Bronchopathy
Introduction
Introduction to bronchial disease Bronchial disease is a common disease of respiratory diseases. It is a frequently-occurring disease. The main lesions are in the bronchus. Those with mild lesions have more cough, chest pain, and respiratory disturbances. In severe cases, they have difficulty breathing, lack of oxygen, and even death from respiratory failure. Due to air pollution, smoking, population aging and other factors, chronic obstructive pulmonary disease (referred to as chronic obstructive pulmonary disease, including chronic bronchitis, emphysema, pulmonary heart disease), bronchial asthma, lung cancer, and diffuse lungs The incidence and mortality of diseases such as fibrosis and lung infections have increased. basic knowledge Proportion of disease: according to different bronchial diseases, the proportion of illness is different Susceptible people: no special people Mode of infection: non-infectious Complications: wheezing-like bronchitis, acute bronchitis in children, bronchiectasis in the elderly, bronchial asthma in the elderly
Cause
Cause of bronchial disease
Cause:
First, the relationship between the structural function of the respiratory system and disease:
The respiratory system is most frequently exposed to the external environment in various systems of the human body, and the contact area is large. At rest, adults have 12,000 L of gas per day entering the respiratory tract, and 300-750 million alveoli (total area of about 100 m2) exchange gas with the capillaries of the pulmonary circulation, extract oxygen from the external environment, and discharge carbon dioxide to the environment. in vitro. During the breathing process, organic or inorganic dust in the external environment, including various microorganisms, heterologous protein allergens, dust particles and harmful gases, can be inhaled into the respiratory tract and cause various diseases. Among them, pulmonary infection is the least common, primary infection is most common in viral infection, first in the upper respiratory tract, followed by bacterial infection; exogenous asthma and exogenous allergic alveolitis; inhalation productivity The pneumoconiosis caused by dust is most common in silicosis, coal sputum lung and asbestos lung; inhalation of irritating gases such as sulfur dioxide, chlorine and ammonia with high water solubility may cause acute and chronic respiratory inflammation and pneumonia, while inhaling low-water-soluble nitrogen and oxygen. Compounds, phosgene, dimethyl sulfate and other gases damage acute pulmonary edema in alveolar and pulmonary capillaries.
There are two groups of blood vessels in the lungs. The arteries and veins of the pulmonary circulation are functional blood vessels for gas exchange; the bronchial arteries and veins of the systemic circulation are nutrient vessels such as airways and visceral pleura. The lungs are connected to the blood and lymphatic circulation of various organs of the body, so the skin and soft tissue sputum, the thrombosis of embolic phlebitis, and the tumor thrombus can reach the lungs, causing secondary lung abscess, pulmonary infarction, and metastasis, respectively. Sexual lung cancer. Lung cancer in the digestive system, lung lesions can also spread to the whole body, such as lung cancer, tuberculosis spread to bones, brain, liver and other organs; also can occur in the lung itself.
The blood vessels of the pulmonary circulation are as fine as the trachea-bronchus, the cross-sectional area of the small arteries is large, the area of the pulmonary capillary bed is larger, and it is easy to expand. Therefore, the lung is a low-pressure (pulmonary circulation blood pressure is only 1/10 of the systemic blood pressure), low-resistance, high-capacity organs. When mitral stenosis, left heart failure, cirrhosis, nephrotic syndrome, and malnutrition hypoproteinemia, pulmonary interstitial edema, or leakage of the chest cavity occurs.
Some immune, autoimmune or metabolic systemic diseases, such as sarcoidosis, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, scleroderma, etc., can affect the lungs. The lungs also have non-respiratory functions, such as endocrine syndromes produced by the production and release of ectopic sex hormones in lung cancer.
Second, the aging of the social population:
With the rapid advancement of science and medical technology, the rate of life extension of human beings has also accelerated rapidly. According to records, the average life expectancy of two thousand years ago is only 20 years old, increased to 30 years in the 18th century, and reached 40 years old by the end of the 19th century. According to the United Nations Population Division, by 2025, the number of people over the age of 60 will increase to 1.121 billion, accounting for 13.7% of the world's population, including 12% in developing countries and 23% in developed countries. At the end of 1993, the number of elderly people over the age of 60 in Shanghai exceeded 2.1 million, accounting for 16% of the total population. So far, the number of elderly people will reach 4 million in 2025, accounting for more than 28%. Respiratory diseases such as chronic obstructive pulmonary disease and lung cancer increase with age, and their prevalence increases. Because of the low immunity of the elderly and the possibility of causing aspiration pneumonia, even if various new antibiotics are introduced, lung infection Still the leading cause of infection in the elderly, often a direct cause of death.
Third, the harm of air pollution and smoking:
Etiology studies have confirmed that increased respiratory disease is closely related to air pollution and smoking. It has been proved that when the smoke or sulfur dioxide in the air exceeds 1000ug/m3, the acute attack of chronic bronchitis is significantly increased; other dusts such as carbon dioxide, coal dust and cotton dust can stimulate the bronchial mucosa, reduce lung clearance and natural defense functions, and be microbial invasion. Create conditions. The incidence of lung cancer in industrialized countries is higher than that in industrially backward countries, indicating that it is related to the pollution of carcinogens in industrial waste gas. Smoking is a major source of pollution in small environments, smoking is associated with chronic bronchitis and lung cancer. In 1994, the World Health Organization proposed that smoking is the biggest plague in the world, and it has been shown that in the past half century, smoking in the developing countries has swallowed 60 million people, of which 2/3 are 45 years old to 65 years old. They died 20 years earlier than non-smokers. If the current smoking situation continues, by 2025, the world will reach 10 million people each year due to smoking, which is three times the current mortality rate, of which China accounts for 2 million. At present, the total consumption of tobacco in China is the highest in the world, and the smoking of young people has increased significantly. In the next 20 years, the number of deaths due to smoking will increase sharply.
Fourth, the increase in inhalation allergens:
With the development of China's industrialization and economy, especially in urban areas, the types and quantities of allergens causing allergic diseases (asthma, rhinitis, etc.) increase. For example, the widespread use of carpets and curtains increases the number of house dust mites, pet breeding. (Birds, dogs, cats) cause an increase in animal hair allergens, as well as airborne fungi, urban pollen spores, organic or inorganic chemical raw materials, drugs and food additives; Such as smoking (passive smoking), nitrogen oxides emitted by automobiles, sulfur dioxide produced by coal burning, bacterial and viral infections, etc., are all factors that increase the prevalence of asthma.
5. The pathogenicity of lung infection and the increase in drug resistance:
Respiratory and pulmonary infections are an important part of respiratory disease. The number of tuberculosis patients (mainly tuberculosis) in China ranks second in the world, with 5 million tuberculosis patients, of which 1.5 million are infectious, and more than 17% of patients infected with multidrug-resistant M. tuberculosis. Since there is no specific method for preventing and treating viruses, the incidence of viral infectious diseases has not been significantly reduced. Since the widespread use of antibiotics, the mortality rate of bacterial pneumonia has decreased significantly, but the mortality rate of elderly patients is still high, and the incidence of pneumonia No reduction. Gram-negative bacteria predominate in hospital-acquired lung infections. Among Gram-positive cocci, methicillin-resistant bacteria also increased significantly; community-acquired pneumonia was still dominated by Streptococcus pneumoniae and Haemophilus influenzae, as well as Legionella, Mycoplasma, Chlamydia, and viruses. The SARS that broke out in 2003 was a SARS coronavirus infection. In addition, respiratory infections in immunocompromised or immunodeficient individuals should focus on specific pathogens such as fungi, Pneumocystis, and atypical mycobacterial infections.
6. Advances in medical science and applied technology have improved diagnostic levels:
In recent years, advances in research in various fields such as physiology, biochemistry, immunity, pharmacology, nuclear medicine, laser, ultrasound, and electronic technology have provided conditions for the diagnosis of respiratory diseases. Cell and molecular biology techniques have been used to provide new and comprehensive understanding of the etiology, pathogenesis and pathophysiology of some respiratory diseases, so that the disease can be diagnosed more accurately and earlier.
7. Respiratory diseases have not received enough attention for a long time:
Because the respiratory organs have a large physiological function of reserve capacity, usually only 1 / 20 lung breathing function can maintain normal life, so the pathological changes of the lungs are often not reflected in the clinic; cough, cough, hemoptysis, respiratory diseases, Chest pain, shortness of breath and other symptoms lack specificity, often mistaken for colds and bronchitis by people and clinicians, and delayed diagnosis of severe pneumonia, tuberculosis or lung cancer; or due to repeated respiratory infections, to develop emphysema, lung Heart disease, respiratory failure is taken seriously, but it is too late, its pathological and physiological functions have been difficult to reverse.
Pathogenesis:
(1) Adjusting the body's immune function:
The onset of the respiratory system is associated with immune dysfunction of immune cells and immune dysfunction caused by imbalance of quantum balance. Why are there positive immune responses to benign stimuli that do not harm the human body? This is mainly due to the imbalance of human immune function.
The immune surveillance system has the function of identifying dissidents, eliminating dissidents, and maintaining the internal environment pure and stable. When the immune surveillance function is out of balance, the ability to identify dissidents is lost, the enemy and the enemy are not divided, the flowers and the poisonous grass are not divided, and the substances that are harmless to the body are mistaken for the harmful enemy, that is, the antigen is removed. Therefore, the pathogenesis of bronchitis is caused by immune dysfunction. Negative oxygen ions have the function of regulating the quantum balance of the immune cells and the protein plate junction function to achieve normalization of function. Adjusting the immune function can normalize the immune function of the disorder, eliminate the abnormal reaction of the body, and achieve the effect of treating respiratory diseases.
(B) regulate autonomic dysfunction:
This is the second pathogenesis of the respiratory system: the vagus nerve is too excited, the sympathetic nerve is excited, and it is more appropriate to compare them to the rebel and royalist forces. Most medications for bronchitis are treated by changing these two forces.
(3) Improving acidity:
The functional activities of each cell of the human body must be carried out in a suitable acid-base equilibrium environment. The normal person's pH is weakly alkaline at pH=7.41, and the elderly are likely to become acidic due to weak acid function.
Long-term stress and stress during work or eating too much acidic food can lead to internal environment disorders, and metabolic disorders can contribute to acidic constitution. In the acidic environment, mast cells easily destabilize and degranulate. Therefore, patients with respiratory system should eat less meat, eat more fruits and vegetables, and strengthen self-adjustment to reduce psychological stress. Patients with respiratory diseases have long-term absorption of ion-neutral H+ (H+ has a positive charge, while ions with a negative charge can neutralize excessive H+ in the body), which is an important factor determining the acidity of the body; The respiratory system, the blood system, and the urinary system improve the acidity of the acid and alkali, which is beneficial to the treatment of bronchitis.
(4) Control of respiratory infections:
The vagus nerve is distributed in the bronchi and alveoli. Since the tracheal inflammation can stimulate the vagus nerve to excite it, it is one of the causes of respiratory diseases. The ion can directly eliminate the tracheal inflammation, reduce the stimulation of the vagus nerve, and maintain the balance between the sympathetic nerve and the vagus nerve. In summary, the pathogenesis of bronchitis is multi-link, therefore, the drug of single preparation is difficult to work. Negative oxygen ions have the characteristics of "multiple diseases and the same treatment", and have unique advantages in treating bronchitis. The West German scholar Surzi used ions to treat 3,000 patients with bronchitis, with an effective rate of 97.4%.
Prevention
Bronchial disease prevention
1. Appropriate physical exercise:
Enhance physical fitness, improve respiratory resistance, prevent upper respiratory tract infections, avoid inhalation of harmful substances and allergens, and prevent or reduce the occurrence of this disease. Exercise should be gradual and gradually increase the amount of activity.
2. Pay attention to climate change and cold season:
When the winter season is severe or the climate suddenly becomes cold, pay attention to the clothes and keep warm, add clothes in time, and don't cause colds due to cold. In the cold winter season, the indoor temperature should be 18 ~ 20 °C.
Complication
Bronchial complications Complications, asthmatic bronchitis, pediatric acute bronchitis, elderly patients, bronchiectasis, bronchial asthma
tuberculosis:
Pulmonary tuberculosis (TB) tuberculosis is a chronic infectious disease caused by tubercle bacillus, which can affect multiple organs throughout the body, but tuberculosis is the most common. The pathological features of this disease are tuberculous nodules and caseous necrosis, which are easy to form voids. Clinically, there are many chronic processes, and a few can be acutely ill. Often have low fever, fatigue and other systemic symptoms and cough, hemoptysis and other respiratory manifestations.
Pulmonary heart disease:
The most common chronic pulmonary heart disease is chronic hypoxic bloody pulmonary heart disease, also known as obstructive emphysema heart disease, referred to as pulmonary heart disease, which refers to the pulmonary circulation resistance caused by chronic lesions of the lungs or pulmonary artery. Increased, a type of heart disease that causes pulmonary hypertension and right ventricular hypertrophy, with or without right heart failure. Pulmonary heart disease is a common disease in China and is frequently ill.
Lung cancer:
Lung cancer is one of the most malignant tumors with the fastest growth in morbidity and mortality and the greatest threat to population health and life. In the past 50 years, the incidence and mortality of lung cancer have been significantly increased in many countries. The incidence and mortality of lung cancer in males accounted for the first place among all malignant tumors. The incidence rate of females ranked second and the mortality rate ranked second.
Symptom
Symptoms of bronchial diseases Common symptoms Cough, nighttime cough, cough, more chronic cough in winter and spring... Cough with chest pain, chest tightness, wheezing activity, qi hemoptysis
First, bronchitis:
Bronchitis refers to chronic, non-specific inflammation of the trachea, bronchial mucosa, and surrounding tissues. The main cause of bronchitis is the repeated infection of viruses and bacteria to form chronic non-specific inflammation of the bronchi. When the temperature drops, the small blood vessels in the respiratory tract, ischemia, and the decline of defense function are conducive to disease; chronic stimuli such as smoke dust and pollution of the atmosphere can also occur; smoking causes bronchospasm, mucosal variation, ciliary movement, and mucus secretion to increase infection; Factors also have a certain relationship.
Second, bronchopneumonia:
Bronchial pneumonia, also known as lobular pneumonia, is the most common form of pneumonia in children. The incidence of bronchopneumonia virus in children with pneumonia in developing countries is significantly higher than that in developed countries, and the mortality rate and mortality rate are higher in developed countries. Similar to other developing countries, pediatric pneumonia is a serious disease that threatens the health of our children. It is the highest in both morbidity and mortality.
Third, bronchiectasis:
Bronchiectasis is caused by chronic suppurative inflammation and fibrosis of the bronchus and surrounding lung tissue, which destroys the muscles and elastic tissues of the bronchial wall, leading to bronchial deformation and persistent expansion. Typical symptoms are chronic cough, massive cyanosis, and repeated hemoptysis. The main pathogenic factors are bronchial infection, obstruction and traction, and some have congenital genetic factors. Patients have a history of measles, whooping cough or bronchial pneumonia.
Fourth, bronchial asthma:
Bronchial asthma is a chronic airway inflammation involving a variety of cells and cellular components. This inflammation is often accompanied by an increase in airway responsiveness, leading to recurrent wheezing, shortness of breath, chest tightness and/or coughing. At night and/or in the early hours of the morning, such symptoms are often accompanied by extensive and variable airflow obstruction that can be reversed by itself or by treatment.
Examine
Examination of bronchial disease
First, laboratory inspection:
1. Blood routine: When the infection is increased, the white blood cell count is increased, the neutrophils are increased, and the eosinophil count is increased in allergic diseases or parasitic diseases.
2, urine routine: diabetic patients with urine sugar positive, urine ketone body positive; urine protein positive urine, tube type and red, white blood cells.
3, blood biochemistry: diabetes patients with increased blood sugar, carbon dioxide binding capacity; uremia when blood urea ammonia and serum creatinine increased.
4, sputum examination: bronchial-lung disease should pay attention to the amount, nature, smell and bacterial culture, fungal culture, sputum to find tuberculosis, sputum pathology to find cancer cells have a certain diagnostic value.
Second, the equipment inspection:
1. X-ray and CT examination: There are obvious cardiopulmonary X-ray signs of dyspnea caused by cardiopulmonary diseases. Microscopic examination can be used to diagnose pneumoconiosis and reticular structure, and tomography (CT) is used to identify the nature of the mass or Find mediastinal and hilar masses; X-ray computed tomography to identify pericardial effusion and cardiac enlargement, large hemangioma and tumor; bronchial angiography for diagnosis of bronchiectasis, bronchial adenoma and carcinoma, pulmonary angiography for diagnosis of pulmonary infarction, mediastinal gastroscope and body Layer photography has diagnostic value in establishing the relationship between tumor and mediastinum.
2, ECG examination: heart disease patients can do ECG, echocardiography, late potential, heart function, 24h dynamic electrocardiogram, 24h dynamic hypertension and other tests.
3, pulmonary function test: lung function tests for chronic lung diseases such as chronic bronchitis, chronic obstructive pulmonary disease (COPD), bronchial asthma, etc. (forced vital capacity FVO, one second forced expiratory volume FEVI, maximum expiratory medium flow rate FEJ0 .25~0.75, lung closed gas volume measurement, residual gas measurement, etc.) to diagnose the nature and extent of lung function damage.
4, radionuclide scanning of the lung: help to diagnose emphysema and pulmonary vascular disease.
5, fiberoptic bronchoscopy: for the diagnosis and treatment of bronchial tumors, stenosis, foreign body.
6, lung biopsy: and lung biopsy to confirm the diagnosis, lung biopsy for pulmonary fibrosis, tumors and other significant.
Diagnosis
Diagnosis of bronchial disease
diagnosis:
Past history: past physical health, denying the history of acute and chronic infectious diseases such as "hepatitis, tuberculosis". Denied the history of chronic diseases such as "hypertension, diabetes, coronary heart disease". Denied the history of food and drug allergies. Denial of surgery, trauma, and blood transfusion history. The history of vaccination is unknown.
Personal history: Born in the original place, long-term living and working in the local, long-term residence history without epidemic areas. Smoking for 40 years, about 20 / day, has been quit smoking for 2 years. Drink a small amount.
Marriage and childbearing history: age-appropriate marriage and childbearing, with 2 females, spouse and daughter are all healthy family history: Parents are deceased, the cause of death is unknown, and there is no history of similar diseases and special genetic diseases in the family.
Differential diagnosis:
1. Acute exacerbation of chronic bronchitis:
There are many long-term smoking history, repeated coughing, coughing, in the winter and spring, chest tightness and shortness of breath are progressively aggravated, pulmonary function tests found that incomplete reversible ventilation function is impaired.
2. Tuberculosis:
There are many symptoms such as low fever, night sweats, weight loss, erythrocyte sedimentation rate, PPD test and tuberculosis antibody positive. Chest CT examination found that the lesions are mostly located in the upper lobe and lower back of the lungs. Generally, anti-infective treatment is ineffective and anti-tuberculosis treatment is effective.
3. Lung cancer:
More common in elderly patients, may have a long history of smoking, early non-specific performance, may have irritating cough, sputum with blood, fatigue, weight loss and other symptoms, elevated serum lung tumor markers, chest CT findings found new lungs Bronchoscopy and percutaneous lung biopsy are helpful for diagnosis and anti-inflammatory treatment is ineffective.
4. Bronchial asthma:
Youth onset, often have a history of allergies, clinical manifestations of recurrent chest tightness, cough, physical examination and expiratory dryness, positive bronchial stimulation or dilation test, hormone and 2 receptor agonist, theophylline treatment is effective , or can be improved on their own; cough variant asthma: characterized by paroxysmal chest tightness, cough, bronchial stimulation or dilatation test positive, hormone and 2 receptor agonists, theophylline drugs are effective.
5 pulmonary embolism:
There may be symptoms such as shortness of breath, hemoptysis, chest pain, and elevated blood D-dimer. CT pulmonary angiography is an important means of diagnosis.
6. Pulmonary interstitial fibrosis:
There may be cough and cough, but the main manifestation is shortness of breath after sexual activity. Chest CT shows that the lesion is severe by the surrounding area and the lower lungs. Hormone therapy may be effective. 8 Coronary heart disease: may have chest pain and other symptoms, electrocardiogram, myocardial zymogram, troponin and coronary angiography as an important means of diagnosis. Pleural effusion.
