Lumpy phlegm

Introduction In patients with old chronic bronchitis with emphysema, sometimes due to serious infection, the white blood cells of the tracheal mucus, inflammation, and exfoliated epithelial cells are excessive, forming a large number of massive sputum, which blocks the airway and causes asphyxia. When this happens, the family should immediately dine on the patient's tongue with a spoon handle, and use a finger wrapped with gauze to reach the throat and pry the blocked block for first aid purposes. More patients than in the cold season, coughing, coughing, especially in the morning, sputum is white mucus foam.

Cause

(1) Causes of the disease

The cause of chronic bronchitis is extremely complex and has not been fully understood so far. In recent years, the relevant factors are as follows:

1. Smoking: Smoking is the leading cause of chronic bronchitis. The incidence of chronic bronchitis in smokers is 4 to 5 times higher than that of non-smokers, and the incidence increases with the number of years of smoking and the increase in smoking. Tobacco smoke contains a variety of harmful ingredients such as tar, nicotine, carbon monoxide, furfural and the like. These harmful substances can directly or indirectly damage the bronchial mucosa epithelium, and even cause squamous metaplasia, inhibit or damage the bronchial mucociliary movement, make it fall, shorten or even fall off, stimulate mucus gland hyperplasia, excessive mucus secretion, secretions Secondary microbial infections inhibit the phagocytosis of lung macrophages, and smoking can also cause bronchospasm.

2. Atmospheric pollution: Harmful gases in the atmosphere, such as nitrogen oxides, sulfur dioxide, chlorine, etc., have stimulating and cytotoxic effects on the bronchial mucosa, which can cause inflammation of the mucous membranes, harmful organic and inorganic dusts in the atmosphere, such as silica and coal. Powder, cotton chips, sugarcane dust, etc. can also cause pulmonary fibrosis, which can damage lung function and create conditions for pathogenic microbial invasion.

3. Infection: Infection of pathogenic microorganisms is another important morbidity and aggravating factor for chronic bronchitis.

4. Allergic factors: Endogenous or exogenous antigens can cause delayed or immediate allergic reactions, causing bronchospasm and leading to tissue damage and inflammation. Especially for asthmatic chronic bronchitis, allergic factors are an important cause.

5. Meteorological factors: Climate change, especially cold, dry, high heat can damage the cilia function and respiratory mucosal blood circulation, so that the local barrier function is reduced and it is easy to follow the infection of the original microorganism.

6. Others: autonomic dysfunction may also be an internal cause of the disease, vitamin deficiency, especially the lack of vitamin C, A can reduce the body's resistance and susceptible to chronic bronchitis, the elderly gonadal and adrenal function decline, throat Slow reflexes, degraded respiratory defenses, declining mononuclear-macrophage system function, malnutrition, etc. can increase the incidence of chronic bronchitis.

(two) pathogenesis

The main pathological change in chronic bronchitis is non-specific inflammation of the tracheal-bronchial mucosa. Due to repeated episodes of inflammation, epithelial focal necrosis and squamous metaplasia, ciliated epithelial cells with varying degrees of damage, cilia become short, sparse or detached, mucous gland hyperplasia, ductal dilatation, serous glands and mixed glands Correspondingly, goblet cells proliferated significantly, Reid index (gland thickness / bronchial wall thickness) increased, bronchial wall inflammatory cell infiltration, congestion and edema, necrosis and fibrosis, mucosal tissue ulceration and granulation hyperplasia, severe bronchus Smooth muscle layer thickening and elastic fiber muscle formation, stenosis of the lumen, collapse of the bronchioles, mucus plugs in the lumen, and swelling of the type I cells under the electron microscope of the alveolar wall, type II cell hyperplasia, thickening of the capillary basement membrane Endothelial cell injury, thrombosis, luminal occlusion, diffuse hyperplasia of alveolar wall fibrous tissue, these changes are particularly significant in patients with emphysema and pulmonary heart disease.

an examination

Related inspection

Sputum trait white blood cell count (WBC)

White blood cell classification count

The total number of white blood cells and the difference counts in the remission period were normal. The total number of white blood cells and neutrophils in the acute attack period complicated with bacterial infection increased, and the blood eosinophils in patients with asthma increased.

2. Sputum examination

The appearance of sputum in the acute attack period is mostly purulent, and a large number of neutrophils can be seen on the smear examination. More eosinophils can be seen in patients with asthma, and growth can be seen in sputum cultures such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

3. X-ray inspection

There was no significant change in the early stage. Repeated acute authors showed that the lungs were thickened, disordered, reticular or cord-like and spotted. This is due to thickening of the bronchial wall, infiltration or fibrosis of bronchial or alveolar interstitial inflammatory cells.

Differential diagnosis

Differential diagnosis of massive sputum:

Chilling: The cold evil sins the lungs, so that the lung fluid in the lungs condenses into sputum. The cockroach is white, the patient is afraid of cold, likes hot drinks, and the tongue is white or greasy.

Windy: caused by the wind evil invading the lungs, that is, the cold, began to sputum white, can turn yellow sticky afterwards, the patient is afraid of the wind, the tongue begins to white, then turn thin yellow.

Enthusiasm: After a few days after the heat is invaded by the lungs or the wind or cold evil, the body fluid is burned and converted into yellow sticky sputum. The patient is afraid of hot and cold drink, the tongue is red and yellow, and the whiteness is scattered.

Wet phlegm: wet evil invades the human body (such as living in a humid environment), causing dysfunction of the lungs and spleen or loss of diet. The skin is white and watery, and the patient has body weight, tiredness or loose stools. The tongue is white or greasy.

Dryness: It is dry and dry, and the lungs are dry and dry, and it is easy to cough up or have hemoptysis. The patient feels nose, throat and throat, and the tongue is thin yellow.

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