Diagnostic criteria for chronic bronchitis. Acute bronchitis

Diagnosis of acute bronchitis is necessary not only for diagnosis accurate diagnosis, as well as to determine the cause of the disease, determine how difficult the disease is.

Any disease has its own causes and symptoms. When diagnosing, the doctor must identify why the disease developed, and the symptoms will help establish a diagnosis. Therefore, you should consider what can cause acute bronchitis and how it manifests itself.

Causes and symptoms of acute bronchitis

Acute bronchitis may begin to develop for two types of reasons or due to their “joint activity.”

Infections

These include viruses, bacteria, and atypical microflora. Moreover greatest number Infectious cases of acute bronchitis occur when viruses influence the human body.

Quite often to viral infection bacterial is also added. The virus infects the inner wall of the bronchi, which contains immune cells, i.e. they are created favorable conditions for the penetration and reproduction of pathogenic bacteria.

Among the viruses that provoke acute bronchitis, such as independent disease or as a continuation of other respiratory ailments, one can distinguish influenza virus, parainfluenza, adenovirus, RS virus, etc.

Bacterial pathogens include pneumococcus, Haemophilus influenzae, streptococcus, and staphylococcus.

Non-infectious pathogens

These can be physical factors (dry, damp, cold or hot air), chemical irritants (vapors of chlorine, ammonia, nitrogen oxides, etc.), allergens (household or industrial dust, pet hair, bird feathers and fluff, pollen flowering plants, medicines, food, etc.).

The symptoms of acute bronchitis are known to almost everyone. When the disease occurs, the patient experiences the following symptoms:

• Cough. This is the most main symptom bronchitis of any kind. Whatever the cause of the disease, cough is an indispensable “attribute” of the disease. In acute bronchitis viral nature The cough will initially be dry and hacking with difficult expectoration, which causes pain in the chest.
  As the disease progresses, the cough gradually moistens, sputum gradually begins to separate, which significantly alleviates the patient’s condition.
• Sputum. Upon joining bacterial infection sputum takes on a greenish or yellowish tint. If acute bronchitis was caused by allergens, then the cough has a paroxysmal character, and it often occurs at night.
• The temperature can fluctuate between 38-4 0 0C. In allergic bronchitis it remains normal.
• Headache, muscle, joint pain.
• Lethargy, fatigue, general weakness.
• Increased sweating.
• Dyspnea. Occurs if air flow is sharply reduced, i.e. obstruction occurs.

History and examination of the patient

Any visit to a doctor begins with collecting an anamnesis from the words of the patient or loved ones who know him. Initially, the doctor listens to all the patient’s complaints about his state of health, and then begins to conduct a survey himself.

To make the most accurate diagnosis and the causes of acute bronchitis, already at the anamnesis stage, the doctor learns from the patient:

• Under what conditions did the patient grow up and live? What are the patient's living conditions? this moment– dry or humid air in the house, whether there is mold in it, pets, whether there are any industries near the home, etc.;
• what are the working conditions (humidity, temperature, dust, crowding, etc.), how many years the patient has been working in this profession;
• what the patient eats;
• does the patient have bad habits, in particular, whether he smokes and, if so, at what age;
• what diseases the patient suffered during his life (surely everyone has heard the question from a doctor: what did you get sick with in childhood?);
• does the patient currently have chronic diseases;
• what serious diseases do the parents suffer from?
• when did the first signs of the disease appear;
• How exactly do the symptoms manifest themselves, in particular: how often does the cough occur, is it dry or wet, at what time of day is it more intense, whether phlegm comes out when coughing, whether the temperature rises or not, whether shortness of breath occurs, etc.

Based on your medical history, your doctor can make an initial diagnosis of acute bronchitis. Moreover, this disease does not have any particular difficulties in diagnosing.

However, the doctor does not have the right to rely only on anamnesis, so an examination of the patient is also required.

When examining a patient with acute bronchitis, the doctor performs auscultation, or simply listening, using a phonendoscope.

Listening to the patient is carried out in order to identify and determine the types of noise in the respiratory system. Auscultation is performed over the entire surface of the lungs in the anterior, lateral and posterior sections.

During the audition, the patient must sit or stand, while the doctor asks for deep breathing for clearer results.

In acute bronchitis, the patient may hear dry or moist rales.

• Moist rales in acute bronchitis are detected when liquid mucus accumulates in the bronchial tubes. Under the flow of air, it foams, and the bursting bubbles create characteristic bubble sounds.
• Dry wheezing in acute bronchitis is heard when viscous fluid accumulates in the bronchi. thick mucus, which fills the bronchial lumen. When mucus accumulates in large bronchi buzzing sounds will be heard, and when it is concentrated in the small bronchi and bronchioles, the sounds become whistling.
• To exclude suspicions of bronchial asthma, the doctor performs a special type of auscultation - bronchophony. When listening with a phonendoscope, the patient must whisper words containing the sounds “r” and “ch”. In case of bronchial asthma, these sounds will be clearly audible; in other cases, only a quiet rustling will be heard.

Lab tests

Among laboratory tests prescribed for acute bronchitis, a blood test, microflora culture and urine test can be noted.

Blood analysis

A blood test for uncomplicated forms of acute bronchitis is not necessary, since the characteristic symptoms of the disease and examination of the patient already allow the doctor to diagnose the disease.

• General analysis blood simply confirms that inflammatory processes are occurring in the body. Blood counts indicate an increased content of leukocytes (10-12*10 9 /l) and a slight increase in ESR (erythrocyte sedimentation rate) - up to 100 mm/h.
• A biochemical blood test for acute bronchitis will show the appearance of C-reactive protein, which is a specific marker of inflammation in the body. The higher the level of CRP in the blood, the more severe the inflammatory process. For acute bronchitis biochemical analysis blood will reveal increased content alpha-2-globulins, which also confirm the presence of inflammatory processes.

General urine analysis

This analysis is necessary in order to monitor the kidneys’ response to inflammatory processes in the body.

It is carried out to assess the course of the disease, monitor the development of complications and the effectiveness of the treatment.

At high body temperatures, increased protein content is usually detected in the urine. The doctor may prescribe a urine test during the period of acute bronchitis, then at the end of treatment and a control test after another 1 month.

Sputum analysis

In acute bronchitis, microscopic and bacteriological analysis sputum.

• Microscopic analysis reveals in sputum dead cells epithelium, significant amount neutrophils and macrophages (cells from a group of white blood cells that fight bacterial infection). In acute obstructive bronchitis, Kurshman spirals, which are spiral-shaped casts of small bronchi, may appear in the sputum.
• Bacteriological analysis of sputum allows you to determine the type of bacteria that caused inflammatory processes in the bronchi. Such information helps the doctor select effective drugs for the treatment of acute bronchitis.

X-ray studies

Auscultation is used in medical practice quite a long time ago. However, this diagnostic method still has some inaccuracies, especially when we're talking about about recurrent or obstructive bronchitis. The doctor uses an x-ray.

With ordinary uncomplicated bronchitis, there is no particular need for an x-ray, since the images will not show any special changes in the lungs and bronchi.

The doctor prescribes an X-ray in the following cases:

• the patient has a high temperature for a long time;
• shortness of breath appears;
• the previously prescribed treatment did not produce any results.

X-ray examination of complicated acute bronchitis may reveal the following signs:

• the presence of liquids and other chemical elements in the lungs;
• the root of the lung is somewhat deformed, has an enlarged and blurry appearance;
• small vessels of the lungs become invisible;
• the walls of the bronchi have a somewhat thickened appearance.

In an advanced situation, the doctor may detect the following changes in the image:

• in some areas of the tissue the vessels are not visible;
• the pulmonary pattern is greatly modified;
• V lower area lungs there is an increased air content.

X-ray examination may be contraindicated in seriously ill people or pregnant women due to radiation exposure.

Diagnostics using devices

If acute bronchitis is complicated by an obstructive component, then the extent of these complications can be detected using instrumental diagnostics.

Pneumotachography

This study determines the amount of air inhaled and exhaled. The pneumotachograph mouthpiece is inserted into the patient's mouth and the nose is pinched.

The device records air volumes in the form of a curve. With the help of a pneumotachograph it is possible to detect abnormalities respiratory function in acute bronchitis at a stage when neither the doctor nor the patient is even aware of it.

Thanks to this, timely and correct treatment can be prescribed.

Peak flowmetry

This study for acute bronchitis allows you to determine the rate of forced expiration.

To do this, the patient exhales air from the lungs with great effort into a device - a peak flow meter, which is a tube with a scale.

Such studies help to identify the degree of narrowing of the bronchial lumens in obstructive acute bronchitis, and therefore prevent the progress of obstruction.

Peak flow meter studies allow the doctor to select the necessary therapy for the treatment of obstructive acute bronchitis.

The peak flow meter is so easy to use that you can conduct research with it at home yourself.

Spirometry, or spirography

This study provides comprehensive assessment breathing conditions. With spirometry, you can examine the following indicators for acute bronchitis:

• indicator of quiet breathing;
• increased exhalation rate;
• maximum lung capacity;
• respiratory parameters after the use of bronchodilators.

With the help of spirometry, it is possible to detect obstruction of the bronchial tree in a timely manner and prescribe the correct treatment.

During the study, a special device, a spirometer, records the volumes of inhaled and exhaled air.

The patient is asked to dial full lungs air, hold your breath for a few seconds, and then exhale slowly, pressing your lips to the special mouthpiece of the device.

Then do the same thing, but the exhalation must be done with effort. Thus, it is fixed calm breathing and exhalation force.

An important indicator in obstructive acute bronchitis is the volume of forced expiration in the first second. All these indicators give a complete picture of the severity of the obstruction.

Thus, when diagnosing acute bronchitis, not only the diagnosis of the disease is established, but also its causes, severity, etc.

We hope that acute bronchitis will never bother you or your family. Be healthy!

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Chronic inflammatory process in the lungs can lead to the development of a number of complications, therefore timely diagnosis chronic bronchitis is very important. The earlier it is delivered correct diagnosis, the more effective the treatment will be. Bronchitis, including chronic bronchitis, is easy to diagnose; the patient’s complaints are already quite informative. The diagnosis is clarified during the examination of the patient, testing and instrumental studies.

WHO diagnostic criteria

The World Health Organization defines chronic bronchitis as a disease in which there are repeated episodes of persistent productive cough lasting at least 3 months for 2 or more years.

This is the main diagnostic criterion, but there are others:

• when you listen to a typical picture: breathing is hard, rough, scattered wheezing, can be dry and wet, exhalation is prolonged;
• Bronchoscopy reveals inflammatory changes in the bronchi;

• function study external respiration shows the presence of bronchial obstruction;
• Based on the results of differential diagnosis, other diseases are excluded, which are also characterized by protracted periods of productive cough that manifest themselves over years. These are tuberculosis, bronchiectasis, chronic lung abscess and a number of others.

Cough with sputum production, which manifests itself throughout long periods, is not always a symptom of chronic bronchitis. If, in its presence, there are inconsistencies with the WHO criteria, especially the first one (duration of 3 months), the reason may be:

• smoking();
• harmful working conditions, as a result of which the respiratory tract is irritated;

• pathologies of the nasopharynx that cause coughing;
• spicy ;
• contact with volatile substances irritating effect causing respiratory discomfort and cough;
• a combination of several factors.

Anamnesis is also taken into account - a high frequency of colds is the basis for a diagnosis of chronic bronchitis.

Symptoms during exacerbation

Complete and lasting recovery with chronic form It is rare, but you can reduce the risk of complications and increase the duration of the remission phase. Prevention of exacerbations carried out during remission of chronic bronchitis reduces their frequency. If an exacerbation does occur, clinical picture acquires additional characteristic features.

During the period of remission, the cough may be absent or mild, manifesting itself in the form of coughing, sometimes without sputum. With exacerbation, it becomes permanent, becomes stronger, longer lasting and more productive. The volume of mucus secreted by the bronchi increases and its viscosity increases. Mucous sputum is replaced by mucopurulent or completely purulent.

In addition to a productive cough and harsh, wheezing breathing, the following are added:

• malaise, general weakness, fatigue and decreased performance;
• sweating, especially pronounced during sleep;
• low-grade fever;
• the temperature may remain normal, but the pulse increases, even at rest.

A number of changes can only be detected using laboratory tests:

• biochemistry indicates inflammation;
• ESR increases moderately, the leukocyte count is shifted to the left;
• A cytochemical study reveals an increase in leukocyte activity.

Diagnostic methods

In addition to studying the medical history, patient complaints, examination, auscultation and other physical diagnostic methods, a number of laboratory tests and instrumental studies are usually prescribed. Depending on the characteristics of the patient’s condition, suspicions of a disease other than acute bronchitis, the doctor may prescribe different tests.

Lab tests

In chronic bronchitis, blood and sputum are examined.

• A general blood test does not reveal any significant changes. The most pronounced signs inflammatory process with exacerbation of chronic bronchitis and its development purulent form. But even in this case, leukocytosis and increase in ESR moderate.
• A biochemical blood test allows you to determine how far the inflammatory process has gone.

• Sputum is subjected to macroscopic and bacteriological examination. Its color, consistency and structure, cellular composition are assessed. These data make it possible to determine the form of chronic bronchitis and distinguish it from other diseases with similar symptoms. When inoculating the microflora, pathogens of the disease are identified. In addition, their sensitivity to antibiotics is determined. This is important for prescribing the correct effective scheme treatment.

Instrumental studies

The main method of instrumental diagnosis for chronic bronchitis is fluoroscopy and radiography. Other studies can be prescribed by a doctor according to indications, usually for the purpose of differential diagnosis. Absent in uncomplicated chronic bronchitis.

They appear in people who have been suffering from chronic bronchitis for several years, especially if other diseases are associated:

• the pulmonary pattern is more pronounced and deformed according to the loop-cellular type;
• lung fields are more transparent than normal;
• the shadows of the roots of the lungs are expanded;
• if peribronchial pneumosclerosis develops, the image may show thickening of the bronchial walls;
• lesions of the bronchi manifest themselves in the form of changes in their contours, caliber and direction.

Bronchography is a type x-ray examination using contrast agent. It is used mainly for the purpose of differential diagnosis, for example, with bronchiectasis or tuberculosis. Allows you to identify extensions peripheral bronchi, evaluate the pattern of contours, the patency of the lateral branches. In the absence of bronchiectasis, the smallest bronchi are not filled with contrast agent.

Bronchoscopy is an invasive diagnostic method. A fiber-optic system is inserted into the bronchi, making it possible to examine them from the inside and collect material.

The most informative is obtained using bronchoscopy. They resort to it if it is not possible to collect sputum for analysis due to its scarcity and viscosity. This method is also used for indications for mucosal biopsy.

During bronchoscopy, the condition of the mucous membrane is assessed according to the following criteria:

• color (pale pink, bright red, purple-bluish);
• the nature of the secretion covering the walls (mucus, pus);
• thickness (thinning or thickening);
• bleeding (absent, sometimes observed, severe).

Based on the totality of these signs, the severity of the disease and the degree of inflammation can be assessed.

Differences between obstructive and non-obstructive chronic bronchitis

To differentiate these two forms of chronic bronchitis, they resort to studying the function of external respiration and gas composition blood

FVD study:

• spirometry. Determination of forced expiratory volume, vital capacity of the lungs, their ratio, residual volume. Changes occur with the development of obstructive bronchitis and become more pronounced as it progresses;
• pneumotachometry – assessment of air flow velocities during inhalation and exhalation. With obstructive phenomena, exhalation slows down significantly;
• peak flowmetry - determination of peak expiratory flow. Allows you to identify bronchial asthma.

Most of these indicators are within normal limits. There may be an increase in residual lung volume, a decrease in volumetric velocity, while the vital capacity of the lungs, peak speed remain normal.

Determination of blood gas composition is carried out in cases of respiratory obstruction and suspicion of the development of an obstructive form of chronic bronchitis. On early stages This disease changes in the gas composition are insignificant. As it progresses, the concentration increases carbon dioxide, oxygen content decreases.

Differential diagnosis

A number of chronic symptoms are similar to respiratory system. They must be distinguished from each other in order to prescribe adequate treatment.

Prolonged, recurrent acute and chronic form.

• In the first case, symptoms of bronchitis persist for more than 2 weeks, but less than 3 months.

• In the second, the episodes are shorter, but repeated frequently, at least 3 times a year.
• Chronic bronchitis is characterized by a duration of exacerbations of 3 months.

Chronic bronchitis develops in mature age, cough is not always accompanied by purulent discharge. For bronchiectasis:

• prolonged periods of coughing have been observed since childhood;
• separates a large number of purulent sputum;
• the phalanges of the fingers and nails acquire a characteristic thickened shape;
• bronchography reveals dilatation of the bronchi.

Bronchial tuberculosis. Night sweats and low-grade fever are characteristic of both tuberculosis and chronic bronchitis in the acute phase. But with tuberculosis:

• weakness, fatigue are more pronounced, loss of appetite and weight are possible;
• the sputum is not purulent, but hemoptysis is observed;
• Koch bacilli are found in sputum and washing waters;
• bronchoscopy reveals scars and fistulas on the mucosal surface.

- which is important to distinguish from bronchitis as early as possible. For cancer:

• cough is more persistent, often with hemoptysis;
• atypical cells are detected in the sputum;
• on late stages appear severe pain in the chest, rapid weight loss is observed;
• biopsy results confirm oncology.

Expiratory collapse of the trachea and large bronchi:

• The cough is dry and paroxysmal, has specific features sound;
• occurs under the influence of provoking factors (laughter, stress, abrupt change body position);
• possible attacks of suffocation, dizziness, fainting;
• fiberoptic bronchoscopy and spirometry demonstrate characteristic changes.

Preventive measures

Prevention of chronic bronchitis can be primary and secondary. The first is aimed at preventing the development of the disease, transition acute form into chronic. The second is to reduce the frequency of exacerbations and prevent complications.

Among the measures primary prevention important role play:

• hardening, physical education and sports;

• avoiding hypothermia;
• to give up smoking;
• regular sanitation of the upper respiratory tract, early diagnosis and treatment of ENT diseases, immunization against influenza;
• compliance with personal hygiene rules and precautions during epidemics of respiratory diseases;
• carrying out wet cleaning and ventilation of premises at the place of residence and work;
• minimizing contact with allergens.

Secondary prevention comes down to exercise and postural bronchial drainage procedures. Great importance also has a review of working and living conditions.

Sometimes in the name of health you have to resort to rather radical measures:

• change of place of work;
• moving to an area with more favorable environmental and climatic conditions;
• improvement of living conditions (exchange or renovation of an apartment).

For chronic bronchitis general forecast quite favorable. People live with this disease for many years without any significant reduction in their ability to work.

But it is almost impossible to completely recover from it. As it progresses, there is a risk of developing a number of severe, life-threatening conditions.

Chronical bronchitis- damage to the bronchial tree with restructuring of the secretory apparatus of the mucous membrane, the development of the inflammatory process and sclerotic changes in the deep layers of the bronchial wall, the manifestations of which are productive cough, constant variable wheezing in the lungs (at least 3 months) and the presence of exacerbations at least 2 times a year for 2 years.

Chronic bronchitis in childhood more often it is secondary and develops with other chronic diseases lungs: cystic fibrosis, bronchopulmonary dysplasia, congenital defects development of the bronchi and lungs. As an independent disease, primary chronic bronchitis is diagnosed more often in older children and adolescents.

Criteria for diagnosing chronic bronchitis:

history of long-term (for 2-3 months) exacerbations of bronchitis at least 2 times a year over the past 2 years; constant complaints (for 9-10 months) moist cough; data about active or passive smoking; burdened heredity bronchopulmonary diseases; living in environmentally unfavorable areas.

Clinical:

— Respiratory syndrome: productive cough with the release of mucous or mucopurulent sputum during an exacerbation; cough persists even with persistent clinical well-being, easily provoked by changes physical and chemical properties air, psycho-emotional factors, physical activity, infections;

— Bronchopulmonary syndrome: persistent moist rales of various sizes in the lungs (usually diffuse) against the background hard breathing;

— Symptoms chronic intoxication varying degrees, With periodic increase body temperature to febrile levels during exacerbation and to subfebrile levels during remission.

Paraclinical:

— Radiography of organs chest: increased bronchovascular pattern and persistent deformation of a local or diffuse nature;

— Bronchoscopy: a picture of catarrhal, catarrhal-purulent endobronchitis during remission and purulent during exacerbation of the process;

— Bronchography: changes in the course of the bronchi, their lumen with expansion of varying degrees in the distal sections;

— Complete blood count: slight leukocytosis with signs of inflammation or no changes during remission, neutrophilic leukocytosis and increased ESR during exacerbation;

— Sputum examination: increased number of segmented neutrophils and eosinophils, decreased number of macrophages, decreased level of secretory IgA;

— Biochemical research blood: dysproteinemia, hypogammaglobulinemia, positive C-reactive protein;

— Broncho-alveolar lavage: increased content of alpha-1 antiproteases, decreased surfactant properties of surfactant, increased number of neutrophils, eosinophils, decreased number of alveolar macrophages, lysozyme, positive results bacteriological research with the release of predominantly gram-positive microflora;

— External respiration function: mixed nature of disorders with a predominance of obstructive changes in pulmonary ventilation;

Differential diagnosis is carried out with bronchial asthma, pulmonary tuberculosis, between primary and secondary forms of chronic bronchitis.

Example of diagnosis: Cystic fibrosis, pulmonary form, chronic purulent bronchitis, on the right in the lower part there are cylindrical bronchiectasis, DN II, exacerbation period.

Treatment of chronic bronchitis.

I. Period of exacerbation of bronchitis:

1. For toxicosis of the first degree - general mode, with toxicosis of the second degree - bed rest.

2. Diet - high protein nutrition, fresh vegetables, fruits, juices. Limit carbohydrates and salt to half of your needs.

3. Antibacterial therapy depending on the selected flora and its sensitivity.

4. Physiotherapy; UHF, microwave therapy, electrophoresis with solutions of platiphylline, copper sulfate, nicotinic acid, calcium chloride. Aerosol therapy: for catarrhal endobronchitis - ultrasonic inhalation of sodium chloride, sodium bicarbonate, potassium iodide. For purulent endobronchitis - trypsin, chymotrpsin, acetylcysteine, inhalation of antiseptics, antibiotics.

5. Bronchoscopic sanitation (for purulent endobronchitis) with solutions of furatsilin, polymyxin, acetyl cysteine.

6. Mucolytics and expectorants: bromhexine, ficimucin, lazolvan, 3% potassium iodide solution.

7. Elimination of broncho-obstructive syndrome: theophylline and teopec.

8. Vibration massage and postural drainage.

9. Medicinal physical training, according to a gentle scheme.

10. Vitamin therapy.

11. Symptomatic therapy.

II. Remission period of chronic bronchitis

1. If there is a cough, use mucolytics and expectorants: bromhexine, mucaltin, terpinhydrate, pertussin.

2. Herbal medicine: collection for Chistyakova (elecampane root, calendula flowers - 30 g each, plantain leaf, thyme herb, coltsfoot leaf - 50 g each) - 1 tablespoon per 200 ml of water, take 50 ml 5 - b once a day for 4-6 weeks; chest collection № 1, № 2, № 3.

3. Postural drainage and vibration massage.

4. Physiotherapy(complex recovery period, then training complex).

5. Breathing exercises (according to Tokarev, according to Strelnikova), respiratory-sound gymnastics.

6. Vitamin therapy.

7. Physiotherapy: ultraviolet irradiation chest, adrenal inductothermy, electrophoresis with lidase.

9. Nonspecific immunomodulation: Eleutherococcus extract, tincture Chinese lemongrass, aralia tincture, ginseng tincture, apilak.

10. Specific immunostimulation: ribomunil, IRS-19, imudon, bronchomunal, prodigiosan, bronchovacone.

11.Sanatorium treatment (climatotherapy).

12. Sanitation of chronic foci of infection of the ENT organs, treatment of intestinal dysbiosis.

13. Clinical examination: examination by a pediatrician - 2-4 times a year; otolaryngologist, dentist - 2 times a year; pediatric surgeon, pulmonologist - 2 times a year.

14. Surgical treatment indicated for children with unilateral bronchiectasis who are resistant to conservative therapy.,

Chronic obliterating bronchiolitis

Chronic obliterating bronchiolitis- chronic inflammatory disease bronchi of viral or immunopathological origin, resulting from obliteration of bronchioles and arterioles of one or more parts of the lungs and leads to impaired pulmonary circulation and the development of emphysema.

Classification of chronic obliterating bronchiolitis:

1. Phases pathological process: exacerbation, remission.

2. Forms of bronchiolitis obliterans: total unilateral, focal unilateral, focal bilateral, partial.

Diagnostic criteria:

Anamnestic: severe respiratory viral infections with obstructive syndrome.

Clinical: persistent small moist rales against the background of weakened breathing; recurrent broncho-obstructive syndrome. Paraclinical:

— X-ray of the chest organs: unilateral weakening of the pulmonary pattern, reduction in the size of the pulmonary field;

— Bronchography: non-filling of the bronchi with contrast at the generation level of the 5th-6th order and below, a pronounced decrease in pulmonary perfusion in areas of the pathological process.

Treatment principles:

1. Correction respiratory failure.

2. Antibacterial therapy.

3. Glucocorticoids in aerosols and parenterally (at the rate of 1-8 mg per 1 kg of body weight) according to indications.

4. Heparin therapy.

b. Symptomatic therapy.

6. Physiotherapy.

7. Postural drainage and gymnastics.

8. Bronchoscopic instillation according to indications.

Acute bronchitis- inflammatory damage to the bronchi of any caliber of various etiologies(infectious, allergic, toxic), developed over short period time. There are acute bronchitis, acute obstructive bronchitis, acute bronchiolitis.

Causes of acute bronchitis

More often etiological factor acute bronchitis - various viruses, less often bacteria. Irritation bronchitis occurs when exposed to toxic and chemical substances, physical factors. Allergic acute bronchitis is possible. Bronchitis often accompanies diphtheria, typhoid fever, whooping cough Etiology of bronchitis and their clinical features often depend on the age of the children.

Etiology of acute bronchitis

Etiology

Diagnostic criteria

Influenza A, B, Sadenovirus infection Parainfluenza, respiratory syncytial infection Rhinovirus infection Chlamydial and mycoplasma infections

Epidemic rise in morbidity. Specific influenza intoxication (high body temperature, chills, dizziness, headaches and muscle pain) Severe catarrhal symptoms. Hyperplasia of lymphoid formations of the nasopharynx. Lymphadenopathy. Catarrhal-follicular, often membranous conjunctivitis Croup syndrome. Broncho-obstructive syndrome Uncontrollable rhinorrhea with mild catarrh of the respiratory tract Prolonged low-grade fever, persistent cough, defeat bronchial system up to low-symptomatic (atypical) pneumonia

Pathogenesis of acute bronchitis

Pathogenesis bronchial obstruction with obstructive bronchitis and bronchiolitis is complex and is caused, on the one hand, by the influence of the respiratory viruses themselves, on the other; - the anatomical and physiological characteristics of children, their tendency to allergic reactions. The influence of respiratory viruses on a child’s bronchopulmonary system is diverse: they damage the respiratory epithelium, increase the permeability of the mucous membrane, contribute to the development of edema and inflammatory infiltration cellular elements, disrupt mucociliary clearance. Bronchospasm may be caused by the release of biologically active substances. In a significant proportion of children, episodes of bronchial obstruction recur, and some subsequently develop bronchial asthma.

Acute bronchitis (simple) - acute inflammatory disease of the bronchi, occurring without signs of bronchial obstruction.

Symptoms of acute bronchitis

In acute bronchitis, as a rule, body temperature rises. The duration of fever varies and depends on the type of pathogen. Thus, with respiratory syncytial and parainfluenza infections, the duration of fever is 2-3 days, and with mycoplasma and adenoviral infections - 10 days or more. The main symptom of bronchitis is a cough, dry and obsessive at the beginning of the disease, later wet and productive. Auscultation reveals widespread diffuse coarse dry and moist medium- and large-bubble rales.

There may be no changes in peripheral blood. With a viral infection, leukopenia and lymphocytosis are detected. There may be a slight increase in ESR, and if a bacterial infection is attached - neutrophilia, a slight shift leukocyte formula to the left. A chest x-ray is performed to rule out pneumonia; with bronchitis, a moderate diffuse increase in the pulmonary pattern is usually detected.

Acute bronchiolitis - acute inflammation small bronchi and bronchioles, occurring with respiratory failure and an abundance of fine wheezing. The disease develops mainly in children in the first year of life. Most often, bronchiolitis is caused by respiratory syncytial virus, parainfluenza viruses, somewhat less frequently by adenoviruses, and even more rarely by mycoplasma and chlamydia.

Clinical picture of acute bronchiolitis

Fever usually lasts 2-3 days (with adenovirus infection- up to 8-10 days). The condition of the children is quite serious, signs of respiratory failure are pronounced: cyanosis of the nasolabial triangle, expiratory or mixed shortness of breath, tachypnea. Swelling of the chest, participation of auxiliary muscles in inhalation, and retraction of the yielding areas of the chest are often observed. Percussion reveals a boxy percussion sound, and auscultation reveals scattered moist fine rales on inhalation and exhalation. Much less often, medium- and coarse-bubbly moist rales are heard, the amount of which changes after coughing.

Complications may develop as it progresses respiratory disorders. An increase in Pa CO 2 and the development of hypercapnia, indicating a deterioration of the condition, can lead to apnea and asphyxia; very rarely pneumothorax and mediastinal emphysema occur.

Laboratory and instrumental studies

A chest x-ray looks for signs of lung inflation, including increased transparency. lung tissue. Atelectasis, strengthening of the hilar pulmonary pattern, and expansion of the roots of the lungs are possible. When studying the gas composition of the blood, hypoxemia, a decrease in P a 0 2 and P a CO 2 are revealed (the latter due to hyperventilation). Spirographic examination in early age it is usually not possible to carry out. Peripheral blood parameters may not be changed or may reveal an unexpressed increase in ESR, leukopenia and lymphocytosis.

Acute obstructive bronchitis - acute bronchitis occurring with bronchial obstruction syndrome. Usually develops in children in the 2-3rd year of life.

Clinical picture of acute obstructive bronchitis

Signs of bronchial obstruction often develop already on the first day of acute respiratory viral infection (earlier than with bronchiolitis), less often - on the 2-3rd day of illness. The child experiences noisy wheezing with prolonged exhalation, audible at a distance (distant wheezing). Children can be restless and often change body position. However, their general condition, despite the severity of obstructive phenomena, remains satisfactory. Body temperature is subfebrile or normal. Expressed tachypnea, mixed or expiratory dyspnea; auxiliary muscles may be involved in breathing; the chest is swollen, its yielding places are retracted. Percussion sound is boxed. Auscultation reveals a large number of scattered moist medium- and large-bubbly, as well as dry wheezing rales.

Laboratory and instrumental studies

An X-ray of the chest organs shows signs of lung distention: increased transparency of the lung tissue, horizontally located ribs, low position diaphragm domes. When examining the blood gas composition, moderate hypoxemia is detected. In the analysis of peripheral blood, a slight increase in ESR, leukopenia, lymphocytosis is possible, and with an allergic background - eosinophilia.

Diagnostics

Most often, acute bronchitis must be differentiated from acute pneumonia. Bronchitis is characterized by a diffuse nature of physical data with a satisfactory general condition of children, while with pneumonia, physical changes are asymmetrical, signs of infectious toxicosis are pronounced, and the general state. The fever lasts longer, inflammatory changes are expressed in the peripheral blood: neutrophilic leukocytosis, increased ESR. X-rays reveal local infiltrative changes in the lung tissue.

In case of repeated episodes of bronchial obstruction, it is necessary to carry out differential diagnosis with bronchial asthma.