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 a person's susceptibility to infectious diseases of the respiratory tract, so he should be under medical supervision and supportive therapy, which may increase with exacerbations of the pathology.
Characteristics and description of the problem
Bronchoectatic disease is a disease caused by irreversible deformation of the bronchi, which disrupts their functionality and leads to the development of a purulent-inflammatory process of a chronic nature. This pathology is diagnosed in 1% of people, most often between the ages of five and twenty-five. It is characterized by recurrence of infectious processes in the bronchi and lungs,which are accompanied by cough and sputum mixed with pus.
Pathological areas (bronchiectasis) can spread to all bronchi, limited to one of its segments or one lobe of the lung. Bronchiectasis are areas of pathological expansion of the walls of the bronchi, they consist of cartilage and glands, while the smooth muscle layer is absent.
Usually, the disease develops against the background of other respiratory pathologies, such as tuberculosis, lung abscess or chronic bronchitis, but congenital disease can also occur. It most often affects men.
Disease types
Bronchoectatic lung disease can be of several types depending on the shape and localization of pathological areas.
In medicine, the following types of diseases are distinguished depending on the form and localization:
- Cistoid (saccular) is characterized by the location of bronchiectasis in the upper sections of the bronchi. At the same time, their walls swell in a certain place and resemble bags in appearance.
- Cylindrical, in which the deformed areas are located in remote 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 occurs in different parts of the organ.
Also, the disease can becongenital and acquired, unilateral and bilateral.
Disease forms
Bronchiectasis comes in several forms:
- Mild form, in which exacerbations are observed twice a year, during remissions a person feels good.
- The pronounced form is characterized by seasonal exacerbations, in which purulent sputum discharge is observed daily. During the remission period, coughing, sputum production, shortness of breath and decreased performance persist.
- Severe form is caused by frequent exacerbations with an increase in body temperature. At the same time, the amount of sputum increases, it has an unpleasant smell of rot. During short-term remissions, a person's ability to work is preserved.
- The complicated form has all the signs of a severe form, while secondary diseases join them: heart and lung failure, amyloidosis of the kidneys and liver, anemia, lung abscess, development of pulmonary bleeding, nephritis and others.
Causes for the development of pathology
Primary bronchiectasis of the lungs develops as a result of congenital anomalies in the development of organs, which provokes underdevelopment of the walls of the bronchi. Such pathologies are rare. The factors that contribute to the development of this process are the abuse of bad habits by a pregnant woman, the infections she has suffered. This leads to deformation of the bronchi in the child, his airways are clogged with sputum, the lower sections of the bronchi expand, sputum accumulates in them,which is rotting. Congenital malformations are observed in Sievert's disease - Kartagenera.
Acquired disease is formed due to frequent infections of the respiratory system in childhood or a foreign body entering the lumen of the bronchi. Chronic respiratory diseases lead to deformation in the muscles and mucous membrane of the bronchi, their walls expand, the lung parenchyma shrinks, stretches and deforms. Pathological processes also extend to the nerves, arterioles, capillaries, which provide nutrition to the bronchi. When an infection joins, an inflammatory process begins, bronchiectasis is filled with sputum mixed with pus, and bronchiectasis develops.
A purulent infection is maintained in the body due to a violation of the self-purification of the bronchial tree, a decrease in local immunity, the presence of chronic infections in the nasopharynx. Infectious diseases transferred in childhood that cause the development of pathology include influenza viruses, whooping cough, measles, staphylococcus aureus, streptococcus.
Symptoms and signs of disease
Symptoms of bronchiectasis are a persistent cough, accompanied by sputum discharge with an admixture of pus. Usually, sputum is secreted in large quantities in the morning, as well as in 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 there ishemoptysis or pulmonary hemorrhage. In some cases, the symptoms of bronchiectasis of the lungs are manifested in the form of shortness of breath during physical activity, respiratory failure, the development of secondary infections, and an increase in body temperature.
Chronic inflammation of the respiratory organs leads to intoxication and exhaustion of the body, anemia begins to appear in a person, weight loss, discoloration of the skin, developmental delay occurs in children.
Stages of disease progression
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 cylindrical epithelium. At the same time, there is mucus without pus in the cavities.
- The second stage is caused by the addition of the inflammatory process and suppuration. The integrity of the epithelial cover is broken, it is replaced by a squamous epithelium and ulceration sites.
- The third stage, in which the infectious process affects the lungs, develops pneumosclerosis. There are necrotic areas in the walls of the bronchi, their cavities contain pus, intoxication of the body occurs.
The left lung is most often affected, 30% of patients have bilateral respiratory involvement.
Complications and consequences
With the progression of the pathological process, there are such complications of bronchiectasis as respiratory failure, cyanosis, thickening of the fingers, deformity of the chest, the addition of secondary respiratory infections.
No therapy orineffective 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 experience hemoptysis. All these negative symptoms can be fatal if left untreated.
Diagnostic Methods
When symptoms of bronchiectasis begin to appear, the diagnosis should be made by a doctor after a thorough examination. First, he studies the history of the disease, conducts an examination and a fiscal examination of the lungs. In this case, a person has a weakening of breathing, a large number of wet rales in the lower parts of the organ, which can decrease after sputum is discharged. In some cases wheezing may be present.
Also, bronchiectasis, the diagnosis of which should be carried out by experienced physicians, requires the following research methods:
- X-ray, in which the images show shadows in the areas of expansion of bronchial segments that are filled with mucus, or these may be cysts with air or fluid. The transparency of the lungs in the pictures will be reduced due to inflammation, the walls of the bronchi will be thickened.
- High expansion CT is the most informative method for diagnosing bronchiectasis, 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 to take this material for cytologicalresearch.
- Bronchography allows you to see the spread of the pathological process, its location and shape.
- Sputum culture is prescribed to detect the sensitivity of pathogenic microorganisms to antibiotics, as well as to identify the causative agent of the infection.
- Spirometry and peak flow is performed annually to determine the degree of respiratory failure.
- CT of the sinuses, saccharin test as additional diagnostic techniques.
- Monitoring the amount of sputum that is excreted 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 refers primarily to the sanitation of the bronchi and the elimination of a purulent infectious process in the respiratory system. For this, the doctor prescribes antibacterial drugs and bronchoscopic drainage. In order to treat respiratory infections, cephalosporins, such as Ceftriaxone, or penicillins in the form of Ampicillin, as well as gentamicins, are used.
Also, for the treatment of bronchiectasis, it may be necessary to sanitize the respiratory system. Sanitation of the bronchi is aimed at eliminating sputum from them, as well as at the local effect of antimicrobial drugs on pathogenic microflora. To do this, the patient is given a special body position, a catheter is placed in the bronchi, and antiseptic, antibacterial and mucolytic drugs are injected through it.
Alsoit is important to use additional means that will contribute to the discharge of sputum, since in case of bronchiectasis, sputum must 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 he althy lifestyle are often prescribed. The diet should include a large amount of vitamins and protein. In this case, it is recommended to eat fish, cottage cheese, vegetables, fruits and meat.
Bronchoectatic lung disease is often treated with bronchoalveolar lavage, in which the bronchi are flushed and purulent sputum is aspirated with a bronchoscope. This technique makes it possible to cleanse the bronchi of pus, introduce antibacterial agents into the organs, and use sanitation.
Surgical treatment
In the absence of contraindications, surgical intervention is performed in case of organic damage to the respiratory system. Age from seven to fourteen years is considered suitable for the operation, in other cases it is not possible to establish the boundaries of the pathological process.
Surgery for a pathology such as bronchiectasis is prescribed only after a detailed assessment of the development of the disease, as well as the impact of drug treatment and repeated diagnostic examinations. Be sure to carry out the operation according to clinical indications, for example, with incessant heavy bleeding. Surgery can only be done whenafter the removal of the lung, the respiratory function will be provided with a sufficient amount of he althy tissue.
In case of unilateral damage to the organ, the removal of the deformed lobe of the lung is used, without affecting he althy tissues. 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. This approach usually makes it possible to achieve a favorable outcome, changes on the non-operated side of the organ do not progress.
In case of symmetrical damage to the lobes of the organ, a bilateral resection is performed in two stages, between which about one year should pass. If large areas are affected, the operation is not performed.
After the bronchiectasis is cured, recommendations for reducing the risk of recurrence will be given by the attending physician. He prescribes adherence to proper he althy nutrition, massage, physiotherapy exercises, electrophoresis.
Forecast
Surgery usually results in complete recovery of the patient. In the course of 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 during the cold period of time to protect yourself as much as possible from the influence of negative factors.
In the absence of therapy, as well as in severe pathology, the prognosis will be unfavorable. The disease often leads todisability of a person, and death is possible.
Prevention
People who have chronic bronchitis or pneumosclerosis should be under constant medical supervision, undergo timely effective treatment. Such patients should exclude addictions, especially smoking, not be in dusty rooms, undergo a hardening procedure. To prevent the development of the disease, it is necessary to timely sanitize the sinuses with sinusitis, sinusitis, ethmoiditis, as well as the oral cavity with pathologies of the teeth and gums. Compliance with all recommendations will avoid the development of such an unpleasant disease as bronchiectasis.
