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Wednesday, 27 November 2013

Bronchiectasis Treatments In conventional medicine perspective

Respiratory Disease is defined as medical conditions, affecting the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and  muscles breathing , etc,.
Bronchiectasis  is defined as a condition chracterized by the damage of the localized, irreversible dilation of part of the bronchial tree and the walls of the large airways of the lung as a result of the destruction of the lung muscles and elastic tissues. Bronchiectasis can be present alone, but in most cases, it is a disease coexisted with patient of chronic obstructive pulmonary disease (COPD).
G. Treatments
C.1. In conventional medicine perspective
C.1.1. Therapies
1. Pulmonary rehabilitation
In the studyn to evaluate the effectiveness of pulmonary rehabilitation (PR) recognized in national and international guidelines and highlighted by the National Institute of Clinical Excellence as one of the six key priorities for improving the care of chronic obstructive pulmonary disease (COPD) patients, PR is likely to be effective in bronchiectasis as it is in COPD, showed that the results highlighted the potential role of PR in patients with bronchiectasis, however further investigations are needed to identify the most eligible patients and to optimize the training programs to maintain long term benefit. Chest x-ray may represent a relevant instrument to observe the clinical improvement of these patients, also when spirometric values do not change significantly(43).
2. Oxygen therapy 
Oxygen therapy is reserved for hypoxemic patients with severe disease and end-stage complications,
3. Exercise training and inspiratory muscle training 
In  the study of thirty two patients with idiopathic bronchiectasis who were randomly allocated to one of three groups: PR plus sham IMT (PR-SHAM), PR plus targeted IMT (PR-IMT), or control, all patients (except the control group) underwent an 8 week training programme of either PR or PR plus targeted IMT. Exercise training during PR was performed three times weekly at 80% of the peak heart rate. IMT was performed at home for 15 minutes twice daily over the 8 week period, found that PR is effective in improving exercise tolerance in bronchiectasis but there is no additional advantage of simultaneous IMT. IMT may, however, be important in the longevity of the training effects(44).
4. Hypertonic saline inhalations
In the study of 37 bronchiectasis patients without cystic fibrosis inhaled 4 ml of a 6 per cent saline solution twice a day for three months, found that inhalation did not decrease oxygen saturation but did lower slightly the PEF value. SGRQ score decreased by 9.2 points on the average (p = 0.002) indicating clinically significant improvement in quality of life(45).
5. Bronchopulmonary hygiene physical therapy
Bronchopulmonary hygiene physical therapy is a form of chest physical therapy including chest percussion and postural drainage to remove lung secretions. But according to the study to assess the effects of bronchial hygiene physical therapy in people with chronic obstructive pulmonary disease and bronchiectasis, showed that there is not enough evidence to support or refute the use of bronchial hygiene physical therapy in people with chronic obstructive pulmonary disease and bronchiectasis(46).
6. Bronchodilator therapy
Bronchodilator therapy helps to dilate the bronchi and bronchioles, decrease resistance in the respiratory airway and increase airflow to the lungs, such as Short-acting β2-agonists,  Long-acting β2-agonists and Anticholinergics.
7. Anti-inflammatory Therapy
The aim of anti-inflammatory therapy is to modify the inflammatory response caused by the microorganisms. In the testing  the hypothesis that azithromycin would decrease the frequency of exacerbations, increase lung function, and improve health-related quality of life in patients with non-cystic fibrosis bronchiectasis, showed that found that Azithromycin is a new option for prevention of exacerbations in patients with non-cystic fibrosis bronchiectasis with a history of at least one exacerbation in the past year(47).
8. Antibiotic Therapy
1. Intravenous (IV) antibiotics therapy
Patients with recurrent exacerbations (five or more exacerbations per year) and subjectively reporting ill health, intravenous (IV) antibiotics therapy is recommended.
In the study to assess the impact of 8-weekly intravenous (IV) antibiotics on exacerbation frequency and health-related quality of life in bronchiectasis, indicated that treatment with 8-weekly intravenous antibiotics in severe bronchiectasis reduced exacerbation frequency and improved exercise tolerance and health-related quality of life(48).
2. Oral antibiotics therapy
a. For patients with moderate-to-severe symptoms, parenteral antibiotics, such as an aminoglycoside (gentamicin, tobramycin) and an antipseudomonal synthetic penicillin, a third-generation cephalosporin, or a fluoroquinolone, etc. are recommended.
b. For patients  with chronic bronchial infections and need regular antibiotic may put on prescribed oral antibiotics either regularly or a set of time.
3. Inhaled antibiotics 
Inhaled antibiotics are increasingly used in patients with non-cystic fibrosis (CF) bronchiectasis. According to the study by Unidad de Neumología, Hospital General de Requena, studies performed to date have shown several positive effects on some key parameters such as a reduction in the number of colonies and the quantity and purulence of sputum, improved quality of life and fewer exacerbations, although this therapy has little impact on accelerated loss of pulmonary function. The percentage of eradication varies, with a low rate of resistance. The clearest use of inhaled antibiotics in patients with non-CF bronchiectasis is probably colonization, especially chronic infection with Pseudomonas aeruginosa. Adverse effects are usually mild and consist of local irritation of the airway, although their frequency is greater than that in patients with CF(49).
C.1.2. Surgery
The role of surgery has declined at least by the number of literature reports. Except for cures for local bronchiectasis, surgical resection is now used to palliate disease activity by removing the most affected segments and lobes, according to the study by Division of Pulmonary and Critical Care Medicine, Oregon Health Sciences University(50).
1.  Sugery of localised areas of lung, surgical resection of the affected segments
Standard treatment for bronchiectasis comprises postural drainage and various regimes of antibiotic therapy. If the disease is confined to localised areas of lung, surgical resection of the affected segments is often performed, according to the stduy  University Hospital Aintree(51).
2. Lung transplantation
Lung transplantation is an established treatment for end-stage bronchiectasis. In  a retrospective observational study of all who received a transplant for bronchiectasis at the unit of Papworth Hospital NHS Trust and to compare the survival after transplant, number of infective and rejection episodes, and the change in forced expiratory volume in 1 second (FEV1), found that here was no evidence that transplant recipients with bronchiectasis and antibody deficiency have a worse prognosis than those with bronchiectasis alone(52).
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