Symptoms and nursing care of bronchiectasis and postural drainage

Bronchiectasis is caused by chronic suppurative inflammation and fibrosis of the bronchi and surrounding lung tissues, which damages the muscle and elastic tissues of the bronchial walls, leading to bronchial deformation and persistent dilation. Most patients have a history of measles, whooping cough, or bronchopneumonia.

Causes of bronchodilation

1. Infection

Infection is the most common cause of bronchiectasis. Pulmonary tuberculosis, whooping cough, and adenovirus pneumonia can cause bronchiectasis. Aspergillus and mycoplasma, as well as pathogens that can cause chronic necrotizing bronchopneumonia, can also cause bronchiectasis.

2. Congenital and genetic diseases

The most common hereditary disease causing bronchiectasis is cystic fibrosis. In addition, Marfan syndrome may also cause bronchiectasis, probably due to poor development of connective tissue.

3. Abnormal hair growth

Abnormalities in the structure and function of the ciliary tissues are important causes of bronchiectasis. Kartagener syndrome is a triad of symptoms, namely, viscera inversus, sinusitis, and bronchiectasis. This disease is accompanied by abnormal ciliary function.

4. Immunodeficiency

Deficiencies in one or more immunoglobulins can cause bronchiectasis. Deficiencies in one or more IgG subclasses are usually associated with recurrent respiratory infections, which can cause bronchiectasis. IgA deficiency is less common with bronchiectasis, but it can coexist with IgG2 subclass deficiency, causing recurrent purulent lung infections and bronchiectasis.

5. Foreign body inhalation

Long-term presence of foreign bodies in the airways can lead to chronic obstruction and inflammation, followed by bronchodilation.

Symptoms of bronchodilation

Bronchiolitis is more common in males than females. It usually develops in childhood, and most patients are already young adults by the time they undergo surgical treatment. The clinical manifestations of bronchiolitis vary depending on the cause and whether the lesions are localized or diffuse. The most common symptoms are chronic cough, sputum, hemoptysis, and recurrent lung infections. The severity of clinical symptoms is related to the severity of bronchial lesions and the degree of infection.

1. Cough

Coughing is caused by inflammatory stimulation, mainly for expectoration. There will be coughing fits when expectorating or doing postural drainage in the early morning. The cough will be relieved by lying on the side with the affected side low. The cough will worsen when the disease worsens and the sputum increases.

2. Coughing up phlegm

The coughing up of phlegm is related to the severity and range of the disease and whether the bronchial drainage is unobstructed. If the disease is aggravated, fever occurs, and bronchial obstruction occurs, the amount of phlegm will decrease. If the disease is static, there may be no phlegm, which is called "dry bronchiectasis". The coughing up of phlegm is called "wet bronchiectasis". Patients with mild disease have a small amount of yellow-green phlegm every day, and the phlegm volume of severe patients can reach hundreds of milliliters a day. At present, due to the availability of many highly effective antibiotics, there are not many patients with large amounts of purulent phlegm.

3. Hemoptysis

Some patients have hemoptysis as the only symptom. The incidence of hemoptysis varies from report to report, accounting for 57% to 75%. The amount of hemoptysis can range from blood in sputum to hundreds of milliliters at a time, or even death due to suffocation. The amount of hemoptysis is not necessarily parallel to the severity of the disease and the scope of the lesion. Bronchiectasis is a benign disease and can survive for many years, but severe hemoptysis is a great threat to life. Due to chronic infection and repeated deterioration of the lungs, there are often systemic poisoning symptoms such as low fever, fatigue, loss of appetite, weight loss, anemia, etc.

Care of bronchial drainage:

First, expectorants should be given to make the sputum thinner and easier to cough up, so as to reduce bronchial infection and systemic toxic reactions. Instruct the patient to turn the affected side upward and open the mouth downward according to the location of the lesion, take deep breaths, cough, and assist with back patting, so that the secretions vibrate in the trachea and are discharged from the body with the help of gravity. If necessary, atomization inhalation can be performed for better results. Postural drainage should be performed on an empty stomach, 2 to 4 times a day, each time for 15 to 20 minutes. During drainage, observe changes in the patient's breathing, pulse, etc. If there are symptoms such as difficulty breathing, palpitations, cold sweats, etc., the drainage should be stopped and oxygen should be given in a semi-recumbent or supine position. After drainage, the patient should be assisted to clean the oral secretions.