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Abstract: A 76-year-old male patient with a frequent cough and white mucus sputum for more than 30 years, who kept coughing and coughing up sputum after a slight activity after getting cold 4 days ago, discharging more light yellow sputum, came to our hospital and was clearly diagnosed with bronchiectasis after related examination, and was treated with physical sputum removal and the use of ciprofloxacin hydrochloride tablets, budesonide suspension, acetylcysteine solution for inhalation, and saline. The condition improved afterwards.
Basic information】Male, 76 years old
Disease Type】Bronchiectasis
Hospital】The First Hospital of China Medical University
Date of Consultation】January 2022
Treatment plan】Physical therapy (physical expectoration) + oral medication (ciprofloxacin hydrochloride tablets) + nebulized medication (budesonide suspension for inhalation, acetylcysteine solution for inhalation)
[Treatment period] 2 weeks of inpatient medication, 1 month after discharge to the hospital for review
Treatment effect】Cough and coughing symptoms disappeared and the condition was stable.
I. Initial consultation
The patient is male, 76 years old. He complained of coughing frequently for more than 30 years and then coughing white mucus sputum, which was easily expelled. 4 days ago, he kept coughing and coughing sputum with a lot of sputum after a little activity after getting cold, and the sputum became light yellow in color. On palpation, he found that the lung percussion sound was too clear, and on auscultation, he found low breath sounds in both lungs with scattered sputum sounds, but there were no other abnormal manifestations. Using a high-resolution CT scan of the chest, bronchial dilatation and coarsening were found, and cystic lesions with air-fluid planes within were seen. The initial diagnosis of bronchiectasis was made and the patient was admitted to the hospital for treatment.
II. Treatment history
After the patient was admitted to the hospital and the relevant tests were completed, it was considered that the bronchiectasis was caused by a respiratory tract infection caused by cold. After effective communication with him, we first took sputum for bacterial culture and selected sensitive antibiotics for treatment according to the culture results. And wearing a nebulizer inhalation device, using inhalation budesonide suspension, which can inhibit the continuous progress of respiratory tract infection, and using inhalation acetylcysteine solution, which can dilute sputum and help sputum discharge.
III. Treatment effect
After 1 week of regular nebulized inhalation solution, sputum was seen to change from yellow to white, the yellow sputum due to the considered pathogenic bacteria disappeared, and the pathogenic bacteria in the respiratory tract were suppressed. After 2 weeks, the patient’s cough and sputum disappeared completely, and the lung percussion sound was found to change from over-clear to clear by palpation, and the breath sounds of both lungs were found to be normal by auscultation, and the sputum sounds disappeared. Using the chest high-resolution CT scan, it was found that the bronchial dilatation was reversed and the air-fluid plane inside disappeared. Considering the improvement of the disease, the drug was discontinued and the results of the review 1 month after discharge were normal.
IV. Precautions
The patient’s condition improved after receiving medication and physical sputum removal, and I was happy for him. At the same time, I reminded him that after discharge, he should avoid smoking, stay away from harmful gases or dust particles, reduce contact with pollen, animal hair and other substances that may cause airway allergy, and ventilate the room regularly every day. In addition, do not get wet or cold to avoid infection and recurrence of the disease. Ensure adequate rest and avoid staying up late or overworking, as this may affect the immune defense mechanism of the airway and is detrimental to airway health. In daily life, you can go for a walk outdoors more often and breathe the fresh air of nature, which can maintain a good mood and help prevent disease recurrence.
V. Personal insight
Patients, due to their age, have signs of diminished respiratory system defenses against external pathogenic bacteria, which can increase the risk of infection with pathogenic bacteria after exposure to cold, so they need to pay particular attention to good living and dietary care in daily life to improve their physical fitness as much as possible and avoid disease recurrence. If patients have repeated respiratory infections, which may lead to frequent episodes of bronchiectasis, then eventually the ability of the respiratory tract to repair itself will also be affected.