This article is from "Nankai Sun Pharmacist", which is used for medical science popularization for reference. What are the most effective drugs for bronchiectasis?How to prevent bronchiectasis without infection**?
Bronchiectasis is a common chronic respiratory disease, which is caused by the destruction of bronchial wall structure caused by various reasons, resulting in abnormal and long-lasting dilation and deformation of the bronchi, continuous and repeated cough and sputum production are its main clinical manifestations, sometimes accompanied by hemoptysis, and in severe cases, massive hemoptysis. Lower respiratory tract infection is the most common cause of bronchiectasis, in addition, patients with bronchiectasis often have bacterial colonization in the airways such as Haemophilus influenzae or Pseudomonas aeruginosa, and the presence of repeated infections and colonizing bacteria can increase the amount of airway secretions and sputum, which is difficult to discharge, thereby aggravating airway obstruction and exacerbating infection, and long-term infection can also lead to invasion of inflammatory cells in the airways, causing persistent inflammatory reactions, therefore, repeated suppuration** Infection causes airway obstruction, causes chronic inflammatory response, induces bronchoconstriction, and causes dyspnea, which is typical of bronchiectasis.
Lower respiratory tract infections are the most common bronchiectasis** At the same time, patients with bronchiectasis in the stable stage have bacterial colonization such as Haemophilus influenzae and Pseudomonas aeruginosa in the airway, which can lead to aggravation of cough, increased sputum, aggravation of airway obstruction, poor expectoration, and can further aggravate the infection, with the prolongation of the course of the disease, the lung tissue around the bronchi will also be infected, damaged by inflammation, resulting in fibrosis of the bronchi and lung tissue, which in turn leads to a decline in lung function, and may eventually develop into cor pulmonale.
Bronchiectasis often leads to acute exacerbation due to infection, manifested as purulent sputum, increased sputum volume, aggravated cough, aggravation of dyspnea, decreased lung function, hemoptysis, systemic fever, etc., at this time, the use of antimicrobial drugs should be considered**, common pathogens are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus and Klebsiella pneumoniae, Escherichia coli, etc., initial empirical ** can choose moxifloxacin, levofloxacin, ampicillin sulbactam, amoxicillin/clavulanate and cefotaxime, If the patient has a history of recent hospitalization, recent frequent use of antibiotics or hormones, and significant decline in lung function, indicating a risk of infection with Pseudomonas aeruginosa, then the selection of antimicrobial drugs should be carried out for Pseudomonas aeruginosa**, such as ceftazidime, cefoperazone sulbactam, cefepime, piperacillin, tazobactam, imipenem, meropenem, ciprofloxacin, levofloxacin, amikacin, etc.
Other ** drugs also include drugs that promote the discharge of airway secretions, such as ambroxol, carbocisteine, etc., which can effectively promote sputum discharge, bronchodilators, such as ipratropium, tiotropium, albuterol, formoterol, etc., which can effectively relieve dyspnea and reduce airway hyperresponsiveness, and inhaled glucocorticoids, such as budesonide, fluticasone, etc., which can reduce the amount of expectoration and improve the quality of life, but the current evidence for the use of these drugs is not reliable, therefore, long-term use is not recommended.
Methods to prevent acute exacerbations of bronchiectasis: first of all, it is necessary to prevent it from an early age, and actively vaccinate against measles, pertussis vaccine, and BCG in childhood to prevent and treat lower respiratory tract infections in children and prevent the occurrence of bronchiectasis;Secondly, for patients with bronchiectasis, it is recommended to receive multivalent pneumococcal vaccine and influenza vaccine every year to prevent pneumonia and pneumonia secondary to influenza, which can reduce acute episodes of bronchiectasisFinally, patients with bronchiectasis should actively quit smoking and use immune boosters such as BCG to improve immunity, thereby reducing respiratory tract infections and preventing acute exacerbations of bronchiectasis.
In addition, studies have confirmed that long-term low-dose administration of erythromycin, azithromycin and other macrolide antibiotics can not only improve the symptoms of cough and phlegm in patients with bronchiectasis, reduce the amount of sputum and the number of bacteria in the sputum, improve the quality of life, but also reduce the acute exacerbation of bronchiectasis. It is recommended that the dose of azithromycin be 500mg 3 times a week, but long-term use of azithromycin will undoubtedly increase the risk of adverse reactions, and attention should be paid to early prevention.