Pulmonology: diseases — симптомы, диагностика и лечение

Bronchiolitis is a viral inflammation of the smallest airways, bronchioles, which occurs mainly in children of the first or second year of life. It is most often caused by respiratory syncytial virus. The disease begins as a common cold with a runny nose and low fever, and after 2-3 days frequent wheezing, coughing, retraction of the intercostal spaces and difficulties with feeding appear. The walls of the bronchioles swell, mucus accumulates in them, and the air becomes tight. Antibiotics do not work for bronchiolitis because the cause is viral; The basis of care is breathing support, nutrition and sufficient fluids.

Bronchitis in children is an inflammation of the bronchial mucosa, which in the vast majority of cases is caused by respiratory viruses. The disease usually begins like a common cold, and after a few days a cough develops: first dry and persistent, then wet. The bronchial mucosa is restored slowly, so a residual cough can last up to two to three weeks even with a successful course, and this does not mean that the treatment does not work. In some children, inflammation is accompanied by narrowing of the bronchi: wheezing and difficulty exhaling. Antibiotics for viral bronchitis do not speed up recovery, and the decision to prescribe them is made only by the doctor.

Bronchopulmonary dysplasia is a chronic lung disease that develops in premature infants who require oxygen support and artificial ventilation in the first days of life. The lungs of such a child have not yet completed development: there are few alveoli, there is not enough surfactant, and oxygen under pressure additionally damages the immature tissue. As a result, the formation of alveoli and blood vessels is disrupted, breathing remains rapid, and the need for oxygen remains. The diagnosis is made if the child requires supplemental oxygen at a certain age. As they grow, the lungs gradually mature, and in most children the condition improves markedly.

Bronchospasm is a sharp contraction of muscles in the walls of the bronchi, due to which the lumen of the airways narrows and air ceases to flow freely from the lungs. The spasm is almost always accompanied by swelling of the mucous membrane and viscous sputum, so breathing becomes noisy and whistling, and exhalation becomes long and difficult. This is not an independent disease, but a syndrome: it occurs with bronchial asthma, obstructive bronchitis, chronic obstructive pulmonary disease, allergic reaction, inhalation of irritants. Mild bronchospasm goes away on its own, but severe bronchospasm is life-threatening and requires immediate help, so it is important to be able to recognize it and know what to do.

Bronchiectasis is an irreversible dilation of the bronchi, the walls of which are damaged by chronic inflammation. In the enlarged areas, mucus stagnates, bacteria constantly live there, and a vicious circle arises: the infection maintains inflammation, and the inflammation further destroys the bronchial wall. The main manifestation is a long-term cough with a large amount of sputum, especially in the morning, and repeated exacerbations with rising temperature. The disease can develop after suffering severe pneumonia or whooping cough in childhood, against the background of tuberculosis, immunodeficiency or cystic fibrosis. It is impossible to cure bronchial dilatation, but regular cleansing of the airways and proper treatment of exacerbations significantly improve well-being.

Respiratory failure is a condition in which the lungs cannot maintain the normal composition of blood gases: oxygen becomes low or carbon dioxide accumulates in the blood. This is not a single disease, but the outcome of many causes - from severe pneumonia and exacerbation of chronic obstructive pulmonary disease to weakness of the respiratory muscles and damage to the nervous system. The acute form develops in hours and requires emergency assistance, the chronic form develops over months and years, and the person partially adapts to it. Key signs are shortness of breath, rapid breathing, bluish lips, confusion or, conversely, drowsiness. Severity is assessed by pulse oximetry and blood gas analysis.

Coughing is a protective reflex that clears the airways of mucus, germs and foreign particles. It is very common in children and in the vast majority of cases is associated with common viral infections. The mere presence of a cough does not indicate the severity of the disease: its nature, duration and accompanying symptoms, especially the child’s breathing, are much more important. A barking cough with noisy inhalation, attacks with respiratory arrest, wheezing and a cough that began suddenly during a game require completely different actions, including calling an ambulance.

A lung cyst is a cavity in the lung tissue, bounded by its own wall and filled with air or liquid. Cysts can be congenital, when the formation of bronchi in the fetus is disrupted, and acquired, after an abscess, tuberculosis, trauma, or against the background of emphysema. A small cyst does not interfere for years and is discovered by chance during an X-ray or CT scan. Problems begin with complications: suppuration with high fever and purulent sputum or rupture with the development of pneumothorax, when air enters the pleural cavity. Tactics depend on the size, symptoms and risk of complications and are determined by the pulmonologist together with the thoracic surgeon.

Hemoptysis is the appearance of blood in the sputum when coughing. This is not a separate disease, but a symptom, which can be either a harmless cause or a serious respiratory disease. Blood occurs in the form of single veins, pink foam or clots; sometimes its source is not in the lungs at all, but in the nasopharynx or stomach. Even a small amount of blood is a reason to consult a doctor and take a chest X-ray, because this symptom helps to identify tuberculosis, bronchiectasis or a tumor in time. Excessive discharge of scarlet blood is an emergency situation that requires calling an ambulance.

Pulmonary hypertension is a persistent increase in pressure in the pulmonary artery, due to which the right ventricle has to work against increased resistance. It thickens, then expands and gradually ceases to cope, right ventricular failure develops with edema and enlargement of the liver. The main complaint is shortness of breath, which increases over months and is long explained by fatigue, excess weight or age. The causes are varied: diseases of the left side of the heart, chronic lung diseases, previous thromboembolism, systemic connective tissue diseases, a rare primary form. Correct diagnosis requires consistent testing because treatment depends entirely on the cause.