Bronchiectasis mostly occurs after acute or chronic respiratory infections and bronchial obstruction, resulting in repeated bronchial inflammation and structural destruction of the bronchial wall, causing abnormal and persistent bronchial dilatation. The clinical manifestations are mainly chronic cough, coughing up large amounts of pus sputum and/or repeated hemoptysis.
I. Clinical symptoms
1. Chronic cough and large amount of pus sputum
This is due to the accumulation of secretion at the site of bronchial dilatation and the cough and sputum discharge caused by the secretion stimulating the bronchial mucosa when changing the body position. Its severity can be estimated by sputum volume: mild, <10 ml >150 ml/d. In acute infection episodes, the volume of yellow-green pus sputum can reach hundreds of ml per day. Sputum collected in glass bottles at the time of infection appears characteristically stratified after resting: foam in the upper layer, suspended purulent components in the lower layer, cloudy mucus in the middle layer, and necrotic tissue deposits in the lower layer. The common pathogens causing the infection are Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Catamorax.
2. Recurrent hemoptysis
Hemoptysis varies from blood in the sputum to massive hemoptysis in 50% to 70% of patients, and the amount of hemoptysis is sometimes inconsistent with the severity of the disease and the extent of the lesion. Some patients have recurrent hemoptysis as the only symptom, which is clinically known as “dry bronchiectasis”, and the lesions are mostly located in the upper lobe bronchi with good drainage.
3.Recurrent pulmonary infections
It is characterized by recurrent pneumonia in the same lung segment that does not heal. This is due to the loss of function of the dilated bronchus to clear secretions, poor drainage, and easy recurrence of infection.
4. Chronic infection poisoning symptoms
If the infection is repeated, fever, malaise, loss of appetite, emaciation, anemia, etc. may occur, and children may be affected in development.
Second, physical signs
Early or dry bronchiectasis may have no abnormal pulmonary signs, but when the lesion is heavy or secondary infection is present, a fixed and persistent limited coarse wet stalls in the lower chest and back can often be heard.
III. Diagnosis
The diagnosis of bronchiectasis can be clearly made based on the history of recurrent purulent sputum and hemoptysis and the history of previous respiratory infections that induce bronchiectasis, and HRCT showing abnormal imaging changes of bronchiectasis. Fibrinoscopy or local bronchography can clarify the site of bleeding, dilatation or obstruction. Local lavage can also be performed via fibrinoscopy, and specimens of lavage fluid can be taken for smear, bacteriological and cytological examination to further assist diagnosis and guide treatment.
IV. Treatment
1.Treatment of the underlying disease
Active pulmonary tuberculosis with bronchiectasis should be actively treated with anti-tuberculosis, and low immunoglobulinemia can be treated with immunoglobulin replacement therapy.
2. Control of infection
Antibiotics should be applied when there are signs of acute infection such as increase in sputum volume and its purulent components. The application of antibiotics can be guided by sputum Gram stain and sputum culture, but empirical treatment is often required at the beginning.
3.Improve airflow restriction
Bronchodilators can improve airflow restriction and help to clear secretions.
4.Clearance of airway secretions
Sputum-clearing drugs, as well as chest physiotherapy such as vibration, back patting and postural drainage can help clear airway secretions.
5.Surgical treatment
If the bronchial dilatation is limited and recurrent recurrence is still stubborn after adequate medical treatment, surgical operation can be considered. Patients with recurrent coughing and hemoptysis are given surgery to determine the site of the lesion, and there are clinical cases of emergency surgery for hemoptysis. Bronchiectasis is generally not easy to improve once it is formed, and it is recurrent and gradually aggravated, so thoracic surgery is an important means to stop the progress of the disease or to cure it.