Respiratory diseases are often diagnosed in medicine today. One of the painful chronic ailments is bronchiectasis (or bronchiectasis), which is characterized by the development of a purulent inflammatory process in the respiratory system. Usually this pathology does not develop independently, but is a consequence of other diseases. This condition increases the susceptibility of a person to infectious diseases of the respiratory tract, so he should be under medical supervision and supportive therapy, which can increase with exacerbations of the pathology.
Description and description of the problem
Bronchiectatic disease is a disease caused by irreversible deformation of the bronchi, which violates their functionality and leads to the development of a chronic inflammatory process. This pathology is diagnosed in 1% of people, most often at the age of five to twenty five years. It is characterized by relapses of infectious processes in the bronchi and lungs, which are accompanied by cough and sputum with an admixture of pus.
Pathological areas (bronchiectasis) can spread to all bronchi, limited to one segment or one lobe of the lung. Bronchiectasis are areas of pathological expansion of the walls of the bronchi, they consist of their cartilage tissue and glands, while the smooth muscle layer is absent.
Usually, the disease develops against the background of other pathologies of the respiratory system, such as tuberculosis, lung abscess or chronic bronchitis, but a congenital disease can also occur. Most often, it affects men.
Types of disease
Bronchiectatic lung disease can be of several types, depending on the shape and localization of pathological sites.
In medicine, the following types of disease are distinguished, depending on the form and location:
- Cystic (saccular) is characterized by the location of bronchiectasis in the upper parts of the bronchi. At the same time, their walls in a certain place swell and resemble bags in appearance.
- Cylindrical, in which the deformed sections are located in the distant parts of the organ, and they look like cylinders.
- Varicose, which is characterized by the spread of pathology between the upper and remote areas of the bronchi, in their appearance they resemble veins with varicose veins, since the wall of the organ evenly swells along its entire length.
- Mixed, in which bronchiectasis is observed in different parts of the body.
Also, the disease can be congenital and acquired, unilateral and bilateral.
Forms of the disease
Bronchiectatic disease can be of several forms:
- A mild form, in which exacerbations are observed twice a year, during a period of remission a person feels good.
- The pronounced form is characterized by seasonal exacerbations, in which purulent sputum secretions are observed daily. During the period of remission, cough, sputum production, shortness of breath and decreased performance are maintained.
- The severe form is caused by frequent exacerbations with an increase in body temperature. The amount of sputum increases while it has an unpleasant smell of rot. During short-term remissions, a person's working capacity is preserved.
- The complicated form has all the signs of a severe form, while secondary diseases join them: heart and pulmonary failure, amyloidosis of the kidneys and liver, anemia, lung abscess, development of pulmonary bleeding, nephritis and others.
Reasons for the development of pathology
Primary bronchiectatic pulmonary disease develops as a result of congenital malformations of organs, which provokes the underdevelopment of the walls of the bronchi. Such pathologies are rare. Factors that contribute to the development of this process are abuse of bad habits by a pregnant woman, her infection. This leads to deformity of the bronchi in the child, his airways are blocked by sputum, the lower parts of the bronchi expand, they accumulate sputum, which rots. Congenital malformations are observed in Sievert's disease - Kartagener.
The acquired disease is formed due to frequent infections of the respiratory system in childhood or getting into the lumen of the bronchi of a foreign body. Chronic respiratory diseases lead to deformation in the muscles and mucous membrane of the bronchi, their walls expand, the pulmonary parenchyma shrinks, stretches and deforms. Pathological processes extend to the nerves, arterioles, capillaries, which provide nutrition to the bronchi. When an infection is attached, the inflammatory process begins, bronchiectasis is filled with sputum with an admixture of pus, and bronchiectasis develops.
Purulent infection is supported in the body due to a violation of self-cleaning of the bronchial tree, a decrease in local immunity, the presence of chronic infections in the nasopharynx. For infectious diseases that have become pathological in childhood, they include influenza viruses, whooping cough, measles, staphylococcus aureus, and streptococcus.
Symptoms and signs of the disease
Symptoms of bronchiectasis are a persistent cough, accompanied by discharge of sputum with an admixture of pus. Usually sputum is excreted in large quantities in the morning, as well as at certain positions of the body. In some cases, the amount of purulent sputum reaches two hundred milliliters. As it accumulates in the bronchi, the cough resumes. Sometimes a strong cough provokes a rupture of blood vessels in the walls of the respiratory system, so hemoptysis or pulmonary hemorrhage occurs. In some cases, symptoms of bronchiectatic pulmonary disease manifest as shortness of breath during physical activity, respiratory failure, the development of secondary infections, and an increase in body temperature.
Chronic inflammation of the respiratory system leads to intoxication and depletion of the body, anemia, weight loss, discoloration of the skin begin to manifest in a person, developmental delay occurs in children.
Stages of the development of the disease
In medicine, there are three stages of pathology:
- The first stage is characterized by a slight expansion of the bronchi, the walls of which are lined with a cylindrical epithelium. In the cavities, there is mucus without pus.
- The second stage is caused by the addition of an inflammatory process and suppuration. The integrity of the epithelial cover is violated, it is replaced by a flat epithelium and places of ulceration.
- The third stage, in which the infectious process affects the lungs, pneumosclerosis develops. There are necrotic areas in the walls of the bronchi, their cavities contain pus, and the body is intoxicated.
Most often, the left lung suffers, 30% of patients have bilateral damage to the respiratory system.
Complications and consequences
With the progression of the pathological process, there are such complications of bronchiectasis as respiratory failure, cyanosis, thickening of the fingers, chest deformation, attachment of secondary respiratory infections.
Lack of therapy or ineffective treatment can lead to the development of an abscess of the lungs and brain, pneumonia, sepsis, pleurisy, sinusitis. Sometimes a metabolic disorder in the form of cachexia, amyloidosis of the kidneys, liver and spleen is possible. A large number of patients have hemoptysis. All these negative symptoms can be fatal if untreated.
Diagnostic Methods
When symptoms of bronchiectasis begin to manifest, the doctor should be diagnosed after a thorough examination. First, he studies the history of the disease, conducts an examination and fiscal examination of the lungs. In this case, a person has a weakening of breathing, a large number of moist rales in the lower parts of the organ, which can decrease after sputum discharge. In some cases, wheezing may be present.
Also, bronchiectatic disease, the diagnosis of which should be carried out by experienced physicians, requires the following research methods:
- X-ray, in which the pictures show shadows in the areas of expansion of the segments of the bronchi, which are filled with mucus, or it can be cysts with air or liquid. The transparency of the lungs in the images will be reduced due to inflammation, the walls of the bronchi will be thickened.
- High expansion CT is the most informative method for diagnosing bronchiectatic disease, which makes it possible to make an accurate diagnosis.
- Bronchoscopy is prescribed in the presence of hemoptysis. This technique makes it possible to determine the purulent contents, as well as take this material for cytological examination.
- Bronchography allows you to see the spread of the pathological process, its location and shape.
- Sputum bacillus is prescribed in order to identify the sensitivity of pathogenic microorganisms to antibiotics, as well as to identify the causative agent of infection.
- Spirometry and peak flowmetry are performed annually to determine the degree of respiratory failure.
- CT of the sinuses of the nose, saccharin test as additional diagnostic methods.
- Monitoring the amount of sputum that is released during the day.
After a comprehensive examination, the doctor makes an accurate diagnosis and develops a treatment regimen in each case.
Pathology therapy
Treatment of bronchiectasis is implied primarily in the rehabilitation of the bronchi and the elimination of purulent infection in the respiratory system. For this, the doctor prescribes antibacterial drugs and bronchoscopic drainage. For the treatment of respiratory infections, cephalosporins, such as Ceftriaxone, or penicillins in the form of Ampicillin, as well as gentamicins, are used.
Also, for the treatment of bronchiectatic disease, sanitation of the respiratory organs may be necessary. Remediation of the bronchi is aimed at eliminating sputum from them, as well as at the local effect of antimicrobials on pathogenic microflora. For this, the patient is given a special body position, a catheter is placed in the bronchi, and antiseptic, antibacterial and mucolytic drugs are administered through it.
It is also important to use additional funds that will contribute to the discharge of sputum, since with bronchiectasis, sputum should be removed from the respiratory system. For this, breathing exercises, chest massage, alkaline drinking, electrophoresis and inhalation, diet, the use of medicinal herbal infusions and maintaining a healthy lifestyle are often prescribed. A large amount of vitamins and protein should be included in the diet. In this case, it is recommended to eat fish, cottage cheese, vegetables, fruits and meat.
Treatment of bronchiectatic pulmonary disease is often carried out using bronchoalveolar lavage, in which the bronchi are washed, and purulent sputum is aspirated by a bronchoscope. This technique makes it possible to cleanse the bronchi of pus, introduce antibacterial agents into the organs, and use reorganization.
Surgery
In the absence of contraindications, surgery is performed in case of organic damage to the respiratory system. Suitable for the operation is considered the age of seven to fourteen years, in other cases it is not possible to establish the boundaries of the pathological process.
An operation for such a pathology as bronchiectasis is prescribed only after a detailed assessment of the development of the disease, as well as the effect of drug treatment and repeated diagnostic examinations. Be sure to carry out the operation according to clinical indications, for example, with incessant heavy bleeding. Surgical intervention is possible only when, after removal of the lung, respiratory function will be provided with a sufficient amount of healthy tissue.
With unilateral organ damage, use is made of the removal of the deformed lobe of the lung without affecting healthy tissue. In the case of a bilateral lesion, an organ resection is performed on the side that has suffered the most. Further treatment is carried out, which is aimed at reducing the risk of relapse. Such an approach usually makes it possible to achieve a favorable outcome; changes on the non-operated side of the organ do not progress.
With a symmetrical lesion of the organ lobes, a bilateral resection is performed in two stages, between which about one year should pass. If large areas are affected, surgery is not performed.
After the bronchiectasis is cured, the attending physician will give recommendations to reduce the risk of relapse. He prescribes the observance of a proper healthy diet, massage, physiotherapy exercises, electrophoresis.
Forecast
Surgical intervention usually leads to a complete recovery of the patient. During drug treatment, doctors prescribe effective courses of anti-inflammatory treatment, which make it possible to achieve long-term remissions. Relapses can occur with hypothermia and viral infections. Therefore, it is recommended in the cold period of time to protect oneself as much as possible from the influence of negative factors.
In the absence of therapy, as well as in a severe form of pathology, the prognosis will be unfavorable. Often the disease leads to a person’s disability, and death is possible.
Prevention
People who have chronic bronchitis or pneumosclerosis should be under the constant supervision of a doctor and undergo timely effective treatment. Such patients should exclude addictions, especially smoking, not to be in dusty rooms, undergo a hardening procedure. To prevent the development of the disease, it is necessary to timely repair the sinuses of the nose with sinusitis, sinusitis, ethmoiditis, as well as the oral cavity with pathologies of the teeth and gums. Compliance with all recommendations will help to avoid the development of such an unpleasant disease as bronchiectasis.