Bronchiectasis in the elderly. Symptoms of bronchiectasis of the lungs. Causes of bronchiectasis

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 agents. IN in this case primary ones come from birth 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 the bronchopulmonary system; the infection must be suffered 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. By scale of expansion inflammatory process, taking into account the period of the segment of the share - one-sided and two-sided.
3. According to the structure of the course of the disease, there are remission and aggravated forms.
4. Depending on the causation– congenital and acquired.
5. Clinical forms are characterized by mild, severe, severe and complicated.

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

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 with complex form pathologies are short-term, exacerbations occur with high temperature. 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 various pathologies may come from lung problems. 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 is detected purulent discharge sputum, expectoration of blood, then treatment can last about six months with the use of antibacterial agents.

Medicines are prescribed that expand the lumens of the bronchi, they eliminate the further spread of the deformity. 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 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 also used in case of acute problems with the heart and bronchi.

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

1. Bactericidal – Amoxiclav.
2. Ceftriaxone is an antibiotic that has a wide spectrum of action.
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 large quantities of sputum are released. 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.

Bronchiectasis is a disease in the lower sections of the bronchi, which is characterized by their irreversible expansion at the time of exacerbation of purulent inflammation.

The disease, with permanent treatment, easily controlled and extremely rarely leads to the death of the patient. IN otherwise the risk of death increases several times. Men get sick 3 times more often than women. Also more susceptible to developing bronchiectasis smoking people and residents of cold and humid regions. This diagnosis is first detected at the age of 5-25 years.

Causes of the disease

The reasons for the initial development of bronchiectasis are not fully known. The following theories can be distinguished:

• Genetic mutations during the development of the bronchopulmonary system, in which sufficiently the muscles of the bronchi, tissue elasticity and other mechanisms that maintain the bronchi in tone do not develop.
• Frequent pneumonia and bronchitis in childhood, which cause disturbances in the structure of the tissues of the bronchial tree.
• Lung abscess - purulent disease lung tissue, which can result in disruption of the functioning of the small bronchi, causing pathological expansion in them.
• Foreign bodies in the bronchi can also cause changes in tissue structure, reducing their tone and elasticity.

The reasons for the development of exacerbation and the occurrence of a purulent process in the dilated bronchi are:

• The inability of the bronchi to cleanse themselves of natural mucus. This leads to stagnation and infection.
• Reduced immunity after suffering from colds and other illnesses
• Hypothermia
• Exacerbation of sore throat

For the first time, if not genetic mutations, dilatation of the bronchi and the development of bronchiectasis, begins after suffering bronchitis with obstruction of patency respiratory tract. Blockage of the bronchial lumen causes a reflex cough and compensatory expansion of the affected bronchi to make breathing easier for the patient. After repeated exacerbations of such bronchitis, the elasticity of the tissues in the walls of the bronchi decreases, and their lumen does not return to its previous level and remains expanded. This is the beginning of bronchiectasis. Subsequently, the natural mucus in the bronchi is not able to evacuate, causing congestion in the lumen, to which infection is associated during predisposing factors.

Classification of the disease

There are several types of disease classifications based on different criteria.

According to the severity of the process:

• Mild - 1-2 exacerbations are possible during the year; during remission, patients have practically no complaints and can perform their work fully.
• Moderate severity - exacerbations up to 3-4 times a year, last longer and more severely. Up to 100 ml can be released during the day purulent sputum(yellow color). During the period of remission, cough and sputum are constantly present, but it does not contain pus and is less in quantity than during exacerbations. Endurance for physical work decreases, lighter work is required.
• Severe - exacerbations are quite long and frequent, and are difficult. There can be up to 5-6 exacerbations per year, sometimes more. The amount of sputum per day can reach up to 200 ml. The periods of remission are not long; patients continue to be bothered by many complaints and become completely incapacitated.

According to the phase of the disease:

• Remission
• Exacerbation

According to the prevalence of the process:

• Single sided shape
• Double sided form

According to the structure of the dilated bronchi:

• Saccular
• Cylindrical
• Varicose (spindle-shaped)
• Mixed

These types of bronchiectasis can be determined by bronchography (x-ray examination of the bronchial tree).

By period of occurrence:

• Congenital
• Acquired

By stages during the exacerbation period:

• Stage of bronchitis (bronchitis stage)
• Expressed stage clinical manifestations
• Stage of complications (not present in every patient and not with every exacerbation)
• Stage of recovery (attenuation of the process)

Symptoms of the disease

• The symptoms of the disease are quite varied and have varying degrees of severity (depending on the severity of the process).
• At the stage of bronchitis, the patient is concerned about the following symptoms:
• Cough like bronchitis, especially severe in the morning
• Sputum (per day from 20 to 500 ml), purulent-serous in nature
• Shortness of breath during physical activity (the intensity of the exercise for the development of shortness of breath depends on the severity of the process).

The stage of pronounced clinical manifestations is characterized by the following symptoms:

The cough becomes paroxysmal

The sputum becomes purulent and is coughed up with a full mouth, especially in the morning or when the patient bends forward. She has yellow, unpleasant putrid odor. Its quantity increases compared to the first period of the disease

Shortness of breath is pronounced even with the slightest exertion

Chest pain when breathing and coughing

Increased body temperature. In mild cases of the disease, the temperature reaches 37.5-37.8ºС, in severe cases it reaches 39-40ºС. In case of severe coughing large quantity sputum, the temperature can drop significantly.

Cyanosis ( Blue colour skin) on the lips occurs in severe cases of the disease.

The attenuation stage of the process is characterized by the following features:

Body temperature drops to normal levels

Sputum decreases in quantity and becomes serous character(almost transparent, without admixture of pus)

Cough becomes less intense

The severity of shortness of breath is less

During the period of mild remission, nothing bothers the patient; moderate severity The disease persists with cough and sputum (not purulent and not as abundant as during an exacerbation), and in severe cases the cough is pronounced, sputum persists, and shortness of breath bothers us (to a lesser extent than during an exacerbation).

Diagnosis of bronchiectasis

To diagnose this disease, physical examination methods (percussion and auscultation), laboratory diagnostics and instrumental methods are used.

During percussion, the pulmonologist hears dullness of the percussion sound or tympanitis

On auscultation - hard breathing and moist rales of large and small caliber

Complete blood count - increased white blood cells and accelerated ESR (erythrocyte sedimentation rate)

Sputum examination - culture to identify the pathogen and smears to study the composition

X-ray of organs chest without contrast - dilated bronchi are detected (a symptom of tram rails)

Bronchography - x-ray of the bronchi using contrast agent. The shape of the expansion and its localization are determined

Bronchoscopy - examination of the bronchial tree using an endoscope with a special camera, during which the doctor examines the structure of the walls of the bronchi on a monitor

Computed tomography helps to clarify the localization of the process, the size of the dilated bronchi, etc.

Study of external respiration function - helps to determine the degree of respiratory failure and determine the possibility of reversibility of the process in the bronchi

Treatment of the disease

To treat bronchiectasis, medications, surgical interventions, and traditional medicine are used.

Conservative treatment

Antibiotics are prescribed first. Most often this is amoxiclav or augmentin, as well as ceftriaxone (1 g daily intramuscularly).

To improve sputum discharge, mucolytics are used. These drugs thin the mucus and ensure its easy and rapid removal. An example of such drugs is ACC (acetylcysteine) - 1 tablet or 1 sachet 3-4 times a day for at least 10 days. Ambroxol will also cope with the task - 1 tablet 3 times a day.

Bronchodilators are used to widen the bronchi, which are clogged with mucus or pus, to make breathing easier. These are Atrovent, Serevent, Ventolin and their analogues. They are used in the form of inhalations, 1-2 breaths 2-5 times a day.

In severe cases of the disease, glucocorticosteroids are used. Prednisolone is prescribed depending on the patient's weight and the severity of his illness.

To reduce body temperature, non-steroidal anti-inflammatory drugs are used - paracetamol, ibuprofen, nimide - 2-4 tablets per day.

Surgery

Indicated for any severity of the disease up to 40 years of age, at a later age only in the presence of life-threatening complications. Surgical treatment involves removing the affected area of ​​the bronchus along with the lung. This operation is performed if, after removing a fragment of an organ, breathing will be provided in full by the remaining bronchi.

Traditional treatment

Traditional methods of treatment are aimed at improving sputum discharge:

• Squeeze the juice from plantain leaves, mix it 1:1 with honey and take 1 teaspoon 2-3 times a day.
• You need to squeeze the juice out of the turnips and take 1 tablespoon 4-6 times a day. Can be used with honey.
• Mix black radish juice with honey in a ratio of 1:1 or 2:1 and take 1 tablespoon 3 times a day.

Traditional medicine, like independent method treatment of this disease is extremely dangerous and can lead to complications and death of the patient.

Exacerbations of bronchiectasis

Exacerbations of the disease include conditions such as:

• Pulmonary hemorrhage
• Respiratory failure
• Sepsis ( general infection blood)
• Pleural empyema (purulent disease of the pleura)
• Pleurisy (inflammation of the pleura)

Bronchopneumonia (a combination of bronchitis and pneumonia)

Prevention

As a preventive measure, it is necessary to promptly treat infectious and viral diseases respiratory system, avoid hypothermia and strengthen the immune system.

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Bronchiectasis(Greek brónchos, trachea + ektasis, stretching) - acquired or congenital disease, characterized by a chronic purulent process in irreversibly changed (dilated, deformed) and functionally defective bronchi, mainly in the lower parts of the lungs.

Bronchiectasis - causes (etiology)

Bronchiectasis as independent disease with characteristic clinical picture develops only when bronchiectasis becomes infected and a chronic inflammatory process is maintained in them. Bronchiectasis is considered a form of chronic nonspecific pneumonia. This disease occurs in people of all ages, but more often from 20 to 40 years old, and the incidence of men is 6-7 times higher than women.

Bronchiectasis – mechanism of occurrence and development (pathogenesis)

Inflammation of the walls of the bronchi and the development of bronchiectasis in childhood can occur with repeated acute bronchitis, whooping cough, measles, diphtheria, and in some cases with tuberculous bronhadenitis. In adolescence and adulthood, the formation of bronchiectasis occurs due to acute diffuse bronchitis, especially occurring against the background of influenza or chronic recurrent bronchitis, unresolved pneumonia, as well as lung abscess, with repeated pneumonia and pulmonary tuberculosis. The formation of bronchiectasis during bronchitis occurs only if the inflammatory process spreads to the muscular layer of the bronchial wall or to all its layers. In this case, death occurs muscle fibers, loss of bronchial tone in this area and thinning of its wall. The absence of ciliated epithelium in areas of inflammation leads to the accumulation of sputum in the bronchial lumen, disruption of its drainage function and maintenance chronic inflammation. Granulation tissue formed at the site of inflammation, and then connective tissue, contributes to further deformation of the bronchus. The expansion of the most affected areas of the bronchial lumen is also facilitated by an increase in air pressure in the bronchial tree during a strong cough.

Bronchiectasis can also occur with prolonged stay of foreign bodies in the lumen of the bronchi, prolonged inhalation of concentrated acid vapors and other toxic substances.

Bronchiectasis - classification.

According to the generally accepted classification, bronchiectasis is distinguished:

• by type of bronchial deformation - saccular, cylindrical, spindle-shaped and mixed;
• according to the degree of spread of the 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 of the interested lung department– atelectatic and not accompanied by atelectasis;
• for developmental reasons - primary (congenital) and secondary (acquired);
• according to the clinical form of bronchiectasis - mild, severe and severe.

A mild form of bronchiectasis is characterized by 1-2 exacerbations per year, long-term remissions, during which patients feel practically healthy and functional.

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.

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.

Bronchiectasis - pathological anatomy

There are cylindrical, saccular and fusiform bronchiectasis; They are most often localized in the lower lobes of the lungs. In the most affected areas, the elements of the bronchial walls are significantly destroyed and in their place, along with inflammatory infiltration, granulation and mature scar tissue is determined. At the same time, damage to capillaries, arterioles and small arteries occurs with disruption of blood flow in the bronchial artery system, as well as nerve endings and axial cylinders of twigs vagus nerve, innervating the bronchus. As a rule, the spread of the inflammatory process to the interstitial peribronchial tissue of the lung is detected.

Bronchiectasis - symptoms (clinical picture)

The clinical symptoms of bronchiectasis are quite varied; it depends on the size of bronchiectasis, their localization and spread along the bronchi, on the activity of the inflammatory process, the degree of development of pulmonary emphysema and dysfunction of external respiration. When bronchiectasis is localized in the upper lobes of the lungs, the drainage function of the bronchi is preserved or slightly impaired. When bronchiectasis is localized in the lower lobes of the lungs, due to the more difficult separation of sputum from them, it is retained, which helps maintain the inflammatory process.

Main clinical symptom bronchiectasis is a cough with the release of serous-mucopurulent (three-layer) or purulent sputum, sometimes with putrid smell, in quantities of 50 to 500 ml or more per day, often streaked with blood. Cough in bronchiectasis is paroxysmal in nature and appears mainly in the morning after sleep as a result of irritation of the sensitive nerve endings of the bronchial mucosa accumulated overnight by sputum, especially in the so-called reflexogenic zones. During the morning, a patient with bronchiectasis produces 2/3 of the daily amount of sputum. After the “morning toilet of the bronchi” during the day, a cough rarely appears as sputum accumulates in bronchiectasis.

Cough and sputum production can also occur when the patient with bronchiectasis is in a position that promotes the best drainage function of the bronchi affected by bronchiectasis. Hemoptysis, shortness of breath, heavy sweating, weakness, headache, loss of appetite, dyspeptic disorders, bad dream, weight loss. During an exacerbation of bronchiectasis, which more often occurs in damp, cold weather, body temperature may rise, leukocytosis appears, and ROE accelerates.

During a general examination of a patient with bronchiectasis, acrocyanosis is detected (in late stages illness), puffiness of the face, and sometimes changes in the extremities of the phalanges of the fingers in the form drumsticks and nails in the form of watch glasses. The shape of the chest is normal or emphysematous. In the presence of unilateral bronchiectasis, a lag in the act of breathing of the sick half may be observed due to the peri-process and the development of pneumosclerosis. When percussing the chest, the percussion sound is often pulmonary with a box sound (due to concomitant pulmonary emphysema), less often with a tympanic tint (above the area of ​​localization of bronchiectasis). Mobility of the lower edge of the lungs may be limited. Breathing is usually harsh or weakened vesicular (due to emphysema), against the background of which dry and sometimes small- and medium-bubble rales are heard over the area of ​​bronchiectasis.

X-ray examination of a patient with bronchiectasis may show increased transparency of the lungs, deformation of the pulmonary pattern and heaviness in the lower lobes; Bronchography and tomography make it possible to detect the presence of bronchiectasis, determine their number, shape and size.

When inflammation spreads to the pleura and adhesions form, a pleural friction noise is often heard.

Spirometry reveals a decrease vital capacity lungs, in severe cases– 2.5-3 times. Compensatory erythrocytosis and neutrophilic leukocytosis are observed in the blood; ROE in some cases can be accelerated, in others (with high erythrocytosis) it can be slowed down to 1-2 mm per hour.

Bronchiectasis - diagnosis.

To methods of diagnosing the disease, except general examination patient include:

• blood chemistry;
• general urine analysis;
• assessment of sputum produced when coughing;
• radiography;
• CT scan of the chest;
• bronchography;
• fibrobronchoscopy;
• study of respiratory functions;
• consultation with an ENT doctor.

Bronchiectasis - course

Bronchiectasis progresses in the absence of appropriate treatment. Anti-inflammatory therapy can lead to long-term remission, when coughing becomes less frequent, sputum production decreases, and wheezing in the lungs is heard in significantly less quantities or is completely absent. However, after some time, exacerbation of bronchiectasis may occur again, for example, after hypothermia.

There are 3 stages of development of bronchiectasis. In the final stage, significant changes are revealed from the outside internal organs: chronic right ventricular failure of the heart (“cor pulmonale”) develops, amyloidosis of the liver, kidneys and other internal organs occurs. Complications of bronchiectasis may include lung abscess, pleural empyema, pulmonary hemorrhage, and spontaneous pneumothorax.

Bronchiectasis - treatment

In the treatment of bronchiectasis, antibiotics are used intramuscularly, per os, intratracheally, and also in the form of inhalations. Treatment with antibiotics can be combined with sulfonamide drugs. To improve the drainage function of the bronchi, expectorants, sedatives, as well as bronchodilators (ephedrine, theophedrine, aminophylline) and antiallergic drugs are prescribed, especially when brochiectasis is accompanied by bronchospasm. For better “bronchial toilet”, it is also necessary to recommend that the patient take a position several times a day that promotes better drainage of the bronchi. The addition of right ventricular heart failure requires active cardiac therapy. At the same time, oxygen therapy and therapeutic breathing exercises are recommended.

When large saccular bronchiectasis is localized in only one lobe, it is indicated surgery– removal of the affected lobe.

Bronchiectasis - prevention

Prevention of the development of bronchiectasis lies in the correct and early treatment acute bronchitis, acute focal pneumonia in children with influenza, measles, whooping cough. Complete cure from acute respiratory infections with restoration of bronchial conductivity in early childhood– the main guarantee for the prevention of bronchiectasis.

Hardening is important, eliminating factors such as smoking, occupational hazards chemical substances, as well as the prescription of courses of drugs that stimulate the body’s reactivity in the spring-winter period of the year, appropriate employment.

Bronchiectasis (BED)- primary chronic disease of the bronchi, in which there is no damage to the lung parenchyma, is characterized by regional dilatation of the bronchi, which occurs in childhood and manifests itself as chronic, predominantly endobronchial suppuration.

According to ICD-10 - J47 Bronchiectasis.

EBD does not include secondary bronchiectasis that developed as a result of tuberculosis, chronic disease, etc., in which the underlying disease leads to a predominance of damage to the pulmonary parenchyma, which is not observed with EBD. In world practice, the terms “bronchiectasis” and “bronchiectasis”, included at the beginning of the diagnosis, are synonyms for EBD.

Epidemiology. EBD occurs in 0.1-0.6% of the population.
The incidence depends on genetic factors, sanitary and hygienic and geographical conditions, as well as on the level medical care.

Classification BEB.
According to the period of the disease: exacerbation, remission;
by severity: mild, moderate and severe;
according to the form of bronchiectasis; cylindrical, saccular, spindle-shaped, mixed;
by the nature of complications: pulmonary (bleeding, respiratory failure), extrapulmonary (chronic cor pulmonale, renal amyloidosis, septicemia).

Etiology. EBD (nosological form) is a genetically determined disease. The health status of pregnant women during pregnancy is important, i.e., the diseases they suffer that can potentially disrupt the development of the fetus, genetic factors, sanitary and hygienic and geographical conditions, and the level of medical care.
Genetic defects are represented by local hypoplasia of the bronchial wall (its cartilaginous, muscular or elastic layers) or hypoplasia of entire sections of the bronchial tree, resulting from a reduction in the branching of pneumomeres (spherical “buds” on the bronchial primordia) in the antenatal period: defects in the bronchial protection system can also be genetically determined.
The disease can be triggered by a bronchopulmonary infection, accompanied by purulent melting of the bronchial wall; aspiration of foreign bodies; development of inflammatory (with bronchoadenitis) or cicatricial (after purulent inflammation) bronchial stenosis with retention of secretions and constant suppuration leafed through the stenosis.

Pathogenesis. The development of BEB is caused by destruction or disruption of the neuromuscular tone of the bronchial walls due to inflammation, leading to their dystrophy and sclerosis, or hypoplasia structural elements bronchi.
There are two trigger mechanisms: a violation of bronchial obstruction (with the formation of obstructive atelectasis) and inflammation of the bronchi (bronchitis), and they are interrelated.
The bronchi located distal to bronchiectasis are usually narrowed. This leads to hypoventilation or, less commonly, to atelectasis of the corresponding part of the respiratory zone with perifocal emphysema and sharp decline drainage efficiency.
The secretion that constantly accumulates in the lumen of the dilated bronchus is populated by Friedlander's bacillus (Klebsiela pneumophila), Pseudomonas aeruginosa or Staphylococcus aureus, less often - by other flora, which constantly maintains, with periodic exacerbations, ongoing endobronchial suppuration.
When erosion of vessels located in the wall of the bronchi occurs, varying intensity pulmonary hemorrhages. Generalization of immune reactions in response to chronic local suppuration leads to the synthesis of pathological immunoglobulins, which are the cause of the development of amyloidosis of internal organs.

The development of Bamberger-Marie periostosis, or pulmonary hypertrophic arthropathy (drumstick fingers), is associated with the reaction skeletal system on chronic intoxication and hypoxia.
The reason for the appearance this symptom there may be a violation metabolic functions lung, as evidenced by its formation in some forms lung cancer within 2-3 months.

Clinical manifestations. The main symptom is a productive cough, mainly in the morning, which changes with changes in body position (postural). The amount of sputum ranges from several tens of milliliters mucopurulent sputum during remission, up to several hundred milliliters of purulent sputum during exacerbation.
Hemoptysis occurs in at least 1/4 of patients, and profuse pulmonary hemorrhage occurs occasionally. Shortness of breath occurs when complications occur. Chest pain can be caused by the addition of pneumonia and pleurisy.
In the acute phase, symptoms of purulent intoxication, low-grade fever or fever appear.
Characteristic changes in the fingers, taking the shape of drumsticks, with deformation of the nails like watch glasses.
Changes in the shape of the chest may be associated with the development of emphysema and/or pulmonary fibrosis.
These percussion data are not very specific.
The most important auscultatory symptom is a focus or lesions of persistent moist medium- or large-bubble rales in the periphery.

Diagnostics. Features of clinical and auscultatory symptoms help to diagnose preliminary diagnosis.
Blood tests reveal changes that characterize the degree of activity of the inflammatory process.
Pathological changes urine tests (primarily proteinuria) may indicate renal amyloidosis.
Sputum studies are important to clarify the nature of the microflora and exclude specific lung lesions.

An x-ray reveals deformation of the pulmonary pattern, local pneumofibrosis, cellular pulmonary pattern, and in case of exacerbation, a focus of perifocal pneumonia. On bronchograms in the affected areas, contrast is revealed various shapes dilatation of the bronchi, usually of the 4th-6th order, and lack of contrast in the bronchi located distal to the EB (symptom of “chopped broom”).
Most often, EB is localized in the lower lobes of the lungs, especially the left.
Today the place of bronchography is firmly occupied by CT scan. Bronchofibroscopy reveals endobronchitis of varying severity in the affected area of ​​the lung.

The function of external respiration is disrupted during exacerbation of the disease or when parenchymal damage occurs (pulmonary emphysema, pulmonary fibrosis), as well as during a generalized process.

Diagnostic criteria. Perennial, usually productive postural cough since childhood; persistent local auscultatory symptoms; documentation method - computed tomography; if unavailable, bronchography with mandatory full contrast of the bronchi of both lungs.

The course of the disease is undulating, with periods of exacerbations, with a general tendency to progression.
Cure achieved surgical methods, is possible only with limited BE.

The prognosis is relatively favorable with limited damage to the bronchial tree, when possible surgical treatment; with a widespread process and the development of complications, the prognosis is unfavorable.

Treatment. Active (endobronchial sanitation, percutaneous microtracheostomy, lavage with the introduction of drugs into the bronchial lumen) and passive (positional drainage, expectorant drugs) methods of sanitation of the bronchial tree are required.

Antibacterial therapy is carried out according to general rules treatment of bronchopulmonary infection, but usually longer and with drugs wide range actions (semi-synthetic penicillins, cephalosporins, etc.).
With gram-positive flora best effect gives lincomcin (1 ml of a 30% solution IM 3-4 times or 0.5 g per os 2-3 times a day), which has a small molecule size that allows it to penetrate into foci of inflammation through areas of peribronchial pneumosclerosis.
For gram-negative flora, the use of aminoglycosides (tobramycin 40-80 mg 3 times a day IM) is more effective.

The most problems in therapy arise when bronchiectasis is colonized by Pseudomonas aeruginosa or Proteus.
They are best treated with carbenicillin (4-8 g/day IV infusion for 2-3 injections), piperacillin or ceftazidime (IM or IV 1-2 g every 8-12 hours) in combination with aminoglycosides (tobramycin, sisomycin 3-5 mg/(kg/day) for 2-3 administrations).

For strains resistant to piperacillin and ceftazidime, use imipenem 0.5-0.75 g 2 times a day IM with lidocaine; for severe infection - 0.5-1 g 4 times a day intravenously slowly (over 30 minutes!) in 100 ml of 0.9% sodium chloride solution in combination with aminoglycosides.
Alternative drugs- ciprofloxacin (0.5-0.75 g 2 times a day per os or intravenous infusion 0.2-0.4 g 2 times a day per 100 ml of 0.9% sodium chloride solution) and aztreonam ( according to J -2 g IM or IV 3-4 times a day).
Parenteral use These drugs must be combined with endobronchial (inhalation, laryngeal syringe or through a bronchoscope) administration.

For any bacterial flora, endobronchial administration of dioxidine, 10 ml of a 1% solution, is highly effective.
Mucolytic drugs are prescribed endobronchially: terrilitin 100-200 PE or other enzymes in 5-8 ml of 0.9% sodium chloride solution and acetylpistein 5 ml of 10-20% solution.

Bronchospasmolytic drugs are indicated that activate mucociliary clearance and improve the condition of patients even in the absence of bronchospasm.

In the remission phase, treatment in specialized sanatoriums is indicated.
With frequent exacerbations and the spread of bronchiectasis to no more than one lobe, surgical treatment (segmental resection, lobectomy) is indicated.
If complications occur, appropriate therapy is carried out.

Prevention Congenital EB has not been developed, since risk factors or genetic signs (markers) of the disease have not been established. Prevention of acquired BE involves early and intensive treatment of bronchopulmonary infections in children.

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Among chronic diseases lung disease (LEB) occurs in 25% of cases, is most often an acquired disease and less often congenital.

Causes of bronchiectasis

What is bronchiectasis? This is a persistent expansion of one or several sections of the bronchi, associated with the destruction of the muscular and elastic layers of their walls.

Congenital or primary bronchiectasis is observed in adolescence or childhood. As for secondary bronectasis, they are registered in adulthood and manifest themselves in the form of chronic complications.

Bronchiectasis, depending on the form of bronchial expansion, is divided into mixed, cylindrical, fusiform, saccular, and according to the degree of distribution - into bilateral and unilateral.

The main reason for the development of BEB are both congenital and acquired pathologies of the bronchial walls, changes in the peribronchial tissue or lung parenchyma, which contribute to sustainable expansion bronchi.

To summarize: primary bronchiectasis develops against the background of abnormalities of the bronchial tree, congenital pathology smooth muscles, cartilaginous and elastic tissues of the bronchi, which contribute to deformation and their local expansion.

Secondary bronchiectasis is observed due to complications of diseases of the respiratory system such as purulent bronchiectasis.

No less important reason the development of the disease is the lack of bronchopulmonary protection from many pathogenic microorganisms, which leads to infection of bronchiectasis.

Typically, bronchiectasis occurs in the lower lobes of the lungs due to the passive drainage of mucus from upper sections. Ultimately, BEB ends with the development of severe respiratory failure and the formation of the so-called pulmonary heart.

Bronchiectatic pulmonary disease, symptoms

Patients with EBD mainly complain of pain, which torments them mainly in the morning with the release of large amounts of purulent or mucopurulent sputum.

During an exacerbation, the amount of sputum reaches 500 ml or more. Some patients experience hemoptysis at the time of exacerbation.

In addition to cough, patients with bronchiectasis complain of shortness of breath associated with moderate physical activity, dull pain in the chest area, increased body temperature (37.2-37.7⁰С), general weakness, sweating and loss of appetite.

At medical examination The patient's doctor observes a change in the phalanges of the fingers, which take the form of “drumsticks” and nails in the form of “watch glasses”.

The skin is pale, sometimes with a gray tint. On percussion, there is a dullness of the percussion sound in the area of ​​the affected area, and on auscultation, dry, medium- or coarse-bubbly moist rales are observed.

The amount of wheezing after coughing decreases, but breathing remains harsh.

According to the degree of progression of EBD, there are 4 degrees:

1. Mild course – exacerbations occur no more than 1-2 times annually.

2.Medium heavy – long-term and frequent exacerbations are observed. During the period of remission, patients continue to have a cough, low performance and exercise tolerance.

3. Severe course – accompanied by frequent exacerbations with increased body temperature, persistent cough with a large amount of sputum. Patients are unable to work, remission occurs only after complex treatment.

4. Complicated severe course – chronic cor pulmonale, pulmonary myocardial dystrophy, renal amyloidosis, and other pathologies are detected.

Diet of a patient with bronchiectasis

This diet is characterized by a slight reduction in calories due to fats and partially carbohydrates; significant reduction in consumption table salt, reduction of fluid.

The content of substances that excite the nervous and nervous system in food products is also limited. cardiovascular system, irritating the kidneys and liver, putting a lot of strain on gastrointestinal tract and increasing flatulence.

With diet No. 10 are shown following products power supply:

- viscous and crumbly porridges (millet, rolled oats, rice and buckwheat);

- puddings, pasta dishes;

- egg white omelette chicken eggs, low fat milk;

— actimel, cream 10%, cottage cheese 0-5%;

— Activia kefir 1%, yogurt;

— cheeses (Suluguni, Adyghe and other fat contents no more than 20%;

- soups made from vegetable broth;

- cereal, fruit, milk soups;

- low-fat broths from veal, chicken, turkey, river fish (pike, pike perch, perch);

- broths for sea ​​fish(cod, pollock, ice cod, etc.;

- main courses prepared from the same types of fish or meat, baked or boiled without crust;

- good for garnish vegetable stew: boiled potatoes, broccoli or cauliflower, carrots, turnips, beets and zucchini;

— fruits and berries can be consumed in any form, both fresh and in the form of jam, juice, preserves.

Sweets are allowed: marmalade, honey, marshmallows, “Korovka” and “School” candies.

The following foods should be excluded from the diet:

- All fatty varieties fish and meat;

- salted, pickled, smoked, spicy, fried with a crust; canned food;

- radish, onion, sorrel, garlic, spinach, radish, raw and sauerkraut;

— confectionery with rich cream, butter buns;

- black bread, shortbread, pancakes, pancakes;

- lemonade, Fanta, Pepsi, Coca-Cola, cold dishes.

Food for a patient with bronchiectasis is usually prepared by steaming, using water, mashed, or baked, but without a crust. The daily diet is 5-6 times, in portions of 250-300 grams.

The principle of constructing nutrition for a patient with EBD:

1.Contents total protein increase to 120-150 g per day.

2. Reduce table salt consumption to 1.5 g per day.

3.Reducing the consumption of fats and carbohydrates.

4.Warm welcome drinking water 800-900 ml, fortified compotes, berry fruit drinks, milk, herbal teas. Alternate drinks.

Recipe for a fortified drink made from viburnum, rose hips and red rowan

Wash 2 tbsp. spoons of dried rose hips, place them in an enamel bowl, pour half a liter of boiling water, put on the stove and cook for 3-5 minutes over low heat. Remove from heat, leave for 2-3 hours, strain.

Grind one tablespoon of fresh or frozen viburnum and red rowan berries in a meat grinder or mixer, pour into a glass boiled water and leave to infuse for 30-40 minutes. We filter.

Combine the chilled infusions and take half a glass warm healthy drink. You can add natural honey for taste.

Treatment of patients with bronchiectasis

Very high season good result treatment as an expectorant can be achieved by regular use grape juice. This juice is rich in microelements such as potassium, magnesium, calcium, manganese, cobalt, vitamins B₁, B₆, B₁₂, C, P, PP, carotene and folic acid.

Moreover, grapes contain a lot of carbohydrates and organic acids (malic, formic, citric, succinic, etc.). Some grape varieties (cabernet, isabella, muscat, etc.) have an antimicrobial effect.

Grape juice also reduces the amount of cholesterol in the blood and has a tonic effect.

Cherry juice has a beneficial effect on the body in many ways. concomitant diseases: lung diseases, anemia, atherosclerosis.

It is recommended to take the juice in small portions (100 ml) three times a day before meals or between meals for fourteen days. Then take a break for 10-12 days and repeat the treatment. Complete 3-4 such courses of treatment per year.

Measures to prevent bronchiectasis

1. Carrying out timely sanitation of foci of chronic infections of the nasopharynx and oral cavity. Effective treatment and prevention of viral respiratory diseases.

2. Fight against smoking, comprehensive treatment of diseases of the bronchopulmonary system: whooping cough, bronchitis, measles and pneumonia.

3. Refusal to use alcoholic drinks. Careful care for patients suffering from alcoholism with impaired swallowing in an unconscious state.

4. Hardening in the warm season: dousing with water, swimming, walking for 1-1.5 hours or more.

5.Fight with harmful conditions labor in production.

As a rule, the above preventive measures help light current bronchiectasis of the lungs.

Be healthy, God bless you!