Bronchiectasis is a common chronic disease of the respiratory system, and many patients are confused by the name “bronchiectasis” and ask, “Doctor, what is bronchiectasis and is it serious?” Such questions are asked. It is not easy to explain in the limited time when many patients are waiting to be seen, and it would take half a day to explain clearly. Here are some basic facts about this disease.
What is bronchiectasis?
Bronchiectasis is caused by chronic purulent inflammation and fibrosis of the bronchi and surrounding lung tissue, resulting in deformation and persistent dilatation of the bronchi. Typical symptoms include chronic cough, coughing up large amounts of purulent sputum and recurrent hemoptysis.
Etiology
1, Infection: Infection is the most common cause of bronchiectasis.
2. Congenital and hereditary diseases: The most common hereditary disease causing bronchiectasis is cystic fibrosis.
3, cilia abnormalities: abnormal cilia structure and function is an important cause of bronchiectasis.
4, immunodeficiency: immunoglobular deficiency can cause bronchiectasis.
5, foreign body inhalation: the long-term presence of foreign bodies in the airways can lead to chronic obstruction and inflammation, secondary to bronchiectasis.
Clinical manifestations
The course of bronchiectasis is mostly chronic and can occur at any age. A history of measles, pertussis or post-influenza pneumonia in early childhood, or a history of tuberculosis, endobronchial tuberculosis, or pulmonary fibrosis.
Symptoms
Typical symptoms are chronic cough, coughing up large amounts of pus sputum and recurrent hemoptysis.
Cough: chronic cough that does not resolve over time.
Coughing up sputum: it is most frequent in the morning and before going to bed, and the sputum is mostly yellow-green and pus-like and may have a foul odor.
Hemoptysis: Patients often have varying degrees of hemoptysis. In some patients, hemoptysis may be the first and only complaint, and in severe cases, hemoptysis may lead to hemorrhagic shock or death from clots blocking the airway.
Bronchiectasis may lead to obstructive emphysema with dyspnea, shortness of breath or cyanosis, and in advanced stages, pulmonary heart disease and cardiopulmonary failure.
Signs Patients can hear localized wet rales at the base of the lungs, which are evident in acute infections and still persist in remission, which is one of the characteristic manifestations of bronchiectasis.
Bronchiectasis examination
1, hypoxemia.
2, pulmonary function tests: manifesting as obstructive ventilation disorders.
3.X-ray chest film: there may be no abnormality or lung texture increase, thickening and disorderly arrangement.
4.CT examination of the chest
The CT performance of bronchiectasis is related to the type of bronchiectasis and the presence or absence of infection. Typical CT manifestations include bronchial cystic or columnar dilatation, which is an important imaging basis for the diagnosis of bronchial dilatation.
5. Fiberoptic bronchoscopy
Fiberoptic bronchoscopy can clarify bronchial dilatation, bleeding and obstruction sites, and can perform local lavage and take lavage fluid for smear examination or bacterial culture to assist diagnosis and guide treatment.
Diagnosis
1. Hourly history of measles, pertussis or post-influenza pneumonia, or history of tuberculosis, etc.
2. Symptoms of long-term chronic cough, coughing up pus or repeated hemoptysis.
3. Physical examination of the lungs with fixed and persistent wet rales on auscultation.
4. Chest imaging: … X-ray examination CT findings suggest bronchiectasis.
Complications
Bronchiectasis often causes pneumonia and lung abscess due to complications of septic bacterial infection. When extensive fibrosis of lung tissue occurs, it can lead to increased pulmonary artery circulatory resistance and pulmonary hypertension, causing chronic pulmonary heart disease with manifestations such as edema and increased dyspnea.
Bronchiectasis treatment
1. Removal of excessive secretions: postural drainage and nebulized inhalation depending on the location of the lesion. Local lavage by fiberoptic bronchoscopy if available.
2, anti-infection: the common pathogenic bacteria are Haemophilus influenzae, Klebsiella pneumoniae, Pseudomonas aeruginosa and other gram-negative bacilli, antibiotics can be selected for these pathogens.
3, improve immunity: available gammaglobulin treatment.
4.Surgical treatment: recurrent infections that are not easily controlled by medication can be considered for surgical treatment.