Bronchiectasis of the lungs: what is it, causes, symptoms, treatment

Bronchiectasis (bronchiectasis) is a chronic pathology of the bronchopulmonary system, which is based on morphological and functional changes in the bronchial wall.

Symptoms of the disease manifest themselves in childhood and adolescence after suffering bronchopneumonia or infection, men are more likely to suffer.

What is bronchiectasis (bronchiectasis)?

The pathology is based on the destruction of the walls of the bronchial tree, which leads to the appearance of saccular or tubular expansions, which are called bronchiectasis.

They can be in one or more segments (lobes of the lung), more often found in the lower sections.

The disease is accompanied by a recurrent purulent-inflammatory process. Bronchiectasis is filled with mucous contents, which become infected and excreted in the form of sputum.

If, for some reason, the lumen of the bronchus becomes clogged, its walls swell, an additional network of capillaries develops in these areas. Pathological changes lead to hemoptysis and pulmonary hemorrhage.

Bronchiectasis eventually provoke pathological changes in the lung tissue.

ICD-10 code

Bronchiectasis belongs to ICD class 10 - respiratory diseases, to the section of chronic diseases of the lower respiratory tract - J40-J47.

ICD 10 code - J47.

Etiology

Primary bronchiectasias appear due to genetically determined inferiority of the bronchial walls - this is the weakness of smooth muscle and connective tissue, the lack of protective factors.

Congenital anomalies of the bronchial tree also lead to the appearance of enlargements. Primary bronchiectasis is less common secondary.

The causes of acquired bronchiectasis are inflammatory diseases (bronchitis, pulmonary tuberculosis, pneumonia, lung abscesses), tumor lesion.

There have been cases of illness after a foreign body enters the bronchi.

Contributing factors are:

• immunodeficiency states;
• smoking during pregnancy and transferred during this period ARVI;
• nasopharyngeal infections in children (sinusitis, tonsillitis, proliferation of adenoid tissue).

Pathogenesis

In the development of the disease, factors are distinguished:

• violation of the patency of the bronchi (compression by their hilar lymph nodes, blockage of a mucous plug, obstruction), as a result of which secretion is disrupted;
• stagnation of the contents of the bronchi occurs, microorganisms multiply in it, inflammation develops;
• obstructive atelectasis occurs - wrinkling of the area of ​​the lung, to which the altered bronchus leads.

The following mechanisms lead to inflammation of bronchiectasis:

• congestion, impaired expectoration;
• decreased local immunity (bacteria multiply - Pseudomonas aeruginosa, Klebsiella, Staphylococcus, Mycoplasma, Proteus).

The altered bronchial walls become compliant, stretch and expand. In them, cartilage plastics are destroyed, smooth muscle fibers are replaced by connective tissue.

The work of the cylindrical epithelium is disrupted - it stops pushing the secret out. These mechanisms lead to a persistent change in the bronchial tube, as a result of which bronchiectasis appears in the lungs.

Classification

• Bronchiectasias are in the form of a sac, tubule, spindle and mixed form.
• By origin - congenital and acquired anomalies.
• According to the severity of the disease - mild, moderate, severe, complicated form.
• In phase, exacerbation and remission are distinguished.
• Depending on the distribution - unilateral and bilateral lesions.

Classification of complications: hemoptysis, development of cor pulmonale, amyloidosis, pulmonary heart failure.

Bronchiectasis symptoms

Symptoms do not depend on whether it is a congenital or acquired defect. The main role is played by the prevalence of the lesion, the degree of dilatation of the bronchus, the presence of pneumosclerosis, atelectasis. Small bronchiectasis can exist for a long time without clinical symptoms.

The main symptom of the disease is a cough with purulent discharge. Exacerbations occur against the background of a cold or a viral disease. In mild forms, the temperature remains subfebrile, in severe cases, fever develops. Symptoms are aggravated, then subside, the disease is recurrent.

A lot of sputum is secreted with bronchiectasis - from 20 ml to half a liter, she comes out with a mouthful. Strengthens its discharge in the morning or when giving the "correct" position of the body - on the sore side with the head down. When standing, the sputum is divided into 2 layers: the upper one is opalescent, contains an admixture of saliva, the lower one is purulent.

In the chronic form of the disease, sputum acquires a fetid odor, and patients also complain of a putrid odor in the mouth.

Concomitant symptoms of the disease:

• dyspneaaccompanying physical activity;
• cyanosis of the nasolabial triangle - in the presence of pulmonary heart failure;
• anemia;
• earthy complexion;
• weight loss, lack of height and weight;
• pain in the sternum - if the pleura is involved.

Changes in the nails in the form of "watch glasses" are now rare and only in severe cases. With the "dry" form of the disease, purulent discharge may not be, the disease is diagnosed when hemoptysis occurs.

A prolonged course of bronchiectasis leads to the development of myocardial dystrophy, which manifests itself in the form of pain in the heart, hypertension, swelling, shortness of breath, tachycardia of the heart.

Diagnosis of bronchiectasis

During the examination of the patient, the following data are observed:

• during auscultation, various wet and dry rales are heard, they decrease or disappear after sputum is excreted;
• with percussion, there is a dullness of sound from the side of the affected lung;
• violation of the mobility of the chest, lag of the sick side in the act of breathing.

X-ray of the lungs reveals a change in the pattern, "amputation" of the lung root, compression of the lung tissue by atelectasis.

During bronchoscopy, the presence of abundant viscous secretion, the phenomenon of endobronchitis, is detected. The method is not only diagnostic, but also curative. During bronchoscopy, material is taken for bacteriological and cytological examination, the bronchial tree is sanitized with the infusion of antiseptic, mucolytic agents, antibiotics.

Bronchography - study of the bronchial tree using a contrast agent. Bronchiectasis is detected on the images, their shape, number, localization and size are determined. The areas of the bronchi located below the dilatations are not filled with a radiopaque substance, which is one of the diagnostic signs. Before performing bronchography, you need to perform bronchoscopic sanitation.

Computed tomography most accurately shows not only the defeat of the large bronchi, but also of the small bronchioles, where the contrast agent does not enter. In addition, CT does not require anesthesia as during bronchography.

Treatment of bronchiectasis

It is carried out by conservative and surgical methods.

Conservative therapy in the presence of purulent sputum involves the appointment of oral and intravenous antibiotics. A group of cephalosporins and semi-synthetic penicillins is used. At the same time, drainage and sanitation of the bronchial tree is carried out using a bronchoscope - washing, removal of sputum. Antibiotics, enzymes (trypsin), mucolytics (bromhexine, acetylcysteine) are poured into the bronchi.

To improve the discharge of sputum, patients are assigned drainage by raising the foot end of the bed. Other methods are also recommended:

• vibration massage;
• breathing exercises;
• inhalation with a nebulizer.

It is possible to treat the disease with physiotherapy methods outside the period of exacerbation, when there is no fever and purulent discharge from the bronchi.

Surgical treatment is resorted to when conservative methods are ineffective and the patient's condition worsens. Removal of the lobe of the lung is performed - lobectomy. In a bilateral process, the operation takes place in stages: first, a section of the lung is removed on one side, and after a few months - on the other. Sometimes surgery is performed for health reasons, when there is massive pulmonary bleeding.

Treatment with folk remedies

They are used in addition to the main treatment prescribed by the doctor. Anti-inflammatory and expectorants.

Badger fat

Single dose - 1 tbsp. spoon, put it in a glass of hot milk and drink it. Another way is to sprinkle generous amounts of sugar on top of the fat and wash down with hot milk. The method promotes the discharge of sputum, but it is used for no more than 30 days, since a fatty product negatively affects the liver. Treatment can be resumed after a month's break.

Anti-bronchiectasis juices

From black radish. It is accepted 2 times a day a dessert spoon before meals. You can add honey to it.

From plantain. It is diluted with honey in a proportion of 2 parts of juice and 1 part honey. Drink a tablespoon several times a day.

Fresh carrot juice is mixed in equal parts with milk, put 2 tbsp. l. linden honey and insist for 6 hours. Consumed up to 6 times a day for a tablespoon.

Infusion with aloe

Several leaves of the plant are poured over with boiling water and lightly crushed, while trying not to release the juice. Pour wine and leave for 4 days. Drink 1 tbsp. spoon three times a day.

Treatment with folk remedies is carried out with the aim of freeing the lungs from phlegm. For this, herbal decoctions with an expectorant effect are used: with coltsfoot, wild rosemary, sage, licorice. They are only taken with a wet cough.

Prophylaxis

Its principles for bronchiectasis are as follows:

• strengthening the immune system;
• a complete diet with a sufficient amount of vitamins and protein;
• breathing exercises on a regular basis;
• prevention of colds and viral infections.

Forecast

Patients are always interested in: is it possible to cure bronchiectasis or not? Changes in the walls of the bronchi are irreversible and it is impossible to completely eliminate the defect. However, with the help of progressive methods of treatment and prevention, the number of relapses of the disease decreases, the patient's quality of life improves.