Bronchiectasis: Symptoms, Treatment, Diagnosis, Causes

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Bronchiectasis

The content of the article:

1. Causes and risk factors
2. Forms of the disease
3. Symptoms
4. Diagnostics
5. Treatment
6. Possible complications and consequences
7. Forecast
8. Prevention

Bronchiectasis is a congenital or acquired inflammatory disease of the respiratory system, accompanied by suppuration in the dilated, deformed and functionally defective bronchi (purulent endobronchitis), leading to irreversible impairment of their drainage function, the development of atelectasis, emphysema and cirrhosis in the regional zone of the lung tissue.

Changes in the bronchi and lungs with bronchiectasis

Bronchiectasis is understood as irreversible, more often segmental expansion of the bronchi, caused by a change in tone or destruction of their walls due to inflammation, local disturbance of trophic processes, sclerosis or hypoplasia.

The debut of bronchiectasis in most cases falls on the age of 5 to 25 years; in women, the disease is recorded less frequently than in men.

The disease occurs primarily and is an independent nosological unit. If bronchiectasis appears as a complication of another disease, they speak of secondary bronchiectasis.

Causes and risk factors

The etiological factors of the disease have not been fully established. The most significant reasons for the development of bronchiectasis are considered to be the following:

• genetically determined structural features of the bronchial tree (inferiority of the wall, underdevelopment of smooth muscles, the connective tissue component of the bronchi, failure of the bronchopulmonary defense system);
• irreversible changes in the structure of the bronchial mucosa, which have arisen against the background of infectious respiratory diseases (both bacterial and viral in nature) transferred in childhood;
• smoking, alcohol abuse of the mother during pregnancy and viral diseases transferred during this period;
• congenital anomalies of the structure of the bronchial tree (about 6% of cases).

Risk factors:

• unfavorable climatic conditions in the area of residence;
• unfavorable ecological situation;
• occupational hazards (industrial contact with toxic and aggressive volatile substances, dust, suspensions, mists);
• smoking, alcohol abuse;
• chronic diseases of the bronchopulmonary zone;
• hard physical work.

Structural changes in the lungs with bronchiectactic disease

As a result of exposure to causal factors (in the presence of aggravating risk factors), structural and functional changes in the bronchial tree occur. Bronchial patency is impaired, which leads to a delay in the adequate evacuation of bronchial secretions; in the bronchi, inflammatory changes develop, which, when progressed, can lead to degeneration of cartilaginous plates, smooth muscle tissue, hardening of the bronchial wall. Violation of coughing, stagnation and infection of the secretion in the dilated bronchi entail the appearance of characteristic signs of the disease.

Forms of the disease

Classification of bronchiectasis according to the form of bronchial dilatation:

• cylindrical;
• saccular;
• fusiform;
• mixed.

Varieties of bronchiectasis in the form of bronchial expansion

According to the clinical course (severity), bronchiectasis are:

• light form;
• moderate;
• severe form;
• complicated form.

Depending on the prevalence of the process:

• one-sided;
• double-sided.

Bronchiectasis occurs with alternating phases of exacerbation and remission.

Symptoms

The main signs of bronchiectasis:

• cough with purulent, offensive sputum;
• hemoptysis (in about 1/3 of patients);
• shortness of breath (mainly with physical exertion, increases as the disease progresses);
• chest pain;
• increased body temperature, weakness, sweating, lethargy, headache during an exacerbation.

The main symptoms of bronchiectactic disease

Sputum in patients with bronchiectasis has a putrid odor, leaves with a mouthful (from 50 to 500 ml per day), in the greatest amount it is separated in the morning after getting up or when taking a certain position of the body (hanging or with the head of the bed lowered). During the period of remission, the amount of sputum separated is significantly reduced; in some patients, sputum outside exacerbations is completely absent.

Hemoptysis often worries a person with an exacerbation of the disease or with intense physical exertion. In rare cases, it may be the only manifestation of the disease (with the so-called dry bronchiectasis).

Objective examination of patients:

• children lagging behind in physical development, low body weight, muscle wasting;
• characteristic changes in fingers and nails (symptoms of drumsticks and watch glasses);
• cyanotic staining of the skin and visible mucous membranes;
• uneven participation of the chest in the act of breathing (half lag on the affected side).

Diagnostics

Diagnosis of bronchiectasis includes:

• collection of anamnesis (prolonged cough with purulent sputum);
• objective research data;
• auscultation (during the period of exacerbation above the lesion, hard breathing, variegated wet rales, decreasing or disappearing after vigorous coughing and sputum discharge are heard);
• a general blood test (leukocytosis with a neutrophilic shift to the left, an increase in ESR are detected);
• biochemical blood test [an increase in the content of sialic acids, fibrin, seromucoid, acute phase proteins (nonspecific signs of the inflammatory process)];
• radiography of the lungs [reveals deformation and strengthening of the pulmonary pattern, cellular pulmonary pattern in the region of the lower segments, thin-walled cyst-like enlightenment (cavities), sometimes with fluid, a decrease in the volume (wrinkling) of the affected segments, an increase in the transparency of healthy segments of the lung, "amputation" of the lung root, the presence of indirect signs of bronchiectasis];
• bronchography with a contrast agent (the expansion of the bronchi of various shapes, their convergence and the absence of filling with a contrast agent of the branches located distal to the bronchiectasis are determined);
• bronchoscopy (the phenomena of purulent endobronchitis are established);
• serial angiopulmonography (anatomical changes in the vessels of the lungs and hemodynamic disorders in the pulmonary circulation are revealed);
• bronchial arteriography (for the presence of anastomoses between bronchial and pulmonary vessels);
• spirography (violation of external respiration is determined).

CT imaging of bronchiectasis

Treatment

Complex therapy of bronchiectasis:

• passive and active sanitation of the bronchial tree, restoration of the drainage of bronchial secretions;
• pharmacotherapy (antibacterial, mucolytic drugs, expectorants, bronchodilators, immunostimulants, immunomodulators);
• aerobic physical training, breathing exercises;
• Spa treatment.

As part of the complex treatment of bronchiectactic disease, breathing exercises are shown

In the absence of the effect of conservative therapy, surgical intervention is recommended.

Possible complications and consequences

Complications of bronchiectasis can be:

• respiratory failure;
• chronic cor pulmonale;
• pulmonary hypertension;
• pulmonary bleeding;
• amyloidosis;
• myocardial dystrophy;
• emphysema of the lungs.

Forecast

The prognosis depends on the multiplicity of bronchiectasis, the severity and the presence of complications. It is favorable with a timely diagnosis, full-fledged complex therapy and worsens with the development of complications (in particular, the involvement of the cardiovascular system in the pathological process).

Prevention

In order to reduce the risk of developing bronchiectasis, it is necessary:

• timely treat respiratory diseases in children;
• carry out seasonal influenza vaccination;
• vaccinate against pneumococcal infection in the presence of a disease (in order to prevent exacerbation);
• avoid exposure to risk factors;
• give up smoking, alcohol abuse (they contribute to a significant deterioration in bronchopulmonary protection).

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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author

Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!