stagnation of bronchial secretions with subsequent infection, which can be observed in patients with a long course of chronic bronchitis and chronic pneumonia (in foci of pneumosclerosis), with pneumoconiosis, tuberculous and syphilitic lung lesions.

The development of bronchiectasis is especially often observed in the area of ​​atelectasis, which develops when the bronchi are obstructed by cicatricial processes, foreign bodies or tumors. Bronchial obstruction easily occurs in childhood due to blockage of the bronchial lumen by a mucus plug or compression of the child’s thin and pliable bronchi by enlarged hilar lymph nodes.

Causes of bronchiectasis

Bronchiectasis develops in both children and adults, and in the latter the cause, apparently, can be pneumonia, measles, and whooping cough suffered in childhood. One common cause is the flu.

The development of a purulent process in the lumen of the bronchus leads to destructive changes in all layers of the bronchial wall, replacement of cartilaginous plates and muscle fibers scar tissue, which also contributes to the loss of elasticity of the bronchi and the occurrence of bronchiectasis.

Certain importance is attached to innervation disorders and associated blood flow disorders in the bronchial arteries, causing trophic changes in the bronchial wall. Cases where bronchiectasis precedes the development of chronic bronchopulmonary diseases are usually referred to as primary bronchiectasis or bronchiectasis.

Bronchiectasis, which has complicated the long-term course of chronic lung diseases, is classified as secondary; they should not be included in the concept of “bronchiectasis” as an independent nosological form.

Symptoms of bronchiectasis

Bronchiectasis can be unilateral or bilateral. There are mild, severe and severe forms of the disease. The diagnosis indicates the phase of the disease - remission or exacerbation.

Bronchiectasis is often diagnosed in childhood and adolescence, however, with a careful history taking and questioning of parents, almost half of the patients have indications of the presence of pulmonary disease in the first years or even months of life.

Bronchiectasis, in the initial phase, is characterized by relapses of persistent cough with sputum production, frequent defeat paranasal sinuses, repeated hemoptysis. Physical data are scarce. In the lower parts of one or both lungs, intermittent local moist rales are heard, which disappear with the cessation of coughing and reappear with a cold.

Gradually, cough with sputum production becomes the main complaint; it is most pronounced in the morning, after waking up and turning in bed, morning toilet, when the patient separates a large amount (“a mouthful”) of purulent or mucous purulent sputum.

A peculiarity of cough is that it intensifies when changing body position, which is explained by the passive flow of bronchial secretions into undamaged areas bronchial tree, where the sensitivity of the mucous membrane is preserved. Often, increased coughing and increased sputum production are observed in a certain body position, depending on the location of bronchiectasis.

Bronchiectasis, during the period of exacerbation, most patients secrete a significant amount of purulent sputum - 100-200 ml per day.

In severe cases with a widespread process, the amount of sputum produced is 0.5-1 liters or more. With prolonged stagnation of bronchial secretions, putrefactive processes occur, the sputum becomes foul-smelling, and when standing, it usually disintegrates into three layers.

Bronchiectasis is accompanied by hemoptysis, but massive pulmonary hemorrhage is uncommon. During the period of remission, the amount of sputum decreases, it becomes mucopurulent or takes on a mucous character, and in some cases, sputum production stops.

Patients often complain of dull pain in the chest, as well as fatigue, weakness, headaches, increased irritability, mental depression, especially in the presence of foul-smelling sputum, dyspepsia.

Periods of exacerbation are usually accompanied by a significant increase in body temperature (up to 38-39°C), which is due to the involvement of nearby areas of the lung parenchyma in the inflammatory process (the development of pneumonia).

However, in patients with a long course of the disease, exacerbations are often accompanied by an increase in temperature only to subfebrile levels, since this mainly involves suppuration of the contents in the lumen of the dilated bronchi, which have lost connection with the respiratory sections.

If there is a sharp disturbance in the outflow of sputum, short-term rises in body temperature to high numbers (temperature “peaks”) may be observed. After separation of stagnant bronchial secretions, the temperature decreases.

Appearance of patients initial period has no disease characteristic features. However, gradually a sallow skin color, a puffy face, emaciation, nails in the form of watch glasses and fingers in the form of drumsticks appear. This last symptom is associated with the presence of purulent intoxication and hypoxemia. There are no characteristic percussion symptoms for bronchiectasis.

Restriction of respiratory excursions is noted chest. In some patients, areas of dullness are identified against the background of pulmonary or box sounds. Bronchiectasis - during an exacerbation, during auscultation against the background of hard breathing, an abundance of dry and sonorous large- and medium-bubbly moist rales, often of a peculiar, crackling nature, are heard over the affected part of the lung. After coughing up the mucus, the amount of wheezing usually decreases.

During the period of remission or after rehabilitation of the bronchial tree, wheezing may disappear or the number may decrease and the area of ​​their auscultation may narrow. A blood test reveals neutrophilic leukocytosis and an increase in ESR. Due to a prolonged inflammatory process, intoxication, and exhaustion, iron deficiency hypochromic anemia may develop.

However, joining pulmonary insufficiency may be accompanied by the development of hypoxic erythrocytosis with an increased hemoglobin content. When involved in pathological process In one or two lobes, indicators of the functional state of the lungs may be slightly impaired. In cases of widespread bronchiectasis, spirographic examination reveals mainly restrictive disorders.

With the development of chronic diffuse bronchitis, and especially with the appearance of bronchospastic syndrome (asthmatic bronchitis), obstructive ventilation disorders also occur: a decrease in the Tiffno index, a decrease in pneumotachometry indicators.

Course of bronchiectasis

Bronchiectasis is characterized by a long course with recurrent exacerbations mainly in the autumn and spring periods. Exacerbations are most often triggered by hypothermia, influenza or other respiratory infections.

Gradually, there is an increase in pneumosclerotic changes, as well as emphysema (due to concomitant diffuse bronchitis), which leads to the development of pulmonary failure, symptoms of chronic compensated, and then decompensated pulmonary heart disease with symptoms of right ventricular failure.

Bronchiectasis may be complicated by the development of chronic asthmatic bronchitis with transition to a detailed picture bronchial asthma. Other complications: massive pulmonary hemorrhage, pleural empyema, spontaneous pneumothorax - develop less frequently. Extrapulmonary complications include the development of amyloidosis and metastatic brain abscess.

Diagnosis of bronchiectasis

The diagnosis of bronchiectasis is based on a history of indications of repeated infections with influenza, sinusitis, bronchitis, long-term, often from childhood, cough with sputum production, and hemoptysis. The separation of a large amount of purulent sputum with an unpleasant odor, mainly in the morning, its three-layer nature, and the presence of changes in the terminal phalanges of the fingers in the form of drumsticks indicate a severe form of the disease.

At x-ray examination Against the background of an intensification of the pulmonary pattern and a rough, radially converging heaviness towards the root, a cellular pattern is often revealed, as well as signs of a decrease in the volume of the affected area of ​​the lung (atelectasis, local pneumosclerosis).

However highest value in the diagnosis of the disease belongs to a contrast study of the bronchi - bronchography, which allows not only to establish the presence and form of bronchiectasis, but also to clarify the extent of the lesion, which is important for deciding the issue of surgical treatment. The main changes are detected in the segmental and subsegmental bronchi.

In the most common saccular bronchiectasis, the affected bronchi appear dilated and blindly end in club-shaped extensions. Due to the impossibility of examining the subsegmental bronchi, bronchoscopic examination is significantly inferior to bronchography in its information content.

However, bronchoscopy makes it possible to assess the condition of those parts of the bronchial tree that are not changed, according to bronchographic examination, and also to carry out therapeutic measures.

Similarities clinical manifestations bronchitis and initial stages bronchiectasis often creates difficulties in the differential diagnosis of these diseases. A carefully collected anamnesis plays an important role.

It should be taken into account that, unlike patients with bronchiectasis, the medical history of adult patients suffering from chronic bronchitis rarely begins in childhood; clinical manifestations more often appear in middle age. Exacerbations of bronchiectasis are characterized by the presence of medium- and large-bubble rales, often of a “crackling” nature, in the same areas of the lung, whereas with chronic bronchitis, scattered dry rales are more often observed.

In difficult cases, bronchographic examination is decisive. Presence of intoxication, prolonged cough, hemoptysis makes it necessary to differentiate bronchiectasis from destructive forms of pulmonary tuberculosis and central cancer lungs.

Treatment of bronchiectasis

Of the conservative methods of treating bronchiectasis, antibacterial therapy is of greatest importance, as well as measures aimed at emptying bronchiectasis and improving the drainage function of the bronchi.

To treat exacerbations of the disease, antibiotics, sulfonamides, and furagin-type drugs are used. Purpose antibacterial agents It is better to carry out taking into account the sensitivity of the sputum microflora.

Are used various ways administration of drugs in generally accepted dosages, but preference is given to the endotracheal method of administration - using a bronchoscope, transnasal catheter or laryngeal syringe.

The most effective are therapeutic bronchoscopy with washing and removal of purulent contents from the bronchial lumen with the introduction of antibiotics, proteolytic enzymes (trypsin, chymotrypsin 10-20 mg per saline solution), mucolytic drugs (acetylcysteine ​​in the form of a 10% solution of 2 ml, 4-8 mg of bromhexine in an isotonic solution).

Initially, the procedures are carried out 2 times a week, and then, as the purulent secretion decreases, once every 5-7 days. An effective measure is postural (positional) drainage by giving the patient's body several times a day a certain position that improves sputum separation. The same purpose is served by the appointment of expectorants.

To increase the overall reactivity of the body, methyluracil, pentoxyl, anabolic hormones (Nerobol, Retabolil), large doses of ascorbic acid, B vitamins are prescribed, and transfusions of blood or blood preparations are performed.

Due to significant loss protein with purulent sputum is indicated for use complete diet, rich in proteins, fats, vitamins. During the period of remission it is necessary dispensary observation, constant implementation postural drainage, restorative measures, sanatorium-resort treatment.

The most popular sanatoriums are the southern coast of Crimea, but treatment in local specialized sanatoriums during the warm and dry season is also effective. Exercises have a beneficial effect breathing exercises, physiotherapeutic procedures (UHF currents, ultraviolet irradiation). If there are occupational hazards, employment is carried out.

The only one radical method Treatment is to remove the affected area of ​​the lung. At timely diagnosis Surgical treatment of the disease is possible in most patients with unilateral bronchiectasis, especially when one lobe or individual segments are affected.

Complete cure occurs in 50-80% of patients. top scores observed during early surgical intervention. After 40 years, surgical treatment is possible only in selected patients. Contraindications to surgery are bilateral diffuse lung damage and severe heart failure.

Prognosis for bronchiectasis

Due to widespread use antibiotics and the introduction of endobronchial methods into practice. After rehabilitation, the prognosis of bronchiectasis has improved somewhat, but remains serious. Death most often occurs from severe pulmonary heart failure or amyloidosis internal organs, less often from urinary bleeding.

Exacerbations in mild and severe forms of bronchiectasis are accompanied by temporary loss of ability to work. The development of chronic pulmonary heart disease leads to its permanent loss.

Prevention of bronchiectasis

Bronchiectasis is preventable timely treatment bronchitis, pneumonia, respiratory infections, whooping cough, measles. Treatment of severe respiratory diseases should be continued until clinical manifestations completely disappear and radiological data normalize.

Activities to harden the body, physical education and sports are of great importance. It should also be noted that the elimination of occupational hazards, the fight against smoking and alcohol abuse.

Questions and answers on the topic "Bronchiectasis"

Question:Hello, I have had bronchiectasis (small bags in the bronchi) since I was 12 years old and the amount of sputum is about 15 ml. per day. During exacerbations, I previously used antibiotics prescribed by the doctor and there was an effect. Sometimes there was an effect when taking only immunomodulators, but recently there was little effect from antibiotics and the sputum remained mucopurulent in color. I tried Miramistin inhalations because... I read that it is a very strong antiseptic, but it had zero effect. Accordingly, the question is: is it worth using antibiotics in the form of tablets or injections, even if the antiseptic Miramistin did not help? And is it possible that this sputum is not a consequence of infection, because... I handed it over for sowing twice and nothing was sown, although the color is definitely yellow-green? My fluorogram is normal.

Answer: Depending on the goals you set for yourself and your doctors. Inhalations for bronchiectasis are pointless and ineffective. The only reasonable thing is high-quality sanitation bronchoscopy, with preliminary sputum culture and selection of abiotic.

Question:Hello, I have had bronchiectasis since I was 16 years old. At the same age she was operated on, lived well for about 10 years, and then bronchiectasis appeared on the other lung. Everything would be fine, but periodically (1-2 times a year) I have sputum with blood clots. I react very violently to this - I am 100% stressed. I see a doctor, including a phthisiatrician. I regularly do flu and x-rays. I want to understand how I should behave in such cases, what medications are taken for this type of hemoptysis, and whether there is any salvation from this. I lead a healthy lifestyle, I am very careful about my health, and every time it’s a shock for me.

Answer: Repeated discharge of sputum with blood clots requires mandatory further examination and a decision on the need for surgical treatment. It is not clear from your letter the scope of the previously performed operation. Must be completed computed tomography chest and fibrobronchoscopy to clarify the localization of bronchiectasis. In case of limited damage, surgical treatment is advisable; on this issue, it is necessary to consult with a thoracic surgeon. For treatment similar situations Hemastatic (hemostatic) therapy is used, which can only be prescribed by a doctor.

Question:Hello! My name is Aizhan, I am 25 years old. I have had this disease since birth. She was on disability. But as soon as I switched to an adult, they immediately took it off. Well, that's not the point! My illness remained with me. Constant cough with phlegm and nasal congestion. Did a CT scan of the chest. Conclusion: CT data for bronchiectasis. Multiple cylindrical broncho-, bronchiolectasis. Signs of bronchiolitis obliterans. Fibrous-cicatricial stricture of the bronchus of the lower lingular segment of the upper lobe of the left lung. Maybe my question is really stupid. But I'll ask it anyway. Is this disease curable? I usually undergo treatment in Astrakhan in pulmonology department. The doctors are certainly good and attentive. I would like to get an appointment with you. Is it possible?

Answer: Good day! Bronchiectactic disease is incurable. But if you correctly draw up an algorithm for treatment and prevention, you can significantly reduce the frequency of exacerbations and improve the quality of life. In addition, it is necessary to evaluate the prospects for surgical intervention. An important role is given to resorts specializing in bronchopulmonary pathology. You can easily sign up and come for a consultation.

is a disease characterized by irreversible changes (expansion, deformation) of the bronchi, accompanied by functional inferiority and the development of chronic purulent inflammatory process in the bronchial tree. The main manifestation of bronchiectasis is persistent cough accompanied by the release of purulent sputum. Hemoptysis and even the development of pulmonary hemorrhage are possible. Over time, bronchiectasis can lead to respiratory failure and anemia, and in children, to retarded physical development. The diagnostic algorithm includes a physical examination of the patient, auscultation of the lungs, and radiography of organs chest cavity, bronchoscopy, sputum analysis, bronchography, respiratory function test. Treatment of bronchiectasis is aimed at stopping the purulent-inflammatory process inside the bronchi and sanitizing the bronchial tree.

ICD-10

J47 Bronchiectasis

General information

Bronchiectasis (BED) is a disease characterized by irreversible changes (expansion, deformation) of the bronchi, accompanied by functional inferiority and the development of a chronic purulent-inflammatory process in the bronchial tree. Modified bronchi are called bronchiectasis (or bronchiectasis). Bronchiectasis occurs in 0.5-1.5% of the population, developing mainly in childhood and at a young age(from 5 to 25 years). The disease occurs in the form of recurrent bronchopulmonary infections and is accompanied by a constant cough with sputum. Damage to the bronchi in bronchiectasis can be limited to one segment or lobe of the lung or be widespread.

Causes

Primary bronchiectasis is caused by birth defects development of the bronchi – underdevelopment (dysplasia) of the bronchial wall. Congenital bronchiectasis is much less common than acquired bronchiectasis. Acquired bronchiectasis occurs as a result of frequent bronchopulmonary infections suffered in childhood - bronchopneumonia, chronic deforming bronchitis, tuberculosis or lung abscess. Sometimes bronchiectasis develops due to foreign bodies entering the lumen of the bronchi.

Pathogenesis

Chronic inflammation of the bronchial tree causes changes in the mucous and muscular layers of the bronchi, as well as in the peribronchial tissue. Becoming pliable, the affected walls of the bronchi expand. Pneumosclerotic processes in lung tissue after suffering bronchitis, pneumonia, tuberculosis or lung abscess lead to wrinkling of the pulmonary parenchyma and stretching, deformation of the bronchial walls. Destructive processes also affect nerve endings, arterioles and capillaries feeding the bronchi.

Fusiform and cylindrical bronchiectasis affects large and medium-sized bronchi, saccular bronchiectasis affects smaller ones. Uninfected bronchiectasis, few in number and small in size, may not manifest itself clinically for a long time. With the addition of infection and the development of the inflammatory process, bronchiectasis is filled with purulent sputum, which maintains chronic inflammation in the modified bronchi. This is how bronchiectasis develops. Maintaining purulent inflammation in the bronchi contributes to bronchial obstruction, difficulty in self-cleaning of the bronchial tree, decreased protective mechanisms bronchopulmonary system, chronic purulent processes in the nasopharynx.

Classification

According to the generally accepted classification, bronchiectasis is distinguished:

• by type of bronchial deformation– saccular, cylindrical, spindle-shaped and mixed;
• by degree of distribution pathological process - unilateral and bilateral (indicating the segment or lobe of the lung);
• according to the phase of the course of bronchiectasis– exacerbation and remission;
• according to the condition of the parenchyma the affected part of the lung - atelectatic and not accompanied by atelectasis;
• for development reasons– primary (congenital) and secondary (acquired);
• according to clinical form bronchiectasis – mild, severe and severe forms.

1. A mild form of bronchiectasis is characterized by 1-2 exacerbations per year, long-term remissions, during which patients feel practically healthy and functional.
2. The severe form of bronchiectasis is characterized by seasonal, longer exacerbations, with the release of 50 to 200 ml of purulent sputum per day. During periods of remission, cough with sputum, moderate shortness of breath, and decreased ability to work persist.
3. In severe forms of bronchiectasis, frequent, prolonged exacerbations with a temperature reaction and short-term remissions are observed. The amount of sputum produced increases to 200 ml, and the sputum often has a putrid odor. The ability to work during remissions was preserved.

Symptoms of bronchiectasis

The main manifestation of bronchiectasis is a persistent cough with the discharge of purulent sputum with an unpleasant odor. Sputum production is especially abundant in the morning (“full mouth”) or with the correct drainage position (on the affected side with the head end down). The amount of sputum can reach several hundred milliliters. During the day, the cough resumes as sputum accumulates in the bronchi. A cough can lead to rupture of blood vessels in thinned bronchial walls, which is accompanied by hemoptysis, and if large vessels are injured, pulmonary hemorrhage.

Chronic purulent inflammation of the bronchial tree causes intoxication and exhaustion of the body. Patients with bronchiectasis develop anemia, weight loss, general weakness, pale skin, and there is a delay in the physical and sexual development of children. Respiratory failure in bronchiectasis is manifested by cyanosis, shortness of breath, thickening of the terminal phalanges of the fingers in the form of “drumsticks” and nails in the form of “watch glasses,” and deformation of the chest.

The frequency and duration of exacerbations of bronchiectasis depend on clinical form diseases. Exacerbations occur in the form of a bronchopulmonary infection with an increase in body temperature and an increase in the amount of sputum discharge. Even without an exacerbation of bronchiectasis, a productive wet cough with sputum persists.

Complications

The complicated course of bronchiectasis is characterized by signs of a severe form, which are accompanied by secondary complications: cardiopulmonary failure, cor pulmonale, amyloidosis of the kidneys, liver, nephritis, etc. Also, the long course of bronchiectasis can be complicated iron deficiency anemia, lung abscess, pleural empyema, pulmonary hemorrhage.

Diagnostics

A physical examination of the lungs in bronchiectasis reveals a lag in lung mobility in breathing and dullness of percussion sound on the affected side. The auscultatory picture in bronchiectasis is characterized by weakened breathing, a mass of different-sized (small, medium and large bubble) moist rales, usually in the lower parts of the lungs, decreasing after coughing up sputum. In the presence of a bronchospastic component, whistling dry rales are added.

On frontal and lateral projections of radiographs of the lungs in patients with bronchiectasis, deformation and cellularity of the pulmonary pattern, areas of atelectasis, and a decrease in the volume of the affected segment or lobe are detected. Endoscopic examination bronchi - bronchoscopy - allows you to identify abundant, viscous purulent secretion, take material for cytology and bacterial analysis, establish the source of bleeding, and also carry out sanitation of the bronchial tree in preparation for the next diagnostic stage - bronchography.

Treatment of bronchiectasis

During periods of exacerbation of bronchiectasis, the main therapeutic measures are aimed at sanitizing the bronchi and suppressing the purulent-inflammatory process in the bronchial tree. For this purpose, antibiotic therapy and bronchoscopic drainage are performed. The use of antibiotics is possible both parenterally (intravenously, intramuscularly) and endobronchially during sanitation bronchoscopy. For the treatment of chronic inflammatory processes of the bronchi, cephalosporins (ceftriaxone, cefazolin, cefotaxime, etc.), semisynthetic penicillins (ampicillin, oxacillin), and gentamicin are used.

In case of bronchiectasis, drainage of the bronchial tree is also carried out by placing the patient in a position in bed with the leg end raised, which facilitates the discharge of sputum. To improve the evacuation of sputum, expectorants, alkaline drinking, chest massage, breathing exercises, inhalations, and medicinal electrophoresis on the chest are prescribed.

Often, with bronchiectasis, they resort to bronchoalveolar lavage (bronchial lavage) and suction of purulent secretions using a bronchoscope. Therapeutic bronchoscopy allows not only to rinse the bronchi and remove purulent secretions, but also to introduce antibiotics, mucolytics, bronchodilators into the bronchial tree, and apply ultrasound sanitation.

The diet of patients with bronchiectasis should be complete, enriched with protein and vitamins. The diet additionally includes meat, fish, cottage cheese, vegetables, juices, and fruits. Outside of exacerbations of bronchiectasis, breathing exercises, taking expectorant herbs, and sanatorium-resort rehabilitation are indicated.

In the absence of contraindications (cor pulmonale, bilateral bronchiectasis, etc.), surgical treatment of bronchiectasis is indicated - removal of the altered lobe of the lung (lobectomy). Sometimes surgical treatment of bronchiectasis is carried out for health reasons (in case of severe, continuous bleeding).

Prognosis and prevention

Surgical removal of bronchiectasis in some cases leads to full recovery. Regular courses of anti-inflammatory therapy can achieve long-term remission. Exacerbations of bronchiectasis can occur in damp, cold seasons, during hypothermia, and after colds. In the absence of treatment for bronchiectasis and its complicated course, the prognosis is unfavorable. Severe long-term course of bronchiectasis leads to disability.

Prevention of the development of bronchiectasis involves dispensary observation by a pulmonologist of patients with chronic bronchitis and pneumosclerosis, their timely and adequate treatment, exclusion of harmful factors (smoking, industrial and dust hazards), hardening. In order to prevent exacerbations of bronchiectasis, timely sanitation of the paranasal sinuses for sinusitis and the oral cavity for diseases of the dentofacial system is necessary.

Bronchiectasis in the lungs is one of the irreversible pathological conditions, and has both a congenital and acquired nature. Bronchiectasis can act as an independent diagnosis, or develop against the background of complications of the underlying disease in a chronic form.

Deformations and expansions that form in the lungs due to this pathology provoke a purulent inflammatory process of the mucous membranes, which leads to partial or complete loss of functionality of the bronchi. It is important to identify the disease in a timely manner, for which it is necessary to recognize the symptoms, undergo a diagnostic examination and select the optimal therapeutic method.

Causes of bronchiectasis

Most often, bronchiectasis occurs in childhood or adolescence, and male patients are most susceptible to the disease. Causes similar dependence and exact data on the appearance and development of the disease are unknown to scientists today, however, the following factors significantly increase the risk of developing a pathological condition:

• weakened immunity and exhaustion of the body;
• diffuse panbronchiolitis;
• diseases transmitted by inheritance;
• narrowing of the lumen due to external and internal scars.

Congenital bronchiectasis in the lungs occurs in cases where pressure has been applied to the fetus in the mother's womb, resulting in respiratory system was deformed and damaged. The reason may be incorrect behavior of the expectant mother who consumes alcoholic beverages, tobacco products or drugs during pregnancy.

Bronchiectasis in the lungs varies according to the following classification:

• According to the characteristics of the clinical form (severe, severe, mild or complicated).
• For the reasons that provoked the occurrence of the pathology (congenital or acquired).
• According to the current state of the parenchyma of the lung parts of interest.
• The pathological process may differ depending on the characteristics of the spread and be bilateral or unilateral.

Bronchiectasis varies depending on the degree and nature of bronchial deformation. Highlight light form a disease in which exacerbations occur no more than twice a year, and periods of remission between them are very long. The severe form is characterized by long-term seasonal exacerbations, accompanied by volumetric sputum production. During the period of remission, patients are often bothered by constant shortness of breath, obsessive cough and general loss of strength.

Features of forms

A severe form of the disease involves frequent, prolonged exacerbations with increased body temperature and various characteristic symptoms, the most pronounced of which is sputum, released in large volumes and having a putrid odor. Bronchiectasis in a complicated form is often complicated by various concomitant diseases, such as:

• pulmonary hemorrhage;
• anemia with severe iron deficiency;
• nephritis;
• cardiopulmonary failure.

Due to general exhaustion of the body, patients develop anemia and pallor skin and weight loss.

Primary bronchiectasis is an independent pathology that is classified as nonspecific chronic diseases lungs. It often occurs in patients of preschool and primary school age who have not previously complained of any problems with the lungs. Secondary bronchiectasis is a complex symptomatology caused by a complication of an underlying disease, such as pneumonia or tuberculosis.

Clinical manifestations of the disease

Bronchiectasis is characterized by a gradual, smooth development, so in the early stages of the disease, symptoms may be mild or completely absent. Often, in parallel with the disease, damage to the body occurs, pneumonia and other diseases of the bronchopulmonary system. Patients experience wheezing during exhalation and inhalation, increased amount sputum (up to 450 ml per day), especially in cold, wet weather.

As the disease progresses, a cough occurs, which is especially disturbing in the morning and is accompanied by copious discharge of sputum with a purulent-mucous consistency and a repulsive odor.

As a result of the disease, the bronchial walls experience high blood pressure Therefore, there is a pronounced lack of oxygen in the body. Patients begin to feel constantly dizzy and complain of general weakness, lethargy, drowsiness and loss of tone. Shortness of breath begins to bother you not only after physical activity, but also in a calm state.

Many people complain about aching pain syndrome, localized in the chest area, indicating the presence of pathological tissue changes. Children often experience delays in mental and physical development.

Diagnostic methods

Physical examination of the lungs in bronchiectasis is accompanied by impaired mobility and dull percussion sound in the affected area. The chest appears deformed and may resemble a barrel. Several diagnostic methods are used to detect this lung disease.

Radiography allows you to see a cellular pattern and the presence of compactions in the affected areas. There are a number of indirect radiological signs, helping to establish the degree of overgrowth (obliteration) of the sinusoidal sections of the diaphragm, and determine the most accurate diagnosis.

It is aimed at studying the bronchial tree, which is studied in detail using a bronchoscope. Thanks to this method you can cleanse the bronchi, identify the extent of suppuration and take control of the process over time.

A blood test monitors the number of white blood cells and the rate at which red blood cells are deposited. Sputum in such a disease has a three-layer structure.

One of the most informative methods for diagnosing diseases of the lungs and bronchi is bronchography using contrast. To perform it, it is necessary to stop the active purulent process and produce maximum. This method makes it possible to determine how dilated and close to each other the affected bronchi are.

If the study was performed correctly, and the patient has a characteristic symptom, then there are no problems with establishing a diagnosis.

Drug therapy for bronchiectasis

If a diagnostic examination of the bronchial tree shows minor changes, bronchiectasis is treated using conservative medicine methods aimed at several aspects:

• prevention of exacerbations;
• maintaining clinical well-being;
• mitigation of the negative consequences of exacerbation of the disease;
• preventing further progression of the disease;
• elimination of the inflammatory process;
• relief of general condition.

Patients are prescribed antibacterial medications and mucolytics to facilitate the process of sputum discharge. If you have pneumonia or other illnesses respiratory tract Patients are recommended to take pneumotropic fluoroquinolones, macrolides and multivitamin complexes.

Surgery for bronchiectasis

For bronchiectasis, gentle resection is performed. It is carried out directly in the area where the bronchi have undergone pathological change. Surgical intervention is permissible in cases where it is possible to determine the boundaries and volume of the lesion.

Since resection is classified as a disabling operation, the decision on the advisability of such a step must be made based on the doctor’s informed decision, taking into account the results of bronchography and other diagnostic methods confirming the presence of negative dynamics. According to statistics, surgery for bronchiectasis shows positive results in approximately 50% of cases.

Prevention of bronchiectasis

The most common procedures aimed at preventing bronchiectasis are:

• postural type massage;
• massage treatments that require special vibrators;
• a set of breathing gymnastic exercises.

It is resorted to in cases where there is a need to drain the bronchial tree through coughing. For correct execution procedures, you need to help the patient take a certain position with his legs raised up to facilitate the discharge of sputum and bronchial mucus. Complicated and severe forms bronchiectasis is difficult to treat therapeutically.

It is worth avoiding hypothermia, weakening of the immune system and other factors that predispose to the occurrence of pneumonia. In case of damage to the respiratory tract, it is necessary to adhere to the recommendations of the attending physician and take all medications prescribed by him even if severe symptoms disappear from clinical picture. When you are sick, it is important to follow a specific diet that includes plenty of protein foods with low fat content, as well as daily use freshly squeezed vegetable and fruit juices.

Bronchiectasis (or bronchiectasis) is an acquired disease accompanied by irreversible structural changes (expansion, deformation) and a chronic purulent process in the bronchi. Most often this pathology affects the lower respiratory tract, and disruption of the structure of the bronchi may affect one segment or lobe of the lung, or be diffuse.

This disease occurs against the background of recurrent bronchopulmonary infection, and its main symptoms are cough and purulent sputum. According to statistics, bronchiectasis most often develops in childhood or young age (from 5 to 25 years) and affects about 1-1.5% of the population. In this article we will talk about the causes and symptoms of the pathology, as well as methods for diagnosing and treating the disease. Let's talk about the consequences.

Causes and classification

The reasons for the development of bronchiectasis and the appearance of deformed areas of the bronchi have not yet been fully elucidated, but the factors that in most cases provoked this bronchopulmonary pathology have been established.

The causes of bronchiectasis (areas of bronchial deformation) include:

• congenital predisposition to bronchial dysplasia;
• frequent and;
• lung abscess;
• foreign bodies;
• expiratory stenosis of the trachea and bronchi;
• allergic bronchopulmonary aspergillosis;
• Mounier-Kuhn syndrome;
• Williams-Campbell syndrome;
• cystic fibrosis, etc.

The above diseases and conditions significantly worsen the mechanisms of mucus discharge from the respiratory tract, and infection with various infections (Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, etc.) is accompanied by filling of the bronchi with a viscous secretion. Sputum accumulated in the bronchial tree can cause expansion and subsequent scarring (deformation) of the bronchi.

The examination reveals the following bronchiectasis:

• cylindrical;
• fusiform;
• saccular;
• mixed.

In the absence of infection, these areas of bronchial deformation may not manifest themselves in any way, but upon penetration pathogenic microorganism the cavities are completely filled with purulent contents and manifest themselves as long-term chronic inflammation. Thus, bronchiectasis begins to develop, which is aggravated by obstruction and difficult self-cleaning of the bronchial tree.

According to severity, pulmonologists distinguish four forms of this disease(according to Ermolaev):

• light;
• expressed;
• heavy;
• complicated.

Bronchiectasis is also classified according to the prevalence of the pathological process:

• right-sided;
• left-handed.

For a more detailed clarification of the localization of pathological foci, a segment of the lung is indicated. Most often, bronchiectasis is localized in the basal or lingular segment of the left lung or in the basal segment or middle lobe of the right lung.

Symptoms

The main complaint of patients during an exacerbation of bronchiectasis is a cough with purulent sputum. The amount of secretion may vary and depends on the stage of the disease. In some severe cases, about 30-300 (sometimes up to 1000) ml of purulent contents can be separated from the bronchi.

The sputum of a patient with bronchiectasis collected in a jar tends to separate over time. The upper layer contains impurities of saliva and is a viscous mucous liquid, and the lower layer consists of purulent secretion. It is the amount of the lower layer that can determine the intensity of the inflammatory process.

The most abundant sputum is released in the morning (immediately after waking up) or during the so-called drainage positions of the body (turning onto the healthy side, tilting the body forward, etc.). As the disease progresses, the sputum acquires a putrid odor and becomes increasingly fetid. Many patients complain of frequent bad breath, shortness of breath, and increased coughing when trying to change body position.

When the disease worsens, purulent inflammation in the bronchi is accompanied by intoxication of the body, and the patient develops the following symptoms:

• weakness;
• fast fatiguability;
• sweating;
• increased body temperature (up to 38-39 °C);
• chills.

During auscultation (listening) the patient hears hard breathing and a large number of wheezing, which is especially pronounced in the morning. Patients may also experience a decrease in body temperature to subfebrile levels after the discharge of a large portion of sputum.

As the disease progresses, coughing can lead to hemoptysis. Patients may complain of dull pain in the chest and lesions of the paranasal sinuses.

In the initial (mild) stages of the disease appearance patients are normal, but as the severity of bronchiectasis increases, the complexion acquires an earthy tint and it becomes puffy. Such patients have fingers shaped like drumsticks and nails shaped like watch glasses. Also, prolonged purulent intoxication of the body and hypoxemia can lead to the appearance of diffuse cyanosis.

Diagnostics

Diagnostic examination for bronchiectasis always includes a complex of various measures:

• taking anamnesis;
• auscultation;
• physical examination;
• radiography;
• bronchography (main method);
• bronchoscopy;
• bacteriological examination of sputum;
• cytological examination of sputum;
• spirometry;
• peak flowmetry;
• CT scan.

As additional methods examinations of the patient may be prescribed:

• sweat chloride analysis;
• analysis to detect rheumatoid factor;
• testing for Aspergillus precipitins;
• immunological blood test, etc.

Treatment

The choice of treatment tactics for bronchiectasis depends on the stage and severity of the disease.

During the period of exacerbation, the main goal of therapy is aimed at eliminating purulent inflammation of the bronchial tree and sanitizing the bronchi. For this, the patient is prescribed antibacterial and antimicrobial drugs:

• semisynthetic penicillins: Oxacillin, Methicillin, etc.;
• cephalosporins: Cefazolin, Ceftriaxone, Cefotaxime, etc.;
• Gentamicin;
• sulfonamide drugs: Sulfadimethoxine, Biseptol, etc.

They can be administered intravenously, intramuscularly and endobronchially (during therapeutic bronchoscopy).

Also, for bronchoscopic drainage, in addition to antibiotics, proteolytic enzymes (Chymotrypsin, Ribonuclease, Trypsin), Dioxidin, mucolytics (Bromhexine, Acetylcysteine, etc.) can be used. At the beginning of the disease, these procedures are carried out 2 times a week, and then they can be used once every 6-7 days. This therapeutic bronchoscopy allows you to wash the walls of the bronchi, remove purulent secretions and deliver medications directly to the foci of bronchiectasis.

For the most efficient removal of sputum, patients are prescribed:

• expectorants;
• massage;
• breathing exercises;
• drinking plenty of alkaline drinks;
• electrophoresis, etc.

After eliminating the inflammation, the patient is recommended to take medicines for (Methyluracil, Retabolil or Nerabol, B vitamins and high doses of ascorbic acid). In the stage of stable remission, it is highly desirable to conduct courses of sanatorium-resort treatment (Evpatoria, Yalta, Sochi, Alupka, etc.).

Radical surgical treatment of bronchiectasis is indicated in cases where, after resection of areas of lung tissue, it is possible to maintain sufficient respiratory function. Conditions accompanied by massive pulmonary hemorrhage may also be an indication for it. In such cases, bronchial embolization is performed and symptomatic treatment is carried out.

In case of unilateral bronchiectasis, the affected parts of the lung are removed during the operation (in extreme cases pneumectomy may be performed). In case of bilateral damage to the bronchial tree, it is possible to perform surgical intervention determined by analyzing data for each clinical case. The condition of patients after such operations in most cases improves significantly, and further clinical observation, anti-relapse treatment and preventive measures allow for complete recovery.

Prognosis and complications

Bronchiectasis lasts a long time and often worsens in the spring and autumn. Its relapses are provoked infectious diseases respiratory tract or hypothermia.

Lack of adequate therapy and prolonged severe course bronchiectasis gives an extremely unfavorable prognosis and leads to disability of the patient. It can be complicated by the following serious diseases and conditions:

• pulmonary hemorrhages;
• pleural empyema;
• amyloidosis of internal organs;
• metastatic brain abscesses.

With adequate treatment, the prognosis of this pathology can be favorable. Effective courses of prophylaxis with anti-inflammatory drugs and spa treatment can lead to stable and long-term remissions, and surgical treatment (removal) of bronchiectasis in some cases guarantees complete relief from this disease.

Treatment of patients with bronchiectasis carried out in two main ways - operational And conservative.
Surgical treatment is in a radical way allowing to achieve practical cure. For unilateral bronchiectasis and good functional indicators Pulmonary ventilation involves surgical removal of the affected segments or an entire lobe of the lung (segmental resection or lobectomy). Sometimes a pneumonectomy is performed. The operation is performed, as a rule, during the period of remission of the disease. Before surgical treatment, it is necessary to carry out sanitation (operatively if indicated) of existing foci of infection in the nasopharynx and oral cavity.
Conservative treatment of bronchiectasis used in the absence of indications for surgical treatment (or in the presence of contraindications), as well as before planned surgical intervention.
The basis of conservative treatment for exacerbation of the inflammatory process is the methods of endobronchial sanitation, combined with rational antibiotic therapy and the use of immunocorrective drugs.

To improve the self-cleaning processes of bronchiectasis, sanitary fibrobronchoscopy is performed with the local use of antiseptics, antibiotics and drugs that improve sputum production. Therapeutic bronchoscopy is performed every 2-3 days until the endoscopic picture improves and the signs of purulent endobronchitis are eliminated or reduced. The drug of choice for endobronchial sanitation is the antiseptic drug dekasan - a 0.02% aqueous solution of decamethoxin. The medicine has a strong bactericidal effect against staphylococci, streptococci, Pseudomonas aeruginosa and diphtheria bacilli, bacteroides, as well as a fungicidal effect on aspergillus and candida. In order to effectively lavage the tracheobronchial tree, it is necessary to administer 50-100 ml of decasan endobronchially. If necessary, especially in young and middle-aged children, therapeutic bronchoscopy is performed using a rigid tube of the Friedel or Storz system under general anesthesia. This achieves more effective sanitation of the bronchial tree. Sometimes, especially if therapeutic bronchoscopy is poorly tolerated, the microtracheostomy method with endotracheal administration of antibiotics and antiseptics can be used. Through a microtracheostomy, dekasan is most often administered at a dose of 25-50 ml 1-2 times a day.
Taking into account the experience of the pulmonology clinic, the basic principles of rational antibiotic therapy in the treatment of exacerbations of bronchiectasis were developed:

1. When choosing antibiotics for empirical therapy, it is necessary to be guided by the specific epidemiological situation that led to an exacerbation of the disease, as well as anamnestic data on previous courses of antibacterial therapy (for the choice of antibiotics, see below).
2. Mandatory identification of microbiological pathogens with determination of its sensitivity to antibacterial drugs. In this case, all possible biological media are collected - sputum, wash water bronchi and bronchial secretions, blood, pleural fluid.
   1. The final choice of an antibacterial drug must be made taking into account the sensitivity of the microorganism to it, as well as the specific epidemiological situation, medical experience and data from scientific medical literature.
   2. The main criteria for stopping antibacterial therapy are the reduction or elimination of signs of purulent endobronchitis during endoscopic control, and if complicated by hemoptysis - its complete cessation. The course of treatment with one antibacterial drug should not exceed 10-14 days.
   3. When conducting pharmacotherapy, advantage is given in different ways administration of antibacterial drugs that are prescribed simultaneously. In this case, as a rule, intravenous, endobronchial and inhalation routes of administration are used. For inhalation therapy It is better to use nebulizers - modern compression and ultrasonic inhalers.

When choosing an antibiotic empirically, “inhibitor-protected aminopenicillins” (amoxicillin/clavulanate, ampicillin/sulbactam), cephalosporins of II-III generation (cefuroxime, cefotaxime, ceftriaxone) and modern “respiratory fluoroquinolones” (levofloxacin, moxifloxacin, gatifloxacin) have an advantage. Availability putrid smell from the mouth and sputum requires the use of drugs with high antianaerobic activity - amoxicillin/clavulanate, moxifloxacin, gatifloxacin. When prescribing cephalosporin antibiotics, they must be combined with metronidazole and/or lincosamide (lincomycin or clindamycin). These drugs are prescribed parenterally, preferably intravenously in medium therapeutic doses. After achieving a therapeutic effect after 5-7 days of treatment, you can switch to administering the same drug orally if it has good bioavailability.
Given the long-term nature of antibacterial therapy, prophylactic administration is necessary. antifungal drugs. The advantage is fluconazole, which is prescribed orally at a dose of 150 mg 1-2 times a week.
If clinical symptoms of oropharyngeal candidiasis arise, fluconazole is prescribed orally at a dose of 50-100 mg/day for 7-14 days. In the most severe cases, it is advisable to administer the drug intravenously at a dose of 100-200 mg/day for 7 days.
Clinical signs of intestinal dysbiosis and the predominance of fungal flora in the coprogram (most often Candida spp.) serve as the basis for prescribing complex therapy. First of all, this is the use of the prebiotic lactuvite, containing lactulose, which is a food substrate for bifidobacteria and lactobacilli. The drug is available in the form of syrup and is prescribed 20 ml once a day orally during breakfast for 2-3 weeks.

It is also advisable to simultaneously administer xenobiotics (bifiform, linex, biosporin, acidophilus), which ensure colonization intestinal tract lactic acid bacteria. However, to achieve full therapeutic effect significant inhibition of the vital activity of Candida spp is necessary. in the intestine, which is provided by targeted pharmacotherapy. The drug of choice is natamycin (proprietary name - Pimafucin®), which has an advantage over other antimycotics, since it is not adsorbed in the gastrointestinal tract and creates a sufficient therapeutic concentration in the intestine. The drug is administered orally in tablets that have a special enteric coating. In most cases, 1 tablet containing 100 mg is prescribed active substance, 4 times a day for 7-10 days. An alternative drug is nystatin, which is prescribed orally at a dose of 500,000 units 4 times a day for 10-14 days.

In order to restore the physiological drainage function of the bronchial tree, modern mucolytic drugs are used (ambroxol, bromhexine, acetylcysteine ​​- orally or parenterally). In case of complications bronchial obstruction aerosol metered dose inhalers are prescribed - salbutamol, fenoterol, ipratropium bromide/fenoterol and ipratropium bromide/salbutamol. To improve sputum production, therapeutic physical training and drainage exercises using positional drainage methods are recommended.
Immunomodulatory therapy is carried out after studying the immunogram. In this case, advantage is given to drugs of natural origin (human immunoglobulin, thymus preparations, echinacea, as well as those containing extracts of shark cartilage and cat's claw).

To reduce purulent-resorptive intoxication, infusion therapy is carried out with the primary use of drugs that simultaneously have a diuretic effect (sorbilact) or improve microcirculation (reopolyglucin, rheosorbilact and others). These drugs are prescribed in a short course over 5-7 days in the form of a drip infusion of 200-400 ml per day. A feature of multifunctional drugs created on the basis of sorbitol (sorbilact, rheosorbilact) is the possibility of simultaneous neutralization metabolic acidosis and maintaining normal blood electrolyte composition.

Literature:

Sakharchuk I.I., Ilnitsky R.I., Dudka P.F. Inflammatory diseases bronchi: differential diagnosis and treatment. - K.: Book Plus, 2005. - 224 p.