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Thursday, 18.04.2024, 01:53
Main » Pulmonology » Clinic and diagnosis of bronchiectasis 
Clinic and diagnosis of bronchiectasis

Clinic and diagnosis of bronchiectasis

Among patients with bronchiectasis is dominated by men, comprising about 60-65%. Usually the disease is recognized at the age of 5 to 25 years, but set the time of onset is difficult, since the first exacerbation of the process is often regarded as "cold" and leave no trace in the memory of the patient. Careful picking up a history with the mandatory survey of parents can set the initial manifestations of pulmonary disease in the early years, or even the first months of life in most patients. The starting point of the disease is often carried over into early childhood pneumonia.

The main complaint of patients with a cough with more or less significant amount of purulent sputum. The most abundant expectoration observed in the morning (sometimes "full mouth"), as well as in patients taking the so-called drainage provisions (turning on the "healthy" side torso forward, etc.). Unpleasant, putrid odor of sputum, which in the past was considered typical for bronchiectasis is currently found only in the most severe patients. During periods of remission sputum can not be separated at all. Sputum is usually divided into two layers, the upper of which, as a viscous liquid that contains a large admixture of saliva, and the bottom consists entirely of purulent sediment. Hemoptysis and pulmonary hemorrhage are rare, mostly in adult patients. Occasionally they are the only manifestation of disease in the so-called "dry" bronchiectasis, characterized by a lack of advanced bronchial suppurative process.

Shortness of breath on exertion are concerned about every third patient, but it often disappears after the surgery. Chest pain associated with pleural changes are observed in a significant proportion of patients.

The temperature rises, usually during periods of exacerbations. High fever, profuse expectoration, after declining stagnant phlegm, sometimes seen in more severe cases. Also, mainly in periods of exacerbation patients complain of malaise, fatigue, reduced work capacity, mental depression (usually in the presence of foul-smelling sputum and not a pleasant smell when breathing).

The appearance of the majority of patients characterized by little. Only in severe observed a delay in physical development and delayed puberty in children and adolescents.

The main method of confirming the existence and location lookup bronchiectasis, bronchography is a complete contrast to the binding of both lungs, which is carried out in stages or simultaneously (mainly in children under anesthesia) after a thorough renovation of the bronchial tree and the maximum relief of suppurative process. Bronhograficheski in the affected department observed some form of bronchiectasis, their approach and failure to complete the branches of contrast material, resulting in the bronchi of the affected share compared to a "beam rods" or "docked with a broom." Bronchoscopic study has implications for assessing the severity of suppuration (endobronchitis) in various segments of the lung, as well as endobronchial remediation and monitoring of the dynamics of the process.

Functional study of the lungs in patients with bronchiectasis shows mostly restrictive, and mixed ventilation disorders. In the long process and its complications lead to abnormalities in diffuse bronchitis, acquire an irreversible character and evidence of missed opportunities for surgical treatment.

During the bronchiectasis is characterized by periodic exacerbations (mainly in spring and autumn) are replaced by a more or less prolonged remissions.

Often, moving in early childhood, one or two pneumonia patients over the years feel almost healthy until puberty, and from 14-18 years of deterioration occur more or less regularly.

Prolonged and Severe bronchiectasia often accompanied by the development of diffuse obstructive bronchitis, which, together with the mentioned above peculiarities of the pulmonary circulation, in the end can lead to respiratory failure and cor pulmonale. In such a flow can occur and other complications

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