What Is Bronchiectasis?

Bronchiectasis is caused by chronic purulent inflammation and fibrosis of the bronchi and its surrounding lung tissue, which destroys the muscles and elastic tissues of the bronchial wall, resulting in bronchial deformation and persistent dilation. Typical symptoms are chronic cough, heavy coughing, and repeated hemoptysis. The main causative factors are bronchial infection, obstruction and traction, and some are congenital. Patients have a history of measles, whooping cough or bronchial pneumonia.

Basic Information

Causes of bronchiectasis

Infection

Infection is the most common cause of bronchiectasis. Tuberculosis, whooping cough, and adenoviral pneumonia can be secondary to bronchiectasis. Aspergillus and mycoplasma, as well as pathogens that can cause chronic necrotizing bronchopneumonia, can also be followed by bronchiectasis.

2. Congenital and hereditary diseases

The most common genetic disease that causes bronchiectasis is cystic fibrosis. In addition, it may be due to weak connective tissue development, Marfan syndrome can also cause bronchiectasis.

3. Abnormal cilia

Ciliary structure and dysfunction are important causes of bronchiectasis. Kartagener syndrome is characterized by a triad of visceral transposition, sinusitis, and bronchiectasis. The disease is accompanied by abnormal ciliary function.

4. Immunodeficiency

Defects in one or more immunoglobulins can cause bronchiectasis, and the lack of one or more IgG subclasses is often accompanied by recurrent respiratory infections, which can cause bronchiectasis. IgA deficiency is not often accompanied by bronchiectasis, but it can coexist with IgG2 subclass defects, causing repeated purulent infections of the lungs and bronchiectasis.

5. Foreign body inhalation

Long-term presence of foreign bodies in the airways can lead to chronic obstruction and inflammation, secondary to bronchiectasis.

Clinical manifestations of bronchiectasis

The course of bronchiectasis is mostly chronic and can occur at any age. He had a history of measles, whooping cough, or pneumonia after the flu, or a history of tuberculosis, bronchial tuberculosis, or pulmonary fibrosis. Typical symptoms are a chronic cough, a heavy cough, and repeated hemoptysis. Sputum is most common in the morning, in the evening, and at bedtime, and can reach 100 to 400 ml per day. When the sputum is unblocked, the patient feels relaxed; if the sputum is not drained smoothly, he will feel chest tightness and systemic symptoms will be significantly worsened. The sputum is mostly yellow-green pus, which can smell when combined with anaerobic infection. The collected sputum is placed in a glass bottle and can be divided into 3 layers after a few hours: the upper layer is foam, and the middle layer is yellow-green cloudy pus. The lower layer is sediment of necrotic tissue. 90% of patients often have hemoptysis to varying degrees. In some patients, hemoptysis may be the first and only complaint. It is clinically referred to as "dry bronchiectasis", which is common in tuberculous bronchiectasis, and the lesions are mostly in the upper lobe bronchi. If repeated infections occur, the patient may have fever, night sweats, fatigue, loss of appetite, and weight loss. When bronchiectasis is accompanied by compensatory or obstructive emphysema, patients may have difficulty breathing, shortness of breath, or cyanosis. Pulmonary heart disease and cardiopulmonary failure may appear in the later stages.

Some patients (1/3) may have club-shaped fingers (toes) and have malnutrition throughout the body.

Bronchiectasis examination

Have hypoxemia

When the infection is obvious, the white blood cells rise and the nucleus moves to the left. Sputum has a foul odor, and pathogenic bacteria can be seen in culture. Bacteriological tests for drug sensitivity, sweat test for cystic fibrosis, serum immunoglobulin assay (B lymphocytes), lymphocyte count and skin test (T lymphocytes), white blood cell count and classification (phagocytic cells), complement components Measurement (CH50, C3, C4).

2. Pulmonary function test

The ratio of forced expiratory volume / forced vital capacity in one second to progressive pulmonary function was progressive, manifested as obstructive ventilation disorder, and FEV1, FEV1 / FVC, and PEF decreased. Residual air volume / total lung ratio increased. Hypoxemia may be present at a later stage.

3.X-ray chest

No abnormalities (10%) or increased lung texture, thickening, and disordered arrangement. Cystic bronchiectasis can be seen on the chest radiograph. There are multiple irregular honeycomb (curly) shadows in the rough lung texture, or round, oval-shaped transparent areas, and even small fluid levels appear, which are more common in the lung base or near the hilum. . Cylindrical bronchiectasis often manifests as "orbital sign", that is, two parallel linear shadows (tubular shadows in the center) appear in the increased texture.

4. Chest HRCT: CT examination

The ability to show bronchiectasis depends on the CT scan method, the level of bronchiectasis, and the type of bronchiectasis. CT diagnosis of cystic bronchiectasis is more reliable than cylindrical expansion. The CT manifestations of bronchiectasis are related to the type of bronchiectasis, infection, and the presence of mucus plugs in the lumen.

5. bronchoscopy fiber bronchoscopy

The site of dilation, bleeding, and obstruction can be clearly identified with a fiberoptic bronchoscope. Local lavage can be performed, and the lavage fluid can be used for smear Gram staining or bacterial culture, which is helpful for diagnosis and treatment; bronchial mucosal biopsy can help diagnose cilia dysfunction.

Diagnosis of bronchiectasis

1. Infant with a history of respiratory infections that induce bronchiectasis, such as a history of measles, whooping cough or influenza after pneumonia, or a history of tuberculosis.

2. Long-term chronic cough, purulent sputum or repeated hemoptysis.

3. On physical examination, the auscultation of the lungs has a fixed, persistent wet rales, and clubbing fingers (toes).

4. X-ray examination showed increased lung texture, thickening, and disordered arrangement. Curly-shaped shadows were seen, and small fluid levels appeared with concurrent infections. CT showed typical "track signs" or "ring signs" or "grape signs". The diagnosis depends on chest HRCT. Examination of suspected congenital factors should be performed, such as serum Ig concentration determination, serum gamma-globulin determination, pancreatic function examination, nasal or bronchial mucosal biopsy, etc.

Differential diagnosis of bronchiectasis

1. Chronic bronchitis is more common in middle-aged patients, cough, sputum or wheezing in winter and spring, mostly white mucus, and pus and sputum may occur when infection occurs.

2. Lung abscess has an acute onset process, chills and high fever. When a large amount of purulent sputum is coughed, the temperature drops, and the symptoms of systemic toxemia are reduced. Large x-rays of dense inflammation can be seen on X-rays, with cavities and fluid levels in between. After acute antibiotic treatment, it can be completely resolved.

3. Pulmonary tuberculosis usually has symptoms of tuberculosis such as low fever, night sweats, general weakness, weight loss, and cough, sputum, hemoptysis, and generally less sputum. The rales are usually located on the apex of the lung, and the chest radiographs are mostly patchy infiltrating shadows of the upper lung. Tubercle bacilli or PCK tuberculosis DNA positive can be found in the sputum.

4. Congenital pulmonary cysts are more coughing, expectorating, and hemoptysis than secondary infections. After the disease is controlled, chest radiographs show multiple rounded shadows with clear borders, thin walls, and no infiltration of surrounding lung tissues.

5. Differentiate from lung cancer.

Complications of bronchiectasis

Bronchiectasis often causes pneumonia, lung abscess, pulmonary gangrene, empyema, and pneumothorax due to concomitant pyogenic infection. When extensive fibrosis occurs in the lung tissue and the pulmonary capillary bed is severely damaged, it can lead to increased pulmonary circulation resistance, pulmonary hypertension, and cause chronic pulmonary heart disease.

Treatment of bronchiectasis

1. Clear excess secretions

Drain according to the position of the lesion, and cooperate with inhalation. Conditional hospitals can perform local lavage through fiberoptic bronchoscope.

2. Anti-infective

Most of the pathogens infected by patients with bronchiectasis are Gram-negative bacilli, common Haemophilus influenzae, Klebsiella pneumoniae, Pseudomonas aeruginosa, etc. Antibiotics can be selected for these pathogens, and sputum culture and drug sensitivity should be done as far as possible Experiment to guide treatment. Patients with underlying diseases (such as cilia) can be treated with antibiotics for a long time according to the condition.

3. Improve immunity

Hypoglobulinemia and IgG subclass deficiency can be treated with gamma globulin.

4. Surgery

Lung atelectasis does not heal for a long time; those whose lesions do not exceed one leaf or one side; those who are not easily controlled by repeated infection drug treatment. Can consider surgery.