Bronchiectasis - irreversible bronchodilation resulting suppurative inflammatory destruction of the bronchial wall.
Classification
In terms of appearance:
- Congenital bronchiectasis;
- Acquired bronchiectasis.
Due to the occurrence of
- Atelektaticheskaya bronchiectasis - bronchiectasis, pulmonary atelectasis developing zone, and characterized by the uniform expansion of many bronchial branches; while lung tissue takes the form of "honeycomb".
- Destructive bronchiectasis - usually sacculated bronchiectasis arising with festering bronchus and its surrounding tissues.
- Postbronhiticheskaya bronchiectasis - bronchiectasis arising in the outcome of chronic bronchitis due to degenerative changes in the bronchial walls or end acute bronchitis because of purulent fusion of the wall of the bronchus or disorders of its tone.
- Poststenotic bronchiectasis - bronchiectasis arising on bronchial constriction due to the stagnation of mucus and atony of the walls.
- Retention bronchiectasis - bronchiectasis that develops due to loss of tone of bronchial wall or its extension bronchial secretions (e.g., cystic fibrosis).
Manifestations of bronchiectasis
Cough with expectoration of purulent arising with characteristic regularity in the morning upon awakening and in the evening at bedtime;
- hemoptysis;
- Pain in the chest when breathing;
- Barrel chest;
- Nails in the form of "time windows";
- finger deformation in the form of "drumsticks."
Diagnostics
- General blood analysis;
- Sputum;
- Determination of the content of electrolytes in sweat fluid: Chloride concentration over 60mEkv / l in children and more 80mEkv / l in adult characteristic of cystic fibrosis;
- X-ray examinations. Bronchography suitable non-acute infection or hemoptysis, t. To. The bronchial secretion blocks the passage of the contrast agent, and pneumonia causing a temporary extension of the bronchi. Contraindications - intolerance of iodine;
- CT scan;
- Bronchoscopy.
Treatment of bronchiectasis
The main direction in complex conservative treatment of bronchiectasis is the purification of the bronchial tree.
purification methods are divided into
- passive (drainage position and application expectorants)
- active (suction bronchi content, their washing and the subsequent introduction of drugs into the bronchi).
Positional drainage is carried out in accordance with the location of bronchiectasis.
When basal bronchiectasis to remove secretions from the bronchial tubes have to significantly raise the foot end of the bed or outweigh the body over the edge of the bed.
When the location of bronchiectasis in IV and V segments patient laid on its back with the head end lowered and the bed under the patient side enclose pillow.
Positional drainage is carried out at least 2 times a day (in the morning after waking and at night before going to bed). During exacerbation of bronchiectasis drainage should be carried out several times, trying to more fully release the bronchial tree of the content.
Promotes discharge of phlegm and breathing exercises, vibration massage chest. drainage effect is enhanced by the appointment of expectorants and mokrotorazzhizhayuschih drugs.
Acetylcysteine administered 2-3 times a day for children up to 5 years - 100 mg per reception, older than 5 years and adults - 200 mg. ACC 600 Long administered 1 time per day, but only for children older than 12 years and adults. Duration of the course depends on the nature and course of the disease.
Bromhexinum: children from 3 to 5 years and 4 mg 3 times a day, from 6 to 12 years - to 8 mg 3 times a day, teenagers and adults - 12 mg 3 times a day.
Ambroxol: dose for children under 5 years of age is 7.5 mg 2-3 times a day for children older than 5 years - 15 mg 3 times a day. Patients over 12 years of ambroxol administered 30 mg 3 times a day or in retard capsule 1 day.
The use of capsules retard is particularly warranted in patients with chronic respiratory diseases. The duration of treatment is from 1 to 3-4 weeks depending on the effect and nature of the disease.
Antimicrobial drugs are prescribed according to the nature and sensitivity of the microbes that caused the abscess.
To obtain the desired effect, and achieve a high antibiotic concentration in the ulcer area necessary to appoint two or three antibiotics with a different spectrum of activity in their maximum concentrations.
Surgical treatment is indicated in all types of bronchiectasis and the presence of a picture of chronic inflammation in patients between the ages of 5-6 months to 40 years.
Older than 40 years of operation is shown in complicated forms of bronchiectasis: pulmonary hemorrhage, abscess formation, persistent atelectasis, aspergilloma.
