Long-term treatment of bronchiectasis co-infection

  Winter illnesses and summer treatment is an important feature of traditional Chinese medicine, which takes advantage of the high temperature in summer, when the body’s yang energy is abundant, to adjust the balance of the body’s yin and yang, so that some chronic diseases can be alleviated and relieved. According to the theory of “nourishing yang in spring and summer, nourishing yin in autumn and winter”, “winter illnesses and summer treatment” is to make use of summer when the body’s yang energy is at its peak to treat certain diseases that are deficient and cold in nature, so as to maximize the effect of overcoming cold with yang and achieve both the symptoms and the root cause, as well as preventive health care. “Winter diseases” refers to certain chronic diseases that tend to occur in winter or worsen in winter, such as chronic obstructive pulmonary disease (chronic bronchitis, emphysema), bronchial asthma, rheumatic and rheumatoid arthritis, cold phobia in the elderly, and diseases belonging to the spleen and stomach deficiency cold category in Chinese medicine. The “summer treatment” refers to the remission of these chronic diseases in summer. While they are in remission, we can take advantage of the remission period to apply dialectical treatment to prevent acute exacerbation/recurrence of diseases in winter and reduce the symptoms of acute exacerbation through internal and external application of some prescription drugs.  The best target of “winter disease summer treatment” is patients with chronic whistle system diseases, mainly chronic obstructive pulmonary disease (chronic bronchitis / emphysema), bronchial asthma, allergic rhinitis, cough variant cough and other Chinese medicine identified as Yang deficiency-based, or cold-heat mixed with cold-based patients; also suitable for cold, wind, easy to It is also suitable for patients who are afraid of cold, wind, and are prone to cold or repeated cold in winter. The contraindications of “winter and summer treatment” include children under 3 years old, pregnant women, patients with malignant tumors, patients with active tuberculosis, patients with bronchiectasis, patients with fever, patients with acute infectious diseases, and patients with yin deficiency and fire.  Bronchiectasis is a chronic inflammatory disease of the airways caused by pathological, permanent expansion of the bronchial tree from various causes, leading to recurrent purulent infections. Bronchiectasis is a chronic purulent whistleblowing disease (CSLD) with a long and irreversible course, which can seriously impair the lung function and quality of life of patients due to the aggravation of recurrent infections. In recent years, with the popularity of high-resolution CT (HRCT), bronchiectasis is found in about 10-30% of patients with chronic whistleblowing diseases that were clinically diagnosed as chronic bronchitis or emphysema.  Most patients with bronchiectasis combined with bacterial infection are in a relatively stable stage in summer, when the symptoms of cough, coughing purulent sputum and shortness of breath are significantly reduced compared to winter, and the quality of life is relatively better, making it the best season to carry out long-term treatment!  Pharmacologists have found that macrolide antibiotics (e.g. azithromycin, clarithromycin) have not only antibacterial but also anti-inflammatory and immunomodulatory effects. In recent years, several large-scale multinational clinical studies in the United States and Australia have shown that long-term low-dose macrolide antibiotics have good efficacy in the treatment of chronic whistling tract diseases such as diffuse panbronchiolitis, cystic pulmonary fibrosis disease, bronchial asthma and bronchiectasis. We started 12-month maintenance treatment with low-dose azithromycin in some adult patients with bronchiectasis in the summer of 2012, and regularly observed the changes of their whistle symptoms, lung function and quality of life, and found that the patients’ quality of life improved after 16 weeks of azithromycin treatment, and the symptoms of whistle infection gradually decreased and lung function improved. After continuing azithromycin treatment until 1 year, the patient’s quality of life further improved and the inflammation level of blood tests returned to near normal. The next step in our current work plan is to further map out the individualized dose of therapeutic drugs, the duration of treatment, and the occurrence of adverse reactions, and therefore recruit adult patients with this disease on a long-term basis.  In cases of limited bronchiectasis with recurrent infections and hemoptysis, surgical treatment can prevent the spread of bronchial infections and exacerbation of the disease. However, for patients with bilobar bronchiectasis, which is common in current clinical practice, long-term medication supplemented with physical fitness can achieve the effect of “winter and summer treatment” similar to that of Chinese medicine.