Bronchiectatic disease - Symptoms

Bronchiectatic disease is most often detected at the age of 5 to 25 years, less often - later. Men get sick more often than women. As a rule, the disease begins to manifest itself in the first years or even months of life. Parents of sick children usually associate the onset of the disease with pneumonia or a viral respiratory disease.

The following main complaints are typical for patients with bronchiectasis:

Cough with separation of purulent sputum with an unpleasant putrid odor. Sputum is coughed up quite easily, "with a full mouth". The largest amount of sputum is coughed up in the morning, and also if the patient is in a certain position ("positional drainage"). If bronchiectasis is located in the lower parts of the right lung (this is the most common localization), then the largest amount of sputum is coughed up when the patient is lying on the left side with the head and body lowered ("hanging off the bed"); if localized in the lower parts of the left lung - in the same position, but on the right side. If bronchiectasis is located in the upper parts of the lungs, sputum is most easily coughed up in an elevated semi-sitting position of the patient. The amount of sputum secreted is also affected to a certain extent by the form of bronchiectasis. Sputum is coughed up more easily and in greater quantities with cylindrical bronchiectasis. In saccular and fusiform bronchiectasis, sputum is often difficult to separate.

The daily amount of sputum is from 20 to 500 ml or more. During the remission period, the amount of sputum secreted is significantly less compared to the exacerbation phase. Some patients may not even secrete sputum during the remission period. A characteristic feature of sputum is its division into two layers: the upper one is in the form of a viscous opalescent liquid with an admixture of a large amount of mucus; the lower one consists entirely of purulent sediment, and its volume is greater, the more intense the purulent-inflammatory process in bronchiectasis;

Hemoptysis - occurs in 25-34% of patients, sometimes profuse pulmonary hemorrhage is observed, the source of which are the bronchial arteries. Hemoptysis usually appears or becomes more pronounced during the period of exacerbation of the disease and during intense physical exertion. There are known cases of hemoptysis in women during menstruation.

In some patients, hemoptysis may be the only clinical manifestation of the disease - in so-called "dry bronchiectasis." With this form of the disease, there is no suppurative process in the dilated bronchi;

Dyspnea is a characteristic manifestation of bronchiectatic disease. It is observed in 30-35% of patients, mainly during physical exertion, and is caused by concomitant chronic obstructive bronchitis and the development of emphysema. Dyspnea bothers patients little at the onset of the disease and becomes much more pronounced as it progresses, also during its exacerbation;

Chest pains are not a mandatory or natural symptom of bronchiectasis, but they often bother patients. They are caused by the involvement of the pleura in the pathological process and appear more often during an exacerbation. Typically, pain increases during inhalation;

Increased body temperature - usually observed in patients during an exacerbation of the disease, especially in severe bronchiectasis. Body temperature most often rises to subfebrile numbers, but a more pronounced increase is also possible. After coughing up a large amount of purulent sputum, body temperature drops significantly. In the remission phase, body temperature is normal;

General weakness, decreased performance and appetite, sweating - these complaints are a reflection of the intoxication syndrome, usually bother patients in the acute phase of the disease and are especially characteristic of patients coughing up a large amount of purulent sputum with an unpleasant putrid odor.

During external examination of patients, the following characteristic signs of the disease are revealed:

• delays in children's physical and sexual development, which is more typical for children who became ill in early childhood and have a severe form of the disease;
• muscle hypotrophy and decreased muscle strength, weight loss are observed in both children and adults, especially with prolonged disease and significant intoxication;
• changes in the terminal phalanges of the fingers (less often - toes) in the form of clubbing, nails - in the form of watch glasses - are detected during the long-term course of bronchiectasis, but are not a mandatory symptom;
• cyanosis - appears with the development of pulmonary or pulmonary-cardiac insufficiency in seriously ill patients;
• lag of the chest during breathing on the affected side, and with the development of pulmonary emphysema - a “barrel-shaped” appearance of the chest.

Classification of bronchiectasis

In a mild form, 1-2 exacerbations are observed during the year, remissions are long, during remission patients feel practically healthy and fully functional.

In the moderate form, exacerbations of the disease are more frequent and prolonged, about 50-100 ml of sputum is released per day. In the remission phase, the cough continues, and 50-100 ml of sputum is also released per day. Moderate respiratory dysfunction is characteristic, tolerance to stress and work capacity are reduced.

The severe form is characterized by frequent and prolonged exacerbations, accompanied by an increase in body temperature, the release of more than 200 ml of sputum, often with a foul odor, patients lose their ability to work. Remissions are short-term, observed only after long-term treatment. Patients remain incapacitated during remissions.

In complicated forms of bronchiectatic disease, various complications are added to the symptoms characteristic of the severe form: pulmonary heart disease, pulmonary heart failure, renal amyloidosis, myocardial dystrophy, hemoptysis, etc.

Classification of bronchiectasis.

A form of bronchial dilation (bronchiectasis)	Clinical course (form of the disease)	Phase of the disease	Prevalence of the process
Cylindrical Saccular Fusiform Mixed	Mild form Moderate form Severe form Complicated form	Exacerbation Remission	Unilateral bronchiectasis Bilateral bronchiectasis With indication of the localization of bronchiectasis by segments

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