Infect

Fungi

Mycobacteria

Virus

Immunodeficiency

congenital disease

congenital structural defects

other

① Continuous or repeated coughing, sputum or purulent sputum are the main symptoms of the patient. The sputum is divided into four layers (foamy upper layer, turbid middle layer, purulent lower layer, and necrotic material at the bottom).

② Some patients present with repeated hemoptysis without cough or sputum, and the site of occurrence has good drainage, that is, dry bronchiectasis

③ Prevalent parts: left lower lobe and lingual lobe bronchus

Hemoptysis occurs in 50% to 70% of cases. Major bleeding is often caused by erosion of small arteries or destruction of proliferated blood vessels.

When there are a lot of secretions in the airway, wet rales (fixed) and dry rales may be heard on physical examination.

When the disease is severe, especially in patients with chronic hypoxia, pulmonary heart disease, and right heart failure, clubbing of the fingers may occur.

Chest X-ray

bronchial iodine lipography

High-resolution CT (HRCT)

fiberoptic bronchoscopy

Sputum test

Sputum smear and culture

Pulmonary function test

bronchial arteriography

Active pulmonary tuberculosis accompanied by bronchiectasis should be treated aggressively with anti-tuberculosis, and hypoimmunoglobulinemia can be treated with immunoglobulin replacement.

①Patients without high-risk factors for Pseudomonas aeruginosa infection—immediate empiric use of antibacterial drugs active against Haemophilus influenzae, such as ampicillin/sulbactam, amoxicillin/clavulanic acid, and second-generation cephalosporins cephalosporins, third-generation cephalosporins (ceftriaxone sodium, cefotaxime), moxifloxacin, levofloxacin, etc.

②Patients with high-risk factors for Pseudomonas aeruginosa infection [such as 2 of the following 4 conditions: recent hospitalization; antibiotic use more than 4 times per year or within the past 3 months; severe airflow obstruction (FEV, <30% predicted value) ) Learn to take oral prednisone <10 mg daily for the past 2 weeks] - Choose β-lactam antibiotics with anti-pseudomonal activity (such as ceftazidime, cefepime, piperacillin/tazobactam, cefopera) Keto/sulbactam), carbapenems (such as imipenem, meropenem), aminoglycosides (gentamicin), quinolones (ciprofloxacin or levofloxacin), can be used alone or in combination

③For patients with chronic cough and purulent sputum, consider using a longer course of antibiotics, such as oral amoxicillin or inhaled aminoglycosides, or intermittent and regular use of a single antibiotic and rotation of antibiotics to enhance the removal of lower respiratory tract pathogens

④Combined allergic bronchopulmonary aspergillus disease (ABPA) - glucocorticoids (prednisone 0.5~1mg/kg) antifungal drugs (such as itraconazole)

⑤ Invasive infection by Aspergillus - voriconazole

Bronchodilators improve airflow restriction and help clear secretions

① Phlegm-reducing drugs (ambroxol) and chest physical therapy such as vibration, back patting and postural drainage can help clear airway secretions

② When using postural drainage, large amounts of phlegm should be discharged gradually. Too fast may lead to suffocation.

① If the amount of hemoptysis is small, symptomatic treatment can be given or oral administration of Carbacol (Anluoxue) or Yunnan Baiyao

② If the amount of bleeding is moderate, pituitaryin or phentolamine can be given intravenously

③ If the amount of bleeding is large and medical treatment is ineffective (multiple lesions), interventional embolization or surgical treatment may be considered

① If bronchiectasis is localized and remains stubborn and reoccurring despite adequate medical treatment, surgical resection of the diseased lung tissue may be considered.

② If the massive bleeding comes from the hyperplasia of the bronchial arteries, and if rest and antibiotic treatment cannot alleviate the massive hemoptysis, surgical treatment may be considered for those with limited lesions.