Bronchiectatic Disease - Treatment

Bronchiectatic disease is an acquired (in some cases congenital) disease characterized by a chronic suppurative process in irreversibly altered (dilated, deformed) and functionally defective bronchi, mainly in the lower parts of the lungs.

Treatment program

1. Antibacterial therapy during periods of exacerbation of the disease.
2. Sanitation of the bronchial tree, removal of purulent bronchial contents and sputum.
3. Detoxification therapy.
4. Immunomodulatory therapy, normalization of general and pulmonary reactivity.
5. Sanitation of the upper respiratory tract.
6. Exercise therapy, massage, breathing exercises, physiotherapy, spa treatment.
7. Surgical treatment.
8. Medical examination of patients.

Antibacterial therapy

Antibacterial therapy is carried out during the period of exacerbation of the disease (preferably after bacteriological examination of the bronchial contents with identification of pathogens and their sensitivity to antibiotics). In bronchiectatic disease, the intrabronchial method of administering drugs through a bronchoscope is preferable; the intratracheal, intralaryngeal and inhalation methods are less effective.

Broad-spectrum antibiotics are recommended: semi-synthetic penicillins, cephalosporins, aminoglycosides, tetracyclines, quinolones.

In addition to antibiotics, dioxidine, nitrofuran derivatives (furacilin) and natural antiseptics (chlorophyllipt) are successfully used for endobronchial administration in such patients.

Endobronchial administration of antibacterial drugs should be combined with intramuscular or intravenous administration of antibiotics, especially in the presence of clinical signs of active infection (increased body temperature, sweating, intoxication). In addition, antibiotics will be very effective in the treatment of concomitant trifocal pneumonia.

Sanitation of the bronchial tree, removal of purulent bronchial contents and sputum

Sanitation of the bronchial tree is the most important therapeutic measure. It is carried out using instillations through a nasal catheter (the method of intratracheal lavage) or during bronchoscopy, introducing medicinal solutions of antiseptics (10 ml of a 1:1000 solution of furacilin, 10 ml of a 1% solution of dioxidine, etc.), mucolytics (mucosolvin, acetylcysteine - 2 ml of a 10% solution).

For the purpose of bronchial tree sanitation, the following are widely used: postural drainage several times a day, chest massage, expectorants; to facilitate the discharge of sputum, it is recommended to take bronchodilators (especially before positional drainage, chest massage).

Detoxification therapy

For the purpose of detoxification, it is recommended to drink plenty of fluids up to 2-3 liters per day (in the absence of contraindications): linden, raspberry tea, rosehip infusions, juices, cranberry juice. Hemodesis, isotonic sodium chloride solution, 5% glucose solution are administered intravenously by drip.

Immunomodulatory therapy, normalization of general and pulmonary reactivity

Levamisole, diucifon, thymoline, T-activin are used as immunomodulators. Adaptogens (ginseng tincture, eleutherococcus extract, Chinese magnolia vine tincture, pantocrine, mumiyo, propolis) are used to normalize general and pulmonary reactivity.

It is also necessary to provide adequate protein-vitaminized nutrition; if body weight and albumin levels decrease, albumin and native plasma are transfused; intravenous drip infusion of intralipid and other fat emulsions is advisable.

All this contributes to the fastest relief of the inflammatory process in the bronchi and increases general and pulmonary reactivity.

Sanitation of the upper respiratory tract

Sanitation of the upper respiratory tract consists of careful treatment of teeth, chronic tonsillitis, pharyngitis, and diseases of the nasal cavity. This reduces relapses of exacerbations of bronchiectasis and increases the overall reactivity of the patient.

Exercise therapy, massage, breathing exercises, physiotherapy, spa treatment

Physiotherapy and breathing exercises should be performed regularly. They help to increase the functional capacity of the bronchopulmonary system and the patient's reactivity.

Chest massage improves the drainage function of the lungs and the discharge of sputum. Massage should be combined with positional drainage, and should be performed not only in a hospital, but the patient and his relatives should be trained in massage techniques.

Physiotherapy is carried out after the symptoms of exacerbation of the disease have subsided. The patient is prescribed microwave therapy, electrophoresis with calcium chloride, potassium iodide, inductothermy and other procedures.

Sanatorium and spa treatment is carried out in the inactive phase of the disease (in the remission phase) after the previous sanitation of the bronchial tree. Sanatorium and spa treatment is recommended in the warm season, best of all in the sanatoriums of the Southern Coast of Crimea. In warm and dry months, you can be treated in local specialized sanatoriums.

Surgical treatment

Indications for surgical treatment are limited bronchiectasis within individual segments or lobes without pronounced chronic obstructive bronchitis. Lung resection eliminates the source of chronic infection, which in turn contributes to the abatement or complete resolution of chronic bronchitis.

Contraindications to surgery are:

• chronic obstructive bronchitis with pulmonary emphysema, severe respiratory and cardiac failure (decompensated pulmonary heart disease);
• renal amyloidosis with renal failure.

Clinical examination

Bronchiectatic disease with local changes and rare (no more than 2 times a year) exacerbations:

• examination by a therapist - 3 times a year;
• examination by a pulmonologist, thoracic surgeon, ENT doctor, dentist - once a year; examination by a phthisiatrician - as indicated;
• examination: blood test, general sputum test and BC test, urine test, fluorography - 2 times a year; biochemical blood test for acute phase reactions, ECG - 1 time per year; bronchoscopy, tomography - as indicated; sputum culture for sensitivity to antibiotics before antibiotic therapy - as necessary;
• Anti-relapse treatment - 2 times a year (in spring and autumn) for acute respiratory viral infections and flu: antibacterial and anti-inflammatory therapy, positional drainage, exercise therapy, bronchial tree sanitation, general strengthening therapy; proper nutrition; treatment in sanatoriums and health resorts; career guidance and employment.

Bronchiectatic disease with widespread changes and frequent (more than 3 times a year) exacerbations:

• examinations by a general practitioner - 4 times a year; examinations by other specialists with the frequency indicated in the previous group;
• the scope of laboratory tests is the same as in the previous group, in addition, a biochemical blood test is performed for total protein, protein fractions, glucose, creatinine, urea - once a year;
• anti-relapse treatment in the above-mentioned scope.

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