Bronchiectasis is a chronic disease of the bronchopulmonary system, accompanied by multiple pathological dilation of the bronchi - bronchiectasis, in the mucous membrane of which a chronic inflammatory process develops, which is characterized by a long, recurrent and progressive course with purulent complications.

This disease occurs and is diagnosed, as a rule, between the ages of 5 and 25 years, but its development in mature and elderly people is not excluded.

According to statistics, for every sick woman there are three sick men.

Bronchiectasis is widespread (on average 15 per 1000 inhabitants). More common in people with bad habits. The incidence rate is slightly higher in areas with poor ecology.

Bronchiectasis develops due to various reasons. They may be due to genetic determination of the inferiority of the bronchial wall, adverse effects on the lungs of the fetus during intrauterine development. In the postnatal period, the bronchi begin to be affected by various respiratory infections, tuberculosis, cicatricial narrowing of the bronchi, exposure to foreign bodies, compression by enlarged lymph nodes, as a result of which the blood supply to areas of the lung suffers and their ventilation is disrupted. The age of the patients is noteworthy. Most often, the disease manifests itself in childhood, when the child often begins to suffer from pneumonia and various colds. At first, the cough during these infections is accompanied by light-colored sputum, and during subsequent exacerbations, gray or greenish color. Chronic tonsillitis and sinusitis are often noted as concomitant pathologies. With massive bronchiectasis, patients often have thickened terminal phalanges on the fingers and toes, which is a manifestation of hypoxia.

Symptoms of bronchiectasis

• Sputum discharge is greenish in color with a rotting smell when coughing. Comes off freely, in large quantities.
• The maximum amount of sputum is released simultaneously, usually in the morning. This is facilitated by a certain position of the patient in space. More than 200 ml of sputum can be released per day.
• Blood in the sputum (no more than 70% of patients).
• Shortness of breath on exertion (no more than 35% of patients).
• Chest pain that gets worse with inspiration.
• Cyanosis.
• Thickening of the terminal phalanges of the fingers and toes, convex nail plates, if the disease, having begun in early childhood, lasts for many years.
• Retarded physical development of patients who have been ill since early childhood.
• Accompanying fever with exacerbation of the disease.

Diagnosis of bronchiectasis

• General blood test: increase in the number of leukocytes at the time of exacerbation, shift in the leukocyte formula, increase in the erythrocyte sedimentation rate. If bronchiectasis lasts for a long time, anemia is possible.
• Biochemical study: increased content of sialic acids, fibrin, seromucoid, α2- and γ-globulins during exacerbation. If the course of the disease is complicated by renal amyloidosis and renal failure, as a rule, the level of creatinine and urea increases.
• Urinalysis: with the development of renal amyloidosis, protein and casts appear in the urine.
• Sputum examination: high percentage of neutrophils, wide microbial palette. Among the microbes, haemophilus influenzae, streptococcus pneumoniae and pseudomonas aeraginosa are more often found, less often - staphylococcus aureus, anaerobic flora. A characteristic sign of the presence of bronchiectasis is the detection of pseudomonas aeruginosa in the sputum.
• X-ray examination of the chest organs: in some cases, especially in mild cases, the data are not very informative.
• Bronchography: when performed, bronchiectasis is usually visible better than on a simple x-ray.
• Computed tomography: in terms of information content it is not inferior to bronchography.
• Fiberoptic bronchoscopy: allows you to exclude bronchial obstruction in case of damage in a limited area.
• Pulmonary function testing: determines the type of ventilation disturbances that typically occur as complications of bronchiectasis. Signs of reversible bronchial obstruction are very typical.

Treatment of bronchiectasis

If the microbe that caused the disease is known, etiotropic drugs that act on a specific pathogen are used. In severe cases and constant separation of purulent sputum, treatment with antibacterial agents is carried out for a long time. Bronchial dilators are used to eliminate their obstruction and stimulate mucociliary clearance.

Against this background, the bronchi are improved with the use of expectorants and the adoption of a drainage position in bed for better discharge of sputum. A very effective means of rehabilitating bronchiectasis is bronchoscopy with the introduction of antibacterial and antiseptic agents. In mild cases of the disease with long-term remissions, antibacterial agents are used only during exacerbations. The indication for surgical treatment of bronchiectasis is a unilateral limited (segmental) lesion that is not amenable to conservative treatment. It is advisable to perform surgical treatment before complications appear: respiratory failure and chronic pulmonary heart disease.

Essential drugs

There are contraindications. Specialist consultation is required.

Dosage regimen (doses are given in terms of amoxicillin): orally for adults and children over 12 years of age or with a body weight of 40 kg or more for severe respiratory tract infections - 875 mg 2 times a day. or 500 mg 3 times/day. The maximum daily dose of amoxicillin for adults and children over 12 years of age is 6 g. The maximum daily dose of clavulanic acid for adults and children over 12 years of age is 600 mg.

When administered intravenously, adults and adolescents over 12 years of age are administered 1 g (amoxicillin) 3 times a day, if necessary - 4 times a day. The maximum daily dose is 6 g.

The duration of treatment is up to 14 days.

Dosage regimen: the drug is administered intramuscularly and intravenously (stream or drip). For exacerbation of bronchiectasis for adults and children over 12 years of age, the dose is 1-2 g 1 time / day. or 0.5-1 g every 12 hours. The maximum daily dose is 4 g. A dose of more than 50 mg/kg body weight should be administered as an intravenous infusion over 30 minutes. The duration of treatment is determined individually.

Dosage regimen: the drug is taken orally 1 or 2 times a day. Do not chew the tablets and take a sufficient amount of liquid (from 0.5 to 1 glass); you can take them before meals or between meals. For exacerbation of bronchoectasis: 500 mg 1-2 times a day - 7-14 days.

Pills: adults and children over 12 years of age are prescribed 1 tablet. (30 mg) 3 times/day for the first 2-3 days. Then the dose of the drug should be reduced to 1 tablet. 2 times/day.

Extended release capsules: adults and children over 12 years of age are prescribed 1 caps. (75 mg) 1 time/day. in the morning or evening after eating, without chewing, with a sufficient amount of liquid.

Syrup 3 mg/1 ml: adults and children over 12 years of age are prescribed 2 scoops (30 mg) 2-3 times a day. in the first 2-3 days. Then 2 scoops 2 times a day. In severe cases of the disease, the dose is not reduced throughout the entire course of treatment. The maximum dose is 4 scoops (60 mg) 2 times a day.

Solution for oral administration and inhalation(1 ml = 20 drops): adults and children over 12 years of age are prescribed 4 ml (30 mg) 3 times a day in the first 2-3 days. Then the dose of the drug should be reduced to 4 ml 2 times a day. The oral solution can also be used in the form of inhalations: adults and children over 5 years of age are recommended to inhale 1-2 times a day, 2-3 ml (40-60 drops, which corresponds to 15-22.5 mg of ambroxol).

Bronchiectasis is a relatively rare disease of the respiratory system, in which the main problem is deformation of the bronchi and the formation of pus in them. Deformed areas of the bronchi are also called bronchiectasis or bronchiectasis. In some cases, these names are also applied to pathology in general.


Bronchiectasis differs from other lung diseases in that bronchiectasis is the primary lesion. That is, first the bronchi expand and suppurate in a certain part of the lung, and then the interstitial tissue may be affected ( actual respiratory alveoli). If bronchiectasis develops against the background of other pathologies ( pneumonia, bronchitis, etc.), then the diagnosis “bronchiectasis” is not made, but they talk about so-called secondary bronchiectasis.

Prevalence of bronchiectasis ( primary lesion) is approximately 3 – 4 people per 100,000 population, but data varies greatly from one region to another. Statistically, men suffer from this pathology 2.5 - 3 times more often than women, but there is no reasoned evidence why this happens. It is also noted that bronchiectasis often develops in young people and becomes chronic. This is explained by the fact that deformation of the bronchi in this pathology is irreversible.

Anatomy of the lungs

The human lungs are a paired organ located in the chest cavity. There is one lung on each side of the sternum. The right one consists of three lobes ( top, middle and bottom) and is larger in volume than the left lung, which consists of two lobes ( top and bottom). This is explained by the fact that the left part of the chest volume is occupied by the heart. The upper limit of the lungs ( top) rises several centimeters above the collarbone, and the lower one is located on the diaphragm ( flat muscle separating the chest and abdominal cavities). Between the two lungs, behind the breastbone, there is a space called the mediastinum. The heart, thymus gland, esophagus are located here, and a number of important vessels and nerves also pass through.

The lungs themselves consist of the following parts:

• trachea;
• bronchial tree;
• pulmonary lobules;
• acini.

Trachea

The trachea is a hollow tube about 10–15 cm long, which begins in the larynx and descends down into the chest cavity. In fact, the trachea is not part of the lungs, but rather refers to the airways. Due to its large diameter, it ensures the passage of a large volume of air to the bronchi. Many pathologies of the trachea are closely related to the functioning of the lungs.

The trachea contains 16–20 semicircular cartilages in its walls. These cartilages are positioned in such a way that the back of the tube remains unprotected. They are connected to each other by a dense film of connective tissue. Thus, in the posterior wall, which is adjacent to the esophagus, there is no cartilage, and it is an elastic membrane. There are no muscles in the walls of the trachea. The interior is lined with mucous membrane, the cells of which can produce mucus. There are also villous cells that can clean the surface of the shell when foreign objects come into contact with it ( dust particles, etc.).

At the lowest point, approximately at the level of the II–V thoracic vertebrae, there is a bifurcation ( bifurcation) trachea. The main bronchi, which carry air to the lungs, originate here.

Bronchial tree

The bronchial system in the lungs is often compared to a tree due to the gradual branching of the airways. The main bronchi begin from the bifurcation of the trachea and are directed into the thickness of the lung tissue. The right bronchus is slightly larger in diameter and does not deviate as much to the side. The left main bronchus departs from the bifurcation site at a large angle and has a smaller diameter.

The bronchial tree consists of bronchi of various orders:

• Lobar bronchi ( first order) . These structures arise directly from the main bronchus and go to each lobe of the lung. Thus, the main bronchus on the right is divided into 3, and on the left into 2 lobar bronchi of the first order.
• Segmental bronchi ( second order) . These bronchi arise from the lobar bronchus and carry air to the various segments of the lung. Each second-order bronchus has its own segment. In total, there are 8 segments in the left lung, and 10 in the right. The segments, like the lobes, are separated from each other by layers of connective tissue.
• Bronchi of the third order and less ( up to the fifth order inclusive) . Their diameter is only a few millimeters. If there were cartilaginous formations in the walls of the wider bronchi, they disappear here. But at this level, smooth muscle cells appear in the wall. They maintain the shape of the bronchus, preventing the walls from sticking together. Under certain conditions, smooth muscle spasm may occur. Then the lumen of the small bronchi will be completely closed, and air will not flow further.
• Bronchioles. The next link is the so-called bronchioles. They are located directly inside the lung. At the end of each bronchiole there is a so-called acinus, which is the main functional unit of the lung.

Thus, the structure of the walls of the bronchi changes depending on their size. The mucous membrane that lines them contains cells capable of producing mucus. Normally, it performs a protective function, destroying microbes that enter here with the air. In various pathologies, mucus production increases so much that its accumulations completely block the bronchial lumen.

It is at the level of the bronchial tree that the main pathological changes occur in bronchiectasis. For various reasons, bronchi of the 3rd - 5th order change their shape. This occurs due to their overstretching and loss of normal muscle tone. As a result, pathological expansions are formed, which, even with full exhalation and during spasm of smooth muscles, are not completely emptied. Here favorable conditions are created for the accumulation of mucus and the proliferation of various pathogenic ( pathogenic) microorganisms.

Pulmonary lobules

Lobules are small sections of the lungs that are ventilated by a single bronchus. They have the shape of a truncated cone, with its apex facing inward. The base of such a lobule lies on the edge of the lung and is in contact with the pleura ( membrane covering the lungs). In each lobule, the bronchus entering it branches into 15–20 bronchioles.

When the air bronchus is blocked, the entire lobule collapses. Even if there is a small volume of air in it, it gradually dissolves. In the absence of ventilation for a long time, connective tissue forms in the collapsed segment, which replaces the respiratory alveoli. This process is called pneumosclerosis and can sometimes be observed in bronchiectasis.

Acini

The acini is the main structural unit of the lung. It consists of air bubbles called alveoli. Air enters the acini through the bronchioles. The alveoli are entangled in a dense network of capillaries - the thinnest vessels, the walls of which are highly permeable. This is where the so-called gas exchange occurs. Oxygen from atmospheric air penetrates the blood vessels and combines with hemoglobin. Carbon dioxide is released from the blood into the cavity of the alveoli, which leaves the lungs when you exhale.

The lungs are covered with a specific membrane called pleura. The same membrane passes to the inner surface of the chest, as if lining it. This leaves a small gap between the lungs and the walls of the chest, called the pleural cavity. It is sealed and is directly involved in the breathing process. The fact is that when you inhale, it is not the lungs themselves that expand, but only the walls of the chest. Due to the tightness of the pleural cavity, negative pressure is created in it, which leads to the expansion of the lungs and the drawing of air into them. Exhalation is a passive process that occurs when the respiratory muscles relax.

With bronchiectasis, the following changes occur in the anatomy and physiology of the lungs:

• Bronchial dilatation medium small caliber. Deprived of a cartilaginous base, the bronchi expand, losing their normal shape. They stop contracting when the smooth muscles spasm. The main reason is stretching of the connective tissue contained in the wall of the bronchus.
• Mucus accumulation. Mucus begins to accumulate in the dilated bronchioles, which is normally removed from the lungs. This is due to air stagnation and lack of muscle tone in the walls.
• Air flow obstruction. In the enlarged area, blockage of the bronchus may occur. It is caused by adhesion of the walls, swelling of the lungs ( for inflammation) mucous membrane or accumulation of mucus ( or pus).
• Inflammation of the bronchus. When an infection enters the dilated bronchus, it actively multiplies. Most often this is accompanied by an accumulation of pus, which cannot drain normally due to deformed walls. An inflammatory process develops, leading to swelling of the mucous membrane.
• Foci of pneumosclerosis. Prolonged inflammation leads to changes in the cellular structure of tissue. Muscle cells die, and in their place dense connective tissue forms. As a result, an area of ​​pneumosclerosis is formed that is not involved in the breathing process.

All these changes in the lungs cause the corresponding symptoms and signs of this disease. It should be noted, however, that bronchiectasis is rarely an isolated process. They are often accompanied by inflammation in the respiratory alveoli themselves ( pneumonia), in larger bronchi that have not undergone deformation ( bronchitis). However, all these pathologies are temporary, while bronchiectasis remains even in the absence of inflammation and pus. This predisposes you to more episodes of respiratory infection in the future.

Causes of bronchiectasis

The mechanisms and underlying causes of the development of bronchiectasis are currently not fully understood. The fact is that the appearance of bronchiectasis can be associated with many different factors, but none of them can be considered the main one. In general, all causes of this disease can be divided into two groups. The first is the main factors influencing the appearance of primary bronchiectasis. The latter are responsible for the appearance of secondary bronchiectasis and are not directly related to bronchiectasis.


It is believed that the causes of bronchiectasis may be:

• genetic factors;
• lung development abnormalities;
• previous respiratory infections.

Genetic factors

Genetic factors are a set of congenital defects that subsequently lead to the formation of bronchiectasis in the lungs. The cause of these diseases is a defect in the DNA molecule, which carries information about all cells in the human body. Some genes encode information about the cells that make up the bronchial walls. People who have these genes damaged or missing are at higher risk of developing bronchiectasis. The role of genetic factors in the development of primary bronchiectasis has been proven by a number of specially conducted studies. In addition, this explains the early onset of the disease, which usually occurs between 5 and 25 years of age.

People with congenital DNA defects may have the following problems:

• local immunodeficiency ( there are not enough cells in the mucous membrane that can fight infection);
• weakness of smooth muscle cells in the walls of the bronchi;
• absence or insufficient number of smooth muscle cells;
• bronchomalacia ( insufficient strength or absence of cartilage tissue in the wall of the bronchi);
• weakness and increased elasticity of connective tissue;
• increased secretion of viscous sputum by mucosal cells ( for cystic fibrosis).

All this predisposes to the appearance of bronchiectasis. The walls of the bronchi are not strong enough and easily lose their shape in the case of various respiratory diseases ( respiratory system diseases). In addition, more favorable conditions are created in the bronchi for the proliferation of pathogenic ( pathogenic) microbes.

Syndromes that are accompanied by the above disorders are:

• Shwachman-Diamond syndrome;
• cystic fibrosis;
• Fixed cilia syndrome;
• Kartagener's syndrome;
• Williams-Campbell syndrome;
• Duncan's disease.

In these diseases, bronchiectasis is primary, that is, bronchial defects are formed first, and then the inflammatory process develops. During exacerbations of bronchiectasis, concurrent pneumonia, pleurisy and other diseases of the respiratory system can be observed. But all these pathologies will already be a consequence of the resulting bronchial defects.

Lung developmental abnormalities

Lung anomalies are birth defects that are rarely the main cause of bronchiectasis ( only in 5 – 6% of cases). In this case, we are not talking about genetic factors, but directly about the development of the fetus in the womb. In rare cases, people are born with bronchiectasis, which then becomes inflamed and causes the appearance of bronchiectasis. The factors leading to such mutations affect the mother’s body before pregnancy or directly during the period of bearing a child.

Factors that cause impaired fetal development may be:

• alcohol abuse;
• taking certain medications ( with effects on fetal development);
• some infections suffered during pregnancy ( cytomegalovirus, Epstein-Barr virus, etc.).
• the presence of chronic diseases of internal organs ( kidney diseases, liver diseases, etc.).

Under the influence of these factors, the normal division of fetal cells is disrupted. Blind pockets, small cavities, or other defects may form in the lungs. After the birth of a child, they are congenital bronchiectasis, where infection easily occurs. With timely diagnosis and the absence of genetic defects, such disorders can be corrected surgically. This depends on the location of the deformed bronchi and the general condition of the patient.

Previous respiratory infections

It's no secret that children are more susceptible to respiratory infections than adults. They get sick especially often at the age of 1.5 - 2.5 years, when breastfeeding usually stops and the child’s body does not receive the maternal antigens that protected it before. In most cases, respiratory diseases at this age do not leave serious consequences.

However, in the presence of genetic defects or congenital developmental anomalies, as mentioned above, the disease does not go away without a trace. Infections suffered in childhood become a trigger mechanism. If the bronchial wall is weak, any pneumonia or bronchitis, accompanied by a strong cough, deforms the bronchial lumen. Bronchiectasis forms, which does not disappear after the infection is cured.

Medical practice shows that almost all patients with bronchiectasis suffered serious acute respiratory infections in childhood ( usually more than once). This allows such diseases to be classified as causes of bronchiectasis.

Secondary bronchiectasis should be considered separately. They can form at any age and cannot be called bronchiectasis. Such bronchial defects are caused by other pathological processes in the lungs. There is a disturbance in the movement of air through the bronchi, partial destruction of lung tissue, massive sclerosis of the lungs ( replacement of normal tissue with connective tissue that does not perform a respiratory function). Secondary bronchiectasis remains after the underlying disease has healed. The accumulation of pus in them and inflammation can give symptoms similar to bronchiectasis. In the future, diagnosis and treatment are not much different. This is why bronchiectasis is often called bronchiectasis.

Secondary dilation of the bronchi and deformation of their walls can be observed in the following pathologies:

• prolonged pneumonia;
• severe bronchitis;
• pneumosclerosis;
• pneumoconiosis ( occupational pathology that develops with prolonged inhalation of dust);
• neoplasms in the lungs and mediastinum;
• connective tissue diseases ( rheumatism, systemic lupus erythematosus, scleroderma, etc.);
• entry of foreign bodies into the respiratory system.

In all these cases, injury or destruction of the bronchial wall or compression of the airways occurs. As a result, the bronchus expands and a pathological cavity is formed.

Regardless of the origin of bronchiectasis ( primary or secondary) Pathogenic microorganisms play an important role in the clinical picture of bronchiectasis. They enter the dilated bronchus with inhaled air and are fixed on the wall of the cavity. Due to disturbances in the structure of the mucous membrane, the infection does not die and is not removed from the body. It is actively multiplying and gradually damaging surrounding tissues. Most often, pus is formed, which gradually fills the bronchiectasis cavity. It is the acute inflammatory process and the formation of pus that largely determine the symptoms characteristic of this disease. Thus, pathogenic microorganisms are also partly responsible for the development of bronchiectasis ( or rather, the cause of its exacerbations).

The inflammatory process in bronchiectasis can be caused by the following microbes:

• Streptococcus pneumoniae;
• Staphylococcus aureus;
• Haemophilus influenzae;
• Klebsiella pneumoniae;
• Mycoplasma pneumoniae;
• Escherichia coli;
• Chlamydia pneumoniae;
• Streptococcus haemolyticus;
• Legionella pneumophila;
• Moraxella catarralis.

All these microorganisms ( and less often some others) are capable of actively multiplying in the cavity of bronchiectasis. They get here mainly through inhaled air, less often through the bloodstream ( if there is another source of infection in the body). Frequent exacerbations of bronchiectasis are observed in patients with chronic tonsillitis ( angina), sinusitis or other infectious processes in the upper respiratory tract. In these cases, pathogens regularly enter the lungs, causing serious exacerbations.

Thus, there are quite a lot of causes that cause bronchiectasis. Typically, the development of this pathology requires exposure to several factors ( for example, genetic defects of the bronchial wall, past respiratory diseases and the presence of an infectious focus). From a practical point of view, it is important to establish whether bronchiectasis is secondary, and which pathogen caused the exacerbation of the disease. It is not always possible to unambiguously establish the cause.

Types of bronchiectasis

There are several classifications of bronchiectasis, each of which has its own practical significance. With their help, the doctor formulates a complete diagnosis and facilitates future treatment of the patient. In addition, many of these classifications reflect the clinical picture ( a set of symptoms and manifestations of the disease).

Each case of bronchiectasis can be assessed according to the following criteria:

• nature of bronchial deformation;
• disease phase;
• prevalence of the process;
• severity of the disease;
• origin of bronchiectasis.

Character of bronchial deformation

The nature of bronchial deformation is considered the main criterion for classification, since it directly describes the pathological process. To classify the disease according to this criterion, a special study is performed - bronchography. It shows exactly how the shape of the bronchus has changed. This largely determines the nature of the course of the disease and its severity.

There are the following forms of bronchial dilatation:

• Cylindrical. Cylindrical bronchiectasis occurs mainly with sclerosis of the bronchial walls. In this case, the lumen of the bronchus expands evenly over a fairly large area. Most often this occurs against the background of other lung diseases ( secondary bronchiectasis). The cylindrical shape does not contribute to the accumulation of a large volume of pus, so the general condition of patients, as a rule, is not too severe.
• Rosary. A bead-shaped expansion occurs if several round or oval cavities are located in succession along one bronchus. A large volume of sputum or pus can accumulate here, which causes a more severe course of the disease. On bronchography, this form of bronchiectasis looks like beads or rosaries ( hence the name).
• Saccular. Saccular bronchiectasis is a single spherical or oval expansion on one side of the bronchus. Often this form occurs with congenital defects in the development of lung tissue. The bags are blind protrusions of the wall that can reach large sizes. A significant amount of sputum and pus accumulates here. The course of the disease in such patients is usually severe.
• Fusiform. Such expansions are called spindle-shaped when the diameter of bronchiectasis gradually narrows, turning into a normal bronchus. This form of cavities does not contribute to the accumulation of pus and difficulty breathing.
• Mixed. Mixed forms are those in which the same patient has bronchiectasis of different forms. This is usually typical for secondary bronchiectasis due to tuberculosis, pneumosclerosis or other processes associated with severe deformation of the lung tissue. The condition of patients largely depends on the number and size of bronchiectasis, but the prognosis generally remains unfavorable.

Disease phase

Since established bronchiectasis does not disappear over time, this disease is always considered chronic. The patient's condition changes periodically depending on the phase.

During bronchiectasis there are two phases:

• Exacerbation phase. The exacerbation phase is characterized by infection entering the bronchiectasis cavity. In most cases, a pronounced inflammatory process develops with the accumulation of pus. During this period, the symptoms of the disease are most pronounced. A rapid deterioration in the patient's condition may occur, leading to emergency hospitalization. In the absence of adequate treatment, the inflammatory process goes beyond the dilated bronchus and pneumonia develops. The frequency of exacerbations can vary - from several episodes per year to several within one month. To improve the patient's general condition, it is recommended to follow measures to prevent exacerbations.
• Remission phase. The remission phase is characterized by the absence of acute symptoms. The patient can feel completely healthy, go about his daily activities, and do work. Bronchiectasis persists, but does not interfere with the breathing process. In the presence of multiple dilations of the bronchi and concomitant pneumosclerosis, a dry cough and signs of respiratory failure may be observed in the remission phase.

Frequent exacerbations of the disease lead to the development of sclerosis of the lung tissue. The inflammatory process is accompanied by the destruction of normal cells and the proliferation of connective tissue. In this case, the so-called peribronchial sclerosis occurs. First of all, the tissues around the affected bronchus are compacted and replaced. The more attentive the patient is to his condition and the more diligently he avoids exacerbations, the longer it is possible to delay the onset of pneumosclerosis and the development of chronic respiratory failure.

Prevalence of the process

When formulating a diagnosis, the doctor is obliged to indicate the localization of the pathological process. Congenital bronchiectasis, formed during fetal development, can be unilateral, affecting only one segment or lobe of the lung. The same can be said about secondary dilatations of the bronchi. They are localized in the place where pneumonia or tuberculosis occurred.

With genetic weakness of the bronchial walls, bronchiectasis usually appears diffusely, in all parts of both lungs. Thus, according to prevalence, one can distinguish between unilateral or bilateral bronchiectasis, as well as single or multiple formations.

Severity of the disease

Assessing the severity of bronchiectasis in general is quite difficult. Here the doctor must compare a number of different criteria, of which the frequency of exacerbations and maintenance of work capacity play the most important role. In general, assessing the severity of bronchiectasis is difficult to do objectively, since there is no clear framework.

Bronchiectasis can have the following degrees of severity:

• Light form. In mild forms of the disease, exacerbations are observed no more often than 1–2 times a year. Hospitalization is usually not required; taking prescribed medications quickly helps. During the period of remission, the patient feels completely healthy and can perform any work.
• Moderate form. With bronchiectasis of moderate severity, the disease worsens 3 to 5 times during the year. At this time, the patient’s condition deteriorates greatly, there is copious sputum production ( up to 50 – 100 ml per day). The patient temporarily loses ability to work, and attacks of respiratory failure may occur. The disease does not respond immediately to medication; symptoms disappear slowly. During the period of remission, a cough with sputum production may also persist. On examination, respiratory function appears to be slightly reduced.
• Severe form. In severe cases, exacerbations of the disease are common. The patient suffers from a severe cough, and more than 200 ml of sputum with pus and blood may be released per day. The skin is pale, blue and cold, indicating respiratory failure. The patient is usually hospitalized to stabilize his condition. The periods of remission are short, and the ability to work does not return completely.
• Complicated form. This form is submitted separately and characterizes the patient’s condition during remission. If a patient develops complications such as pneumosclerosis or cor pulmonale due to bronchiectasis, then his general condition practically does not return to normal. During the period of exacerbation, symptoms caused by an acute infectious process predominate, and during the period of remission, respiratory or cardiovascular failure predominates.

Origin of bronchiectasis

By origin, as mentioned above, bronchiectasis is divided into primary and secondary. Sometimes it is not possible to clearly determine this. If secondary bronchiectasis is detected, the underlying pathology that caused its appearance should be treated ( prolonged pneumonia, tuberculosis, etc.). This will prevent damage to other areas of the bronchi in the future.

Symptoms of bronchiectasis

Bronchiectasis is identified as a separate disease not only because of the typical structural abnormalities in the bronchi, but also because of the unique clinical picture. Most symptoms appear during the period of exacerbation of the disease, when an active inflammatory process begins in the cavities of bronchiectasis. Often, bronchiectasis can be confused with other respiratory diseases ( pneumonia, purulent bronchitis). The problem is that these pathologies often develop in parallel, which masks the typical picture of bronchiectasis. During the period of remission, patients may not have any complaints at all, and only complex examinations will reveal the disease.


The most common complaints of patients with bronchiectasis are:

• cough;
• increased body temperature;
• fingers of Hippocrates;
• decreased ability to work;
• weight loss;
• developmental delay.

Cough

Cough is the main and leading symptom that is observed in all patients with bronchiectasis. It is caused by irritation of the bronchial mucosa and difficulty in the passage of air. Essentially, this is a protective reaction of the body designed to clear the airways. Irritation of the mucous membrane occurs due to the inflammatory process, accumulation of sputum and pus, and deformation of the bronchus.

During the period of exacerbation of the disease and during the period of remission, the cough is usually different. During remission it is often dry. Sputum, if coughed up, is in small quantities, without admixtures of pus or blood.

During an exacerbation of bronchiectasis, cough has the following features:

• The onset of coughing in the form of attacks. Despite the fact that sputum comes out quite easily, a person still cannot cough up. Each contraction of the respiratory muscles leads to the release of a new portion of pus from the cavity and causes a new attack.
• Copious sputum production. Depending on the size and number of bronchiectasis, as well as on the microorganisms that have entered the lungs, the volume of sputum coughed up per day may vary. On average, 50 - 200 ml are separated, but in rare cases the daily amount exceeds 0.5 l ( mainly due to the accumulation of pus).
• Impurities of pus in the sputum. As noted above, many microorganisms entering the cavity of bronchiectasis lead to the accumulation of pus. Pus is formed from the waste products of microbes when they die, when fluid is released from the bronchial mucosa, and also when lung cells are destroyed. The sputum has an unpleasant odor and a characteristic color ( white, yellowish or greenish). The color depends on the microorganism that multiplies in the lungs.
• Blood in the sputum. Blood in sputum is not a constant phenomenon, but it is observed periodically in every third patient. Blood usually appears in the form of veins. It enters the bronchial cavity in the process of purulent melting of the walls. Small blood vessels pass through the walls ( arterioles), when damaged, blood enters the sputum. After sclerosis of the wall, the vessels in it are overgrown, and pus no longer leads to its destruction. Therefore, in patients with pneumosclerosis, blood in the sputum rarely appears. In some cases ( in case of damage to a large vessel) cough may be accompanied by the discharge of scarlet blood. This is most often observed in patients with tuberculosis, since the causative agents of this disease are especially aggressive in destroying lung tissue.
• The cough usually appears in the morning. This is due to the fact that a large volume of sputum accumulates in the bronchiectasis cavity overnight. After waking up, breathing quickens, irritation of the mucous membrane occurs and a coughing attack occurs with copious discharge of sputum or pus.
• Cough occurs when changing body position. This feature is explained by the presence of large bronchiectasis. They are not completely filled with pus. When you change your body position, some of the fluid flows into the lumen of the bronchus, making breathing difficult and causing a coughing attack.
• Sputum from bronchiectasis often contains two fractions. They are detected if a small amount of coughed up liquid is placed in a transparent glass. After some time, the less dense fraction, mucus, will collect in the upper part in the form of a cloudy light layer. Below, a column of opaque purulent sediment of white or yellowish color will clearly stand out.

With bronchiectasis, the cough has another interesting feature. Sputum is cleared more easily if the patient lies down on the healthy side ( with unilateral cavities). Sometimes patients intuitively accept this position. If, for example, bronchiectasis is located in the lower parts of the lungs ( this is the most common location), then the patient can hang out of the bed or lean his chest on the armrest or back of a chair, hanging over it.

In the first stages of the disease ( usually in childhood and adolescence) cough appears periodically, being the main symptom during exacerbations. Over time, as the disease progresses, coughing becomes more frequent.

Wheezing

During the period of exacerbation of the disease, patients themselves may complain of wheezing in the lungs. They are explained by a large accumulation of pus and sputum in the dilated bronchi. When taking a deep breath, wheezing can sometimes be heard even at some distance from the patient. The patient himself feels them as vibrations in the chest, which temporarily disappear after a coughing attack.

Dyspnea

This symptom is characteristic of the later stages of the disease. In childhood and adolescence, soon after diagnosis, shortness of breath does not appear. As bronchiectasis increases in size, the airways become increasingly distorted. Because of this, air has difficulty reaching the alveoli. In the later stages, with the development of concomitant pneumosclerosis or cor pulmonale, shortness of breath becomes the main symptom, which is present even during the period of remission, when there is no cough or other manifestations of the disease. Attacks are more often triggered by physical exertion or excess emotions.

Chest pain

The lungs do not have nerve endings, so they do not feel pain. However, 30–40% of patients with bronchiectasis complain of periodic chest pain. This symptom always appears during exacerbations, when there is acute inflammation and accumulation of pus. If this process reaches the pleura, which is rich in nerve endings, patients complain of pain. Their character can vary from dull and aching attacks lasting several days ( during the period of exacerbation) to an acute outbreak at the moment of deep inspiration.

Increased body temperature

An increase in body temperature is a characteristic symptom of an exacerbation of bronchiectasis. Most often, it indicates the involvement of the lung parenchyma in the inflammatory process ( alveolar sacs) and the parallel development of pneumonia. This symptom occurs due to toxic substances entering the blood. These substances are partially released by microbes at the site of infection, and partially penetrate into the bloodstream during the process of resorption of pus.

Usually the temperature is kept at a low-grade level ( 37 – 38 degrees) for several days or weeks. It responds to taking antipyretics, but rarely decreases to normal. Sometimes the rapid accumulation of pus leads to an increase in temperature to 39 degrees. It subsides after coughing up a large amount of pus. This is typical specifically for bronchiectasis, but is not observed in all patients.

Fingers of Hippocrates

Hippocratic fingers are the expansion of the terminal phalanges of the fingers, which occurs as respiratory failure progresses. This symptom is rarely seen in patients under 40 to 45 years of age. The mechanism of its appearance is not completely clear. It is believed that the nail phalanx of the finger becomes more porous due to prolonged lack of oxygen. This leads to its expansion. Most often the fingers are affected ( here the symptom is more clearly visible), but some changes are also present on the toes. Over time, the fingers take the shape of a drumstick.

The fingernails begin to rise dome-shaped. They are sometimes called watch glass nails due to their resemblance. These changes are irreversible and persist until the end of life.

Decreased ability to work

A decrease in working capacity is observed in moderate and severe forms of the disease. The patient does not tolerate almost any physical activity well, as it causes coughing or shortness of breath. If work involves inhaling dust, caring for animals, or spending a long time outdoors, the patient is more likely to experience exacerbations. Due to breathing difficulties, the body does not receive enough oxygen, and the patient constantly feels overwhelmed, tired, and experiences prolonged attacks of headaches and dizziness. During exacerbations, this is also facilitated by intoxication due to the infectious process.

Weight loss

Weight loss is most often observed after an exacerbation of the disease. This is explained by the fact that during the purulent process the patient has an elevated temperature, excessive sweating and poor appetite. With frequent exacerbations, the patient looks emaciated. At the same time, the face may remain puffy ( swollen), and the chest is slightly expanded. This disproportion is also a typical feature of bronchiectasis.

Developmental delay

Developmental delays are observed in children with congenital bronchiectasis. They often suffer from respiratory infections. Decreased appetite and lack of oxygen prevent the body's cells from dividing normally. With time ( from 3 – 4 years) the child begins to noticeably lag behind his peers in height and weight. The level of mental development does not suffer, that is, the disease does not directly affect the central nervous system. However, after prolonged mental stress, the child may experience headaches. The level of attention and concentration is reduced. These signs, combined with a chronic cough and periodic fever, should suggest bronchiectasis.

With the development of complications, patients may experience other symptoms, for example, pallor of the skin with pneumosclerosis, lower back pain with renal amyloidosis, swelling of the neck veins with cor pulmonale. However, all these manifestations of the disease are not directly related to bronchiectasis.

In general, it can be noted that the combination of symptoms and the nature of the course of the disease allows us to suspect bronchiectasis at the first visit to the doctor. However, none of these symptoms clearly confirms the diagnosis. To do this, it is necessary to conduct a number of special studies.

Diagnosis of bronchiectasis

Diagnosis of bronchiectasis is aimed at detecting deformed bronchi and clarifying the characteristics of the course of the disease in a particular patient. At the initial stages, diagnostics is carried out by general practitioners or pediatricians ( if signs of pathology are found in children). If bronchiectasis is suspected, the patient is sent to a pulmonologist for a final diagnosis.

In general, bronchiectasis is quite difficult to diagnose, since it is accompanied by other pathological processes in the lungs. During an exacerbation, the patient is monitored and symptoms are assessed. During the period of remission, it is much more difficult to detect bronchiectasis.


At the first stages of diagnosis, the following methods of examining the patient are used:

• General inspection. A general examination is carried out to detect visible symptoms ( drum fingers, pale skin, etc.). In addition, with bronchiectasis, you may notice bulging or retraction of the skin in the intercostal spaces. This is explained by the fact that areas with closed air cavities or no air at all are formed in the lung. During breathing, the affected side lags somewhat behind, and the amplitude of respiratory movements ( how much the ribs rise when you inhale) may be reduced.
• Chest percussion. Percussion of the chest involves tapping the entire projection of the lungs with fingers. With bronchiectasis of significant size in the affected area, the percussion sound is dulled. Under the fingers there is a cavity with fluid or an area of ​​pulmonary fibrosis that does not contain air.
• Auscultation of the chest. Auscultation during remission of the disease reveals harsher breathing and a characteristic hum over the dilated bronchi. It is created when air passes through a deep breath. During an exacerbation, moist rales of various sizes are heard, associated with a significant accumulation of pus and sputum.

Physical examination data ( this is the name of the above examination methods) do not provide unambiguous information for diagnosis. However, with their help, an experienced doctor may suspect the presence of bronchiectasis and prescribe more informative instrumental examinations.

The following instrumental research methods are used in the diagnosis of bronchiectasis:

• functional tests;

X-rays of light

An X-ray machine is a device capable of creating X-ray radiation, which, after passing through the human body and hitting the film, forms an image on it.
The resulting image is subsequently called an x-ray. It shows alternating light and dark areas of varying intensity. They characterize the internal structure of the chest.

At the time of the examination, the patient must be between the X-ray machine and the film so that the film is closely adjacent to the patient’s body, and the distance to the device is on average about 1 meter. The radiation dose for a single examination is about 0.3 millisievert ( energy unit), which confirms the absolute safety of this diagnostic method. With modern devices, the dose received is so small that neither pregnancy nor the patient’s youth can be considered absolute contraindications. However, these categories of people are prescribed examinations only when necessary, and not routinely.

On average, such radiography takes several minutes. The patient is not allowed to move for approximately 20–30 seconds. This is necessary to obtain a clear picture. With the classical method, the result will be ready the next day, since the film must undergo pre-treatment in the laboratory. On monitor screens in digital form, the result can be obtained faster.

The examination is usually performed in an upright position(standing)in several projections:

• straight, when the direction of the rays is perpendicular to the frontal plane ( forehead plane), and the film is adjacent to the chest or back;
• lateral, when the X-rays come from the side ( direction is determined by the affected side).

The role of radiography in bronchiectasis is quite large, since in the images a good specialist can examine the deformed bronchi themselves. By comparing images in two projections, the exact localization of bronchiectasis can be established. In addition, it is possible to notice the beginning of pneumosclerosis, enlargement of the right side of the heart or other complications.

Signs of bronchiectasis on x-ray are:

• Deformation of the pulmonary pattern. The bronchi do not branch evenly over the entire area of ​​the lungs. In some places their walls are thickened, which is reflected in the image as darkening.
• Local pneumosclerosis. On an x-ray, this complication resembles a white spot against the background of darker lung tissue. This contrast is explained by the absence of air in the sclerotic area. Often in the center of the darkening one can discern a clearly demarcated cavity ( actual dilated bronchus).
• Honeycomb drawing of the affected area. This symptom appears with multiple bronchiectasis. Small expansions of the bronchi create in the picture a resemblance to a honeycomb with irregularly shaped cells.
• Decrease in the volume of functional lung tissue. In the picture it looks like a decrease in the volume of one of the lungs or an increase in the other ( formation of a specific expansion - emphysema). Such changes are characteristic of the late stage of the disease.
• The appearance of cysts. Actually, bronchiectasis looks like cystic cavities on an x-ray. During an exacerbation, you can even see the fluid level in them.

Functional tests

In bronchiectasis, measurement of external respiratory function is of great importance ( FVD). This indicator may indicate the degree of functional insufficiency of the lungs affected by this pathology. The most accessible and common method is spirometry. This diagnostic procedure is carried out using a special device - a spirometer. Modern spirometers consist of several components - a tube, a sensor and a microcomputer. All necessary information about the respiratory function is displayed on the device screen after the procedure is completed.

No special preparation is required for this study. The procedure is usually performed in the morning on an empty stomach. 12 to 24 hours before the test, you must stop taking medications that may affect the test results. Having previously rested in the office, the patient should sit on a chair and breathe into the tube of the device for several minutes. Spirometry is absolutely safe and has no absolute contraindications. The doctor receives the results of the study instantly by reading the readings from the screen of the device.

The main indicators that are recorded during spirometry are:

• Tidal volume of the lungs- this is the amount of air that is inhaled and exhaled by the patient during a normal breathing rhythm. As pneumosclerosis progresses in patients with bronchiectasis, tidal volume gradually decreases.
• Inspiratory reserve volume. This is the name for the amount of air that a patient can inhale after a normal inhalation, making additional efforts. This indicator characterizes the elasticity of lung tissue. In bronchiectasis and sclerosis it is greatly reduced.
• Expiratory reserve volume. This volume is the reverse of the one described above. It characterizes the amount of air that a patient can exhale with effort. In patients with bronchiectasis, coughing attacks are often observed, since increased exhalation expels fluid from the pathological cavities into the lumen of the bronchi.
• Vital capacity of the lungs is calculated by summing the three previous indicators.
• Forced vital capacity– the maximum volume of exhalation after the deepest inhalation. It characterizes how well the respiratory system as a whole works.
• Forced expiratory volume is the amount of air that a patient can exhale in one ( first) give me a sec. This indicator is also reduced in the presence of bronchiectasis.
• Tiffno index- This is an important practical indicator of lung function. It represents the relationship between forced expiratory volume and forced vital capacity. This indicator serves as the main indicator for assessing bronchial patency. When it decreases, we can say for sure that there are obstacles at the level of the bronchial tree.

All of the above indicators, like many others, serve as important criteria in assessing the degree of damage to the respiratory function that occurs in the late stages of bronchiectasis. In the initial stages, the study of respiratory function may not detect any changes. This study is prescribed rather for the timely detection of broncho-obstructive syndrome accompanying the disease. It also indirectly reflects the degree of respiratory failure.

Bronchoscopy

Bronchoscopy is an instrumental method that involves examining the mucous membrane of the trachea and bronchi using a special camera. The device used for this procedure is called a fiberoptic bronchoscope. It is a flexible wire, at one end of which there is a miniature camera, and at the other - a small peephole and various image controls.

Bronchoscopy is a rather complex and unpleasant study for the patient. It lasts about 5 - 10 minutes, during which he experiences difficulty breathing. In addition, when inserting a bronchoscope, nausea is felt, and when passing through the larynx, pain is felt.

Bronchoscopy requires the following preparation measures:

• the study is carried out on an empty stomach;
• several hours before the procedure you should not even drink water;
• local anesthesia of the mucous membrane of the throat is performed using special sprays;
• the day before the procedure, the patient begins to receive sedatives ( in injections or tablets);
• the study is carried out after taking medications that help cleanse the bronchi from mucus and expand them;
• The patient should have a towel or napkins, as hemoptysis is possible after the procedure.

With bronchiectasis, the doctor sees in the bronchoscope an inflamed mucous membrane with small accumulations of pus. Bronchiectasis themselves cannot be detected, since they are located in the bronchi of a smaller diameter, where it is impossible to penetrate with a bronchoscope. However, this research method provides indirect confirmation of the diagnosis.

Bronchography

Bronchography is an X-ray of the lungs after the injection of special contrast into them. This contrast is distributed throughout the bronchial tree and makes it distinct in the resulting image. In most cases, the contrast is made on the basis of oil or water mixtures with the addition of iodine. The patient receives it some time before the x-ray. The administration and distribution of contrast throughout the bronchi is accompanied by unpleasant sensations.

To obtain a high-quality image, it is necessary to pre-clean the bronchi from sputum. To do this, the patient is given medications to help remove sputum. Otherwise, the contrast will not be distributed evenly and will not show a clear outline of the bronchi.

This research method has a number of contraindications:

• individual intolerance to contrast components ( allergy);
• severe respiratory failure;
• pulmonary hemorrhage;
• chronic kidney disease ( it is through them that the contrast must leave the body after the procedure).

In patients with bronchiectasis, this research method is the most important to confirm the diagnosis. The image clearly shows the pathological expansion of the bronchi, their shape, location and size. Usually the contrast does not reach the areas located behind the bronchiectasis, so part of the lung remains unstained.

All of these methods are aimed at visually displaying structural abnormalities in the lungs and collecting data on the functioning of the respiratory system. However, the diagnostic process is not limited to them. To collect complete information about the disease and prescribe the correct treatment, a number of additional studies are carried out.

A complete examination program for patients with bronchiectasis includes the following procedures:

• bacteriological analysis of sputum;
• electrocardiography ( ECG);
• consultation with an ENT doctor.

General blood analysis

In the general blood test, changes are observed mainly during exacerbations. Typical for bronchiectasis is an increase in the level of leukocytes and a shift in the leukocyte formula to the left. Most often this indicates the presence of an acute inflammatory process. With prolonged and severe course of the disease, anemia may occur ( decreased red blood cell levels).

Blood chemistry

A biochemical blood test is more sensitive to pathological processes in the body than a general one. Based on its results, one can judge not only the presence of inflammation, but also the development of some complications of bronchiectasis. Sometimes the results of the analysis indicate pathological changes in the body even before the appearance of visible symptoms.

Typical changes in a biochemical blood test are an increase in the level of the following substances:

• sialic acids;
• seromucoid;
• fibrin;
• haptoglobin;
• alpha globulins and gamma globulins.

In kidney amyloidosis, the excretion of nitrogenous bases is impaired. The level of urea and creatinine begins to gradually increase.

General urine analysis

In general urine analysis, no changes are usually observed. The appearance of columnar epithelial cells in the urine ( cylindruria) and proteins ( proteinuria) is typical only in the case of renal amyloidosis.

Bacteriological analysis of sputum

Bacteriological analysis of sputum is recommended for all patients with bronchiectasis. The material for research in this case is sputum or pus, separated with a cough. They contain a large number of microorganisms that cause an exacerbation of the disease.

When collecting sputum for analysis, the following rules should be followed:

• It is advisable to take sputum in the morning, since at this time more of it comes out and you can get more living microorganisms;
• A bacteriological test should be done before starting antibiotics ( otherwise there is a risk of getting a false negative result);
• in the presence of foci of infection in the upper respiratory tract ( sinusitis, frontal sinusitis) microbes from these areas must be prevented from entering the sample ( this may distort the analysis result).

After receiving sputum, it is cultured on a nutrient medium. This is a special mixture of substances necessary for the rapid growth of bacteria. Within a few days, doctors can obtain a colony of pathogens. This allows you to determine their type with high accuracy.

The next step, which also needs to be carried out in patients with bronchiectasis, is drawing up an antibiogram. The resulting microbial culture is tested for resistance to various antibiotics. As a result, within a few days it is possible to obtain reliable information about which drug will be most effective for treating a given patient. Most often, repeated exacerbations of the disease are caused by the same type of microbes, so an antibiogram is not always compiled ( to save time). However, identification of the pathogen on nutrient media or under a microscope must be carried out at each exacerbation.

Electrocardiography

Electrocardiographic study ( ECG) is prescribed to assess cardiac function. In the early stages of bronchiectasis, no pathological changes are usually observed. Minor disruptions can be observed only during periods of severe exacerbations. In patients with multiple bronchiectasis and pneumosclerosis, an ECG must be taken at least once every six months. This will allow you to notice signs of the formation of cor pulmonale in the early stages and promptly begin treatment for this complication.

Consultation with an ENT doctor

Consultation with an ENT doctor is necessary to detect foci of infection in the upper respiratory tract. If there are any, the doctor should take measures to eliminate them. For example, in case of chronic sinusitis or sinusitis, taking antibiotics does not always completely destroy the infection. Because of this, exacerbations of bronchiectasis are often observed and the prognosis for the future worsens. In case of chronic tonsillitis, the tonsils should be removed, and in case of sinusitis, a puncture should be performed and the sinuses should be washed out of pus. All this will reduce the likelihood of infection in bronchiectasis. An ENT doctor diagnoses and treats such problems.

The purpose of these examinations is to diagnose complications and features of the course of the disease. The information that the doctor receives helps to choose faster and more effective treatment. These examinations will be most informative during the period of exacerbation, when there is an acute inflammatory process and the development of infection. During remission, no changes may be detected.

Treatment of bronchiectasis

Treatment for bronchiectasis can be approached in different ways. The approach depends mainly on the severity and phase of the pathological process. With a mild course, it is only necessary to follow preventive measures to avoid frequent exacerbations. If the patient's condition is more severe, urgent hospitalization may be required, followed by treatment in a hospital setting. Appropriate treatment and care can be provided by specialists in the department of pulmonology or internal medicine.

In different cases, a variety of methods for treating bronchiectasis can be used - from traditional methods of treatment to surgical removal of deformed bronchi. The data obtained during diagnostic procedures are of great importance. It is on their basis that a treatment plan for the patient is drawn up. In some cases, this process can drag on for many years, as the disease periodically worsens. The patient should visit a doctor regularly and monitor his health.

In the process of treating bronchiectasis, the following methods are used:

• drug treatment;
• surgery;
• instrumental methods of treatment;
• prevention of exacerbations of the disease;
• maintaining proper nutrition;
• traditional methods of treatment.

Drug treatment

Drug or conservative treatment is the main treatment for bronchiectasis. Various groups of drugs can be used, each of which has its own effect. Sometimes patients with severe forms of the disease have to take medications constantly, even during remission. During the period of exacerbation, the number of drugs increases.

Drug treatment of bronchiectasis in the acute phase has the following goals:

• cleansing the bronchi from mucus ( its liquefaction and expectoration);
• improvement of respiratory function;
• destruction of pathogenic microbes;
• elimination of acute inflammatory process ( this will prevent the development of pneumosclerosis);
• decrease in body temperature;
• detoxification of the body ( cleansing of microbial toxins).

Groups of drugs used in the treatment of bronchiectasis

Group of drugs	Mechanism of action	Drug name	Dosage and directions for use
Antibiotics	Suppresses the growth of microbes and destroys them.	Ciprofloxacin	200–500 mg 2–3 times a day, depending on the severity of symptoms.
		Levofloxacin	250 - 500 mg 1 - 2 times a day.
		Azithromycin	The daily dose for adults is 0.25–1 g; children are prescribed at the rate of 5–10 mg per 1 kg of body weight ( mg/kg/day).
Anti-inflammatory drugs	They have an anti-inflammatory and antipyretic effect.	Paracetamol	Adults: 0.3 - 0.5 g 3 - 4 times a day. Children from 9 to 12 years old – up to 2 g/day. Children under 9 years old at the rate of 60 mg/kg/day 3 - 4 times a day.
		Aspirin	The daily dose for adults is from 0.25 to 1.0 g/day. The dosage for children depends on age and ranges from 0.05 to 0.3 g/day.
		Ibuprofen	To reduce body temperature below 39 degrees, the dosage is 10 mg/kg/day, at lower temperatures ( 38 – 39 degrees) – 5 mg/kg/day.
Mucolytic drugs (mucolytics)	These agents help thin the mucus and facilitate its release from the bronchi.	Acetylcysteine	The daily dose for adults is 600 mg, for children under 2 years old - 200 mg, and for older people - 400 mg.
		Bromhexine	Patients over 14 years of age are prescribed 8-16 mg 3-4 times a day. Children from 6 to 12 years old are prescribed 6–8 mg 3–4 times/day. Children under 6 years old - 2 - 4 mg with the same frequency.
		Ambroxol	Patients over 12 years of age are prescribed 30 mg 2-3 times a day. Children from 5 to 12 years old - 15 mg 2 – 3 times a day. Children under 5 years old: 7 mg 2 - 3 times a day. ( dosage indicated for tablets).
Selective β2-agonists	They have a bronchodilator effect, facilitate the passage of air through the bronchi, and facilitate coughing up mucus.	Salbutamol	The dosage depends on age, dosage form, and severity of symptoms. Before using these drugs, you should always consult your doctor, as serious side effects are possible.
		Terbutaline
		Fenoterol

The choice of antibiotic is made depending on the pathogen detected and its sensitivity to the drugs. Before starting antibiotic therapy, it is advisable to draw up an antibiogram. If complications develop ( renal amyloidosis, cor pulmonale, pulmonary hemorrhage) some of the above drugs may be contraindicated. Therefore, self-medication during an exacerbation of bronchiectasis is strictly prohibited. The advisability of using therapeutic aerosols and inhalations should also be discussed with your doctor. With intensive formation of pus in bronchiectasis, they may be contraindicated.

Surgery

Surgical treatment of bronchiectasis is a radical method that can completely cure some patients. It is resorted to only in cases where one or two bronchi are dilated, preferably within one pulmonary lobe. The location of bronchiectasis and their size also play a big role. In some cases, removing even a single formation is associated with an unjustified risk. Therefore, not all patients can get rid of bronchiectasis surgically.

Contraindications to surgical treatment are:

• multiple bilateral bronchiectasis;
• phase of exacerbation of the disease with accumulation of pus;
• renal amyloidosis with signs of renal failure;
• pulmonary heart;
• deep location of bronchiectasis ( this complicates surgical access);
• patient age up to 14 – 16 years ( Before this, the chest is actively growing and the position of bronchiectasis may change slightly).

If surgical treatment can be performed, then the patient can be considered completely cured of bronchiectasis. The very cause of exacerbations is removed - pathological cavities where pus could accumulate. However, in the presence of genetic defects ( weakness of the bronchial wall) bronchiectasis may reappear.

Instrumental treatment methods

Instrumental treatment methods are used mainly as maintenance therapy or in severe cases of the disease. These include, for example, endobronchial administration of certain drugs. Using the same bronchoscope, the doctor penetrates the bronchial tree and comes as close as possible to the site of expansion. After this, an antibacterial agent or drugs to thin the sputum are injected here. The effectiveness of such administration of drugs is much higher than when they are used in the form of tablets or injections.

Another instrumental method is physiotherapy. It is carried out mainly during the period of remission of the disease and prevents exacerbations of the disease.

The main physiotherapeutic treatment methods are:

• microwave irradiation;
• electrophoresis with calcium chloride;
• inductometry ( exposure to high frequency magnetic field).

Prevention of exacerbations of the disease

As noted above, a significant place in the treatment of bronchiectasis is occupied by the prevention of exacerbations. When the patient understands the essence of the pathological process in the body, he can easily follow all the necessary precautions so that his condition does not worsen.

Prevention of exacerbations of bronchiectasis includes the following measures:

• avoiding hypothermia;
• timely treatment of colds or other upper respiratory tract infections;
• timely treatment of caries and infectious processes in the oral cavity;
• limiting contact with patients who spread the infection by airborne ( when breathing) by;
• visiting a therapist or pulmonologist at least 3–4 times a year, even in the absence of exacerbations;
• to give up smoking;
• restriction of dust inhalation ( if necessary, change workplace);
• vaccination of children ( but not during an exacerbation period) and the use of seasonal vaccines ( against flu).

All these measures will allow you to achieve long periods of remission and significantly reduce the likelihood of complications of the disease.

In addition, as part of prevention ( and sometimes treatment of exacerbations) bronchiectasis patients are often prescribed spa treatment. Fresh air helps increase resistance ( resistance) of the body, which reduces the likelihood of developing an infection. During exacerbations, you should resort to physical therapy and massage, which help cleanse the bronchi, release phlegm and ease breathing.

Maintaining proper nutrition

With the development of bronchiectasis, preventive diet No. 13 according to Pevzner is recommended for all patients. It is especially important in the prevention of exacerbations. In general, this diet is used for infectious diseases.

The essence of diet No. 13 comes down to the following basic postulates:

• high calorie food;
• consumption of foods rich in vitamins and minerals;
• consumption of large amounts of fluid;
• rational diet and proper culinary processing of products;
• limited consumption of fatty, salty, seasoned foods.

The main goal of diet No. 13 is to increase overall resistance ( disease resistance) and reduction of general intoxication of the body. For this, a high-calorie daily diet of 2500 to 3200 kcal is recommended. The increase in calorie content mainly falls on the share of proteins, the content of which in the daily diet can reach up to 160. The content of fats and carbohydrates should be within physiological norms - 80 - 90 g and 350 - 400 g, respectively.

All patients need to consume foods rich in vitamins ( A, C, B1, B2) and minerals ( calcium, phosphorus, magnesium, zinc, etc.). Consuming large amounts of fluid is one of the main mechanisms for reducing body intoxication, which occurs due to the death of microbes and destruction of lung tissue. The total volume of liquid should be at least 1.5 - 2 liters per day. The diet is reusable - up to 5 - 6 times a day in small portions. They eat well thermally and mechanically processed food, which is most often steamed and served warm. Preference is given to soups or purees, as they are easier to digest for a weakened body.

The following foods are excluded from the nutritious diet:

• fatty meats;
• baking in large quantities;
• pasta;
• fried eggs;
• fatty broths;
• alcohol.

The following types of products are allowed for consumption:

• lean varieties of meat, fish, poultry;
• dairy products;
• juices, fruit drinks;
• fresh fruits and berries, vegetables;
• honey, jam, marmalade;
• soft-boiled eggs or in the form of an omelet.

It should be remembered that in case of complications from the heart and kidneys ( which occur in patients with bronchiectasis) appropriate adjustments must be made to this diet. In particular, the consumption of salt and water is greatly limited.

Traditional methods of treatment

Traditional methods of treating bronchiectasis are aimed at thinning mucus and facilitating its release. In most cases, these methods can be used in parallel with drug treatment. In case of a serious condition of the patient or complications of the presence of complications, it is necessary to warn the attending physician about the traditional methods that the patient uses. With a pronounced purulent process in the bronchi, a number of folk remedies may be temporarily contraindicated. During the period of remission, you can continue the course.

The following folk remedies help best with bronchiectasis:

• Flax seed grind into powder and mix with garlic-honey mixture. For half a liter of mixture you need to grind about 100 g of seeds. Take it 1 teaspoon half an hour before meals. This remedy strengthens the immune system, helps defeat infection and helps liquefy the contents of the bronchi.
• Garlic decoction. One head of garlic is cut into small pieces, retaining the juice, and mixed with 250 ml of milk. The mixture is boiled for 3 – 5 minutes over low heat. Then the pieces of garlic are filtered through cheesecloth, and the milk is drunk 1 tablespoon 3 times a day before meals.
• carrot juice mixed with boiled milk and linden honey. For 50 grams of honey, take 250 g of the remaining components. The mixture is infused, stirring occasionally, for 5 – 6 hours. Take it heated to 40 - 50 degrees 3 - 5 times a day until the cough relieves.
• Aloe leaf infusion. The infusion is made with grape wine of moderate strength. For 4 large sheets you need 0.5 liters of wine. The leaves are scalded with boiling water, kneaded without loss of juice and placed in a vessel. Infusion in wine lasts 3–4 days in a dark place. After this, the drug is taken 1 tablespoon 3 times a day for 5 - 7 days.

It should be remembered that treating bronchiectasis only with folk remedies without consulting a doctor is fraught with serious consequences. In this case, the rapid development of various complications is possible, which pose a threat to the health and life of the patient.

Consequences of bronchiectasis

Bronchiectasis is a pathology that can cause a variety of complications. Often the mechanism of these complications remains not fully understood. Their high prevalence is confirmed only statistically. This applies, for example, to renal amyloidosis, the development process of which is still unclear. In general, complications of bronchiectasis can affect not only the respiratory system, but also other organs. Often, during the period of remission of the underlying disease, it is the consequences and various complications that cause the serious condition of patients. Some of them can pose a serious threat to life.


The main consequences and complications of bronchiectasis are:

• chronic respiratory failure;
• pneumosclerosis;
• pulmonary heart;
• kidney amyloidosis;
• septicemia;
• pulmonary hemorrhages.

Chronic respiratory failure

Chronic respiratory failure is the main problem in all patients with bronchiectasis. Deformed areas of the bronchi and peribronchial sclerosis of the lung tissue prevent the normal passage of air. Because of this, gas exchange in the alveoli is difficult. Venous blood, when passing through the lungs, is not enriched with oxygen to the required level. With appropriate analysis, a decrease in the partial pressure of oxygen in arterial blood can be detected.

Respiratory failure progresses as pneumosclerosis develops. The more often the patient experiences exacerbations of bronchiectasis, the more the breathing process is disrupted. In the later stages of the disease, it is respiratory failure, rather than infection, that becomes the main problem.

Typical signs of respiratory failure are:

• shortness of breath on exertion;
• muscle weakness;
• increased fatigue;
• dizziness;
• blueness of the tip of the nose, fingertips;
• cold intolerance.

All these symptoms occur due to poor oxygen supply to tissues. To maintain respiratory function, you have to constantly take a number of medications that improve gas exchange.

Pneumosclerosis

Pneumosclerosis in bronchiectasis develops slowly. The process of proliferation of connective tissue begins around the affected bronchi. It is triggered by chronic inflammation and aggressive action of pus. Most often, patients with bronchiectasis experience focal proliferation of connective tissue, which is limited to the segment in which the bronchiectasis is located.

Pneumosclerosis is an irreversible process and represents the main problem in the respiratory system. Because of this, the tidal volume of the lungs decreases and chronic respiratory failure develops, as discussed above. There is no effective treatment for pneumosclerosis, so patients with bronchiectasis should follow all doctor's recommendations to prevent this dangerous complication.

Pulmonary heart

The term “pulmonary heart” refers to the expansion of the right chambers of the heart ( right ventricle and, less commonly, right atrium). The reason for this change is an increase in pressure in the vessels of the lungs. In single bronchiectasis without pneumosclerosis, the cor pulmonale does not develop. The pressure increases significantly only when a large number of arterioles and capillaries in the lungs become overgrown or become compressed as a result of deformation and degeneration of the tissue.

With cor pulmonale, the thickness of the ventricular wall increases significantly. Because of this, symptoms that are not typical for bronchiectasis may periodically appear. Common complaints are pain in the chest, swelling of the neck veins, swelling in the ankles, heart rhythm disturbances ( arrhythmias).

Kidney amyloidosis

Amyloidosis or amyloid dystrophy of the kidneys is the accumulation of pathological protein - amyloid - in their tissue. Normally, there is no such substance in the body, but it can be formed against the background of chronic inflammatory processes. So-called autoantigens begin to circulate in the blood, destroying the body’s own cells. In the kidneys, all decay products and antibodies are deposited, which can lead to the formation of amyloid. In this case, the normal tissue of the organ is gradually saturated with pathological protein, and its functions are disrupted.

Patients with bronchiectasis are at increased risk of developing renal amyloidosis. At the first sign of this complication, treatment must be started immediately. A course of drug treatment and a special diet will help avoid further progression of this disease.

Symptoms of renal amyloidosis, which are not typical for uncomplicated bronchiectasis, are:

• swelling in the arms, legs, face;
• increased blood pressure;
• hepatosplenomegaly ( increase in the size of the liver and spleen);

It is by the appearance of these complaints in a patient that the development of amyloidosis can be suspected. It usually occurs after years of illness with frequent exacerbations. The prognosis worsens sharply.

Septicemia

Septicemia is the entry of pathogenic microorganisms into the blood. In bronchiectasis, this can occur during a severe exacerbation. Microbes penetrate into the cavity of bronchiectasis, multiply there and sometimes lead to the destruction of the walls of the bronchial tube. As a result of damage to blood vessels, the infection enters the blood. First it goes to the left side of the heart, and from there it spreads throughout the body.

Most often, with bronchiectasis, new lesions do not appear in other organs. However, such complications are possible with some particularly aggressive pathogens. The most common complaints are severe headaches, chills, and a sharp increase in temperature. With timely treatment with properly selected antibiotics, the spread of infection can be stopped.

Pulmonary hemorrhage

Pulmonary hemorrhage is a rare complication of bronchiectasis. They can occur against the background of tuberculosis infection or with massive formation of pus. In these cases, there is active destruction of lung tissue, which inevitably affects the blood vessels. When a more or less large vessel is damaged, bleeding begins. It is usually limited to blood in the sputum. In rare cases, blood is released in small droplets when breathing.

Since large vessels are rarely damaged during bronchiectasis, bleeding most often does not require urgent measures to stop it. The blood stops coming out after a while ( minutes, rarely hours), and the total blood loss is not sufficient to cause anemia, hypotension, or other serious disorders. However, some of the blood remaining in the lungs ( accumulated in bronchioles and alveoli), is a favorable environment for the development of microbes. Episodes of pulmonary hemorrhage may be followed by severe pneumonia.

If the examination showed that bronchiectasis has developed in the lungs. This means that treatment for bronchiectasis of the lungs awaits. It's not a simple matter, but is this a problem if you love life? Without treatment, bronchiectasis develops and develops into complications: emphysema, atrophic pharyngitis, and bronchial asthma may develop.

Friends, hello! Svetlana Morozova is with you. Do you know this gnawing feeling when you don’t know what’s wrong with you and you suspect everything in the world? Sometimes the hero of the book “Three in a Boat, Not Counting a Dog” awakens in everyone - remember when he took a reference book of diseases in the library and discovered that he had every one of them, except for puerperal fever? So, let's talk about a disease such as bronchiectasis. It doesn’t occur very often, and it’s not easy to recognize it right away. And we’ll take it and sort it out! Forward!

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Treatment of bronchiectasis of the lungs: how will we treat it?

Let's start right away with treatment. So where does it always start? That's right, let's go to the doctor. And then there is the following:

• Treatment with antibiotics. The primary task is to stop the spread of infection. The medication regimen is always prescribed for each case separately. I'll explain why. If the lesion is severe, then antibiotics must be taken daily, even during periods of remission. If bronchiectasis is developed quite easily, it’s easier.

In this case, the method of administration can be different: in tablets, inhalers, aerosols, through intramuscular and intravenous injections. But the most effective way is to administer the antibiotic using bronchoscopy. More on this a little further.

Breathing exercises

There are a couple of nuances here. Firstly, you need to breathe in a special way, in jerks, that is, simulating a cough, with long exhalations. Secondly, during exercises, sometimes you need to tap on the place where, as determined, there is an accumulation of sputum. Do not hit the chest, but lightly tap it. Such manipulations are again needed to relieve phlegm. And during the period of exacerbation, it is better not to do gymnastics.

So, the main positions, lying everywhere:

1. IP: on the back. Your legs should be slightly elevated; you can place a bolster/pillow or place your legs on the armrest of the sofa. One hand lies on the stomach, the other on the chest. We breathe with our stomachs, calmly, and try to stretch the exhalation. Using our hands, we make sure that the breathing is abdominal.
2. IP: on the back, arms along the body. As you inhale, spread your arms to the sides, and as you exhale, pull your knees to your chest with your hands.
3. IP: as in the previous one. As you inhale, raise your arms behind your head, as you exhale, raise your straight leg and at the same time lower your arms.
4. IP: same. Inhaling, we spread our arms to the sides, trying to bend our back. As you exhale, cross your straight arms in front of you as much as possible, slightly squeezing your chest.
5. IP: on the side. Extend your arm near the floor along your body, and place your free hand behind your head. As you inhale, we lift it up, as you exhale, we lower it to the chest, trying to put pressure on the chest.
6. IP: same. We raise our free hand up as we inhale, and as we exhale we simultaneously pull our knee to our chest and lower our hand, helping the knee.
7. IP: on the stomach. As you inhale, move your hand behind your back and reach behind it with your upper body. As we exhale, we return to IP.

The exercises are all based on similar movements. Lift, pull, press, breathe slowly and with intense exhalation. You can do any similar movements that come to mind. The main thing is that the pose is natural. Don’t “reach your left heel to your right ear.”

Treatment of bronchiectasis of the lungs: folk advice

Do not forget that folk remedies cannot be used instead of medicines. Only as an addition. Everyone knows chest infusions made from medicinal herbs. Probably everyone was given this when they coughed. But with purulent sputum, some herbs cannot be used, so we consult a doctor about everything.

Which recipes are considered the most effective:

• Garlic. The head of garlic should be chopped and mixed with a glass of milk. Boil the resulting mixture over low heat for 5 minutes, then filter and take a tablespoon three times a day before meals.
• Carrot. Namely its juice. Whether you make it yourself or buy it doesn’t matter. Mix a glass of juice with a glass of milk and add 2 tbsp. l. linden honey, set aside in a dark corner for 6 hours. Sometimes we come to interfere. When it brews, take 1 tbsp throughout the day. l. up to 6 times, preheated.
• Wine infusion. Take large aloe leaves, 4-5 pieces, scald with boiling water and knead. We try not to squeeze out the juice. Then pour the leaves with wine and let it brew for 4 days. After this, you can take the infusion according to Art. l. three times a day.
• Herbs. We need expectorant herbs that are taken for wet coughs. And this is licorice root, calendula, wild rosemary, marshmallow, coltsfoot, anise, sage.

Determining the signs

Bronchiectasis is not always diagnosed immediately. It's all about camouflage, so to speak. At first it looks like pneumonia, then it looks like pneumonia, and all the time it looks like bronchitis. Therefore, the picture can only be clarified by a complete diagnosis, including X-rays, bronchoscopy, bronchography, and determination of respiratory function (peak flowmetry, spirometry).

The main symptoms are:

• Cough. Very wet, frequent. There is a lot of sputum, it has a characteristic purulent color and an unpleasant odor. My favorite time of day is morning. People get up with a mouthful of exudate. That's when the morning doesn't start with coffee.
• If blood vessels are affected, blood appears in the sputum. This can range from completely innocent veins to hemoptysis, and even pulmonary hemorrhage.
• Almost everyone here has anemia. Manifests itself typically: pallor, weakness, weight loss. Children lag behind in physical development, puberty begins later.
• During exacerbations, the temperature rises, the cough intensifies, and there is also more sputum. All signs of bronchopulmonary infection and intoxication.
• Respiratory failure is especially pronounced in children: shortness of breath, cyanosis (cyanosis), and changes in the chest. Often it is enough to look at your hands. With respiratory failure, the nail phalanges of the fingers swell and become like “drumsticks.” And the nails are compared to “watch glasses” - flat, round.

Oh this infection

Most people only learn that such a disease exists when they or their children are diagnosed with it. So what is this disease?

The bronchi change shape and expand. Unfortunately, irreversibly, forever. Such changes in the bronchial trunk are called bronchiectasis, which I have mentioned so many times today. Purulent sputum accumulates in them, and respiratory function becomes impaired.

In rare cases, the cause of bronchiectasis is the underdevelopment of the bronchopulmonary system from birth. But most often the disease begins in childhood, from 5 to 25 years, when an aggressive infection constantly invades the fragile bronchi of children.

The medical history of patients with this diagnosis is almost always replete with records of weak symptoms, frequent colds, chronic bronchitis, bronchiolitis - and here is ready-made bronchiectasis.

This differs from pneumonia in that here the lung parenchyma (surface tissue) is not affected by inflammation, and atelectasis (deflated, flaccid, areas of the lungs that have lost porosity) do not form.

It’s not hard to imagine what will happen if the situation starts. Without treatment, bronchiectasis develops and develops into complications (COPD, emphysema, cardiac, renal, respiratory failure, atrophic pharyngitis), and bronchial asthma may develop. By the way, there is an interdependent relationship here. And asthma can occur due to bronchiectasis, and vice versa.

If treated as expected, the prognosis is good. In 80% of cases, it is possible to ensure that the exacerbation occurs no more than once a year. And sometimes, with the help of a good operation, they completely get rid of such a problem.

That's all, basically.

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1. Bronchiectasis: etiology, pathogenesis, clinical picture, diagnosis, treatment.

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

Etiology.

Reasons for development bronchiectasis cannot be considered sufficiently clarified to date. Microorganisms that cause acute respiratory processes in children, which can be complicated by the formation of bronchiectasis (pathogens of pneumonia, measles, whooping cough, etc.), can be considered an etiological factor only conditionally, since in the vast majority of patients these acute diseases end in complete recovery. Infectious pathogens that cause exacerbations of the suppurative process in already changed bronchi (staphylococcus, pneumococcus, Haemophilus influenzae, etc.) should be considered as the cause of exacerbations, and not bronchiectasis. A very significant, and possibly decisive, role V The formation of bronchiectasis is caused by a genetically determined inferiority of the bronchial tree (congenital “weakness” of the bronchial wall, insufficient development of smooth muscles, elastic and cartilaginous tissue, insufficiency of protective mechanisms contributing to the development and chronic course of infection, etc.). At present, it is still difficult to assess the significance of the factor under consideration in specific patients, and the identification of a special group of so-called dysontogenetic bronchiectasis associated with postnatal bronchial dilatation in children with congenitally defective bronchopulmonary tissue is still controversial.

Pathogenesis.

The most important role in the pathogenesis of bronchiectasis is played by disruption of the patency of large (lobar, segmental) bronchi, causing disruption of their drainage function, retention of secretions and the formation of obstructive atelectasis. In children, the cause of the formation of atelectasis may be compression of pliable, and possibly congenitally defective, bronchi by hyperplastic hilar lymph nodes or prolonged blockage of them by a dense mucus plug in acute respiratory infections (banal or hilar pneumonia) or tuberculosis. Atelectasis may also be facilitated by a decrease in surfactant activity, either congenital or associated with an inflammatory process or aspiration (for example, amniotic fluid in a newborn).

Bronchial obstruction and retention of bronchial secretions inevitably lead to the development suppurative process distal to the site of obstruction, which, being the second most important factor in the pathogenesis of bronchiectasis, apparently causes progressive irreversible changes in the walls. A decrease in the resistance of the bronchial walls to the action of the so-called “broncho-dilating forces” (increased endobronchial pressure due to coughing, stretching with accumulated secretions, negative intrapleural pressure, increasing due to a decrease in the volume of the atelectatic part of the lung) leads to a persistent expansion of the lumens of the bronchi. Irreversible changes in the affected part of the bronchial tree retain their significance even after restoration of bronchial patency, as a result of which a periodically aggravated suppurative process occurs chronically in the dilated bronchi with a persistently impaired cleansing function.

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

Classification.

Depending on the forms of bronchial dilatation bronchiectasis is distinguished:

cylindrical,

baggy,

fusiform

mixed.

Between them there are many transitional forms, the assignment of which to one or another type of bronchiectasis is often arbitrary. Bronchiectasis is also divided into atelectatic and not associated with atelectasis.

By clinical course and severity Based on the classification of V. R. Ermolaev (1965), 4 forms (stages) of the disease are distinguished:

• expressed

• complicated

By prevalence process, it is advisable to distinguish between unilateral and bilateral bronchiectasis, indicating the exact localization of changes by segment. Depending on the patient’s condition at the time of examination, the phase of the process should be indicated: exacerbation or remission.

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

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

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

The temperature rises to low-grade levels, usually during periods of exacerbation. High fever, which decreases after expectoration of copious stagnant sputum, is sometimes observed in more severely ill patients. Also, mainly during periods of exacerbations, patients complain of general malaise, lethargy, decreased performance, and mental depression (usually in the presence of foul-smelling sputum and unpleasant odor when breathing).

The appearance of most patients is not very characteristic. Only in severe cases are some delays in physical development and delayed puberty observed in children and adolescents. Cyanosis, as well as club-shaped deformation of the fingers (“clubs”), considered in the past a typical symptom of bronchiectasis, have been rare in recent years.

Diagnostics.

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

On sightseeing radiographs bronchiectasis can be suspected by characteristic cellularity against the background of an enhanced pulmonary pattern, better defined on the sides, as well as by such signs as a decrease in volume and thickening of the shadow of the affected parts of the lung.

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

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

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

Prevention.

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

Differential diagnosis.

Differential diagnosis is carried out with chronic bronchitis, tuberculosis and lung abscess, abnormalities of lung development.

Conservative treatment plays an important role in the treatment of patients with bronchiectasis. The main link of conservative treatment is the sanitation of the bronchial tree, which involves, on the one hand, emptying it of purulent sputum, and on the other, local action of antimicrobial agents on the pyogenic microflora. Along with sanitation by lavage with the help of installations into the affected bronchi through a transnasal catheter or during bronchoscopy of solutions of antiseptics, antibiotics, mucolytics, etc., auxiliary means that promote the discharge of purulent sputum have also retained significant importance: the so-called postural drainage, breathing exercises, vibration chest massage, etc. A properly chosen regimen, restorative procedures, nutritious, protein-rich nutrition, etc. are of great benefit.

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

Radical surgical intervention consists of resection of the affected area, but is not always indicated and cannot cure all patients with bronchiectasis. The optimal age for intervention should be considered 7-14 years, since at a younger age it is not always possible to accurately determine the volume and boundaries.