Diagnostic criteria for chronic bronchitis. Acute bronchitis

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

Any disease has its 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 can begin to develop for two types of reasons or with their "joint activity".

infections

These include viruses, bacteria, atypical microflora. And the largest number infectious cases of acute bronchitis occurs when exposed to viruses on the human body.

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

Among the viruses that provoke acute bronchitis, like independent disease or as a continuation of other respiratory ailments, it is possible to isolate the influenza virus, parainfluenza, adenovirus, RS virus, etc.

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

Pathogens of a non-infectious nature

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

Symptoms of acute bronchitis are known to almost everyone. When the disease occurs, the patient has 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.
  With the course of the disease, the cough is gradually moistened, sputum gradually begins to separate, which greatly alleviates the patient's condition.
• Sputum. When joining bacterial infection sputum becomes greenish or yellowish. If acute bronchitis was caused by allergens, then the cough is paroxysmal in nature, and it often occurs at night.
• The temperature can fluctuate between 38-40 0C. With allergic bronchitis, it remains normal.
• Headache, muscle, joint pain.
• Lethargy, fatigue, general weakness.
• Increased sweating.
• Dyspnea. Occurs if the patency of the air flow decreases sharply, i.e., there is an obstruction.

History and examination of the patient

Any visit to the doctor begins with the collection of anamnesis from the words of the patient or those close to him who know him. Initially, the doctor listens to all the patient's complaints about the state of health, and then he himself begins to conduct a survey.

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

• In what conditions the patient grew up and lived. What are the living conditions of the patient this moment- dry or humid air in the house, whether there are mold formations in it, pets, whether there are any industries near the dwelling, etc.;
• what are the conditions of his work (humidity, temperature, dustiness, 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, from what age;
• what diseases the patient suffered during his life (for sure, everyone heard the question from the doctor: what did they hurt in childhood?);
• whether the patient currently has a chronic disease;
• what serious illnesses the parents suffer from;
• when the first signs of the disease appeared;
• how exactly the symptoms manifest themselves, in particular: how often the cough occurs, whether it is dry or wet, at what time of the day it is more intense, whether sputum is coughed up, whether the temperature rises or not, whether shortness of breath occurs, etc.

Based on the history, a doctor can make an initial diagnosis of acute bronchitis. Moreover, this disease has no special difficulties in diagnosing.

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

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

Listening to the patient is performed in order to identify and determine the types of noise in the respiratory system. Auscultation is carried out 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.

• Wet rales in acute bronchitis are detected when liquid mucus accumulates in the bronchial tubes. Under the flow of air, it foams, and bursting bubbles create characteristic bubble sounds.
• Dry rales in acute bronchitis are heard when a viscous fluid accumulates in the bronchi. thick mucus that fills the bronchial lumen. With accumulation of mucus 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 conducts a special type of auscultation - bronchophony. When listening with a phonendoscope, the patient must whisper the words in which the sounds “p” and “h” are present. With bronchial asthma, these sounds will be clearly audible, in other cases only a quiet rustle will be heard.

Laboratory tests

Among laboratory tests prescribed for acute bronchitis, one can note a blood test, microflora culture and urinalysis.

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 taking place in the body. Blood parameters 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 content 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 control the reaction of the kidneys to inflammatory processes in the body.

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

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

Sputum analysis

In acute bronchitis, microscopic and bacteriological analysis sputum.

• Microscopic examination of sputum reveals 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's spirals, which are spiral casts of small bronchi, may appear in the sputum.
• Bacteriological analysis of sputum allows you to determine the type of bacteria that caused inflammation in the bronchi. Such information helps the doctor to choose effective drugs for the treatment of acute bronchitis.

X-ray studies

Auscultation is used in medical practice long enough. However, this diagnostic method still has some inaccuracies, especially when we are talking about recurrent or obstructive bronchitis. The doctor resorts to the help of x-rays.

With ordinary uncomplicated bronchitis, there is no particular need for x-rays, since no special changes in the lungs and bronchi will be observed in the pictures.

An x-ray doctor prescribes in the following cases:

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

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

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

With a running situation, the doctor in the picture can detect such changes:

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

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

Diagnostics with instruments

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

Pneumotachography

In this study, the amount of inhaled and exhaled air is determined. The mouthpiece of the pneumotachograph is inserted into the patient's mouth, and the nose is clamped.

The device records air volumes in the form of a curve. With the help of a pneumotachograph, violations can be detected respiratory function in acute bronchitis at a stage when neither the doctor nor the patient is aware of this.

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

Peakflowmetry

This study in acute bronchitis allows you to determine the speed of forced exhalation.

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

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

Peak meter studies allow the doctor to choose the right therapy for the treatment of obstructive acute bronchitis.

The peak flow meter is so simple to use that it can be used to conduct research with it at home on your own.

Spirometry, or spirography

This study gives comprehensive assessment breathing states. With spirometry, the following indicators for acute bronchitis can be investigated:

• indicator of calm breathing;
• expiration rate;
• maximum lung capacity;
• respiratory rates 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 spirometer records the volume 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 against the special mouthpiece of the device.

Then do the same, but the exhalation must be done with effort. Thus, fixed calm breathing and exhalation power.

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

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

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

famous german philosopher Arthur Schopenhauer claimed that nine-tenths of our happiness depended on health. Without health, there is no happiness! Only complete physical and mental well-being determines human health, helps us successfully cope with illnesses, adversities, and lead an active life. social life, reproduce offspring, achieve goals. Human health is the key to a happy full life. Only a person who is healthy in all respects can be truly happy and capable ofto fully experience the fullness and diversity of life, to experience the joy of communicating with the world.

They talk about cholesterol so unflatteringly that it is just right for them to scare children. Do not think that this is a poison that only does what destroys the body. Of course, it can be harmful, and even dangerous to health. However, in some cases, cholesterol is extremely necessary for our body.

The legendary asterisk balm appeared in Soviet pharmacies in the 70s of the last century. It was in many ways an indispensable, effective and affordable drug. "Asterisk" They tried to treat everything in the world: both acute respiratory infections, and insect bites, and pains of various origins.

Language is important organ a person who not only can talk incessantly, but without saying anything, can tell a lot. And there is something to tell him, especially about health.Despite its small size, the tongue performs a number of vital functions.

Over the past few decades, the prevalence allergic diseases(AZ) received the status of an epidemic. According to the latest data, more than 600 million people worldwide suffer from allergic rhinitis(AR), approximately 25% of them are in Europe.

For many people, there is an equal sign between a bath and a sauna. And a very small number of those who are aware that there is a difference can clearly explain what this difference is. Having considered this issue in more detail, we can say that there is a significant difference between these pairs.

Late autumn, early spring, periods of thaw in winter are a period of frequent colds both adults and children. From year to year the situation repeats itself: one member of the family falls ill and after him, as in a chain, everyone suffers a respiratory viral infection.

Salu odes can be read in some popular medical weeklies. It turns out that it has the same properties as olive oil, and therefore it can be used without any reservations. At the same time, many argue that it is possible to help the body "purify itself" only by fasting.

In the 21st century, thanks to vaccination, the prevalence infectious diseases. According to the WHO, vaccination prevents two to three million deaths a year! But, despite the obvious benefits, immunization is shrouded in many myths that are actively discussed in the media, and in general in society.

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 delivered correct diagnosis the more effective the treatment will be. Bronchitis, including chronic, is easy to diagnose, the patient's complaints are already quite informative. The diagnosis is specified in the process of examining the patient, conducting tests and instrumental research.

WHO diagnostic criteria

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

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

• when listening to a typical picture: breathing hard, rough, scattered rales, can be dry and wet, exhalation is elongated;
• bronchoscopy reveals inflammatory changes in the bronchi;

• function research external respiration shows the presence of violations of bronchial patency;
• according to the results of differential diagnosis, other diseases are excluded, which are also characterized by prolonged periods of productive cough, manifested for years. These are tuberculosis, bronchiectasis, chronic lung abscess and a number of others.

Cough with sputum production that persists for long periods, is not always a symptom of chronic bronchitis. If, if present, there are inconsistencies with WHO criteria, especially the first one (duration of 3 months), the reason may be:

• smoking();
• harmful working conditions, due to which the respiratory tract is irritated;

• pathology of the nasopharynx, causing cough;
• spicy ;
• contact with volatile substances irritant causing respiratory discomfort and cough;
• a combination of several factors.

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

Symptoms during an exacerbation

Complete and lasting recovery chronic form it is rare, but it is possible to reduce the risk of complications and increase the duration of the remission phase. The prevention of exacerbations carried out during the period of remission of chronic bronchitis reduces their frequency. If the exacerbation nevertheless developed, clinical picture acquires additional features.

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

To a productive cough and hard, with wheezing, breathing, are added:

• malaise, general weakness, fatigue and reduced performance;
• sweating, especially pronounced during sleep;
• subfebrile temperature;
• the temperature may remain normal, but the pulse quickens, even at rest.

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

• biochemistry indicates inflammation;
• the ESR moderately increases, the leukocyte formula is shifted to the left;
• cytochemical examination reveals an increase in the activity of leukocytes.

Diagnostic methods

In addition to studying the anamnesis, 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 studies.

Laboratory tests

In chronic bronchitis, blood and sputum are examined.

• A general blood test does not reveal significant changes. The most pronounced symptoms inflammatory process with exacerbation of chronic bronchitis and its development purulent form. But 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 evaluated. These data allow you to determine the form of chronic bronchitis and distinguish it from other diseases with similar symptoms. When sowing on the microflora, the causative agents of the disease are detected. In addition, their sensitivity to antibiotics is determined. This is important for assigning the correct efficient scheme treatment.

Instrumental Research

The main method of instrumental diagnosis in chronic bronchitis are fluoroscopy and radiography. Other studies can be prescribed by a doctor according to indications, usually for the purpose of differential diagnosis. None in uncomplicated chronic bronchitis.

They appear in people who have been suffering from chronic bronchitis for more than a year, especially in the case of the addition of other diseases:

• the pulmonary pattern is more pronounced and deformed in a looped-cellular type;
• lung fields are more transparent than normal;
• the shadows of the roots of the lungs are expanded;
• if peribronchial pneumosclerosis develops, the picture may show thickening of the bronchial walls;
• bronchial lesions are manifested in the form of changes in their contours, caliber and direction.

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

Bronchoscopy is an invasive diagnostic method. An optical fiber system is inserted into the bronchi, which makes it possible to examine them from the inside and take the material.

The most informative obtained with the help of bronchoscopy. It is resorted to 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 mucosa is assessed according to the following criteria:

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

Based on the combination of these signs, one can assess the severity of the disease, the degree of inflammation.

Differences between obstructive and non-obstructive chronic bronchitis

For the differential diagnosis of these two forms of chronic bronchitis, they resort to the study of 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 rates during inhalation, exhalation. With obstructive phenomena, expiration slows down significantly;
• peak flow - determination of peak expiratory flow. Allows to detect bronchial asthma.

Most of these parameters are within the normal range. Perhaps an increase in residual lung volume, a decrease in volumetric velocity, while the vital capacity of the lungs, peak speed remain normal.

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

Differential Diagnosis

Some of the symptoms of chronic respiratory system. They must be distinguished from each other in order to prescribe adequate treatment.

Protracted, recurrent acute and chronic form.

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

• In the second, the episodes are less long, but often repeated, at least 3 times a year.
• For chronic bronchitis, the duration of exacerbations is characteristic from 3 months.

Chronic bronchitis develops in adulthood, 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 bronchial dilatation.

tuberculosis of the bronchi. night sweats and subfebrile temperature are characteristic of both tuberculosis and chronic bronchitis in the exacerbation phase. But with tuberculosis:

• weakness, fatigue are more pronounced, loss of appetite and weight is possible;
• sputum is not purulent, but hemoptysis is observed;
• Koch sticks are found in sputum and washings;
• 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 hacking, often with hemoptysis;
• atypical cells are detected in sputum;
• on the late stages appear severe pain in the chest, there is a rapid weight loss;
• biopsy results confirm oncology.

Expiratory collapse of the trachea and large bronchi:

• dry and paroxysmal cough 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, the transition acute form into chronic. The second is to reduce the frequency of exacerbations and prevent complications.

Among the measures primary prevention important role are playing:

• hardening, physical education and sports;

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

Secondary prevention is reduced to classes, postural bronchial drainage procedures. Great importance also has a revision of working conditions, accommodation.

Sometimes, in the name of health, one has to resort to rather drastic measures:

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

For chronic bronchitis general forecast quite favorable. With this disease, they live for many years without much reduction in their ability to work.

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

Chronical bronchitis- defeat of the bronchial tree with the 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 various rales 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, birth 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 the diagnosis of chronic bronchitis:

History of prolonged (within 2-3 months) exacerbations of bronchitis at least 2 times a year for the last 2 years; complaints about permanent (within 9-10 months) moist cough; information about active or second hand smoke; weighed down heredity bronchopulmonary diseases; living in ecologically unfavorable areas.

Clinical:

- Respiratory syndrome: productive cough with mucus 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 wet rales of various sizes in the lungs (often diffuse) against the background of hard breathing;

– Symptoms chronic intoxication varying degrees, With periodic increase body temperature to febrile numbers during exacerbation and to subfebrile - during remission.

Paraclinical:

– Radiography of organs chest: increased bronchovascular pattern and persistent deformity 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 the 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 an increase in ESR during exacerbation;

- Sputum examination: increase in the number of segmented neutrophils and eosinophils, decrease in the number of macrophages, decrease in the level of secretory IgA;

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

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

- The function of external respiration: a 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 a diagnosis: Cystic fibrosis, pulmonary form, chronic purulent bronchitis, on the right in the lower part, cylindrical bronchiectasis, DN II, period of exacerbation.

Treatment of chronic bronchitis.

I. Period of exacerbation of bronchitis:

1. With toxicosis I degree - common mode, with toxicosis II degree - bed rest.

2. Diet - high protein nutrition, fresh vegetables, fruits, juices. Limit carbs and salt to half of what you need.

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

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

5. Bronchoscopic sanitation (with purulent endobronchitis) with solutions of furacilin, 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. Medical physical education, according to a gentle scheme.

10. Vitamin therapy.

11. Symptomatic therapy.

II. The period of remission of chronic bronchitis

1. In the presence of a cough - mucolytics and expectorants: bromhexine, mukaltin, terpinhydrate, pertussin.

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

3. Postural drainage and vibration massage.

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

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

6. Vitamin therapy.

7. Physiotherapy: ultraviolet irradiation chest, inductothermia of the adrenal glands, electrophoresis with lidase.

9. Non-specific immunomodulation: Eleutherococcus extract, tincture Chinese magnolia vine, aralia tincture, ginseng tincture, apilak.

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

11.Sanatorium treatment (climatotherapy).

12. Sanitation of chronic foci of infection of the upper respiratory tract, treatment of intestinal dysbacteriosis.

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 with resistance 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 areas 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 obliterating bronchiolitis: total unilateral, focal unilateral, focal bilateral, partial.

Diagnostic criteria:

History: 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: unilateral weakening of the lung pattern, a decrease in the size of the lung field;

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

Principles of treatment:

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- inflammation of the bronchi of any caliber various etiologies(infectious, allergic, toxic), developed for short span time. Allocate acute bronchitis, acute obstructive bronchitis, acute bronchiolitis.

Causes of acute bronchitis

Most often etiological factor acute bronchitis - various viruses, rarely bacteria. Irritant 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, SAdenoviral infection Parainfluenza, respiratory syncytial infection Rhinovirus infection Chlamydia and mycoplasma infections

Epidemic rise in morbidity. Specific influenza intoxication (high body temperature, chills, dizziness, headaches and muscle pain) Severe catarrhal phenomena. Hyperplasia of lymphoid formations of the nasopharynx. Lymphadenopathy. Catarrhal-follicular, more often membranous conjunctivitis Croup syndrome. Broncho-obstructive syndrome Irresistible rhinorrhea with mild airway catarrh Prolonged subfebrile condition, persistent cough, defeat bronchial system up to asymptomatic (atypical) pneumonia

The pathogenesis of acute bronchitis

Pathogenesis bronchial obstruction with obstructive bronchitis and bronchiolitis is complex and due, on the one hand, to the effects 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 the bronchopulmonary system of a child 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 interfere with mucociliary clearance. Spasm of the bronchi can 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. So, with respiratory syncytial and parainfluenza infections, the duration of fever is 2-3 days, and with mycoplasma and adenovirus - 10 days or more. The main symptom of bronchitis is a cough, dry and obsessive at the beginning of the disease, later on it is wet and productive. Auscultation reveals widespread diffuse coarse dry and moist medium and coarse bubbling rales.

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

Acute bronchiolitis - acute inflammation small bronchi and bronchioles, proceeding with respiratory failure and an abundance of small bubbling rales. The disease develops mainly in children in the first year of life. Most often, bronchiolitis is caused by respiratory syncytial virus, parainfluenza viruses, adenoviruses are somewhat less common, and mycoplasmas and chlamydia are even less common.

Clinical picture of acute bronchiolitis

The fever usually lasts 2-3 days (with adenovirus infection- up to 8-10 days). The condition of the children is quite severe, signs of respiratory failure are expressed: cyanosis of the nasolabial triangle, expiratory or mixed dyspnea, tachypnea. Often observed swelling of the chest, participation of auxiliary muscles inhalation, retraction of compliant places of the chest. On percussion, a boxed percussion sound is detected, and on auscultation, diffuse, moist, finely bubbling rales on inhalation and exhalation are detected. Much less often, medium and large bubbling wet rales are heard, the number of which changes after coughing.

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

Laboratory and instrumental research

Chest X-ray shows signs of pulmonary distention, including increased transparency lung tissue. Possible atelectasis, increased basal pulmonary pattern, expansion of the roots of the lungs. When examining the gas composition of the blood, hypoxemia, a decrease in P a 0 2 and P a CO 2 (the latter due to hyperventilation) are detected. Spirographic examination in early age usually fails to do so. Peripheral blood values ​​may be unchanged or reveal an unexpressed increase in ESR, leukopenia and lymphocytosis.

Acute obstructive bronchitis - acute bronchitis, occurring with bronchial obstruction syndrome. It 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 infections (earlier than with bronchiolitis), less often - on the 2-3rd day of illness. The child observes noisy wheezing with prolonged expiration, audible at a distance (remote wheezing). Children can be restless, 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; accessory muscles can participate in breathing; the chest is swollen, its compliant places are drawn in. Percussion sound box. Auscultation reveals a large number of diffuse moist medium- and large-bubbly, as well as dry whistling rales.

Laboratory and instrumental research

On the radiograph of the chest organs, signs of bloating of the lungs are expressed: an increase in the transparency of the lung tissue, horizontally located ribs, low position domes of the diaphragm. When examining the gas composition of the blood, moderate hypoxemia is detected. In the analysis of peripheral blood, a slight increase in ESR, leukopenia, lymphocytosis, and with an allergic background - eosinophilia are possible.

Diagnostics

Most often, acute bronchitis must be differentiated from acute pneumonia. For bronchitis, the diffuse nature of physical data is characteristic with a satisfactory general condition of children, while with pneumonia, physical changes are asymmetric, signs of infectious toxicosis are pronounced, significantly impaired general state. The fever is longer, inflammatory changes are expressed in the peripheral blood: neutrophilic leukocytosis, an increase in ESR. X-ray determined local infiltrative changes in the lung tissue.

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