Daily Archive 21.12.2019

Diagnosis and differential diagnosis of bronchiectasis

Bronchiectasis is suspected in patients complaining of a constant productive cough, often accompanied by hemoptysis, as well as with recurrent pneumonia affecting the same segments or lobes of the lung. Differential diagnosis is carried out with chronic bronchitis, tuberculosis and lung abscess. X-ray with bronchiectatic disease, depending on the volume and nature of the lesion, it is possible to identify unchanged lung tissue, increased and (or) deformation of the pulmonary interstitial pattern, cystic formations with a diameter of 1-2 cm, often with levels liquids. In recent years, computed tomography has been widely used in the diagnosis of bronchiectasis. The presence of bronchiectasis is confirmed by bronchography, which allows to determine their prevalence, size and shape. Bronchography should be performed in patients with unchanged radiographs (without exacerbation of the disease), as well as with local bronchiectasis to solve the issue of surgical intervention. Bronchoscopy may be useful to determine the cause of bronchial obstruction, the presence of anatomical defects, localization of bleeding sources or foreign bodies. external respiration reveals signs of bronchial obstruction, and with a common process – a decrease in VC. In the period of exacerbations of the disease in the blood can observe leukocytosis with a shift of the leukocyte formula to the left, an increase in ESR, hypochromic anemia are given. Of great importance for establishing a diagnosis and determining treatment tactics is the study of sputum, especially its sowing and staining of smears to identify the pathogen. hired for pneumonia). Therapy with antibacterial drugs is recommended to be carried out already at the beginning of any viral infection of the upper respiratory tract (without waiting for an exacerbation of bronchopulmonary infection), as well as annually in winter. An important link in the treatment is to improve the drainage of the bronchi – breathing exercises, chest thumping, taking mucolytic drugs, positional drainage. Bronchoscopy is indicated only for removal of a foreign body or elimination of bleeding and should not be used for therapeutic purposes to remove secretions or endobronchial administration of antibiotics. Surgical interventions are possible in the presence of local bronchiectasis, as well as to stop bleeding. A complete diet rich in proteins and vitamins, sufficient drinking is required . Prevention of bronchiectasis – timely adequate treatment of bronchopulmonary infection, elimination of factors predisposing to the development of bronchiectasis.