Bronchiectasis

2021-01-28 12:00 AM

Bronchitis in the immediate vicinity causes an obstructive syndrome combined with bronchiectasis restriction

Define

Bronchiectasis is an irreversible dilatation of small and medium bronchi with a disturbance of bronchial layers and multiple bronchial secretions, which may be congenital or acquired, often with periodic superinfection. Bronchiectasis is 4 times more common in men than in women.

Reason

Get

Currently considered the most common; these can be localized or diffuse.

Localized:

Causes of partial bronchial stenosis: a build-up of secretions that leads to infection and a dilated bronchus, sometimes for 2-3 weeks. These causes are usually discovered only through bronchoscopy, the first is that the tumour can be benign or malignant, possibly something foreign especially to children, it may be tuberculosis by the fistula or the tumour. granules from a progressive primary infection or on a calcified sequel.

Lung abscess: sequelae of fibrosis or on a chronic lung abscess.

Bronchial aspergilloses: less common, but very special in association with type I and type II hypersensitivity manifestations (look for aspergillus-resistant precipitates), eosinophilia may be present and localized bronchus very close to the base, so only the large bronchi are damaged and the terminal frontal bronchi are good (Hinton's disease).

Diffuse:

Sequelae of severe acute bronchopulmonary diseases in adolescence: may be forgotten at the onset of the bronchopulmonary syndrome. Measles and pertussis are the two most common diseases, the most severe viral infections due to Arbovirus being the cause of bronchiectasis sequelae.

Mucus disease (fibrosis of the pancreas, mucous - cocoon): are inherited diseases; in these diseases there are secretory disorders due to slowed purification, causing recurrent bronchopulmonary infections that lead to very severe bronchiectasis with chronic respiratory failure and premature death.

Natural

Bronchiectasis is usually diffuse, very rare.

Polycystic lung disease:

Often combined with renal, pancreatic and hepatic publicists.

Immunodeficiency:

Humoral Immunodeficiency: Total or absent impairment (blood globulin, selective impairment of serum IgA or even only decreased IgA secretion.

Cellular Immunodeficiency: Due to a purification impairment that is a disease of immunity; This abnormality is usually located in Kartagener's syndrome (bronchiectasis in combination with visceral island and sinusitis - cavernous sinus).

Pathology

General

The large bronchi are not damaged, so endoscopy cannot be detected; lesions that begin in the 4th branch and spread slightly to the 8th branch. bronchiectasis is called terminal; or the terminal bronchus is still open to the further bronchi, the master lung tissue is also able to breathe, dilating the bronchi is called the terminal front.

In bronchiectasis, there are different types of anatomical injuries:

The vesicle, the silhouette or the cocoon pounding is seen in the terminal bronchiectasis.

Chain and cylindrical shape are found in terminal bronchiectasis. There are often coordination abnormalities:

Bronchitis in the immediate vicinity causes an obstructive syndrome combined with bronchiectasis restriction.

Increasing the network of blood vessels in the system, the arterioles become twisted, conducting blood in the opposite direction due to the short-circuit connections of the arteries - arteries called arteries, the pulmonary veins are drawn blood in the pulmonary artery. side bronchial artery abnormality.

Micro

Mucosal damage:

Under an almost normal epidermis at first, then dysplasia and eventually rupture, there is a thickened membrane and inflammatory cell infiltrates and many blood vessels are newly formed from bronchial vessels. In some diseases, inflammatory lesions with mucosal hypertrophy and hyperproliferation, causing clinical polyclonosis. in other cases, the mucous layer is atrophy with a decrease in the serous-mucous glands and intercystic fibrosis, so there is no increase in secretion. These two types are often combined on the same patient.

Lesions under the mucosa:

Injured connective tissue is associated with a decrease and disorganization of elastic and muscle fibres; is cut by collagen fibres and has a pseudo-muscle tumour.

Cartilage damage:

It is degenerative cartilage damage replaced by calcified tissues or by fibrosis of collagen; bronchi lose their support and elasticity.

Alveolar lesions:

Contributing significantly to respiratory dysfunction and in the exchange of oxygen in the lungs, these lesions vary widely with the patient, depending on the location in the same patient, which is atrophic reticulitis or hypertrophy.  haemorrhagic alveoli, atelectasis.

Clinical symptoms

Functional symptoms

Sputum:

Meet 80% of cases of bronchiectasis.

Time: Most in the morning, sometimes evenly throughout the day.

Quantity: Varies depending on patients, usually many, about 20-100 ml/day, or possibly more during exacerbations; however, they may be dry, not spitting up.

 Taste: Gypsum odour, sometimes foul-smelling; If left to settle, there will be 4 layers from top to bottom: foamy phlegm, clear mucus, nasal mucus, thick pus.

Analysis: rare because the infection is often comorbid.

Cough:

A symptom often accompanied by sputum production.

Haemoptysis:

Importantly, in 8% of cases, maybe accompanied by sputum or sometimes alone. Haemoptysis may be in the form of a red rather than a black ray of blood, indicating an inflammatory episode or more extensive haemoptysis corresponding to the systemic bleeding considered a complication.

Shortness of breath:

Uncommon, although some bronchiectasis is diagnosed only in the stage of chronic respiratory failure.

Other manifestations

Recurrent acute bronchopulmonary infections:

With a moderate fever of 38o - 38o5, there are 2 characteristics that are the fixed infection site suggestive of an abnormality below, the overall condition usually does not change.

Fluid pleural effusion - fibres rather than pus:

Clinical examination

Question:

Exactly the situation of finding the disease, the time of illness; In fact, often inaccurate, it is possible during adolescence the patient has severe whooping cough or measles. Ask the disease to know the cycle of multiple bronchial secretions, the frequency of superinfection episodes, especially in the winter and related to nasopharyngeal infections (rhinitis, sinusitis, tonsillitis); ask about your personal and family history, current and past career and smoking.

Physical examination:

Lung examination: It may be normal outside the exacerbation, can detect snoring, hissing, large moist crackles. In superinfection, dry bursts or small wet explosions can be heard or pleural effusion syndrome.

Finger shaped drumstick.

In progressive forms, there are two serious complications: chronic respiratory failure and chronic heart-lung.

Subclinical

Sputum

Cells: There are many bronchial epithelial cells, many degenerative neutrophils and mucus, no elastic fibres.

Bacteria: Haemophilus influenza and pneumococcus the most common, in addition, can meet gram-negative bacteria such as Pseudomonas aeruginosa; anaerobic bacteria; In addition to finding BK.

Lung film

Standard film:

Usually, a reticular translucent from the umbilicus to the diaphragm; sometimes systemic blurred vision most often in the middle and lower lobes of the lung; sometimes has a "small rose" image that resembles an overlapping cocoon, may have a picture of the gas water level during a purulent stage.

Density tomography:

Allows the easy detection of most cylindrical bronchiectasis. Currently in practice few bronchial staining; density tomography helps diagnose the most accurate especially in patients with chronic respiratory failure.

Explore respiratory function

Pulmonary function measurement: Shows a combination of both restrictive and obstructive syndrome.

Blood gases: Only severe disturbances, ie bronchiectasis has chronic respiratory failure and the heart of chronic bronchitis, there may be decreased PaO2, increased PaCo2, decreased SaO2

Bronchial exploration

Bronchoscopy:

To identify inflamed bronchi, at the same time can take pus to examine bacteria.

Bronchial staining:

Little use since density tomography, but still necessary before deciding to surgery; bronchodilators showed the following types of bronchiectasis:

The most common cylinder.

An enlarged vein or a rosary shape.

Silhouette or bag.

Often there is a combination of many types of bronchiectasis.

There are also many typical types such as dead trees with no branching of the bronchioles - alveoli, bronchi collapsed in a segment with atelectasis.

Location: The usually damaged bronchi are located between the 4th and 8th branch bronchus. In diffuse forms, the disease predominates in the lower lobes (paranasal, basal segment), middle lobe and lobe. In addition, there may be one-sided or bilateral lodgings.

Evolution

Light form

Superinfection episodes occur infrequently; The disease is limited to only one region, does not spread to the master lung tissue, does not suffer from respiratory failure.

Heavy form

Infections occur frequently, antibiotics must be used. Chronic respiratory failure and chronic heart failure will appear after many years of progression; the patient can die after a few years.

Symptoms

Lobular pneumonia, bronchitis inflammation, lung abscess, pleural effusion.

Pulmonary tuberculosis, cerebral abscess, osteoarthritis caused by lung, is uncommon.

Common haemoptysis; Maybe bloody sputum or coughing up massive amounts of blood.

Treatment

Internally medical treatment

Treatment of bronchopulmonary infections such as bronchitis or lung abscess.

Posture drainage:

It is a very necessary, important and compulsory treatment for the patient so that the pus can drain out, done 3 times/day for about 10 minutes each time.

Advocacy therapy:

It is essential for the patient to be able to spit out as much phlegm as possible.

Antibiotic:

At the central level, it is necessary to transplant sputum and make antibiotics to select the appropriate antibiotic.

However, while waiting for the results of sputum culture or at the grassroots level, according to the literature, the common bacteria are Streptococcus pneumonia, Hemophilus influenza, Mycoplasma pneumoniae, Legionella pneumophila; therefore, antibiotics must be used immediately, often used as:

Cefalexin, 500 mg, 3 tablets/day divided equally 3 times can be combined with a drug of the Fluoroquinolones group such as Ciprofloxacin (Quintor), 500 mg, 3 tablets/day divided equally or Ofloxacin (Zanocin), 200 mg, 2 capsules/day divided equally 2 times.

Cefadroxil (Oracéfal), 500 mg, 3 tablets / day divided equally 3 times.

Roxithromycin (Rulid), 150 mg, 2 tablets / day in 2 divided doses.

If severe, the patient must be referred to the central level for treatment, antibiotics must be administered by the gastrointestinal tract, ie by meat injection or intravenous or intravenous. One can use a 3rd generation Cephalosporin such as Cefotaxime (Claforan), vial 1 g, meat injection 2 g / day divided equally or Ceftriaxone (Rocephine) vial 1 g, intravenous 1 time 2 g / day mix With an Aminoxide such as Amikacins (Amiklin) 500 mg vial, 15 mg / kg / day, 1 lane or 2 divided doses, if there is mucus, it means that there is superinfection of anaerobic bacteria must use more Metronidazole, bottle 500 mg / 100 ml, 3 vials / day intravenously divided equally 3 times.

Radical treatment:

Foci of ENT infections: With appropriate antibiotics.

Treatment of haemoptysis:

Often difficult to treat because there is no specific treatment.

If mild, it can be treated at the primary level, often using Adrenoxyl, tube 1,500 μg, 3 to 4 syringes of meat divided equally 3 to 4 times.

If severe, they must be transferred immediately to the central level, can use OctrĂ©otide (Sandostatine), 50 μg tube, 100 μg, 3 ampoules of 50 μg / day divided equally 3 times and close monitoring of haemoptysis. Because this type of haemoptysis is difficult to stop, if it is beyond medical treatment, it is necessary to consult with surgery to intervene in haemostasis surgery.

Surgical treatment

Unilateral localization:

Surgery indications are best.

Possible bilateral lesions:

If the lesion is localized, stable and symmetrical, both sides can be cut.

If lesions are not symmetrical, cut off one main side.

Diffuse:

Usually non-surgical, it is possible to remove only major lesions.

Surgery can be applied to remove an area, cut a section, cut a lobe or a lung.

Preventive treatment

Get a flu shot if you have one.

If there is no vaccine, when colds and flu usually occur in the fall and winter, oral antibiotics must be used immediately as mentioned in the treatment section to prevent bronchopulmonary infections.

Oral and ENT hygiene.

Immediately transfer to the central level when the patient has complications with severe haemoptysis by an equipped ambulance.