Bronchiectasis: symptoms

Bronchoectatic disease is more often detected at the age of 5 to 25 years, more rarely - later. Men are 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 connect the onset of the disease with a history of pneumonia or viral respiratory disease.

For patients with bronchiectasis the following main complaints are typical:

Cough with separation of purulent sputum with an unpleasant putrefactive odor. The phlegm clears throat quite easily, with a "full mouth." The greatest amount of sputum is given in the morning, and also if the patient occupies a certain position ("position drainage"). If the bronchiectasis is located in the lower parts of the right lung (this is the most frequent localization), then the greatest amount of sputum goes to the patient's position on the left side with the head and the lowered head lowered ("hanging from the bed"); when localized in the lower parts of the left lung - in the same position, but on the right side. If the bronchiectasis is located in the upper parts of the lungs, phlegm most easily clears throat in an elevated semi-sitting position of the patient. The amount of sputum is also affected to a certain extent by the form of bronchiectasis. It is easier and more sputum goes away with cylindrical bronchiectasis. With saccular and spindle-shaped bronchiectasis, sputum is often difficult to separate.

The daily amount of sputum is from 20 to 500 ml or more. In the period of remission the amount of sputum is much less compared with the phase of exacerbation. In some patients in the period of remission, sputum may not even separate. A characteristic feature of sputum is its division into two layers: the upper one - 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, the volume of which is the greater, the more intensely the purulent-inflammatory process in bronchiectasises;

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

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

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

Pain in the chest - are not mandatory and not a regular sign of bronchiectasis, but often disturb the patients. They are caused by the involvement of the pleura in the pathological process and appear more often in the period of exacerbation. Characteristic is increased pain during inspiration;

The rise in body temperature is observed in patients usually in the period of exacerbation of the disease, especially with severe bronchiectasis. Body temperature often rises to subfebrile numbers, but a more pronounced increase is possible. After coughing up a large amount of purulent sputum, body temperature is significantly reduced. In the phase of remission, the body temperature is normal;

General weakness, decrease in efficiency and appetite, sweating - these complaints are a reflection of the intoxication syndrome, usually worried about patients during the exacerbation of the disease and are especially characteristic for patients who cough up a large amount of purulent sputum with an unpleasant putrefactive odor.

At external survey of patients the following characteristic signs of the disease are revealed:

• the backwardness of children in physical and sexual development, more characteristic of children who became ill in early childhood and who have a severe form of the disease;
• muscle hypotrophy and decreased muscle strength, weight loss are observed in both children and adults, especially with the long existence of the disease and significant intoxication;
• changes in the terminal phalanges of the fingers (less often - legs) in the form of tympanic sticks, nails - in the form of hourglasses - are detected with a long course of bronchiectasis, but are not an obligatory sign;
• cyanosis - appears with the development of pulmonary or pulmonary heart failure in severe patients;
• lag of the thorax when breathing on the side of the lesion, and with the development of emphysema - a "barrel-like" view of the chest.

Classification of bronchiectasis

With a mild form, 1-2 exacerbations occur throughout the year, long-term remissions, during remission patients feel almost healthy and fully functioning.

When the form of the average severity of the exacerbation of the disease is more frequent and prolonged, about 50-100 ml of sputum are released per day. In the phase of remission, cough continues, and 50-100 ml of sputum per day is also separated. Moderate violations of the respiratory function, tolerance to exercise and performance decrease.

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 fetid odor, patients lose their capacity for work. Remissions are short-lived, only after prolonged treatment. Patients remain disabled and during remissions.

With complicated form of bronchoectatic disease, various complications are attached to the signs characteristic of severe form: pulmonary heart, pulmonary heart failure, amyloidosis of the kidneys, myocardial dystrophy, hemoptysis, etc.

Classification of bronchiectasis.

Form of bronchiectasis bronchiectasis)	Clinical course (form of the disease)	The phase of the disease	Prevalence of the process
Cylindrical Sacred Spindle-shaped Mixed	Light form Medium shape Heavy Form Complicated form	Exacerbation Remission	Unilateral bronchiectasis Bilateral bronchiectasis Indication of the location of bronchiectasis by segment

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