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“cough, cough, cough…” 65-year-old Uncle Zhang (pseudonym) last year After I caught the cold, I started coughing non-stop, repeatedly, from winter to spring, which lasted for three months.
“Director He, I don’t smoke or drink, so why can’t this cough be cured?” Uncle Zhang went to the Respiratory and Critical Care Medicine of Hangzhou Red Cross Hospital. Ke He Fei, the chief physician of integrated traditional Chinese and Western medicine, saw a doctor.
The cough is more than COPD
Uncle Zhang said , For the past three months, he wakes up every day with a violent cough, and if he is active, he will be short of breath. He has gone to many hospitals for examinations. The blood tests are basically normal. Some doctors suspect that it is a “pulmonary tuberculosis” infection. The CT examination of the lungs showed old tuberculosis, and there were no new infection lesions. The sputum for acid-fast bacilli was negative for many times. In the end, only a few conventional cough and phlegm medicines were prescribed, and the effect was not good.
“Have you ever been infected with tuberculosis before?” He Fei asked after carefully reviewing the medical history and related test results.
“I had tuberculosis once 20 years ago, but it was cured at that time, and I didn’t cough again.”
He Fei auscultated Uncle Zhang’s breath sounds and found that the breath sounds were relatively low, and his lung CT examination showed that in addition to the old tuberculosis lesions, there were many signs of emphysema in the surrounding area. Therefore, Uncle Zhang was arranged for a pulmonary function test, and it was diagnosed that Uncle Zhang suffered from “chronic obstructive pulmonary disease”.
He Fei explained to Uncle Zhang that although tuberculosis was cured at that time, its complications were ignored. After pulmonary tuberculosis is cured, the lung function of patients will decline faster than normal people. If there is no timely intervention and long-term management, long-term complications such as chronic obstructive pulmonary disease are prone to occur. After the diagnosis was confirmed, He Fei adopted a comprehensive treatment plan of integrated traditional Chinese and Western medicine. When returning to the clinic a month later, Uncle Zhang said that the cough had been significantly relieved, and the shortness of breath had also improved.
Don’t Ignore Complications After Tuberculosis Recovery
Residuals after Tuberculosis Treatment Injury is a problem that has been neglected for a long time. He Fei said that in clinical situations such as Uncle Zhang are often encountered. Some patients are cured of tuberculosis, but then develop new respiratory symptoms and structural changes in the lungs and bronchi. Therefore, even after a sufficient amount of pulmonary tuberculosis and a full course of anti-tuberculosis treatment, there may remain permanent pulmonary structural and functional damage, including chronic obstructive pulmonary disease, bronchiectasis, airway stenosis and fistula formation, bronchovascular malformations, and fibrosis, etc., various clinical complications occur, mainly in the following aspects:
1. Hemoptysis and bronchial stenosis: Pulmonary tuberculosis is the most common hemoptysis One of the reasons for TB can occur at any stage of deterioration, improvement and recovery of pulmonary tuberculosis. After tuberculosis is cured, the airway will be narrowed due to scar growth, and bronchoscopy should be used if necessary.
2. Spontaneous pneumothorax: When the pulmonary tuberculosis lesion is located under the pleura, the lung tissue forms bullae and emphysema during the repair process. As the disease progresses, the rupture of the visceral pleura leads to the development of spontaneous pneumothorax.
3. Pulmonary infection: Pulmonary tuberculosis is associated with pulmonary infection, the pathogen is more complex, mixed infection is mostly, and it can coexist with the early stage of pulmonary tuberculosis, It can also be secondary to the course of the disease. Fungi (most common Aspergillus), Pseudomonas aeruginosa, viruses, nontuberculous mycobacteria, etc.
4. Bronchiectasis: In the localized lesions, after being organized by fibrous tissue, the normal tissue structure of the bronchial wall is destroyed, the elasticity is lost, and the The formation of localized bronchiectasis, severe cases may be secondary to infection or hemoptysis.
5. Chronic obstructive pulmonary disease (COPD): One of the risk factors for COPD is a history of tuberculosis infection. After the patient’s pulmonary tuberculosis is cured, the lung function continues to decline, and then develops into chronic obstructive pulmonary disease, which still requires later maintenance treatment.
6. Pulmonary heart disease: The normal lung tissue is destroyed to form emphysema, pulmonary bullae, ventilation and ventilation dysfunction, Lead to chronic respiratory failure, due to long-term hypoxia, the fibrous tissue in the lungs pulls the blood vessel wall, resulting in pulmonary hypertension, secondary pulmonary heart disease, and right heart failure.
He Fei suggested that clinical evaluation and intervention should be carried out after the treatment of pulmonary tuberculosis. Clinical assessment should include lung structure, function, and symptoms, and whether these changes affect the patient’s quality of life, and assess whether the patient is at risk for fungal colonization or infection after treatment. Ultimately draw lessons from pulmonary health practice in chronic diseases to develop post-TB continuum care strategies. Only in this way can the harm of these residual injuries be minimized and the quality of life of patients can be further improved.
(Chen Xiaoqing, Zhang Chi, Cui Jinyu and He Fei)
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