Bronchial central granulomatosis

　　1. Etiology

　　The etiology of BG in patients with asthma may be related to immune reactions to certain aspergillus species parasitizing the bronchus, while in patients without asthma, it may be related to hypersensitivity reactions caused by inhaling unknown antigens.

　　2. Pathogenesis

　　The prominent pathological feature is the granuloma rich in eosinophils and non-caseating. In the early stage, the mucosa of the bronchioles is replaced by histiocytes, followed by non-caseating and necrotic granulomas distributed within the bronchioles, destroying them. In the asthma group, more eosinophils can be seen in the lesions; in the non-asthma group, the lesions are mostly composed of plasma cells. Special staining shows hyphae in the granulomas. The pulmonary arteries and veins adjacent to the granulomas show the manifestations of vasculitis, but unlike WG, there is no vascular center destruction. The bronchi can be dilated, with tough gray-brown stratified material in the lumen, which can be seen under the microscope as mucus, necrotic epithelium, inflammatory cells, eosinophils, and Charcot-Leyden crystals, and fungal hyphae can be found. There may be infiltration of eosinophils and chronic inflammatory cells around the bronchi, accompanied by fibrosis. A few patients have submucosal necrotic granuloma nodules, which can destroy the tracheal cartilage.

　　Pulmonary atrophy is common in complications. Pulmonary atrophy refers to a decrease in the volume or gas content of one or more pulmonary segments or lobes, usually accompanied by a decrease in opacity in the involved area due to the absorption of gas in the alveoli. Adjacent structures (bronchi, pulmonary vessels, pulmonary interstitium) gather towards the atrophic area, and sometimes there is actualization of the alveolar cavity, and other pulmonary tissues compensate with emphysema. Lateral airway communication between pulmonary acini and segments (occasionally pulmonary lobes) can allow the completely blocked area to still have a certain degree of transparency.

　　Most patients have asthma, and the patients in the asthma group generally onset at a young age, most of whom belong to specific体质, often have a family history of asthma, onset is acute, often accompanied by fever, cough, sputum is mostly mucopurulent, sometimes there are brownish mucous plug sputum, some patients have shortness of breath and chest pain, without asthma group patients, onset age is larger, average 50 years old, symptoms are mild, with slight cough, fatigue, upper respiratory tract infection, etc., without the manifestation of extrapulmonary vasculitis, a few even without symptoms.

　　1. The etiology is unknown, so it is necessary to explore effective preventive measures. At present, adrenal cortical hormones are still the first choice for treatment, and reducing the dose while not affecting treatment can greatly reduce the occurrence of opportunistic infections. Adrenal cortical hormones are a class of steroid compounds synthesized and secreted by the adrenal cortex, mainly functioning to regulate the water and salt metabolism and sugar metabolism in animals.

　　2. Diabetic patients may worsen with hormones and should be used with caution.

　　1. Hematological examination shows an increase in peripheral blood eosinophils, often exceeding 5×10^9/L.

　　2. The total white blood cell count and erythrocyte sedimentation rate can also increase during the acute phase.

　　3. In sputum culture, 50% can detect the growth of Aspergillus.

　　4. The skin test with the mixed extract of the Aspergillus species showed positive wheals and erythema reactions in 90% of active patients within a few minutes, and the serum IgE level is often more than twice that of normal people.

　　5. Chest X-ray often shows infiltrative shadows, solitary or multiple nodules, and atelectasis.

　　What foods are good for the body for central granulomatous disease of the bronchus: It is advisable to eat light foods, eat more vegetables and fruits, and properly balance the diet, ensuring adequate nutrition.

　　Characteristics of fresh fruits and vegetables

　　1. After harvesting, fruits and vegetables are still living organisms. Their life activities are maintained mainly by decomposing the nutrients within their bodies and absorbing oxygen, while expelling carbon dioxide and other gases. They are different from processed foods that lack vitality.

　　2. Fresh fruits and vegetables contain 80-95% water. Just reducing the water content by 5% will cause them to lose luster, wrinkle, degrade in quality, and decrease in commercial value.

　　3. Rich in nutrients required for microbial growth, it is easily decomposed by microorganisms and becomes rotten and deteriorated.

　　4. Tissue is loose and soft, not resistant to collisions or compression, and it is prone to rot once damaged.

　　1. Treatment

　　The main treatment is with corticosteroids. Steroids can alleviate asthma attacks and the invasion and destruction of the lung tissue by aspergillus. Prednisone 0.5-1mg/(kg·d), taken orally once a day, is changed to every other day after 2 weeks of continuous administration, and the dose is gradually reduced according to the condition, continuing for 3 months. Follow-up for 2 years, with chest X-rays reviewed every six months. For those who do not respond to steroids, azathioprine therapy can be considered. Bronchodilators and expectorants can promote the rapid excretion of sputum clots or purulent sputum. Rest, increased nutrition, and regular exercise can enhance resistance to aspergillus. The use of antifungal drugs can also achieve good efficacy. Amphotericin B is administered intravenously, with an initial dose of 0.1mg/kg, which can be gradually increased to 0.5-1mg/kg, dissolved in 250-500ml of 5% glucose, and slowly infused in the dark for 4-6 hours, administered daily or every other day. This drug has many side effects and requires monitoring of liver and kidney function. Fluconazole 400mg/d treatment can also achieve good efficacy. Recently, overseas reports indicate that for patients with unexplained pulmonary nodules, thoracotomy and lung biopsy can be performed, and after the pathological diagnosis is clear, the lesion can be surgically removed.

　　2. Prognosis

　　Good prognosis.