Bronchiectasis: treatment

Bronchoectatic disease is an acquired (in some cases congenital) disease characterized by chronic suppuration in irreversibly altered (enlarged, deformed) and functionally inferior bronchi predominantly in the lower parts of the lungs.

Therapeutic program

1. Antibacterial therapy in the period of exacerbation of the disease.
2. Sanitation of the bronchial tree, removal of purulent bronchial contents and sputum.
3. Detoxification therapy.
4. Immunomodulating therapy, normalization of general and pulmonary reactivity.
5. Sanitation of the upper respiratory tract.
6. LFK, massage, respiratory gymnastics, physiotherapy, sanatorium treatment.
7. Surgery.
8. Clinical examination of patients.

Antibiotic therapy

Antibiotic therapy is carried out in the period of exacerbation of the disease (preferably after bacteriological examination of the contents of the bronchi with identification of pathogens and their sensitivity to antibiotics). With bronchoectatic disease, the intrabronchial route of administration of drugs through the bronchoscope is preferable, intratracheal, intralaryngeal and inhalation methods are less effective.

Antibiotics of a wide spectrum of action are recommended: semisynthetic penicillins, cephalosporins, aminoglycosides, tetracyclines, quinolones.

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

The endobronchial administration of antibacterial drugs should be combined with intramuscular or intravenous administration of antibiotics, especially with clinical signs of active infection (fever, 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 medical event. It is carried out with the help of installations through the nasal catheter (the method of intratracheal lavage) or with bronchoscopy, introducing therapeutic solutions of antiseptics (10 ml of a 1: 1000 solution of furacilin, 10 ml of a 1% solution of dioxidine, etc.), mucolytics (mucosolvinum, acetylcysteine - 2 ml 10 % solution).

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

Detoxification therapy

For the purpose of detoxification, a plentiful drink of up to 2-3 liters per day is recommended (in the absence of contraindications): linden, raspberry tea, rose hips, juices, cranberry juice. Intravenously drip haemodes, isotonic sodium chloride solution, 5% glucose solution.

Immunomodulatory therapy, normalization of general and pulmonary reactivity

As immunomodulators used levamisole, diuzifon, timolin, T-activin. To normalize the general and pulmonary reactivity, adaptogens are used (tincture of ginseng, extract of Eleutherococcus, tincture of Chinese magnolia vine, pantocrine, mummy, propolis).

It is also necessary to provide a full protein-vitamin nutrition, with a decrease in body weight and albumin level, transfusion of albumin, native plasma, expediently intravenous drip infusion of intralipid and other fat emulsions.

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

Upper airway sanitation

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

LFK, massage, respiratory gymnastics, physiotherapy, sanatorium-and-spa treatment

Physiotherapy and breathing exercises should be performed regularly. They contribute to increasing the functional capacity of the bronchopulmonary system and the reactivity of the patient.

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

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

Sanatorium treatment is conducted in the inactive phase of the disease (in the phase of remission) after the previous sanation of the bronchial tree. Sanatorium treatment is recommended in the warm season, best in the sanatoriums of the Southern coast of Crimea. In warm and dry months it is possible to be treated in the local specialized sanatoriums.

Surgery

Indications for surgical treatment are limited to individual segments or lobes of bronchiectasis without pronounced chronic obstructive bronchitis. Resection of the lung eliminates the focus of a chronic infection, which in turn contributes to the subsidence or complete resolution of chronic bronchitis.

Contraindications to surgery are:

• chronic obstructive bronchitis with emphysema of the lung, expressed respiratory and heart failure (decompensated pulmonary heart);
• Amyloidosis of kidneys with renal insufficiency.

Clinical examination

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

• examination by a therapist - 3 times a year;
• examination by pulmonologist, thoracic surgeon, ENT doctor, dentist - once a year; examination by a phthisiatrist - according to indications;
• Examination: blood test, sputum analysis total and on BK, urinalysis, fluorography - 2 times a year; biochemical blood test for acute phase reactions, ECG - once a year; bronchoscopy, tomography - according to indications; sputum culture on sensitivity to antibiotics before antibiotic therapy - as needed;
• anti-relapse treatment - 2 times a year (in spring and autumn) with ARVI and influenza: antibacterial and anti-inflammatory therapy, positional drainage, exercise therapy, sanation of the bronchial tree, general restorative therapy; high-grade food; treatment in sanatoriums-dispensaries, at resorts; vocational guidance and employment.

Bronchoectatic disease with common changes and frequent (more than 3 times a year) exacerbations:

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

[1], [2], [3], [4], [5], [6], [7], [8], [9]