Acute simple bronchitis. Simple chronic bronchitis - symptoms (signs), treatment, medications

There are diseases for which, according to statistics, people most often seek help from a doctor; many have encountered them at one point in their lives. One of these diseases is bronchitis.

Bronchitis: what is it

This disease is an inflammatory process in the bronchi, which affects the mucous membrane of the lungs. Most often it is caused by the same viruses as acute respiratory infections, but other causes of the disease are also possible. There are two main types of bronchitis - acute and chronic. They differ in the reasons for their appearance, the course of the disease and, accordingly, the choice of treatment.

As a rule, the disease proceeds without any particular complications, and recovery occurs quickly. However, if you do not begin to treat the acute form in a timely manner, there is a possibility that it will become chronic, dangerous for older people. In them it can lead to pulmonary heart failure and fatal outcome.

Causes

The main and most common cause of bronchitis is a virus. The disease can begin with a common cold, flu, or any advanced respiratory disease. Sometimes bacteria replace viruses. You can also get infected from someone who is already sick. by airborne droplets, for example, in a personal conversation.

There are other causes of this disease that often affect the occurrence of the chronic form:

• smoking;
• constant contact with toxic substances or allergens;
• unfavorable environmental conditions;
• unstable, too humid climate.

Sometimes bad heredity is added to the list of reasons, but this factor is not so significant.

Types of bronchitis

There are several types of bronchitis, distinguished by the severity of the disease, the choice of therapy, and even the age of the person suffering from it. The main ones are acute and chronic, but there are other forms.

Acute bronchitis

The acute form develops like a common cold or flu and occurs without complications with timely treatment. Its causative agents are viruses or toxic substances. Acute bronchitis is easily diagnosed, its symptoms disappear within ten days.

Important! Despite the relative safety of acute bronchitis, without treatment or with decreased immunity, it can develop into chronic form or cause pneumonia.

Signs of acute bronchitis in an adult

During illness, you should avoid strong tea and coffee; they dehydrate the body, which, on the contrary, needs more liquids. But they will be very useful herbal infusions: , chamomile. You can drink them with honey.

You can treat yourself at home with expectorants prescribed by your doctor. The most popular, affordable and effective drugs:

• Lazolvan;
• Bromhexine;
• Gerbion.

There are also many breast fees for coughs, allergy sufferers need to be careful with them. From folk remedies Malt syrup and thermopsis are good for bronchitis.

Inhalations

It's good if you have a nebulizer. On this moment inhalations are recognized as one of the most effective remedies for respiratory diseases, they allow medicinal substances get to the foci of inflammation in the lungs.

Important! Inhalations should not be done at high temperatures and rapid heartbeat.

There are a great variety of solutions and recipes for inhalation. Eat medical supplies, produced specifically for the treatment of bronchitis and other diseases respiratory system: Lazolvan, Ambrobene, Berodual and others.

Solutions based on soda or salt are a good antiseptic. If there are no contraindications or allergies, then you can do inhalations based on essential oils eucalyptus, pine, rosemary or herbal infusions. But they are suitable only for adult patients; they are categorically not recommended for young children.

Massage and physiotherapy

After the peak of the disease has passed, when the patient’s condition returns to normal, the doctor may prescribe a course of massage, breathing exercises or physical therapy. There are many methods, you just need to choose the right one and follow all the recommendations of specialists.

Such measures will help avoid relapse of the disease, strengthen the lungs and the body as a whole.

What not to do if you have bronchitis

If you are sick, you should not use warming ointments and mustard plasters, especially for children. In a warm environment, inflammation develops even faster, making complications and bacterial infections more likely.

Important! If the condition worsens sharply, you should consult a doctor.

Prevention of the disease is quite simple. Should be avoided colds, do not allow them to develop and do not carry them “on your feet” if you end up getting sick. Quitting smoking will reduce the risk of chronic bronchitis.

Bronchitis often affects people with weakened immune systems. To prevent this, you should exercise, eat a balanced diet and consume enough vitamins and nutrients, especially during the cold season.

It is worth remembering that contact with toxic substances and allergens also contribute to the development of bronchitis. If the work is associated with hazardous production, you should fully comply with safety standards and precautions, and do not neglect special uniforms and masks that protect the respiratory tract.

If the form of the disease is allergic, you should keep your home clean. There should not be an abundance of food in the apartment of an allergy sufferer. soft toys, carpets, fabric curtains, on which dust accumulates well. Wet cleaning and ventilation should be done frequently.

The diet should also be free of irritants. Allergens among food are red and bright foods, foods with dyes, sweets, spicy foods, some vegetables and fruits.

Observing simple rules prevention, you can avoid encountering bronchitis and its complications or achieve remission if the disease has already entered the chronic stage.

Bronchitis is an inflammatory disease of the bronchi that manifests itself severe cough with sputum discharge. The development of this condition is facilitated by respiratory infection and prolonged hypothermia. If a person has been for a long time...

Inflammatory pathologies in the respiratory organs occupy one of the leading positions among diseases diagnosed in humans of different ages. Antibiotics for bronchitis in adults are prescribed almost...

In chronic bronchitis, the development of an inflammatory process is observed.

Causes of chronic bronchitis

When improper treatment acute illness A chronic form of bronchitis may develop. In addition, the cause of chronicity of the inflammatory process may be chronic inflammatory diseases nasal cavity, chronic pneumonia, bronchiectasis, cystic fibrosis.

The following factors influencing the development of the disease are identified:

• smoking;
• air pollution;
• occupational hazards;
• climate impacts;
• infectious effects.

The development of chronic bronchitis can be facilitated by obesity, kyphoscoliosis, which limits respiratory movements, and alcoholism, which increases bronchial secretion. Insufficient reactivity of the bronchial vessels, for example, after a hot summer or during unusual cooling with subsequent hyperemia and increased secretion, contributes to bronchitis, probably increasing susceptibility to infections. This is confirmed by the fact that among polar explorers, bronchitis, like a runny nose, is a completely unusual phenomenon and occurs only in patients with chronic catarrh of the respiratory tract.

It is necessary to distinguish between actually uncomplicated Chronical bronchitis as such, from chronic bronchitis as a concomitant or subsequent, secondary disease (similar, for example, to chronic cystopyelititis), when without eliminating the underlying disease, bronchitis is incurable.

Pathogenesis of chronic bronchitis

The formation of chronic bronchitis is associated with insufficiency of local immune reactions(the function of mucociliary transport is impaired, surfactant synthesis, humoral and cellular protection are reduced). Bronchoobstruction in chronic bronchitis can be reversible and irreversible. Reversible bronchial obstruction is caused by bronchospasm and increased mucus production by the secretory glands of the respiratory tract.

In pathogenesis diseases, disorders of the cleansing, secretory and protective functions bronchi. The role of infection and such environmental factors as effects on the mucous membrane is undoubted bronchial tree critical temperatures of inhaled air, its dust content and gas contamination, in maintaining the pathological process. It is impossible to single out the determining influence of any one cause on any link in the pathogenetic process. Under the influence of inhaled atmospheric air particles and substances, structural changes occur and progress in the mucous layer of the bronchial tree, which lead to an increase in the amount of bronchial mucus, a deterioration in its evacuation from the bronchial tree, and the processes of resistance to bronchogenic infection are disrupted. As in any long-term pathological process, hyperfunction is initially noted defensive reactions organism, then their fading is gradually observed. Excessive amount of bronchial mucus, worsening of it rheological properties together with the deterioration of the evacuation function of the ciliated epithelium, they contribute to the creation of conditions for slowing down the evacuation of mucus from the bronchial tree, especially its lower sections. Protective mechanisms in small bronchi are less effective compared to large bronchi. Part of the bronchioles is obstructed by bronchial mucus. Proven changes local immunity, which promotes the addition or activation of pre-existing bronchogenic microbial flora. The spread of infection and inflammation into the bronchial wall leads to the progression of bronchitis and peribronchitis, resulting in the formation of deforming bronchitis.

There are two clinical and functional variants of the course of chronic bronchitis. The first, most common option (3/4 of cases), when, with long term disease, signs of DN do not develop. At the same time, vital capacity indicators correspond to the age norm.

The second variant of the course of chronic bronchitis is more unfavorable, with the development of obstructive syndrome, which is confirmed by spirography and an increase in bronchial resistance.

The formation of chronic bronchial obstruction is facilitated by a gradual decrease in the elastic properties of the lungs, which play a leading role in the exhalation mechanism. Long-term chronic obstructive bronchitis is always accompanied, or rather complicated, by pulmonary emphysema. The formation of the latter in chronic bronchitis involves bronchial obstruction, arterial hypoxemia, and disturbances in surfactant activity. Pulmonary emphysema in the case of obstructive bronchitis is centroacinar in nature, and emphysematous bullae develop in the peripheral parts of the lungs, ahead of Clinical signs emphysema. Thus it happens early defeat respiratory sections of the lungs.

Chronic bronchial obstruction is always complicated by DN with arterial hypoxemia. The main factor determining this process is the unevenness of ventilation, i.e. with the emergence of hypoventilated or unventilated zones. In unventilated areas lung tissue the blood is not oxygenated. An increase in the volume of unventilated lung tissue as the process progresses aggravates hypoxemia, which leads to a change in the function of external respiration with a shift in breathing to the inspiratory side. This circumstance has a number of compensatory advantages: a decrease in bronchial resistance and an increase in the elastic recoil of the lungs to overcome the increased bronchial resistance during exhalation. The load on the muscular apparatus involved in the act of breathing increases, the depletion of which aggravates the processes of hypoventilation. Hypercapnia is formed and arterial hypoxemia worsens.

The natural outcome of chronic obstructive bronchitis is the formation of precapillary pulmonary hypertension, which ultimately leads to hypertrophy and dilatation of the RV, its decompensation and the progression of right ventricular heart failure.

Classification

• chronic downtime;
• chronic purulent;
• chronic obstructive;
• chronic purulent-obstructive;
• chronic hemorrhagic;
• chronic fibrous.

Symptoms and signs of chronic bronchitis

Patients complain of a cough, often of a paroxysmal nature; for general malaise, slight fever during exacerbations of bronchitis; with sluggishness chronic course Bronchitis can occur with almost no general symptoms.

Clinical forms and course of the disease. Chronic bronchitis can give special clinical options, occurring, for example, with copious serous sputum (bronchorrhoa serosa) or, on the contrary, almost without sputum production, with severe shortness of breath and paroxysms severe cough(so-called dry catarrh).

A course with constant exacerbations in the cold season (winter cough). Patients become sensitive to drafts, perspiration, and cold feet, which forces them to wrap themselves up and avoid movement; thus, even with uncomplicated bronchitis, a vicious circle is created.

As follows from the definition of chronic bronchitis, its course is characterized by alternating phases of exacerbation of the process and phases of remission. According to the dynamics of each phase of chronic bronchitis, its clinical manifestations change.

It is necessary to distinguish between two main variants of the course of the disease:

• without obstructive syndrome (3/4 patients);
• With obstructive syndrome(in 1/4 patients).

The exacerbation phase is characterized by an increase in the frequency of coughing and an increase in the volume of sputum produced to 100-150 ml per day. There is a transformation of relatively easily separated mucous sputum, which is characteristic of the remission phase, into viscous mucopurulent or purulent, sometimes streaked with blood. Attention should be paid to the patient’s complaints about the appearance of shortness of breath against the background of cough paroxysm, which may be an early symptom of bronchial obstruction. The exacerbation phase is also characterized by symptoms of general intoxication, an increase in body temperature, usually not exceeding 38 °C. Patients complain about profuse sweating(due to severe sweating at night, there is a need to change underwear several times). Performance decreases. Expression and variety clinical symptoms depend on its presence during previous remission. For example, if a patient did not have signs of bronchial obstruction in the remission preceding a given exacerbation, then during a subsequent exacerbation of the disease they may not be present or they may appear to varying degrees of severity. In the phase of fading exacerbation, on the contrary, regression of the above symptoms occurs.

At objective research sick him general state and symptoms depend not only on the influence of endotoxemia, but also on the presence and severity of broncho-obstructive syndrome, the degree of DN, decompensation of the right heart in patients with symptoms of chronic pulmonary heart disease.

During the examination, the patient’s position in bed is assessed and the respiratory rate is determined. The timbre of wheezing increases as it originates in smaller bronchi. When coughing and auscultation of the same area, the timbre and amount of dry rales change.

Diagnosis of chronic bronchitis

To diagnose the disease, it is necessary to identify the patient’s complaints, medical history, conduct an objective examination and laboratory and instrumental examination. From special methods Research must include an X-ray examination, bronchoscopy, and bronchography. In some cases, spirography, pneumotachometry, and determination of blood gases are required.

The diagnosis of chronic bronchitis can be considered justified only by excluding all other causes of bronchitis in the patient.

It is very important to differentiate uncomplicated chronic bronchitis from bronchitis accompanying pneumosclerosis, emphysema, bronchial asthma, bronchial carcinoma and other tumors, pneumoconiosis, bronchiectasis, to distinguish specific forms of tuberculosis, bronchial actinomycosis, etc. Chronic bronchitis is especially often misrecognized in cases of bronchiectasis , which must be kept in mind primarily in case of so-called putrefactive bronchitis, bronchitis with hemoptysis, etc.

Laboratory research are not reliable enough to clearly distinguish between exacerbation and remission phases. The appearance of neutrophilic leukocytosis is not always noted. ESR indicators do increase with exacerbation of the disease, however, it should be remembered that with DN, compensatory erythrocytosis is possible, which causes low ESR numbers.

The duration of the exacerbation phase of the disease is approximately in the range of 2-4 weeks. The frequency of exacerbations per year depends on many factors and ranges from 2 to 6 and 8 per year.

Prognosis of chronic bronchitis

The prognosis for chronic, superficial, recurrent bronchitis is favorable for life. However, bronchitis is difficult to completely cure. In chronic peribronchitis, the more severe the prognosis is, the more severe the symptoms of emphysema and pneumosclerosis. Also bronchitis, accompanying tumors of the bronchi and lungs and other serious illnesses lungs, heart, etc., its prognosis is determined by the course of the underlying disease. The presence and degree of pneumosclerosis are extremely important for resolving the issue of the ability to work in patients with chronic bronchitis.

Treatment and prevention of chronic bronchitis

Treatment of chronic bronchitis is, if possible, causal - sanitation of the nasopharynx, removal of a foreign body from the bronchus; for specific bronchitis, chemotherapy is used; for congestive bronchitis, heart disease is treated.

From symptomatic remedies for thick, difficult to separate sputum, expectorants are prescribed: potassium iodide, soda, ipecac, thermopsis; for profuse sputum, they enhance bronchial peristalsis and disinfectants: ammonium chloride, turpentine, guaiacol; for spasms - ephedrine.

In case of exacerbation, it is necessary to carry out antibiotic therapy (the greatest effect is observed when prescribing sulfonamides).

Chronic simple bronchitis

Pathogenesis of chronic simple bronchitis

Influenced etiological factors(tobacco smoking, environmental pollutants, etc.) activation of effector cells of bronchial inflammation occurs. Proteases and free oxygen radicals released from neutrophils and some other cells damage surrounding tissues. Damage to the integumentary epithelium creates favorable conditions for implantation of microflora into the respiratory tract, which is a powerful attractant stimulator for phagocytes. Hypertrophy of the bronchial glands and hyperplasia of goblet cells lead to hyperproduction of mucus.

Pathomorphology. Inflammatory swelling of the mucous membrane of the proximal respiratory tract, a relative decrease in the number of ciliated cells and an increase in the number of goblet cells, and the participation of squamous cell metaplasia of the epithelium are noted.

Classification. There are catarrhal, mucopurulent and purulent chronic simple bronchitis. Indicate the phase of exacerbation or remission.

Symptoms and signs of chronic simple bronchitis

There is a cough (mainly in the morning) with the discharge of a small amount of serous sputum (“smoker’s cough”). After hypothermia and colds, the cough intensifies, the amount of sputum produced increases, and it can become mucopurulent in nature. Auscultation during this period reveals hard vesicular breathing and isolated dry wheezing, low-grade fever and inflammatory changes in the blood may appear. Bronchoscopy confirms catarrhal or mucopurulent endobronchitis. Other physical and instrumental studies are uninformative. X-ray and computed tomography of the lungs can exclude other diseases accompanied by cough with sputum.

The proximal respiratory tract is mainly affected. There is no such thing as rapid progression.

Diagnosis of chronic simple bronchitis

Anamnesis is taken into account (long-term heavy smoking, exposure to occupational and household pollutants, alcoholism, drug addiction), long-term (at least 2 years) productive cough, data clinical examination, bronchocopies, absence of shortness of breath and signs of obstruction according to spirometry and noticeable progression of the disease.

Differential diagnosis is carried out with acute bronchitis, pneumonia, lung cancer, respiratory tuberculosis, bronchiectasis, chronic obstructive pulmonary disease.

Forecast. Chronic simple bronchitis has a relatively benign course.

Treatment of chronic simple bronchitis

Drug therapy includes expectorants, bronchodilators and corticosteroids for broncho-obstructive syndrome, antibiotics for exacerbation of chronic simple bronchitis. To improve mucociliary clearance, bromhexine, ambroxol, acetylcysteine, alkaline, salt and oil inhalations, herbal medicine (thermopsis herb, licorice root, etc.) are used.

Prevention. Includes smoking cessation, sanitation of lesions chronic infection, careful hardening. If chronic simple bronchitis occurs, observation by a therapist and monitoring of PEF and FEV testing are necessary.

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A comment

Bronchitis(lat. inflammation) is a disease of the respiratory system in which the bronchi are involved in the inflammatory process. A common cause of bronchitis is an infection, such as a viral or bacterial infection, which requires antiviral treatment. Chronic bronchitis as a result long acting non-infectious irritants.

In some cases, with bronchitis, blockage of the bronchi develops due to swelling of the mucous membrane; such bronchitis is called obstructive. Treatment of bronchitis depends on the provoking factor, type of course and form of the disease.

Types of disease

There are 3 types of bronchitis in children:

• spicy simple;
• acute obstructive;
• acute bronchiolitis(occurs in infants and infants, affects the small bronchi).

In adults, there are 2 types of the disease:

• acute form
• chronic form.

Symptoms of acute simple bronchitis in children

The main symptom of acute bronchitis is a cough, which at the beginning of the disease is usually dry and persistent. The cough may be accompanied by a feeling of pressure or pain in the chest. In the second week of illness, the cough becomes mild and productive. Cough and other symptoms may persist for more than 2 weeks. Simple bronchitis is also characterized by harsh breathing and moist wheezing, the amount of which changes with coughing. With deeper bronchitis, you can listen to fine wheezing. The duration of acute bronchitis usually does not exceed two weeks, although in some cases a dry cough lasts longer without being accompanied by a disturbance in the general condition.

Symptoms of obstructive bronchitis

Bronchitis often occurs in preschool children with broncho-obstructive syndrome which is usually called obstructive bronchitis. Obstruction is caused by a combination of several factors, including: an initially narrow lumen of the bronchi, massive swelling of the mucous membrane, which further narrows this lumen, copious production of viscous and poorly discharged sputum, and (in older children) bronchospasm (additional narrowing of the bronchial lumen). As a result, instead of moving freely along a “wide highway,” the air has to “squeeze” through narrow openings. All this is accompanied by wheezing, which can be heard by placing your ear to the baby's chest. Wheezing is the most distinguishing feature namely obstructive bronchitis.

Symptoms of acute bronchiolitis

In most cases, the disease develops in children of the first two to three years of life against the background of acute respiratory viral infection; the maximum peak incidence occurs at the age of 5-7 months. Every year, 3-4% of children suffer from acute bronchiolitis early age. The onset of acute bronchiolitis resembles ARVI: the child becomes restless and refuses to eat; body temperature rises to subfebrile levels, rhinitis develops. After 2-5 days, signs of damage to the lower parts of the respiratory tract appear - obsessive cough, wheezing, expiratory shortness of breath. At the same time, hyperthermia increases to 39°C and above, and moderately pronounced symptoms of pharyngitis and conjunctivitis occur.

Symptoms of acute bronchitis

Infectious bronchitis usually occurs in winter. It begins with symptoms reminiscent of a common cold, primarily fatigue and a sore throat, followed by a cough. At first, the cough is often dry, but later it becomes wet and white, yellow or even greenish sputum is coughed up. In more serious cases, a rise in temperature may occur.

Symptoms of chronic bronchitis

The term “chronic bronchitis,” in contrast to acute bronchitis, is used by doctors to designate a long-term disease that sometimes does not go away for several months. Cough and sputum production may recur annually and last longer each time. Chronic bronchitis often occurs due to prolonged inhalation of various irritants, such as cigarette smoke.

The main difference between the processes in the lungs during acute and chronic bronchitis is that with chronic bronchitis, the bronchial mucosa produces more mucus, which causes a cough, while with infectious bronchitis, the cough occurs mainly due to inflammation of the respiratory tract. One of the most common reasons Chronic bronchitis is caused by constant smoking.

The meaning of sputum color in bronchitis

The color of sputum released when coughing is important. diagnostic value for a doctor. Thanks to only this sign, the doctor can determine the stage of the disease, its severity, and the cause of its occurrence. The composition of sputum includes saliva, which is produced in the mouth, cells produced by the immune system, particles of blood and plasma, dust, and pathogenic microorganisms.

• Green sputum.Green color sputum indicates existing infection of a chronic nature. The green color is the result of the decay process of neutrophils that tried to cope with pathogenic agents. If the disease is infectious nature, then the green tint of sputum can also indicate the presence of a large amount of pus in the sputum. If the disease is non-infectious, then there will be more mucus in the sputum than greens.
• White sputum. When the color of the sputum is white, the patient’s condition is regarded as normal course diseases. However, it is worth paying attention to the amount of sputum discharged and the presence of foam in it. So, with foamy, abundant white sputum, pulmonary edema, tuberculosis or asthma can be suspected.
• Yellow sputum. Indicates the presence of white blood cells, namely neutrophils. They always show up in large quantities for allergic, infectious and chronic inflammation. By yellow color Doctors most often define bronchial discharge as: asthma, sinusitis, acute stage of pneumonia or bronchitis.

When a deviation is detected yellow sputum You should not hesitate to go to the doctor, as her morning analysis allows you to determine the presence of a bacterial infection.

• Black (dark gray) sputum. If a patient produces black or dark gray sputum, this most often indicates the presence of dust from smoking tobacco. Also, blackening of sputum may occur when taking certain medications.
• Brown sputum. Brown color sputum – serious sign, which requires medical assistance. This mucus color indicates decay large number red blood cells and the release of hemosiderin.
• Red sputum (with blood). The presence of blood in the sputum may indicate a serious infection or pulmonary hemorrhage.

Treatment of bronchitis

Treatment of acute bronchitis boils down to bed rest, drinking plenty of fluids and distracting procedures. Drug therapy consists of prescribing drugs that relieve cough and promote rapid recovery (expectorants and mucolytics). For a dry cough without discharge, take antitussives combination medications. At high temperatures, antipyretics are prescribed. When pneumonia occurs, antibiotic therapy is administered.

In case of chronic bronchitis, the doctor can give several recommendations. Your doctor will most likely recommend stopping smoking, as this will significantly slow the progression of the disease and reduce shortness of breath. The doctor may prescribe bronchodilators (bronchodilators), which widen the airways and make breathing easier. They are often prescribed as inhalations (using inhalers). At the time of exacerbation, corticosteroids and antibiotics are sometimes prescribed. In severe cases or with frequent exacerbations, the use of corticosteroids may be continuous.

Possible complications

Bronchitis can be complicated by the development of the following conditions:

• transition of acute bronchitis to a chronic form of the disease;
• development of pneumonia;
• inflammation of the lungs with the possible onset of a septic process;
• the occurrence of cardiopulmonary failure;
• appearance bronchial asthma or obstructive bronchitis. This complication is especially common in people prone to allergic reactions.

Prevention of bronchitis

Primary prevention of the disease comes down to following the following rules:

• Refusal bad habits and primarily from smoking and drinking alcohol.
• Avoiding activities that involve inhalation harmful fumes lead, aluminum, chlorides.
• Getting rid of sources of chronic infection.
• Avoiding low temperatures.
• Strengthening the immune system: rational nutrition, hardening, adherence to work and rest, dosing of physical activity.
• Seasonal flu vaccination.
• Frequent ventilation of living spaces.
• Walks in the open air.

When the first symptoms of the disease occur, you should consult a therapist. It is he who performs all diagnostic measures and prescribes treatment. It is possible that the therapist will refer the patient to more narrow specialists such as: pulmonologist, infectious disease specialist, allergist.

information about the disease and treatment

Simple chronic bronchitis is a disease of class X (Diseases of the respiratory system), included in block J40-J47 Chronic diseases of the lower respiratory tract, has a disease code: J41.0.

CHRONIC BRONCHITIS - diffuse progressive inflammation of the bronchi, not associated with local or generalized damage to the lungs and manifested by cough. ABOUT chronic nature process is usually said if the cough continues for at least 3 months in 1 year for 2 years in a row. Chronic bronchitis is the most common form of chronic nonspecific diseases lungs (CNLD), which tends to become more frequent.

Etiology, pathogenesis. The disease is associated with prolonged irritation of the bronchi by various harmful factors(smoking, inhalation of air contaminated with dust, smoke, carbon monoxide, sulfur dioxide, nitrogen oxides and other chemical compounds) and recurrent respiratory infection (the main role belongs to respiratory viruses, Pfeiffer's bacillus, pneumococci), less commonly occurs with cystic fibrosis, alpha (one) - antitrypsin deficiency. Predisposing factors are chronic inflammatory and suppurative processes in the lungs, chronic foci of infection in the upper respiratory tract, decreased body reactivity, hereditary factors. To the main pathogenetic mechanisms include hypertrophy and hyperfunction of the bronchial glands with increased mucus secretion, a relative decrease in serous secretion, a change in the composition of the secretion - a significant increase in acidic mucopolysaccharides in it, which increases the viscosity of sputum. Under these conditions, the ciliated epithelium does not ensure emptying of the bronchial tree and the normal renewal of the entire layer of secretion (emptying of the bronchi occurs only when coughing). Long-term hyperfunction leads to depletion of the mucociliary apparatus of the bronchi, dystrophy and atrophy of the epithelium. Violation of the drainage function of the bronchi contributes to the occurrence of bronchogenic infection, the activity and recurrence of which largely depend on the local immunity of the bronchi and the development of secondary immunological failure.

A severe manifestation of the disease is the development of bronchial obstruction due to hyperplasia of the epithelium of the mucous glands, edema and inflammatory infiltration of the bronchial wall, fibrous changes in the wall with stenosis or obliteration of the bronchi, obstruction of the bronchi with excess viscous bronchial secretions, bronchospasm and expiratory collapse of the walls of the trachea and bronchi. Obstruction of the small bronchi leads to overstretching of the alveoli during exhalation and disruption of the elastic structures of the alveolar walls, as well as the appearance of hypoventilated and completely unventilated zones that function as an arteriovenous shunt; due to the fact that the blood passing through them is not oxygenated, arterial hypoxemia develops. In response to alveolar hypoxia, spasm of the pulmonary arterioles occurs with an increase in total pulmonary and pulmonary arteriolar resistance; precapillary pulmonary hypertension occurs. Chronic hypoxemia leads to polycythemia and increased blood viscosity, accompanied by metabolic acidosis, which further increases vasoconstriction in the pulmonary circulation.

Inflammatory infiltration, in large bronchi superficial, in the middle and small bronchi, as well as bronchioles, it can be deep with the development of erosions, ulcerations and the formation of meso- and panbronchitis. The remission phase is characterized by a decrease in inflammation in general, a significant decrease in exudation, proliferation connective tissue and epithelium, especially with ulceration of the mucous membrane. The outcome of the chronic inflammatory process of the bronchi is sclerosis of the bronchial wall, peribronchial sclerosis, atrophy of glands, muscles, elastic fibers, and cartilage. Possible stenosis of the lumen of the bronchus or its expansion with the formation of bronchiectasis.

Symptoms, course. The beginning is gradual. The first symptom is a cough in the morning with mucous sputum. Gradually, the cough begins to occur both at night and during the day, intensifying in cold weather, becomes constant over the years. The amount of sputum increases, it becomes mucopurulent or purulent. Shortness of breath appears and progresses. There are 4 forms of chronic bronchitis. In a simple, uncomplicated form, bronchitis occurs with the release of mucous sputum without bronchial obstruction. At purulent bronchitis Purulent sputum is constantly or periodically released, but bronchial obstruction is not expressed. Obstructive chronic bronchitis is characterized by persistent obstructive disorders. Purulent-obstructive bronchitis occurs with the release of purulent sputum and obstructive ventilation disorders. During an exacerbation of any form of chronic bronchitis, bronchospastic syndrome may develop.

Frequent exacerbations are typical, especially during periods of cold, damp weather: cough and shortness of breath intensify, the amount of sputum increases, malaise, night sweats, and fatigue appear. Body temperature is normal or subfebrile, hard breathing and dry wheezing over the entire surface of the lungs can be detected. The leukocyte count and ESR often remain normal;

a slight leukocytosis with a band shift in the leukocyte formula is possible. Only with exacerbation of purulent bronchitis do they change slightly biochemical parameters inflammation (C-reactive protein, sialic acids, seromucoid, fibrinogen, etc.). In diagnosing the activity of chronic bronchitis, sputum examination is of relatively great importance: macroscopic, cytological, biochemical. Thus, with a severe exacerbation, a purulent nature of sputum is detected, predominantly neutrophilic leukocytes, an increase in the content of acidic mucopolysaccharides and DNA fibers that increase the viscosity of sputum, a decrease in the content of lysozyme, etc. Exacerbations of chronic bronchitis are accompanied by increasing disorders of respiratory function, and in the presence of pulmonary hypertension - by disorders blood circulation

Bronchoscopy provides significant assistance in recognizing chronic bronchitis, in which the endobronchial manifestations of the inflammatory process (catarrhal, purulent, atrophic, hypertrophic, hemorrhagic, fibrinous-ulcerative endobronchitis) and its severity are visually assessed (but only to the level of the subsegmental bronchi). Bronchoscopy allows you to perform a biopsy of the mucous membrane and histologically clarify the nature of the lesion, as well as identify the tracheobronchial hypotonic dyskinesia(increased mobility of the walls of the trachea and bronchi during breathing up to expiratory collapse of the walls of the trachea and main bronchi) and static retraction (change in configuration and reduction of the lumens of the trachea and bronchi), which can complicate chronic bronchitis and be one of the causes of bronchial obstruction.

However, in chronic bronchitis, the main lesion is most often localized in the smaller branches of the bronchial tree; Therefore, bronchial and radiography are used in the diagnosis of chronic bronchitis. On early stages Chronic bronchitis shows no changes in bronchograms in most patients. With long-term chronic bronchitis, bronchograms may reveal breaks in medium-sized bronchi and lack of filling of small branches (due to obstruction), which creates a picture of a “dead tree”. In the peripheral parts, bronchiectasis can be found in the form of small cavity formations filled with contrast with a diameter of up to 5 mm, connected to small bronchial branches. Radiographs may reveal deformation and intensification of the pulmonary pattern, similar to diffuse reticular pneumosclerosis, often with concomitant pulmonary emphysema.

Important criteria for diagnosis, selection adequate therapy, determining its effectiveness and prognosis in chronic bronchitis are the symptoms of bronchial obstruction (bronchial obstruction): 1) the appearance of shortness of breath with physical activity and leaving warm room to the cold; 2) sputum production after a long, tiresome cough; 3) the presence of whistling dry rales during forced exhalation; 4) prolongation of the expiratory phase;

5) method data functional diagnostics. Improvement in ventilation and respiratory mechanics when using bronchodilators indicates the presence of bronchospasm and the reversibility of bronchial obstruction. IN late period The disease is accompanied by disturbances in ventilation-perfusion ratios, diffusion capacity of the lungs, and blood gas composition.

Often there is a need to differentiate chronic bronchitis from chronic pneumonia, bronchial asthma, tuberculosis and lung cancer. Unlike chronic pneumonia, chronic bronchitis is always a diffuse disease with the gradual development of widespread bronchial obstruction and often emphysema, respiratory failure and pulmonary hypertension (chronic cor pulmonale); X-ray changes are also diffuse in nature: peribronchial sclerosis, increased transparency of the pulmonary fields due to emphysema, expansion of the branches pulmonary artery. Chronic bronchitis is distinguished from bronchial asthma by the absence of asthma attacks. Differential diagnosis chronic bronchitis and pulmonary tuberculosis is based on the presence or absence of signs of tuberculosis intoxication, Mycobacterium tuberculosis in sputum, X-ray and bronchoscopic examination data, tuberculin tests. Early recognition of lung cancer against the background of chronic bronchitis is very important. A hacking cough, hemoptysis, and chest pain are signs that are suspicious for a tumor and require urgent X-ray and bronchological examination of the patient; The most informative ones are tomography and bronchography. Necessary cytological examination sputum and bronchial contents for antipic cells.

Treatment, prevention. In the phase of exacerbation of chronic bronchitis, therapy should be aimed at eliminating the inflammatory process in the bronchi, improving bronchial patency, and restoring impaired general and local immunological reactivity. Antibiotics and sulfonamides are prescribed in courses sufficient to suppress the activity of the infection. The duration of antibacterial therapy is individual. The antibiotic is selected taking into account the sensitivity of the microflora of sputum (bronchial secretions), prescribed orally or parenterally, sometimes combined with intratracheal administration. Inhalation of garlic or onion phytoncides is indicated (garlic and onion juice is prepared before inhalation, mixed with a 0.25% solution of novocaine or isotonic sodium chloride solution in the proportion

1 part juice to 3 parts solvent). Inhalations are carried out

2 times a day; for a course of 20 inhalations. Simultaneously with the treatment of active bronchial infection, conservative sanitation of foci of nasopharyngeal infection is carried out.

Restoring or improving bronchial patency is an important link in the complex therapy of chronic bronchitis, both during exacerbation and in remission; expectorants, mucolytics and bronchospasmolytics are used, drinking plenty of fluids. Potassium iodide, infusion of thermopsis, marshmallow root, coltsfoot leaves, plantain, as well as mucolytics and cysteine ​​derivatives have an expectorant effect. Proteolytic enzymes (trypsin, chymotrypsin, chymopsin) reduce the viscosity of sputum, but are now used less and less due to the threat of hemoptysis and development allergic reactions. Acetylcysteine ​​(mucomist, mucosolvin, fluimucil, mistabrene) has the ability to break the disulfide bonds of mucus proteins and causes strong and rapid liquefaction of sputum. Apply as an aerosol 20% solution, 3-5 ml 2-3 times a day. Bronchial drainage is improved with the use of mucoregulators that affect both the secretion and synthesis of glycoproteins in the bronchial epithelium (bromhexine, or bisolvone). Bromhexine (bisolvone) is prescribed 8 mg (2 tablets) 3-4 times a day for 7 days orally, 4 mg (2 ml) 2-3 times a day subcutaneously or inhaled (2 ml of bromhexine solution diluted with 2 ml distilled water) 2-3 times a day. Before inhalation of expectorants in aerosols, bronchodilators are used to prevent bronchospasm and enhance the effect of the drugs used. After inhalation, positional drainage is performed, which is mandatory for viscous sputum and inability to cough (2 times a day with prior administration of expectorants and 400-600 ml of warm tea).

In case of insufficient bronchial drainage and the presence of symptoms of bronchial obstruction, bronchospasmolytics are added to therapy: aminophylline rectally (or intravenously) 2-3 times a day, anticholinergic blockers (atropine, platiphylline orally, subcutaneously; atrovent in aerosols), adrenergic stimulants ( ephedrine, isadrine, novodrine, euspiran, alupent, terbutaline, salbutamol, berotec). In a hospital setting, intratracheal lavages for purulent bronchitis are combined with sanitation bronchoscopy (3-4 sanitation bronchoscopy with a break of 3-7 days). The restoration of the drainage function of the bronchi also contributes to physiotherapy, chest massage, physiotherapy. If allergic syndromes occur, calcium chloride is prescribed orally and intravenously with antihistamines; if there is no effect, it is possible to carry out a short (until the allergic syndrome is relieved) course of glucocorticoids (the daily dose should not exceed 30 mg). The danger of infection activation does not allow us to recommend long-term use glucocorticoids.

If a patient with chronic bronchitis develops bronchial obstruction syndrome, etimizol (0.05-0.1 g 2 times a day orally for 1 month) and heparin (5000 units 4 times a day subcutaneously for 3-4 weeks) with gradual withdrawal of the drug. In addition to the antiallergic effect, heparin at a dose of 40,000 units/day has a mucolytic effect. In patients with chronic bronchitis complicated respiratory failure and chronic pulmonary heart, the use of veroshpiron is indicated (up to 150-200 mg/day).

The diet of patients should be high-calorie and fortified. Assign ascorbic acid V daily dose 1 g, B vitamins, nicotinic acid; if necessary - levamisole, aloe, methyluracil. Due to the known role in the pathogenesis of chronic bronchitis of a number of biologically active substances(histamine, acetylcholine, kinins, serotonin, prostaglandins) indications for inclusion in complex therapy inhibitors of these systems. When the disease is complicated by pulmonary and pulmonary-heart failure, oxygen therapy and auxiliary artificial ventilation lungs. Oxygen therapy includes inhalation of 30-40% oxygen mixed with air, it should be intermittent. This position is based on the fact that with a pronounced increase in carbon dioxide concentration, the respiratory center is stimulated by arterial hypoxemia. Eliminating it by intense and prolonged inhalation of oxygen leads to a decrease in function respiratory center, increasing alveolar hypoventilation and hypercapnic coma. For stable pulmonary hypertension, long-acting nitrates and calcium ion antagonists (verapamil, phenigidine) are used for a long time. Cardiac glycosides and saluretics are prescribed for congestive heart failure.

Anti-relapse and maintenance therapy begins in the phase of subsiding exacerbation, can be carried out in local and climatic sanatoriums, and is also prescribed during medical examination. It is recommended to distinguish 3 groups of dispensary patients. The first group includes patients with severe respiratory failure, cor pulmonale and other complications of the disease, with loss of ability to work; patients need systematic maintenance therapy, which is carried out in a hospital or by a local doctor. The goal of therapy is to combat the progression of pulmonary heart failure, amyloidosis and others. possible complications diseases. These patients are examined at least once a month. The second group consists of patients with frequent exacerbations of chronic bronchitis and moderate respiratory dysfunction. Patients are examined by a pulmonologist 3-4 times a year, anti-relapse courses are prescribed in spring and autumn, as well as after acute respiratory diseases. Convenient method of administration medicines is inhalation; according to indications, the bronchial tree is sanitized by intratracheal lavage and sanitary bronchoscopy. For active infection use antibacterial drugs. An important place in the complex of anti-relapse drugs is occupied by measures aimed at normalizing the body's reactivity: referral to a sanatorium, dispensary, exclusion occupational hazards, bad habits, etc. The third group consists of patients in whom anti-relapse therapy led to the subsidence of the process and the absence of relapses for 2 years. They are shown seasonal preventive therapy, including agents aimed at improving bronchial drainage and increasing reactivity.

- inflammation of the bronchial mucosa. All bronchi extend from the main respiratory canal of the human body - the trachea. In the lungs they diverge into countless branches (bronchial tree), the diameter of which gradually decreases. The mucous membrane of the bronchi is covered with a special epithelium, or so-called cilia, which vibrate in the mucus, creating an upward movement in it (like an escalator). This prevents germs from moving down.

Cough with sputum performs protective role: removes mucus along with microorganisms that provoked inflammation - this is self-cleaning of the bronchi. A cough without sputum is associated either with the fact that the sputum is very thick and cannot be cleared, or with the absence of mucus and thickening of the mucous membrane of the trachea or bronchi and its inflammatory process. Depending on the duration of the disease, bronchitis is divided into acute and chronic.

Acute bronchitis is an inflammation of the bronchial mucosa caused by viruses or pathogens. He is accompanied periodic attacks cough, burning sensation behind the sternum or in the throat, weakness, chills, fever up to 37-38 ° C, headache and muscle aches. After 2-3 days, a small amount of sputum is released, the cough becomes less painful, and your health improves. Bronchitis usually lasts 1-2 weeks, but cough can last up to 1 month. If measures are not taken in time, acute bronchitis can develop into chronic bronchitis. This disease is characterized by alternating periods of exacerbation and remission. Exacerbations are associated with hypothermia, OP3 and often occur during the cold season. The main indicator is chronic moist cough, especially in the morning, which is accompanied by copious purulent sputum and continues for several months for more than 2 years in a row. The temperature rises rarely and insignificantly. Often bronchitis is accompanied by shortness of breath associated with “clogging” of the bronchi.

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For acute bronchitis, half-bed rest or bed rest, increased nutrition, plentiful warm drink(tea with raspberry jam or honey, milk with soda or half and half with mineral water, raspberry infusion, linden blossom). Smoking is strictly prohibited. It wouldn’t hurt to put up jars, mustard plasters, pepper patch on the chest and back. But these procedures can only be performed with the permission of the attending physician. Treatment of acute bronchitis is mainly symptomatic: fever reduction, inhalations, expectorants. In acute bacterial bronchitis A course of antibiotic treatment may be needed.

Currently, the term “chronic obstructive pulmonary disease” (COPD) is increasingly used instead of the term “chronic bronchitis,” which means chronic bronchitis. Treatment of COPD prescribed in 4 stages: 1 - quitting smoking, 2 - prescribing medications that dilate the bronchi, 3 - expectorants, 4 - antibiotics.

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In cases of mild forms of bronchitis and during the recovery period, use is encouraged.

Plantain tincture helps with bronchitis: 3-4 tbsp. spoons of dry leaves pour 500 ml of boiling water, wrap and leave for 1.5 hours in a warm place, strain and take 1-2 tbsp. spoons 3-4 times a day before meals.

Honey with onions thins phlegm. Pass a medium-sized onion through a meat grinder, add natural honey to

proportions 1:1 and take 1 tbsp after meals. spoon 3 times a day.

Promotes coughing carrot juice, diluted with warm water (1:1) with a few tablespoons of honey. This drink should be drunk 1 tbsp. spoon 4-5 times a day before meals.

For bronchitis, drainage exercises are very effective, facilitating the discharge of sputum. Breathing exercises are also useful - breathing with your stomach, exhaling through closed lips.

Inhalations with infusion of herbs, onion juice, and garlic are also useful.

Massage and self-massage of the chest, aimed at strengthening the respiratory muscles, helps with bronchitis.

In any case, the treatment program must be agreed upon with the attending physician, since exacerbation of chronic bronchitis may mask pneumonia, which requires special treatment.