The Bronkhoektatichesky disease is the disease which is characterized by irreversible changes (expansion, deformations) of bronchial tubes which are followed by functional inferiority and development of chronic pyoinflammatory process in a bronchial tree. The main display of a bronkhoektatichesky disease is the constant cough which is followed by allocation of a purulent phlegm. The blood spitting and even development of pulmonary bleeding is possible. Over time the bronkhoektatichesky disease can result in respiratory insufficiency and anemia, at children - to lag in physical development. The diagnostic algorithm includes fizikalny inspection of the patient, an auskultation of lungs, a X-ray analysis of bodies of a chest cavity, a bronkhoskopiya, the analysis of a phlegm, a bronchography, research FVD. Treatment of a bronkhoektatichesky disease is directed to knocking over of pyoinflammatory process in bronchial tubes and sanitation of a bronchial tree.
Bronkhoektatichesky disease (BEB) – the disease which is characterized by irreversible changes (expansion, deformations) of bronchial tubes which are followed by functional inferiority and development of chronic pyoinflammatory process in a bronchial tree. Modified bronchial tubes carry the name of bronkhoektaz (or bronkhoektaziya). The Bronkhoektatichesky disease occurs at 0,5-1,5% of the population, developing mainly at children's and young age (from 5 to 25 years). The disease proceeds in the form of recurrent bronchopulmonary infections and is followed by constant cough with a phlegm. Damage of bronchial tubes at a bronkhoektatichesky disease can be limited to one segment or a share of a lung or to be widespread.
As the reason of primary bronkhoektaz serve congenital malformations of bronchial tubes – an underdevelopment (dysplasia) of a bronchial wall. The congenital bronkhoektatichesky disease meets much less often than the acquired bronkhoektaz. The acquired bronkhoektaza result from the frequent bronchopulmonary infections postponed at children's age – bronchial pneumonia, the chronic deforming bronchitis, tuberculosis or abscess of a lung. Sometimes the bronkhoektatichesky disease develops owing to hit of foreign matters in a gleam of bronchial tubes.
The chronic inflammation of a bronchial tree causes changes in mucous and muscular layers of bronchial tubes, and also in peribronkhialny fabric. Becoming pliable, the struck walls of bronchial tubes extend. Pneumosclerous processes after the postponed bronchitis, pneumonia, tuberculosis or abscess of a lung bring in pulmonary fabric to wrinkling of a pulmonary parenchyma and stretching, deformation of bronchial walls. Destructive processes also strike the nervous terminations, arteriola and capillaries feeding bronchial tubes.
Spindle-shaped and cylindrical bronkhoektaza affect large and average bronchial tubes, meshotchaty – smaller. Not infected bronkhoektaza, not numerous and small by the sizes, can clinically not prove a long time. With accession of an infection and development of inflammatory process of a bronkhoektaza are filled with the purulent phlegm supporting a chronic inflammation in modified bronchial tubes. So the bronkhoektatichesky disease develops. Maintenance of a purulent inflammation in bronchial tubes is promoted by bronchial obstruction, difficulty of self-cleaning of a bronchial tree, decrease in protective mechanisms of bronchopulmonary system, chronic purulent processes in a nasopharynx.
According to the standard classification of a bronkhoektaza differ:
- by the form deformations of bronchial tubes – meshotchaty, cylindrical, spindle-shaped and mixed;
- on extent of distribution of pathological process - unilateral and bilateral (with the indication of a segment or share of a lung);
- on a phase of a course of a bronkhoektatichesky disease – an aggravation and remission;
- on a condition of a parenchyma of the interested department of a lung – atelektatichesky and not followed atelektazy;
- for the development reasons – primary (congenital) and secondary (acquired);
- in a clinical form of a bronkhoektatichesky disease – the easy, expressed and heavy forms.
- The easy form of a bronkhoektatichesky disease is characterized by 1-2 aggravations in a year, long remissions during which periods patients feel almost healthy and efficient.
- Ezhesezonny, longer aggravations, with office from 50 to 200 ml of a purulent phlegm in days are characteristic of the expressed form of a bronkhoektatichesky disease. During the periods of remissions cough with a phlegm, moderate short wind, decrease in working capacity remains.
- At a severe form of a bronkhoektatichesky disease frequent, long aggravations with temperature reaction and short-term remissions are observed. The quantity of the allocated phlegm increases to 200 ml, the phlegm often has a putrefactive smell. Working capacity during remissions is kept.
Symptoms of a bronkhoektatichesky disease
As the main display of a bronkhoektatichesky disease serves constant cough with an otkhozhdeniye of a purulent phlegm with an unpleasant smell. Especially plentiful allocation of a phlegm happens in the mornings ("a full mouth") or at the correct drainage situation (on the struck side to the lowered head end). The quantity of a phlegm can reach several hundred milliliters. During the day cough renews in process of accumulation in phlegm bronchial tubes. Cough can lead to a rupture of blood vessels in the thinned bronchial walls that is followed by a blood spitting, and when traumatizing large vessels – pulmonary bleeding.
The chronic purulent inflammation of a bronchial tree causes intoxication and exhaustion of an organism. At patients with a bronkhoektatichesky disease anemia, weight loss, the general weakness, pallor of integuments develops, lag of physical and sexual development of children is observed. Respiratory insufficiency at a bronkhoektatichesky disease is shown by cyanosis, short wind, a thickening of trailer phalanxes of fingers of hands in the form of "drum sticks" and nails in the form of "hour fragments of glass", deformation of a thorax.
Frequency and duration of exacerbations of a bronkhoektatichesky disease depend on a clinical form of a disease. Aggravations proceed in the form of a bronchopulmonary infection with temperature increase of a body, increase in quantity of the separated phlegm. Even out of an exacerbation of a bronkhoektatichesky disease productive damp cough with a phlegm remains.
The complicated course of a bronkhoektatichesky disease is characterized by signs of a severe form which secondary complications join: warm and pulmonary insufficiency, pulmonary heart, kidneys, liver, nephrite, etc. Also long course of a bronkhoektatichesky disease can be complicated by iron deficiency anemia, abscess of lungs, an empiyemy pleura, pulmonary bleeding.
At a fizikalny research of lungs at a bronkhoektatichesky disease lag of mobility of lungs in breath and obtusion of a perkutorny sound on the struck party is noted. The Auskultativny picture at a bronkhoektatichesky disease is characterized by the weakened breath, weight mixed (small - average and krupnopuzyrchaty) damp rattles, usually in the lower departments of the lungs decreasing after a phlegm expectoration. In the presence of a bronkhospastichesky component the whistling dry rattles join.
On a direct and side projection of the roentgenogram of lungs deformation and a yacheistost of the pulmonary drawing, sites of atelektaz, reduction in volume of the struck segment or a share are found in patients with a bronkhoektatichesky disease. An endoscopic research of bronchial tubes – the bronkhoskopiya – allows to reveal a plentiful, viscous purulent secret, to take material on cytology and , to establish a bleeding source, and also to carry out sanitation of a bronchial tree for preparation for the following diagnostic stage – bronchographies.
The bronchography (contrast radiological research of bronchial tubes) is the most reliable diagnostic method at a bronkhoektatichesky disease. She allows to specify degree of prevalence of bronkhoektaz, their localization, a form. The bronchography at adult patients is carried out in under local anesthesia, at children – under the general anesthesia. By means of the soft catheter entered into a bronchial tree there is a filling of bronchial tubes with contrast substance to the subsequent radiological control and a series of pictures. At a bronchography deformation, rapprochement of bronchial tubes, their cylindrical, meshotchaty or spindle-shaped expansions, lack of contrasting of branches of the bronchial tubes located distalny bronkhoektaz comes to light. For diagnostics of degree of respiratory insufficiency to the patient with a bronkhoektatichesky disease conduct researches of respiratory function: spirometry and pikfloumetriya.
Treatment of a bronkhoektatichesky disease
During the periods of exacerbations of a bronkhoektatichesky disease the main medical actions are directed to sanitation of bronchial tubes and suppression of pyoinflammatory process in a bronchial tree. Antibiotic treatment and a bronchoscopic drainage is for this purpose carried out. Application of antibiotics is possible as parenterally (intravenously, intramuscularly), and endobronkhialno when carrying out a sanatsionny bronkhoskopiya. Apply tsefalosporina to treatment of chronic inflammatory processes of bronchial tubes (, cefazolin, tsefotaksy, etc.), semi-synthetic penicillin (ampicillin, ), gentamycin.
At a bronkhoektatichesky disease the drainage of a bronchial tree is carried out also by giving to the patient of the situation in a bed with the raised foot end facilitating otkhozhdeny phlegms. For improvement of evacuation of a phlegm expectorant means, alkaline drink, massage of a thorax, respiratory gymnastics, inhalations, a medicinal electrophoresis are appointed to a thorax.
Often at a bronkhoektatichesky disease resort to carrying out a bronkhoalveolyarny unleavened wheat cake (washing of bronchial tubes) and suction of a purulent secret by means of the bronchoscope. The medical bronkhoskopiya allows not only to wash out bronchial tubes and to remove a purulent secret, but also to enter antibiotics, mucolytics, bronchial spasmolytics into a bronchial tree, to apply ultrasonic sanitation.
Food of patients with a bronkhoektatichesky disease has to be the full-fledged, enriched protein and vitamins. The diet in addition joins meat, fish, cottage cheese, vegetables, juice, fruit. Out of exacerbations of a bronkhoektatichesky disease occupations by respiratory gymnastics, reception of expectorant herbs, sanatorium rehabilitation are shown.
In the absence of contraindications (pulmonary heart, bilateral bronkhoektaz, etc.) surgical treatment of a bronkhoektatichesky disease - removal of the changed lung share is shown (lobectomy). Sometimes expeditious treatment of a bronkhoektatichesky disease is carried out according to vital indications (in case of heavy, ongoing bleeding).
Forecast and prevention
Expeditious removal of bronkhoektaz in some cases leads to an absolute recovery. Regular courses of anti-inflammatory therapy allow to reach long remission. Exacerbations of a bronkhoektatichesky disease can arise in crude, cold season, when overcooling, after catarrhal diseases. In the absence of treatment of a bronkhoektatichesky disease and its complicated current option the forecast is adverse. The heavy long course of a bronkhoektatichesky disease leads to an invalidization.
Prevention of development of a bronkhoektatichesky disease assumes dispensary observation of the pulmonologist of patients with chronic bronchitis and a pneumosclerosis, their timely and adequate treatment, an exception of harmful factors (smoking, production and dust vrednost), a hardening. For the purpose of the prevention of exacerbations of a bronkhoektatichesky disease timely sanitation of additional bosoms of a nose at sinusitis and an oral cavity at diseases of zubo-maxillary system is necessary.