非囊性纤维化支气管扩张症患者的咳嗽

A. Kantar, Woo-Jung Song, Andrew Bush, Grigorios Chatziparasidis
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摘要

非囊性纤维化支气管扩张症(NCFBE)属于慢性化脓性肺部疾病,以持续性湿咳/咳痰和气道扩张为特征。气道的形态和结构变化会导致气流变化,影响呼吸引起的粘液运输和滑动,并降低咳嗽的剪切力。此外,粘液粘度过高也会影响纤毛活动和疾病的发病机制。由于纤毛和呼吸诱导的粘液运输功能减弱,以及粘液异常,当粘液清除功能受损时,咳嗽是主要的后备机制。咳嗽克服粘液的内聚性和粘附性的效率取决于气流作用于粘液的力和粘液-气道表面的特性。全国鼻功能性阻塞性肺气肿理疗方案的主要目标是补充粘液水分和建立最佳呼气流速,因为呼气流速会对气道表面的粘液产生剪切力。在可能的情况下(通过呼吸动作、纤毛活动和咳嗽)改变粘液的流变特性并增强其运输,是预防疾病进展、甚至在疾病早期逆转支气管扩张以及预防肺部恶化的首要目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cough in Non-Cystic Fibrosis Bronchiectasis
Non-cystic fibrosis bronchiectasis (NCFBE) belongs to the spectrum of chronic suppurative lung diseases and is characterised by persistent wet/sputum-productive cough and airway dilatation. Morphological and structural changes in the airways lead to changes in airflow, impair breathing-induced mucus transport and sliding, and reduce the shear forces of cough. Moreover, mucus hyperviscosity contributes to compromised ciliary activity and the pathogenesis of the disease. This review highlights the role of cough in NCFBE, especially with respect to mucus clearance.Cough is the principal backup mechanism when mucus clearance is impaired due to either or both reduced function of cilia- and breathing-induced mucus transport, as well as abnormal mucus. The efficiency of cough in overcoming the cohesive and adhesive properties of mucus is determined by both the forces applied to mucus by airflow and the mucus-airway surface properties.In NCFBE, mucus hyperviscosity contributes to impaired mucus clearance and confers to disease pathogenesis; therefore, it may be a therapeutic target. The primary objectives of physiotherapy regimens in NCFBE are mucus hydration and the establishment of an optimal expiratory airflow velocity, which exerts shearing forces on the mucus located on the airway surface. Modifying the rheological properties of mucus and enhancing its transport whenever possible (by breathing manoeuvres, ciliary activity, and cough) represent prime goals in preventing disease progression and indeed reversing bronchiectasis in the early stages of the disease, as well as preventing pulmonary exacerbations.
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