Additional methods of examination

Clinical blood analysis: secondary erythrocytosis; leukocytosis, neutrophilia, accelerated ESR (during progression of chronic diseases), eosinophilia (bronchial asthma).

Sputum analysis: data depends on the main disease.

X-ray examination: the signs of increased airiness of the pulmonary tissue, low diaphragm's position.

Spirometry shows decreased vital lung capacity.

Bronchiectasis

This is a condition characterized by dilatation of the bronchi. Bronchiectatic conditions are divided into primary (congenital, which are very rare) and secondary (secondary to various diseases of the bronchi, lungs and pleura). Bronchiectasis develop in bronchitis only when the inflammatory process extends on to muscular layer of the bronchial wall or on to all its layers. Muscle fibres are destroyed, the bronchus tone is lost at this area and its walls became thin. The absence of ciliated epithelium at the inflamed portions of the bronchus promotes accumulation its sputum in its lumen, upsets its draining function, and thus stimulates chronic inflammation. The inflamed site is first granulated but later connective tissue develops which disfigures the bronchus. Severely affected portions of the bronchi dilate during intense coughing.

Etiology

- genetic incompetence of bronchial tree;

- inflammatory and infection diseases of bronchopulmonary system in childhood, particularly with often recurrence;

- changes of bronchial secret characteristics (α-deficiency);

- bronchial obstruction due to the foreign corpuses, intrathoracix lymphatic nodes enlargement, protracted chronic bronchitis;

• longterm inspiration of toxic substances;

• bronchopulmonary infection.

Pathogenesis

I. The factors lead to bronchiectasis development:

- obstructive atelectasis via of bronchial secret expectoration;

- decreased of bronchial wall corresponding to improved bronchial dilation (augmented intrabronchial pressure in coughing, enlarged intrapleural negative pressure);

- development of progressive inflammatory process in bronchi (degeneration of smooth muscle tissue and its replacement by fibroses tissue).

//. The factors lead to bronchiectasis infection:

- impaired sputum discharge, congestion and secret infectivity in dilated bronchi;

- damage function of local bronchopulmonary protection and immunity.

Clinical features

Bronchiectatic disease more commonly occurs in age from 5 to 25 years, strangely later. Manifestation of the disease linked to acute respiratory pathology or pneumonia.

The main complaints in patients with bronchiectatic disease are cough, hemoptysis, dyspnea, pain in the chest, hyperthermia, general weakness, loss of ability to work and appetite, perspiration.

Cough is commonly moist, periodic with purulent greenish-yellow strong smell sputum discharge. The daily amount of sputum vary from 10-15 ml to 21, the amount of morning sputum is two thirds of the entire daily expectoration and changes of posture can set off coughing and sputum discharge. The prominent particularity of sputum on bronchiectatic disease is its three-layers on standing (pus, plasma and upward mucus). In periods of remission the sputum amount decreases.

Hemoptysis - appears or becomes more intensive in period of disease progression or physical activity. Sometimes occurs substantial bleeding with clots from affected bronchial arteries. In bronchiectasis, however, hemoptysis not uncommonly mixed with mucopurulent sputum.

Dyspnea - has expiratory or mixed character, occurs frequently during increased physical activity or periods of disease progression and is the signs of chronic bronchitis and lung emphysema.

Pain in the chest - isn't permanent complaint and associated with pleura affection, as usual increased during deep inspiration.

Hyperthermia, general weakness, perspiration, loss of appetite are the signs of intoxication syndrome and observed during progression of disease.

Objective examination. General patient's condition may be satisfactory (early stage of the disease, the stage of remission); may be middle grave, moderate grave or grave (progression of bronchiectatic disease, destructive process in the lung). Due to the gradual chronic hypoxia in last stages of disease may be observed the deranged consciousness.

In general examination may observe loss or deflection of weight, muscular dystrophy and weakness, lack of secondary sexual characters, nails in a form of "watch glass" (Hippocratic fingers). Digital clubbing in its most gross form is seen as a bulbous swelling of the tip of the finger or toe.

The posture of the patients may be active (initial stage, period of stable remission) or observed the forced posture in form of orthopnea (spasm of bronchi, decreasing the breath surface).

The color of the skin is characterized by central or diffuse cyanosis due to the accumulation of the carbon dioxide and reduced restored hemoglobin.

Inspection of the chest may reveal barrel-like (emphysematous) form of the chest with protruded supra- and subclavicular fosses, horizontal direction of the ribs, smoothed and narrow intercostals spaces, increased anteroposterior diameter. As usual the chest is symmetrical, the type of respiration is mixed or thoracic, accessory respiratory muscles active participate in the breathing act. In patient may be observed tachypnea with shallow respiration depth and poor movement of the chest on affected side.

Palpation of the chest. The chest is painless, elastic or rigid, vocal fremitus is increased on the affected side.

Percussion of the lungs. In comparative percussion of the lungs may be detecting intermediate pulmonary sound; in cause of emphysema - generalized hyperresonance (bandbox sound). In topographic percussion of the lungs is observed unilateral or bilateral lowering of the lower lungs edges (in cause of compensatory pulmonary emphysema), respiratory mobility of the lower borders of the lungs on the affected side decreased.

Auscultation of the lungs. In auscultation of the lungs over the pathologically increased vesicular breathing identify different moist rales decreased after cough and sputum discharge. In developing of bronchi urn obstruction over the bronchovesicular or pathological bronchial breathing, a lot of sibilant and sonorous dry rales are detected.

Cardiovascular system. Accordanly to chronic hypoxia and intoxication develops myocardial dystrophy that manifests by tachycardia, palpitation, arrhythmias and decreased loudness of heart sounds.

Complications. Bronchospastic syndrome, lung emphysema, respiratory failure, "cor pulmonale", lung bleeding, renal amiloidosis, metastatic brain abscesses.