Bronchiectasis and bronchiectasis

For the first time the disease has been described at the beginning of the 19th century inventor of the stethoscope doctor R.Laennekom the results of autopsies of patients who died. Lifetime diagnosis of this disease has become possible only in the last century, after the introduction of the practice bronhografii - X-ray examination of the bronchi.

Bronchiectasis - a congenital or acquired pathological expansion of individual sections of the bronchi with the change in the structure of their walls. The changes in the walls of the bronchial tubes bronchiectasis different from the functional (reversible) changes in chronic obstructive (with impaired patency of the bronchi) bronchitis. Bronchiectasis can be congenital (congenital malformation) and acquired.

The origin of acquired bronchiectasis crucial role played by acute viral, bacterial and fungal inflammation of the bronchial tubes and lungs, as well as tuberculosis Tuberculosis - a full recovery is not guaranteed   light. In childhood bronchiectasis often appear after suffering whooping cough, measles Measles in children - may cause serious complications   or flu.

Contribute to the development of bronchiectasis factors increasing intrabronchial pressure (violation of patency of the bronchi, bronchoconstriction, cough, congestion of bronchial phlegm, and so on) and promoting damage to the bronchial wall.

Uninfected bronchiectasis, especially, few and small size, a long time can not be shown. With significant in number and size of bronchiectasis and the presence of purulent inflammation develops bronchiectasis - acquired disease characterized by chronic suppurative process in irreversible changes (expanded and changed its shape) and functionally defective bronchi mostly lower lung.

Symptoms of bronchiectasis

The initial symptoms of bronchiectasis detected by chance during X-ray examination for inflammatory bronchopulmonary diseases. With the defeat of the entire thickness of the wall of the bronchi during cough appears a large number of muco-purulent sputum, often "full mouth", which is typical for her release from the cavity. Often purulent sputum departs after a night's sleep Dreams: how to understand our dreams   and in a "drain position" (for example, in the lateral position or lowering the body down), in which sputum better flows away from the affected bronchus. There are also general malaise, fever, characteristic deformation of nail phalanxes of fingers as drumsticks.

Deep stage bronchiectasis characterized by purulent sputum up to 400 ml per day, often with a putrid odor. If this sputum stand up for a while, you can see that it has become a three-layer: the bottom layer - yellow-green (purulent), medium - clear (serous), upper - foam (mucopurulent). In sputum often appears blood, may be pulmonary hemorrhage.

With long flowing bronchiectasis impaired lung function due to sprawl around the affected bronchi connective tissue, thereby reducing general and vital capacity. This is manifested by shortness of breath on exertion, cyanosis of the skin.

Bronhoektoticheskaya disease often is prolonged for years, with the increase in functional impairment and pulmonary exacerbations in spring and autumn, but also encountered a more rapid flow, complications and rapidly increasing functional impairment of the lungs.

Diagnosis of bronchiectasis

The diagnosis of bronchiectasis is made by the typical symptoms of the disease and the doctor's examination, confirmed by X-ray examination. On X-rays can see the proliferation of connective tissue along the bronchi (increased pulmonary pattern). With the introduction of contrast medium into the bronchi on radiographs (bronchograms) you can see the extended portions of the bronchi. Bronchoscopy allows you to assess the condition of the walls of the bronchial tubes.

Treatment

Treatment of patients with bronchiectasis should be comprehensive, aimed at combating an existing infection, the maintenance of the drainage bronchus and restore the body's defenses. Antibacterial agents are selected individually, the results of sputum culture to identify the pathogen and its sensitivity to antibiotics Antibiotics - whether they will help you in the foreseeable future? . Depending on the location and nature of the chosen route of administration inflammation antibiotics (intravenous, inhaled, installation directly into the bronchi and so on). In the presence of large amounts of pus anesthetized reorganization carried bronchoscopic lung: using the bronchoscope is removed from the bronchial pus and washed with solutions of antibiotics and proteolytic enzymes (the enzymes are dissolved protein, including pus).

If conservative treatment does not help, but after a preliminary post-operative preparation carried out an operation removing part or all of the affected lung. In some cases, surgery is practically complete recovery occurs.

Galina Romanenko

Types of bronchoscopy

Bronchoscopy was first performed in the late 19th century for the removal of foreign bodies from the bronchi and used for this purpose more than fifty years. The procedure was painful and traumatic. Further development of bronchoscopy associated with the improvement of equipment to carry it out, which allowed to carry out research under the first of the bronchi, and then (with the creation of a flexible bronchofiberscope) - under local anesthesia.

Bronchoscopy - a method of visual (eye directly) study the inner surface of the trachea and bronchi with a special device - bronchoscope. Bronchoscopy is a diagnostic and therapeutic. It has become a safe method that can be performed on an outpatient basis (in the clinic) under local anesthesia.

Bronchoscopes are divided into rigid and flexible or bronchofiberscope. Rigid bronchoscopes are used mainly for therapeutic purposes. Bronchofiberscope is an apparatus consisting of managed flexible rod, control knobs and the light source associated with the bronchoscope. Modern bronchofiberscope usually equipped with a camera and special instruments for biopsy and various therapeutic procedures, including the removal of foreign bodies.

Diagnostic Bronchoscopy

Diagnostic bronchoscopy is performed in order to clarify or establish the diagnosis of benign and malignant tumors of the trachea and bronchi, purulent diseases of the bronchi and lungs, pulmonary tuberculosis, foreign bodies of the trachea and bronchi (especially not reflect on X-rays), bronchial asthma, persistent cough, hemoptysis and pulmonary hemorrhage, bronchoconstriction, atelectasis (spadenie) lung tissue. Diagnostic Bronchoscopy is also used to assess the condition of the bronchi after resection of the lung or bronchus.

With tight brnhoskopii you can quickly find the location of acute lung abscess, bacterial abscess distinguish from decaying cancer and so on.

In the process of diagnostic bronchoscopy performed inspection of the mucous membrane of trachea and bronchi, and if necessary - taking a piece of tissue of the bronchi in the study (biopsy).

Therapeutic bronchoscopy

Therapeutic bronchoscopy performed to remove from the trachea and bronchi foreign bodies, bronchial secretions and topical medicaments for various diseases broncho-pulmonary system.

Rigid bronchoscopy allows you to remove the foreign body airway (including inaccessible for removal by bronchofiberscope) to restore patency of the trachea and main bronchi at their narrowing or obstruction of scars and tumors. Rigid bronchoscopy is effective for installing stents bronchi (special devices that extend the areas of narrowing of the bronchi). Rigid bronchoscopes are used for therapeutic lavage (washing) of the bronchi with significant congestion in remote parts of the bronchi thick viscous sputum in bronchial asthma. There are also other treatments, including providing emergency aid to the patient.

Contraindications

Absolute contraindications for bronchoscopy are: idiosyncrasy of the drugs used for pain, myocardial infarction, myocardial less than six months ago, a stroke, expressed cardiac arrhythmia, increased blood pressure (the lower or diastolic blood pressure - more than 100 mmHg), severe cardiovascular failure, bronchial asthma in acute, severe narrowing (stenosis) of the larynx or trachea, mental illness Mental illness - ashamed to ask for help?   (epilepsy, post-traumatic brain injury, schizophrenia), severe abdominal pain Abdominal pain: Types and Symptoms , Severe general condition of the patient.

Relative contraindications are inflammatory diseases of the upper respiratory tract, coronary heart disease, severe diabetes Diabetes - threatening and incurable disease The second half of pregnancy, chronic alcoholism, a significant increase of thyroid Increase in thyroid - that underlies the disease , Menstrual bleeding.

For rigid bronchoscopy in addition to all the listed contraindications are diseases of the oral cavity, the violation of joint mobility of the lower jaw, damaged cervical vertebrae, aneurysm (a sharp local extension) of the aorta.

Preparing for bronchoscopy

Before bronchoscopy the patient should be fully examined to avoid contraindications for bronchoscopy. On the day of the study, patients do not eat or drink (the last meal - no later than 20-21 hours of the day before). The night before, the patient is prescribed sedatives and sleeping pills in the morning makes premedication: intramuscularly administered soothing, relaxing muscles of the bronchi, reduces the secretion of bronchial mucus and saliva drugs. Before the beginning of anesthesia the patient should remove the dentures.

Local anesthesia (to eliminate pain during the endoscope through the nose and cough suppressants) is carried out by spraying an aerosol painkillers. After that, through the nose (sometimes through the mouth) is introduced bronchoscope (it does not interfere with the patient to breathe, as it does not completely close the lumen of the bronchi), as it moves along the airway endoscopist examines the state of the mucous membranes of the trachea and bronchi, and, if necessary, with special Tool takes bronchi tissue for research or remove the foreign body, after which the endoscope is removed.

Bronchoscopy is not an easy process, it can produce complications such as damage to the bronchial wall, bleeding, inflammatory diseases of the bronchi and lungs and so on. Therefore, bronchoscopy is carried out strictly on the evidence, when it is really needed.

Galina Romanenko