Criteria for the diagnosis of chronic bronchitis. Effective methods of treating various forms of bronchitis

– a form of diffuse inflammation of the bronchial tree, characterized by increased bronchial secretion and impaired bronchial patency. Acute bronchitis is characterized by an abrupt onset, respiratory symptoms(runny nose, sore throat, paroxysmal cough with sputum, chest pain, shortness of breath, bronchospasm) and symptoms of intoxication (fever, headache, weakness). In the diagnosis of acute bronchitis, physical examination data, chest radiography, laboratory tests, functional tests, ECG, and bronchoscopy help. Treatment of acute bronchitis is complex and conservative; includes antiviral, antibacterial, antipyretic, antihistamine, mucolytic, expectorant and antispasmodic drugs, NSAIDs, glucocorticoids, physiotherapy.

In acute bronchitis, the inflammatory process can affect only the mucous membrane of the bronchi, but in the case of severe cases, it can affect more deep tissue: submucosal and muscular layers. Pathological changes in the bronchial wall in acute bronchitis are characterized by swelling and hyperemia of the mucous membrane, pronounced infiltration of the submucosal layer with hypertrophy of the mucous-protein glands, an increase in the number of goblet cells, degeneration and a decrease in the barrier function of the ciliary epithelium. On inner surface Serous, mucous or mucopurulent exudate is noted in the bronchi. Increased secretion of mucus in acute bronchitis leads to disruption of the patency of small bronchi and bronchioles.

Causes

Depending on the etiological factor, acute bronchitis is divided into infectious, non-infectious, mixed and unknown origin. The leading mechanism for the development of acute bronchitis is infection: the causative agents are viruses (ARVI, influenza and parainfluenza, measles, rubella), less often bacteria (pneumococcus, staphylococcus, mycoplasma, chlamydia, representatives of the typhoid paratyphoid group). Infectious agents can enter the bronchi through the air, hematogenous and lymphogenous routes.

A significant role in the etiology of acute bronchitis is played by respiratory syncytial viral infection, which in most cases is accompanied by damage to the bronchial tree. Primary acute bacterial bronchitis are rare, usually there is a layering of secondary bacterial infection to viral due to activation of opportunistic microflora of the upper respiratory tract.

Non-infectious acute bronchitis is caused by physical and chemical factors(dust, smoke, cold or hot dry air, chlorine, ammonia, hydrogen sulfide, acid and alkali vapors). In addition, acute bronchitis can develop with a combination of infection and the action of physical and chemical irritants. Acute allergic bronchitis occurs, as a rule, in patients genetically predisposed to allergic reactions.

Factors that reduce general and local resistance of the body and contribute to the occurrence of acute bronchitis are frequent hypothermia, harmful conditions labor, smoking and alcoholism, foci of chronic infection in the nasopharynx and impaired nasal breathing, congestion in the pulmonary circulation, severe illnesses, poor nutrition. Acute bronchitis is more often observed in childhood and old age.

The inflammatory process in acute bronchitis of viral etiology usually begins in the upper respiratory tract: nasopharynx, tonsils, gradually spreading to the larynx, trachea, and then to the bronchi. Activation of opportunistic microflora aggravates catarrhal and infiltrative changes in the bronchial mucosa, causing a protracted course or complications of acute bronchitis.

Symptoms of acute bronchitis

Peculiarities clinical picture acute bronchitis depend on causative factor, nature, prevalence and severity pathological changes, level of damage to the bronchial tree, severity inflammatory process.

The disease is characterized by an acute onset with signs of damage to the upper and lower respiratory tract and intoxication. Acute bronchitis infectious etiology are preceded by symptoms of ARVI - nasal congestion, runny nose, sore and sore throat, hoarseness. The development of general intoxication in acute bronchitis is manifested by chills, increased body temperature to subfebrile levels, weakness, fatigue, headache, sweating, pain in the muscles of the back and limbs. At mild flow There may be no temperature reaction in acute bronchitis. Acute bronchitis caused by measles, rubella and whooping cough is accompanied by symptoms characteristic of the underlying disease.

The leading symptom of acute bronchitis is a dry, painful cough that appears from the very beginning and lasts throughout the disease. The cough is paroxysmal, rough and sonorous, sometimes “barking”, increasing the feeling of rawness and burning behind the sternum. Due to overvoltage pectoral muscles and spastic contraction of the diaphragm with forced coughing, pain appears in lower section chest And abdominal wall. The cough is accompanied by the release of scanty and viscous sputum at first, then the nature of the sputum gradually changes: it becomes less viscous and passes more easily, and may have a mucopurulent character.

A severe and protracted course of acute bronchitis is observed during the transition of the inflammatory process from the bronchi to the bronchioles, when a sharp narrowing or even closure of the bronchiolar lumen leads to the development of severe obstructive syndrome, impaired gas exchange and blood circulation. When bronchiolitis is added to acute bronchitis, the patient’s condition suddenly worsens: there is fever, pale skin, cyanosis, severe shortness of breath(40 or more breaths per minute), painful cough with scanty mucous sputum, first excitement and anxiety, then symptoms of hypercapnia (lethargy, drowsiness) and cardiovascular failure (low blood pressure and tachycardia).

Acute allergic bronchitis is characterized by a connection between the disease and exposure to an allergen, a pronounced obstructive syndrome with paroxysmal cough, and the release of light, glassy sputum. The development of acute bronchitis, caused by inhalation of toxic gases, is accompanied by chest tightness, laryngospasm, suffocation and painful cough.

Diagnosis of acute bronchitis

The diagnosis of acute bronchitis is made by a therapist or pulmonologist based on clinical manifestations, as well as laboratory and instrumental studies. When examining a patient, it is necessary to take into account that acute bronchitis can be a manifestation of various infectious diseases(measles, whooping cough, etc.).

Auscultatory data in acute bronchitis are characterized by hard breathing of an obstructive type, scattered dry rales. When liquid secretions accumulate in the bronchi, moist, fine-bubble wheezing may be heard, disappearing after vigorous coughing up of sputum. In acute allergic bronchitis, there is an absence of mucopurulent and purulent sputum, a history of tendency to allergic reactions.

To diagnose acute bronchitis, general, biochemical and immunological blood tests, urinalysis, chest X-ray, bronchoscopy, and function tests are performed. external respiration(spirometry, peak flowmetry), ECG and echocardiography, sputum culture for microflora. Functional parameters of external respiration in acute bronchitis show a violation of pulmonary ventilation of the obstructive type. Changes in the blood picture include neutrophilic leukocytosis, acceleration of ESR; and in the case of allergic genesis of the disease - an increase in the number of eosinophils.

An X-ray examination in the case of acute bronchitis of viral etiology reveals a moderate expansion and blurred pattern of the roots of the lungs; in the case of a protracted course, it helps to detect the addition of complications (bronchiolitis, pneumonia). Differential diagnosis of acute bronchitis is carried out with bronchopneumonia, miliary pulmonary tuberculosis.

Treatment of acute bronchitis

In most cases, treatment of acute bronchitis is carried out in outpatient setting, only in severe cases of the disease (for example, with severe obstructive syndrome or complicated by pneumonia) requires hospitalization in the pulmonology department.

In acute bronchitis, accompanied by fever or low-grade fever, bed rest is indicated, with diet and drinking plenty of fluids(warmed alkaline mineral water, herbal infusions), smoking ban. The room where a patient with acute bronchitis is located should be frequently and well ventilated, maintaining high air humidity. For pain in the chest, you should use warm compresses, mustard plasters, cups on the sternum, interscapular area, mustard foot baths.

In the treatment of acute bronchitis against the background of ARVI, it is used antiviral therapy(interferon, rimantadine), antipyretics, painkillers, NSAIDs. Antibiotics or sulfonamides are prescribed only for secondary bacterial infections, for prolonged acute bronchitis, and for a pronounced inflammatory reaction.

In the case of a dry, painful cough in acute bronchitis, in the first days of the disease, take codeine, dionine, libexin, which suppress the cough reflex. With an increase in sputum secretion, mucolytic and expectorant agents are indicated to thin it and improve drainage function: infusion of thermopsis herb, marshmallow, bromhexine, ambroxol, alkaline steam inhalations. It is recommended to take vitamins and immunomodulators. In case of obstruction, adrenolytics (ephedrine), antispasmodics (euffiline, papaverine) are used to relieve bronchospasm; according to indications - steroid hormones(prednisolone). If necessary, carry out intensive care acute cardiac and respiratory failure.

In acute bronchitis, physiotherapeutic methods (Ural irradiation, inductothermy of the interscapular region, chest diathermy, UHF), exercise therapy, and vibration massage are widely used. In the treatment of acute allergic bronchitis, antihistamines (clemastine, chloropyramine, mebhydrolin), sodium cromoglycate, ketotifen are used; in severe cases, glucocorticoids are indicated.

Uncomplicated acute bronchitis, as a rule, ends in clinical recovery within 2 - 3 weeks, while recovery functional indicators(functions of external respiration and bronchial patency) occurs within a month. With a prolonged course of acute bronchitis, clinical recovery occurs more slowly, approximately 1-1.5 months from the onset of the disease.

Complications of acute bronchitis

Complications of acute bronchitis include bronchiolitis obliterans, bronchopneumonia, asthmatic bronchitis, and in severe cases in elderly and weakened patients, acute respiratory and heart failure is possible. Regularly recurring acute bronchitis contributes to the transition of the disease to chronic form, with the progression of which the development of COPD, bronchial asthma, and emphysema is possible.

Forecast and prevention of acute bronchitis

In acute catarrhal bronchitis, the prognosis is favorable, the disease usually ends full restoration structures of the bronchial mucosa and absolute recovery. In the case of acute purulent bronchitis or the development of bronchiolitis, the prognosis worsens due to residual fibrous thickening of the bronchial wall and narrowing of the bronchial lumen. Violation of the drainage function and deformation of the bronchial tree in acute bronchitis contribute to the protracted course of the disease and its chronicity.

Prevention of acute bronchitis should consist of eliminating possible reason diseases (compliance with sanitary and hygienic standards at work, eliminating dust and gas pollution, quitting smoking and alcohol abuse, timely treatment chronic infections and respiratory diseases, prevention of acute respiratory viral infections, hypothermia), increasing the body's resistance.

Acute bronchitis - inflammatory lesion 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 commonly bacteria. Irritation bronchitis occurs when exposed to toxic and chemical substances, physical factors. Allergic acute bronchitis is possible. Bronchitis often accompanies diphtheria, typhoid fever, and 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, damage to the bronchial system up to low-symptomatic (atypical) pneumonia

Pathogenesis of acute bronchitis

Pathogenesis of bronchial obstruction in obstructive bronchitis and bronchiolitis is complex and is caused, on the one hand, by the influence of the respiratory viruses themselves, on the other; by 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) - spicy inflammatory disease 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.

IN peripheral blood there may not be any changes. 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 of the 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 are pronounced respiratory failure: 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 compliant 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 researching gas composition blood reveals hypoxemia, a decrease in P a 0 2 and P a C0 2 (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, it is retracted yielding places. 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 inflation: increased transparency of the lung tissue, horizontally located ribs, low position of the dome of the diaphragm. 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.

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

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 a productive cough, constant wheezing of various sizes in the lungs (at least 3 months) and the presence of exacerbations at least 2 times a year in for 2 years.

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

Diagnostic criteria chronic bronchitis:

history of long-term (for 2-3 months) exacerbations of bronchitis at least 2 times a year over the past 2 years; complaints of a constant (for 9-10 months) wet 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:

— X-ray of the chest organs: 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;

— General analysis blood: 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, cylindrical bronchiectasis in the lower right part, 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 isolated 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. Therapeutic physical exercise, 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; breast 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- a chronic inflammatory disease of the 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 of 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.

1) Constant cough with sputum production for at least 3 months for 2 consecutive years or more (WHO criterion)

2) A typical auscultatory picture is rough, hard vesicular breathing with prolonged exhalation, scattered dry and moist rales.

3) Inflammatory changes in the bronchi according to bronchoscopy.

4) Exclusion of other diseases manifested by long-term productive cough (bronchiectasis, chronic lung abscess, tuberculosis, etc.)

5) Detection of airway obstruction (reversible and irreversible components) for the diagnosis of chronic obstructive bronchitis.

Diagnosis of exacerbation of chronic disease.

An active inflammatory process in the bronchi is indicated following signs:

Increased general weakness, the appearance of malaise, decreased general performance

The appearance of severe sweating, especially at night (symptom of “wet pillow or sheet”)

Increased cough

Increased amount and purulence of sputum

Low-grade fever

Tachycardia with normal temperature

The appearance of biochemical signs of inflammation

A shift in the leukocyte formula to the left and an increase in ESR to moderate numbers

Differential diagnosis

CB should be differentiated from:

Acute and prolonged recurrent bronchitis

Bronchiectasis

Bronchial tuberculosis

Bronchial cancer

Expiratory collapse of the trachea and large bronchi

A protracted course of acute bronchitis is characterized by the existence of symptoms for more than 2 weeks; recurrent acute bronchitis is characterized by repeated but short-lived episodes of the disease 3 times a year or more. Thus, both variants of bronchitis do not meet the temporary criteria for chronic bronchitis.

Bronchiectasis is characterized by the appearance of a cough with early childhood, discharge of a large amount of purulent sputum (“mouth full”), connection of sputum secretion with a certain position of the body, thickening of the terminal phalanges in the form of “ drumsticks"and nails in the form of "watch glasses", local purulent endobronchitis during fibrobronchoscopy, detection of bronchial dilations during bronchography.

Bronchial tuberculosis: characterized by tuberculosis intoxication - night sweats, anorexia, weakness, low-grade fever, in addition, hemoptysis, absence of purulence in the sputum, the presence of Koch's bacilli in the sputum and bronchial lavage water, family history of tuberculosis, positive tuberculin tests, local endobronchitis with scars and fistulas during fibrobronchoscopy, positive effect of treatment with tuberculostatic drugs.

Bronchial cancer is more common in smoking men and is characterized by a hacking cough mixed with blood, atypical cells in the sputum, and in advanced stages, chest pain, emaciation, hemorrhagic exudative pleurisy. Bronchoscopy and biopsy play a decisive role in diagnosis.

Expiratory collapse of the trachea and large bronchi (tracheobronchial dyskinesia) is manifested by expiratory stenosis due to prolapse of the membranous part. basis clinical diagnostics is the analysis of cough: dry, paroxysmal, “trumpety”, “barking”, “rattling”, rarely bitonal, provoked by sudden bending, turning the head, forced breathing, laughter, cold, straining, physical activity, accompanied by dizziness, sometimes fainting, urinary incontinence, feeling of suffocation. During forced exhalation, a characteristic “notch” is visible on the spirogram. The diagnosis is confirmed by fiberoptic bronchoscopy. There are three degrees of stenosis: 1st degree - narrowing of the lumen of the trachea or large bronchi by 50%, 2nd degree - up to 75%, 3rd degree - more than 75% or complete closure of the lumen of the trachea.

Examples of formulation of the diagnosis of CB

Chronic catarrhal bronchitis with rare exacerbations, remission phase, DN-0

Chronic purulent bronchitis with frequent exacerbations, exacerbation phase, DN-1

· Chronic obstructive bronchitis, exacerbation phase, DN-2

Complications of chronic disease

All complications of chronic disease can be divided into two groups:

1- Directly caused by infection

a. Pneumonia

b. Bronchiectasis

c. Bronchospastic (non-allergic)

d. Asthmatic (allergic) components

2- Caused by the evolution of bronchitis

a. Hemoptysis

b. Emphysema

c. Diffuse pneumosclerosis

d. Pulmonary failure

e. Pulmonary heart

The prognosis for complete recovery is unfavorable in chronic disease. The prognosis for obstructive bronchitis is worse, since pulmonary insufficiency quickly develops, and then cor pulmonale.

Treatment of chronic disease

Therapeutic measures in case of chronic disease, its clinical form, the peculiarities of its course and should be aimed at reducing the rate of progression, reducing the frequency of exacerbations, increasing tolerance to physical activity, improving the quality of life.

The main direction of treatment and prevention of the progression of chronic disease is the elimination of exposure to harmful impurities in the inhaled air (smoking, passive smoking is prohibited, rational employment is necessary). Treatment of CB consists of a set of measures that differ slightly in the period of exacerbation and remission. The period of exacerbation should be treated in a hospital, preferably in a specialized one (pulmonology). Exists treatment program for patients with chronic disease:

1- Bed rest prescribed when high temperature, the development of complications in the form of respiratory failure, the formation of cor pulmonale, etc.

2- Therapeutic nutrition - a balanced diet with sufficient quantity vitamins, easily digestible proteins. Most often this is diet number 10

3- Drug treatment consists of 2 main directions: etiotropic and pathogenetic

Etiotropic treatment is aimed at eliminating the inflammatory process in the bronchi and includes antibiotic therapy. Antibacterial therapy is carried out during the period of exacerbation of purulent bronchitis for 7-10 days (if severe, up to 14 days). Criteria for the effectiveness of therapy during an exacerbation:

1- Positive clinical dynamics

2- Slimy character sputum

3- Reduction and disappearance of indicators of the active inflammatory process (normalization of ESR, leukocyte count, biochemical indicators of inflammation)

Can be used for chronic disease the following groups antibacterial drugs: antibiotics, nitrofurans, trichopolum, antiseptics (dioxidine), phytoncides. They can be administered in the form of aerosols, parenterally, endotracheally and endobronchially. The last two methods are the most effective, as they allow the drug to penetrate directly into the site of inflammation.

Antibiotics. They are prescribed taking into account the sensitivity of the flora sown from sputum or bronchial contents. If sensitivity cannot be determined, then treatment should be started with penicillin antibiotics (penicillin, ampicillin). In case of intolerance, antibiotics of the cephalosporin group (cephamezin, ceporin) are administered. In recent years, macrolides (summamed, rultd) have been prescribed. The main causative agents of exacerbation of catarrhal or purulent bronchitis are sensitive to them. The most preferred method of administration is intratracheal (filling with a laryngeal syringe or through a bronchoscope). With pronounced activity of the inflammatory process in the bronchi and its purulent nature, local (intratracheal) administration of antibiotics should be combined with parenteral administration. For simple (catarrhal) chronic disease, the main, and in most cases, the only method of treatment is the use of expectorants aimed at normalizing mucociliary clearance and preventing the addition of purulent inflammation.

Pathogenetic treatment aimed at improving pulmonary ventilation, restoring bronchial patency, combating pulmonary hypertension and right ventricular failure.

Improvement of impaired pulmonary ventilation is achieved by eliminating the inflammatory process in the bronchi, as well as oxygen therapy and exercise therapy.

The main thing in CB therapy is the restoration of bronchial patency, which is achieved by improving their drainage and eliminating bronchospasm. To improve bronchial drainage, expectorants are prescribed (hot, alkaline drink, herbal decoctions, mucaltin, etc.), mucolytic drugs - acetylcysteine, bromhexine, ambroxol (lasolvan, lasolvan). Therapeutic bronchoscopy has been successfully used. To eliminate bronchospasm, bronchodilators are used. This type of therapy is the main (basic) one for obstructive CB. Anticholinergic drugs are used (ipratropium bromide-antrovent, domestic drug-troventol), a combination of atrovent and fenoterol (berodual) and methylxanthines (aminophylline and its derivatives). Most preferred and safe inhalation route introduction medicinal substances. Long-acting aminophylline preparations (teoprek, theodur, etc.) are effective, which are prescribed orally 2 times a day. If there is no effect of such therapy, small doses of corticosteroids are administered orally (10-15 mg of prednisolone per day) or inhalation of Ingacort 500 mg 2 times a day.

To combat pulmonary hypertension, long-term (several hours) oxygen inhalations are used; according to indications, calcium channel blockers (veropamil) and long-acting nitrates (nitrone) are used.

For prolonged exacerbations, immunocorrective drugs are used: T-activin or thymalin (100 mg subcutaneously for 3 days), orally immunocorrective drugs: ribomunil, bronchomunal, bronchovacone.

Physiotherapeutic procedures are prescribed: diathermy, electrophoresis, chest massage, breathing exercises.

Beyond exacerbation in chronic disease mild course eliminate foci of infection, conduct hardening of the body, exercise therapy (breathing exercises). With moderate and severe chronic disease, patients are forced to constantly receive supportive care. drug treatment. The same drugs are prescribed as during an exacerbation, only in smaller doses.

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They talk about cholesterol so unflatteringly that they are just right 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 balm “star” appeared in Soviet pharmacies in the 70s of the last century. It was in many ways an irreplaceable, effective and affordable drug. “Star” tried to treat everything in the world: acute respiratory infections, insect bites, and pain of various origins.

Language is important organ a person who not only can talk incessantly, but can talk about a lot without saying anything. And I have 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 epidemic status. 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 bathhouse and a sauna. And very few of those who realize that the difference exists can clearly explain what this difference is. Having examined 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 - this is a period of frequent colds, both adults and children. From year to year the situation repeats itself: one family member gets sick and then, like a chain, everyone suffers a respiratory viral infection.

In some popular medical weeklies you can read odes to lard. It turns out that it has the same properties as olive oil, and therefore you can use it without any reservations. At the same time, many argue that you can help the body “cleanse” only by fasting.

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