Bronchiectasis (bronchiectasis) is a common chronic infectious bronchial disease caused by abnormal expansion of the bronchial tree, mostly secondary to inhalation tract infection and bronchial obstruction, resulting in destruction of the bronchial wall and persistent lumen expansion and deformation. The clinical manifestations are chronic cough with copious mucopurulent sputum and recurrent hemoptysis.
Infection not only destroys the bronchial tissues, especially smooth muscle fibers and elastic fibers, weakening the wall support, but also aggravates the infection due to mucosal congestion, edema and increased secretions, resulting in poor drainage and lumen obstruction. In addition, increased pressure in the lumen during coughing, peribronchial fiber growth, and negative pressure in the thoracic cavity during pulmonary atelectasis also contribute to the occurrence and development of bronchiectasis (because the bronchial walls of infants are weak and the lumen is narrow and easily obstructed, infections such as measles, whooping cough, and bronchopneumonia are the most common causes of bronchiectasis).
Diagnostic procedure of bronchiectasis
Diagnostic criteria.
1, history of chronic cough with large amount of (pus) sputum, or repeated hemoptysis, and signs such as wet rales or pestle-like fingers (toes) in the lung lesion.
2, Chest X-ray showed multiple irregular ring-shaped translucent shadows in the coarse and disorganized lung texture or curly shadows along the bronchi.
3, Chest CT shows columnar dilatation of bronchial wall thickening or cystic changes in bunches and clusters.
4.Bronchography shows dilated cystic, columnar, or cystic-columnar bronchial shadows.
Those with item 1 or one of items 2-4 can be diagnosed with bronchiectasis.
Treatment.
Removal of causative factors, (e.g., removal of damage that can obstruct the bronchi, in addition to gamma globulin supplementation for those with low immunoglobulin), should control symptoms and prevent further disease progression; control of infection and basic supportive therapy – maintain good pulmonary drainage and relieve bronchospasm and small airway disease.
1.Control of infection
(1) Immunotherapy: basic immunotherapy in children against potential pathogens that can cause bronchial expansion of some diseases (e.g. influenza, pertussis, measles and other vaccines).
(2) Active anti-infection and treatment of coexisting acute pneumonia and acute bronchitis. (pathogens can refer to sputum Gram stain or culture results, often Haemophilus influenzae, Streptococcus pneumoniae)
2. drainage: postural sputum drainage and chest snapping, expectorants
Especially for patients with sputum >30-50 ml/day
3, hydration and nebulization
4.Bronchodilators.
(1) improve the clearance of mucosal cilia of the whistle tract.
(2) facilitate the clearance of the accumulated secretions in the whistle tract.
5, smoking cessation.
6, surgical treatment: commonly used in young, limited lesions (can do lung segment, lobectomy, both sides of the lung lobectomy poor efficacy).