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How to treat bronchitis in adults? Effective drugs and methods

Bronchitis is an inflammatory disease of the bronchial mucosa. Most often it develops against the background respiratory infections but may have other reasons. To understand how to treat bronchitis in a particular case, it is important to identify these causes. Competent therapeutic tactics will help eliminate the main symptoms of the disease in a few days.

Basic principles of treatment of bronchitis in adults

Treatment of bronchitis is the competence of a pulmonologist, but in mild forms this disease is treated by generalists - therapists.

What drugs, antibiotics help with the disease?

Before prescribing any drug, the doctor determines the cause of the disease. Bronchitis of a viral, bacterial and allergic nature requires a different approach.

Therefore, in the list of drugs for the treatment of bronchitis there are funds from different groups:

Antibiotics for bronchitis are prescribed only if an infection is detected. bacterial origin. Antiviral drugs are recommended for the treatment of infectious bronchitis of a viral nature. Bronchodilators - with the development of bronchospasm or in cases where hypersecretion of mucus is observed in the bronchi, and they cannot get rid of sputum on their own.

Therapy of bronchitis various origins also implies the use of anti-inflammatory and immunomodulatory drugs: Timogen, Aflubin, Immunal. can be assigned and antihistamines- "Suprastin", "Zirtek".

Inhalations as a method of treatment

Inhalations are a mandatory procedure included in the bronchitis therapy program.

Direct delivery of the drug to the bronchi helps to achieve the following effects:

liquefaction of thick sputum;
moisturizing the mucous membrane;
reduction of inflammation;
removal of bronchospasm.

You can carry out inhalation at home using the “old-fashioned” method - breathe over a hot solution, covering yourself with a towel. But it is much more convenient and safer to perform this procedure using a nebulizer.

Nebulizer allows use for inhalation pharmaceutical preparations from bronchitis - "Fluimucil", "Lazolvan", "Gensalbutamol", "Berodual". In the absence of the device, steam inhalations are carried out with home solutions, which will be discussed below.

This procedure is also contraindicated in cardiovascular diseases history of heart attacks and strokes, severe pathologies respiratory system (emphysema, pneumothorax, etc.).

Folk remedies

In the piggy bank of folk remedies there are many useful recipes that can be used as auxiliary in the treatment of bronchitis:

Infusion for inhalation of chamomile and pine buds. Put 30 grams of chamomile flowers and 30 grams of pine buds in a thermos and brew 0.5 liters of boiling water. Screw on the lid and leave for 1 hour.
Expectorant and anti-inflammatory infusion for inhalation. Make a herbal collection: 1 tablespoon of eucalyptus leaf, licorice root, calendula and chamomile flowers, sage herb. Put everything in a thermos, pour 0.5 liters of boiling water and tighten the lid. Insist 2 hours.
Propolis solution for inhalation. 1 tablespoon alcohol tincture Pour propolis into 1 glass of hot water and use for steam inhalation.
Expectorant with honey and aloe. Mix 120 ml of honey, 150 grams of butter and 20 ml of aloe juice and store in the refrigerator. For bronchitis, 2 times a day, dilute 2 teaspoons of the remedy in 1 glass of hot milk.
Althea root decoction. Put 2 tablespoons of dry crushed marshmallow root into 1 cup of hot water and place in a water bath. Keep covered for 30 minutes, cool, filter and consume 0.5 cup 4 times a day.

With bronchitis it is useful to drink a lot of warm vitamin drinks. For this, general strengthening infusions of rose hips, dried fruit compotes are useful. At a temperature, you can cook fruit drinks from cranberries, lingonberries, black currant. Raspberry tea - another universal remedy traditional medicine for the treatment of many respiratory diseases.

Massage and therapeutic gymnastics

Auxiliary methods in the treatment of inflammation of the bronchi - massage and breathing exercises.

Treatment of bronchitis at home: acute, chronic, folk remedies

Bronchitis most often begins in the flu or SARS program or as a complication of them, when a dry, debilitating or moist cough and if you help your body in time, quickly turn a dry cough into a wet one, then bronchitis can be cured faster than in 10 days.

Any treatment should be complex:

Active fight against virus and infection
Improvement of bronchial patency, liquefaction of sputum and its fastest removal
Elimination of provoking factors

Regime for bronchitis

At the very beginning of the disease, it is simply necessary to conduct bed rest for 2-3 days, then you can keep a semi-bed rest for another 3-4 days, when it becomes easier, the temperature will be normal, you can go out and make small hiking on fresh air, better in the park, and not along the highway.

It should be observed mainly vegetable - cereal, dairy diet, during the period of illness, the body especially needs vitamins, it is better if they are natural vitamins- fruits and vegetables.

If a person smokes, smoking cessation should happen as if by itself, since smoking increases and provokes a dry cough so much, and delays the day of recovery, that it is not even worth talking about. very many heavy smokers Those who think about their health quit smoking precisely after acute bronchitis, pneumonia or obstructive bronchitis!

One of the options Get well soon with bronchitis - the fastest liquefaction of sputum and its excretion from the body, and this is very simply achieved by plentiful warm drinking. This is a banal advice, but the most correct and true, the more fluid a patient with bronchitis drinks, the faster the sputum is liquefied, and hence the release of the bronchi.

Also, during inflammation during intoxication, a lot of harmful substances are formed. toxic substances, which poison the body, and drinking plenty of water up to 2-3 liters per day is the way to cleanse toxins and speedy recovery.

You can drink any drinks, it is best if they are fortified natural vitamins- a decoction of wild rose, raspberry, linden, mint, chamomile tea, milk-mineral honey cocktails (mineral water without gases Borjomi, Narzan + milk + honey). And you should refrain from strong tea and coffee, since caffeine dehydrates the body, which is not desirable for any illness.

When the air is dry, the cough is much stronger, so try to moisten the air in the room where the patient is. It is best to use an air purifier and humidifier for this purpose. It is also desirable to carry out daily wet cleaning of the patient's room to purify the air.

Do you need antibiotics for bronchitis?

There are cases of very severe bronchitis with obstructive syndrome and respiratory failure, in such a situation, hospitalization in the pulmonology department is indicated. With a mild form of bronchitis, uncomplicated by other pathologies, after contacting a doctor, acute bronchitis can be treated at home, using various medicines or traditional medicine.

Usually, it is not advisable to use antibiotics for bronchitis if it is caused by the flu virus, the common cold. Strong immunity copes well with inflammation of the bronchi. Antimicrobial agents in the absence of appropriate changes in the blood and in the absence of purulent sputum cannot be used for bronchitis, since they not only do not have anti-inflammatory and antiviral effect, but also increase allergization, can provoke broncho-obstructive syndrome. But in case:

high fever lasts for a long time, purulent sputum is released when coughing
or after an acute period of the disease, after 4-5 days, the condition suddenly worsens, a new jump in high temperature appears, purulent sputum (yellow or green) is released when coughing, the general condition of the patient worsens

you should once again consult a doctor who will examine, listen to patients, send them for tests and x-rays, after which he recommends a course of antibiotics aimed at destroying the attached bacterial infection. Antibiotics should never be started without a doctor's recommendation. 11 rules - how to take antibiotics correctly.

How to quickly cure bronchitis at home

Antivirals

If bronchitis occurs against the background of the flu, then for therapy you can connect antiviral drugs. You can use intranasal interferon preparations, that is, instillation into the nose of both children and adults, the use of other antiviral drugs for ARVI and influenza is widely advertised and recommended today, however, there are no convincing studies and evidence of their effect and safety, so the decision to use them is a private matter for everyone.

Expectorants

To improve sputum discharge, the doctor prescribes expectorants, mucolytic drugs, they pharmacy network many - the most popular and effective among them: Lazolvan, Ambrohexol, Bromhexine, Gerbion, herbal breast preparations (which can be used if there is no allergy to medicinal herbs). At persistent cough and elements of bronchial obstruction, Ascoril (Joset, Kashnol) containing salbutamol is prescribed.

At the very beginning of bronchitis, the patient usually has a long dry non-productive cough. Therefore, to alleviate the condition, you should take drugs such as Glaucin, Libexin, Tusuprex, Levopront, which suppress dry cough, and expectorants are taken later, when the cough turns into a wet one. You can also use combined preparations, such as Sinekod - instruction, Bronchicum, Bronholitin. For the treatment of bronchitis folk remedies, with a dry cough, thermopsis, licorice, coltsfoot are used.

After 4 days, as a rule, sputum begins to depart, therefore, cough suppressants should be discontinued and sputum thinners should be taken:

Mucolytics - these include acetylcysteine - ACC, Mukonex, Fluimucil, as well as carbocysteine - Fluifort.
Expektorants - means that improve expectoration of sputum, that is, a reflex effect, these include the well-known plantain (Gerbion), ivy leaves (Prospan), marshmallow, thyme, anise drops, and also Breast collection.
Mucokinetics - drugs that facilitate the movement of sputum, for example, Bromhexine. Such popular drugs as Lazolvan (in Ambroxol tablets), Ambrobene, in addition, have the ability to thin sputum, making it not so viscous, and easily remove it from the body.

Inhalations

It is very effective to treat bronchitis with the help of various inhalations. If you want to quickly cure bronchitis, then you should definitely do inhalations. Just make sure you don't have a high temperature or palpitations first.

There are many recipes for steam inhalation with bronchitis - these are saline and soda solutions, and essential oils of eucalyptus, pine, myty, herbal preparations, inhalation of phytoncides, which are rich in essential oils of garlic, rosemary - reduce cough shocks and facilitate the process of coughing. However, it is not uncommon for essential oils and medicinal herbs to have allergic reactions, and therefore it is better for people prone to allergies (hay fever) not to take risks and avoid the use of various herbs and essential oils.

Also, for those who have a home inhaler, it is possible to carry out inhalations for bronchitis with a nebulizer with Lazolvan, Ambrobene, and other special medicinal solutions designed to improve the release of bronchial sputum.

In the case of obstructive bronchitis in children or adults, Berodual is an effective bronchodilator; special solutions are available for inhalation.

Massage, breathing exercises

It always effectively and quickly helps to cope with almost all diseases - massage, with bronchitis it can be carried out only if the body temperature is normal, you can do it yourself, using various massagers, Kuznetsov's applicator, or vibration massage. To date various kinds There are many massagers, so you can buy any of them.

After it's over acute period inflammation and there will be only residual effects in the form of a rare cough, you can start doing therapeutic breathing exercises, for example, according to Strelnikova. Women can try to perform simple exercises from Bodyflex breathing exercises, which strengthens not only the respiratory system, but also normalizes metabolism and promotes weight loss.

Oddly enough, but the old proven means are forgotten by modern man, and methods such as banks, mustard plasters, warm compresses are rarely used by people. But these are safe and very effective procedures.

Treatment of chronic bronchitis folk remedies

In every family there are grandmothers, great-grandmothers, who used to treat all diseases, exclusively with folk remedies. Among all the methods of treating chronic bronchitis with folk remedies, we will talk about the most simple and accessible to everyone:

Radish, honey

A very old and effective recipe is a radish, a small depression is made in it, into which a teaspoon of honey is placed. After a while, the radish gives juice and can be consumed 3 times a day. This is a good way to relieve a cough if you are not allergic to honey.

Chamomile, St. John's wort, sage, calendula, calamus

Such medicinal herbs as chamomile, St. spoons in a glass of boiling water, insist for an hour and drink 3 r / day.

Garlic, dill, butter

Sandwiches with garlic, dill and butter- to prepare such a sandwich, you should take 5 cloves of garlic, squeeze through a garlic press, mix with 100 g butter, you can add finely chopped dill or parsley. Eat this sandwich 3 times a day.

medicinal plants

Plantain has always been valued by traditional healers for its excellent expectorant properties. Therefore, for the treatment of bronchitis, you can buy plantain leaves, 4 tbsp. grind spoons of leaves, pour half a glass of boiling water, let it brew for 4 hours, strain and drink this amount during the day.
Medicinal plants such as thyme, eucalyptus, pine buds, cumin, St. John's wort, fennel have an expectorant effect, so infusions and inhalations can also be made from them.
Medicinal plants such as decoctions of plantain, yarrow, violet, marshmallow roots, coltsfoot help to increase immunity in chronic bronchitis.
Taking natural mummy, echinacea tincture, licorice root syrup also improves immunity.
Decoctions of parsley, juniper, horsetail, birch, lingonberry leaves. These remedies are not direct methods of treating acute bronchitis at home, but they are very helpful in strengthening the body and speedy recovery.

Sorbents

To relieve symptoms of intoxication in viral and infectious diseases, in order to quickly remove toxins from the body, you can also use pharmaceutical products sorbents - Polysorb, Enterosgel, Filtrum STI, Polyphepan, etc., but they should be taken in the intervals between taking medicines and food, best of all 1 time per day at night, 2 hours after the last meal and medicine and a short course.

Psychological attitude

It may seem strange and unacceptable to many, but the psychological, emotional, positive attitude towards recovery is always of great importance, especially in chronic diseases. Faith in healing - gives the brain a very strong impetus to intensify the struggle of the body itself with the disease. daily reading positive attitude that you can come up with for yourself, saying affirmations, doing self-suggestion, meditation - can help more than some medicines. The main thing is to believe that it works, to believe in the strength of your body and the disease will go away.

juice therapy

Juice therapy has long been considered the most powerful way to improve the whole body. Vegetable juices are especially useful:

Beetroot juice is considered the most highly effective juice for cleansing the blood of toxins, it helps to normalize the composition of the blood, increases platelets especially well, the only condition for taking it is that you can’t drink freshly squeezed juice, first raw beets are rubbed on a grater, squeezed out the juice, and then put in refrigerator, after 3-4 hours you can drink it.
Carrot juice - plenty beetroot juice drinking is not recommended, no more than 100 ml., it is better to dilute it with useful freshly squeezed carrot juice. It is both delicious and extremely healthy.
Cowberry juice - very good for sputum discharge.
Freshly squeezed cabbage juice is not very pleasant to drink, but if you add a little sugar, then it is very effective as an expectorant. In addition, cabbage juice helps with stomach diseases.

Treatment of bronchitis at home in adults and children

One of the most common diseases of the human respiratory system is bronchitis. This disease is an inflammatory process that affects, including the bronchi. Bronchitis occurs due to infection: in most cases of viral, less often bacterial origin. In the international classifier of diseases, bronchitis is presented in two forms: acute and chronic. They differ among themselves in etiology, pathogenesis and necessary therapy.

Cough is the main symptom of bronchitis. In the first days of the disease it is dry with severe night attacks. Due to coughing, the patient often cannot sleep normally and suffers from physical ailments. After a few days, the cough becomes wet and, with the right treatment tactics, bronchitis disappears in 10 days. Quite frequent are cases when cough, in the form of a residual effect after bronchitis, lasts much longer than the disease itself. This is due to the fact that the process of restoration of the bronchi after the inflammatory process is quite long.

Only a cough that lasts more than four weeks should cause concern. In such cases, you need to consult a pulmonologist, who will determine the presence third-party reasons cough. In addition, third-party inclusions in the sputum, especially blood, should alert during bronchitis. They should cause an immediate visit to the hospital, where they will be examined for tuberculosis and lung cancer, for which blood in the sputum is a fairly characteristic symptom.

Bronchitis treatment

Considering the issue of therapy for bronchitis, first you need to identify two important points:

the tactics of treating inflammation of the bronchi are influenced by the form of the disease (infectious or bacterial) and the type of course (acute or chronic);
bronchitis treatment should be complex. The result only from taking medications in most cases will not be effective enough.

At the same time, it is drug therapy for bronchitis that is quite simple. By itself, it does not require any complex drugs or procedures. The main thing that this disease requires is the correct determination of the causative agent of the inflammatory process and the form of the course.

Antibiotic therapy for inflammation of the bronchi

The question of the use of antibacterial drugs in bronchitis causes a lot of debate. But official medical protocols state that the use of antibiotics to treat this disease is necessary in two cases:

if inflammation of the bronchi is provoked by a bacterial infection;
if the flow viral bronchitis comes with complications or the patient is diagnosed with concomitant diseases.

The list of antibiotics here is classic for bacterial infections: penicillins, cephalosporins, macrolides. The choice depends on the individual characteristics of the patient.
In most cases, with a viral origin of inflammation of the bronchi, antibacterial drugs do not have the necessary effect. effective action. In addition, they can cause the development of broncho-obstructive syndrome - blockage of the bronchi caused by swelling of the mucous membrane.

The main symptom of bronchitis, which indicates the need for the use of antibiotics, is sputum with purulent inclusions. If it is present, the doctor prescribes an additional study, according to the results of which he prescribes an antibacterial agent. But in no case should an antibiotic be prescribed for bronchitis on its own. The possible harm from its use can significantly exceed the expected effect.

Inflammation of the bronchi acute form almost always treated at home and requires only drugs local impact. Antibiotics for bronchitis are not a key drug.

Use of antivirals for bronchitis

The fact that inflammation of the bronchi is provoked by a viral infection, in itself, hints at the need for the use of antiviral drugs to treat this disease. But, the question of the use of medicines in this group is very, very debatable. Many doctors are sure that there are no antiviral drugs with proven effectiveness, and to fight viruses, the body just needs to create optimal conditions. In a way, they will be right. Another group of doctors insists that viruses need to be suppressed by antiviral drugs and without them the disease cannot be overcome.

Used for viral infections two agents: interferon and oseltamivir. At the same time, no one takes them in a pharmacy without a prescription and does not drink without medical prescription. The use of antiviral drugs is indicated for the treatment of chronic bronchitis, in most cases with concomitant hospitalization.

The truth, in fact, is somewhere in the middle. With a normal course, bronchitis is overcome without antiviral drugs, as well as without antibiotics. If the disease is accompanied by complications or there are individual prerequisites, the use of drugs in this group can be justified and necessary.
Now about what you really can’t do without with bronchitis.

Expectorants for bronchitis

Bronchitis always begins with a strong and dry cough. Therefore, the only group of drugs that are really needed for inflammation of the bronchi are expectorants.
In medicine, this group of drugs is divided into two subgroups according to the way they affect the body:

drugs to stimulate expectoration,
mucus thinners.

Medications to stimulate expectoration

This subgroup is also called secretomotor agents. The action of stimulant drugs is aimed at irritating the gastric mucosa, which provokes an increased work of the cough and vomiting centers of the medulla oblongata. The consequence of this is an increase in the production of liquid secretions in the bronchi and an increase in cough reflexes.

The main preparations of this group are thermopsis herb, a number of essential oils, ammonium chloride and others. It should be noted that drugs to stimulate expectoration have a fairly short-term effect, and an overdose threatens with vomiting, nausea, nasal congestion and tearfulness.

Mucus thinners

A subgroup of these drugs, also called mucolytics, thins sputum without causing it to increase in volume. This effect is achieved due to the fact that disulfide bonds are broken in acidic mucopolysaccharides. The main prerequisite for their use is viscous sputum, which is produced in diseases of the respiratory tract, including bronchitis.

The most popular thinning drugs are:

In principle, all these drugs can be considered as analogues to each other and the appointment of a particular drug is carried out solely because of the preferences of the doctor and the individual characteristics of the patient's body.

In addition to the aforementioned groups of medicines, the course of bronchitis may require the use of antipyretics. In most cases, inflammation of the bronchi is accompanied only slight increase body temperature at which the body is given the opportunity to cope with the problem. But if the temperature goes beyond 38 degrees, then to drug therapy you need to add classic ibuprofen or paracetamol.

This completes the medical treatment of inflammation of the bronchi. In the normal course, this disease does not require other drugs, but it needs a special regimen for the patient and physiotherapy procedures.

Changes in lifestyle and regimen for bronchitis

When wondering how to quickly cure bronchitis, you need to remember: with bronchitis, the main condition for recovery is to create the most favorable environment for natural recovery normal operation respiratory system.

The first and most important thing for bronchitis is moisture. At the same time, in addition to moist air in the room where the patient is located, he needs to provide the most plentiful drink. Moreover, you can drink absolutely everything, with the exception of soda: water, juices, herbal teas. The main thing is that the drinking temperature is comfortable.

To ensure sufficient humidity in the room, it is best to use humidifiers. If they are not there, hang wet towels on the radiators, spray water with a spray bottle - do everything to increase the water content in the air.

Already these two rules will create favorable conditions for overcoming a dry cough and starting the process of sputum separation.

In addition, with bronchitis, especially in the first three days, bed rest and lack of physical activity are necessary. Small walks are allowed only at the first relief, and they need to be carried out in places with clean air: in squares, parks, in the forest.

A separate point of the regime for bronchitis is a complete cessation of smoking. Inhalation tobacco smoke is a provoking factor of dry cough and smoking in bronchitis can not only stretch the healing process in time, but also cause the development of serious complications. By the way, doctors believe that inflammation of the bronchi is an excellent (so to speak) reason to quit smoking.

By adhering to these simple rules, the treatment of bronchitis will take place as soon as possible and with a minimum of necessary medicines.

Physiotherapy for bronchitis

inhalation,
massage,
breathing exercises.

Inhalations for bronchitis

It is recommended to carry out inhalations with the help of special devices - inhalers. Steam inhalation is also possible, but, especially for children, you need to be extremely careful to prevent burns of the mucous membranes.
Effective for bronchitis inhalation with the following drugs:

saline and soda solutions;
essential oils of eucalyptus, pine, mint, garlic and rosemary;
Lazolvan, Ambrobene and other medications, the action of which is aimed at removing sputum from the bronchi.

There are only two contraindications for inhalation: high temperature and palpitations. But immediately after overcoming them, inhalations can be used. This is one of the most effective methods for inflammation of the bronchi.

Breathing exercises for bronchitis

There are many methods of breathing exercises for pathologies of the respiratory tract. Regardless of who developed a specific set of exercises, they all have positive influence on the pace of overcoming bronchitis. You need to choose the appropriate breathing exercises yourself or on the recommendation of a doctor. The most popular are the methods of Strelnikova, Buteko, Kofler, as well as yoga and martial arts wushu.
Any set of exercises for the respiratory system puts the following goals at the forefront:

increase in the functional reserves of the organs of the respiratory system;
changes in the work of organs, which are achieved by influencing the respiratory system.

And most importantly: when performing such exercises, you need to remember that they need to be carried out in the fresh air, which in itself has a positive effect on the state of the organs of the respiratory system.

Massage for bronchitis

Massage during inflammation of the bronchi is prescribed when the disease has subsided: there is no high temperature, the cough has passed into the wet stage, there are no concomitant complications.
A very warm bath should precede the massage, which will soften the skin and allow you to stay in a room with 100% humidity for some time. There are several massage techniques for bronchitis. Let's describe them:

1. The patient lies on his back on a hard surface. The masseur, while inhaling, holds his hands on the sides in the direction from the chest to the back, and during exhalation - back. Rib cage during this, it should squeeze a little.
2. Lying on his back on a hard surface, the patient needs to slightly raise his head, placing a pillow. With the palms of the masseur's hands pressed, movements are carried out from the abdomen to the shoulders. Similar movements are carried out for the patient, who lies on his stomach. Hand movements, respectively, are carried out along the back. This allows you to stimulate the removal of sputum from the bronchi.
3. Another massage procedure that improves sputum removal is as follows: the patient lies on his stomach so that his head goes beyond the massage table and is slightly lowered down. At the same time, a pillow is placed under the legs so that they are raised. In this position, intercostal massage is done. The recommended duration of the procedure is 25 minutes.

Finally, we note that the treatment of inflammation of the bronchi in a regular course is quite simple, but at the same time it requires a competent construction of tactics for taking medications and using physiotherapy. Therefore, if you get sick with bronchitis, consult a doctor. He will tell you how to treat bronchitis at home, accurately determine the characteristics of the disease and select a therapy that will give the most effective result in the shortest possible time.

The tactics of drug treatment of bronchitis

Bronchitis is a disease bronchial tree inflammatory nature, which is characterized by hypersecretion of mucus, productive or unproductive cough. Bronchitis occurs in acute and chronic form. special problem is a chronic bronchitis that occurs as a result of prolonged exposure to an irritating factor and entails the processes of sclerosis of the bronchial wall and surrounding tissues, as well as a violation of the cleansing and protective functions bronchi. Worldwide, about 10% of the population suffers from chronic bronchitis. Most of them are males over the age of 40.

Etiology of bronchitis

There are many reasons for the development of bronchitis.

In this case, it is more appropriate to talk about risk factors for the development of the disease:

Smoking, including passive.
Action of various pallutants: street (exhaust gases, industrial emissions into the atmosphere); household (from finishing materials - benzene, formaldehyde, styrene, nickel, phenol, cobalt and others).
Occupational hazards for builders, weaving mill workers, miners, chemical workers, steelworkers.
Physiological factor - elderly age, male gender.
Congenital deficiency of antitrypsin.
Infections, especially long-term persistent cytomegalovirus.
Chronic alcoholism and drug addiction.

The mechanism of the development of the disease

The mechanism of development of bronchitis is based on morphological reversible and irreversible changes in the bronchi.

Reversible changes:

hypertrophic changes in the glands of the bronchi;
increased secretion of bronchial mucus;
swelling of the mucosa;
infiltrative changes in the mucous membrane and submucosal layer.

Irreversible changes (develop only in chronic form):

inflammation of the outer lining of the bronchus;
development of pneumosclerosis;
development of emphysema;
respiratory failure;
cor pulmonale syndrome.

Clinical picture of bronchitis

The acute form of bronchitis is very often a complication of respiratory infectious disease. It is characterized by subfebrile and febrile fever, the appearance of symptoms of general malaise - drowsiness, weakness, headache. Then comes the cough. As a rule, cough at the beginning of the disease is dry and unproductive. Against the background of the treatment, the cough is moistened, the amount of sputum discharge increases.

Exacerbation of chronic bronchitis is manifested by the same symptoms, but the disease lasts longer. In addition, there are symptoms such as shortness of breath, a feeling of lack of air. Breathing is hard, wheezing can be heard. Also, with chronic bronchitis, the patient can intensively lose body weight. Weight loss occurs due to muscle and adipose tissue. This is a sure sign of the development of respiratory failure. Possible sleep disturbances: intermittent sleep, short, accompanied by snoring, frequent awakenings. Sleep disturbances lead to irritability, fatigue, sexual disorders.

Diagnosis of the disease

Diagnosis of bronchitis is mainly based on data clinical picture and interviewing the patient. As a result of the survey, you can find out the predisposing factors, which will help to make the correct diagnosis.

In addition to collecting an anamnesis and examining the patient, complex diagnostic methods are used:

X-ray method. The method allows to exclude pneumonia and to suspect pulmonary emphysema.
Sputum examination for cytology. Allows you to determine the type of inflammatory process. It will help to differentiate catarrhal, purulent and hypertrophic bronchitis.
Microbiological analysis of sputum. It is used to determine sensitivity to antibacterial agents.
Bronchoscopy allows to exclude oncological disease of the lungs and bronchi, tuberculosis, bronchiectasis.

Bronchitis treatment

Before starting treatment, the patient and his relatives should explain the causes of the disease and predisposing factors. Compliance with certain restrictions will facilitate the course of the disease and help to achieve high efficiency of treatment. Treatment of acute bronchitis consists in the appointment of antitussive, expectorant, anti-inflammatory drugs, in more severe cases - the use of antibiotic therapy. Phytotherapy and physiotherapy are also shown. Treatment of exacerbation of chronic bronchitis is always more complex and lengthy.

The basic principles of chronic bronchitis treatment require more detailed consideration:

Complete smoking cessation required. If refusal is not possible, then replacement therapy preparations containing nicotine in transdermal form or in the form of chewing gum.
An important point in the treatment is the observance of home hygiene and workplace. Recommended daily wet cleaning of the house and the elimination of harmful working conditions. If it is impossible to comply with these conditions in the workplace, then a change in professional activity should be considered.
Compliance with seasonality in the choice of clothes. Avoid drafts, hypothermia. It is advisable to wear clothes made from natural, simple fabrics that do not allow heat loss and overheating.
Compliance with the rules of medical nutrition. The basic principles of nutrition in chronic bronchitis are quite simple: nutrition should be fractional - up to 5 times a day; the content of fats and carbohydrates in food should not exceed the norm, and the amount of protein should be significantly increased; meals should be fortified; preferably a large number of warm drinks. Recommended: dairy and dairy products, lean meats, oily fish, eggs, strong chicken bouillon, fruits and vegetables rich in vitamin C (cabbage, onions, tomatoes, citrus fruits, kiwi), rosehip broth with honey.

Medical therapy:

Antibacterial drugs. Antibiotic treatment is prescribed only if the clinical picture includes a cough with purulent sputum, fever, increased ESR. The drugs of choice in this case are bactericidal antibiotics belonging to the group of semi-synthetic penicillins, in combination with clavulanic acid. One of these drugs is Amoxiclav. It is also possible to prescribe a combined preparation containing ampicillin and sulbactam. It is also possible to prescribe antibiotics from the group of 3-generation cephalosporins and macrolides. As a rule, an exacerbation of chronic bronchitis is treated on an outpatient basis, so drugs are prescribed in the form of tablets, suspensions for oral administration.

Important! Antibacterial drugs are not prescribed for prophylactic purposes!

Medications that have a bronchodilatory effect. Most often, for this purpose, a drug is used, the active substance of which is Ipratropium bromide - Atrovent. The drug does not have a systemic effect, since it does not have the ability to be absorbed into the bloodstream. The medicine is not used for emergency assistance, since its action develops only 30 minutes after ingestion. Atrovent is administered by inhalation. Also used to expand the bronchi Berotek, Ventolin. Drugs are also administered by inhalation. Suitable for emergency care, as they act after 3-8 minutes. Drugs from the theophylline group can be prescribed - Theopec, Theotard. These drugs relieve fatigue respiratory muscles, reduce pressure in the pulmonary circulation, moderately expand the bronchi. Separately, it is worth highlighting the drug Erespal, which in addition to bronchodilating action has an anti-inflammatory effect.

Drugs that reduce the viscosity of sputum- mucolytics and mucoregulators. Mucoregulators include Bromhexine, Ambroxol. The drugs of this group disrupt the synthesis of sialomucoproteins, which leads to a decrease in the viscosity of bronchial mucus. Mucolytics prescribed for chronic bronchitis: Acetylcysteine, Carbocysteine- destroy mucoproteins, which also leads to a decrease in sputum viscosity.

Expectorants. Herbal medicines are very effective in this group: Licorice syrup, Thermopsis tablets, Breast collection №2,4, as well as decoctions coltsfoot, thyme, Violets tricolor. The drugs have a reflex effect, as a result of which the action of the bronchial glands is enhanced.

Antitussives medicines used for dry cough with sputum difficult to separate. The drugs of this group suppress the cough reflex, have an effect on the viscosity of sputum and contribute to a moderate expansion of the bronchi. These include: Libeksin, bluecode, Omnitus, Herbion with plantain.

Hormonal drugs glucocorticoid series. in severe chronic bronchitis prescribed Prednisolone in individual dosages. Against the background of treatment with systemic glucocorticoids, the appointment of calcium preparations is indicated to prevent the development of osteoporosis.

oxygen therapy. Treatment with oxygen is carried out during the period of remission of the disease. with the systematic application of the technique, the prognosis of the disease improves and life expectancy increases to 10 years.

Rehabilitation treatment:

Medical examinations up to four times a year, preferably with a consultation with a pulmonologist.
Control of laboratory parameters of blood (ESR), sputum (cytology, bacteriology, general analysis).
Assessment of the immunological status.
Pneumotachometry is a method for determining the flow of air during inhalation and exhalation. Widely used in the diagnosis of broncho-pulmonary diseases.
Prophylactic appointment in the spring and autumn period expectorants containing herbal ingredients: Thermopsis, Ledum, Thyme, Marshmallow, Coltsfoot, Plantain.
Supportive treatment with inhalation methods. For inhalations during remission, sodium chloride 0.9% solution, sodium bicarbonate 2% solution, eucalyptus tincture are usually used. Also shown are oil inhalations using natural oils Eucalyptus, Sea buckthorn, Almond. Oil inhalations should not be prescribed to people who are employed in dusty industries. Oil combined with dust can form crusts that can affect bronchial patency.
immunorehabilitation treatment. Most often carried out with the drug Ribomunil. The drug causes an immune response, which provides strong immunity against pathogens of respiratory infectious diseases. It is noted that after treatment with Ribomunil, the frequency of exacerbations of bronchitis is markedly reduced. In addition, concomitant pathologies are cured - sinusitis, rhinitis, tonsillitis with a predominance of purulent processes.
Also shown Spa treatment in specialized institutions all year round.

Features of drug therapy for certain categories of patients:

pregnant women. Antibiotics are prescribed, which are not able to have a negative impact on the development of the unborn child. These are drugs penicillin series and cephalosporins. The bronchodilator drug Atrovent is contraindicated. According to the indications, it is possible to prescribe glucocorticoids in small doses, expectorants and mucolytics;
elderly and old age. Before the appointment of antibacterial drugs, it is necessary to determine the sensitivity to antibiotics. Drugs without nephrotoxic action are used. M-cholinolytics are used extremely rarely, as they can cause constipation, urinary retention, and increased intraocular pressure. Glucocorticoids are prescribed only in stationary conditions under the strict supervision of a doctor. Taken together with hormones mineral complexes for the prevention of osteoporosis. Antitussive drugs should be prescribed very carefully, as they can depress the respiratory center.

Treatment of bronchitis is always complex and complex. Only combination therapy can be effective. Self-treatment of bronchitis is highly discouraged, since irrational therapy can lead to chronic process and the development of severe complications

JMedic.ru

Chronical bronchitis is an inflammatory disease of the bronchial tree, characterized by the appearance of a cough with sputum and shortness of breath. The inflammatory process proceeds with constant exacerbations and remissions.

Therapy Methods

Chronic bronchitis should only be treated conservatively. What are the methods of conservative treatment? These are all methods of non-invasive treatment, namely drug treatment, treatment using inhalation through inhalers, folk and physiotherapy treatment.

It should be noted that drug treatment is the most effective remedy for chronic bronchitis. This treatment includes both tablet forms of drugs and injections. Usually, drugs such as antibiotics and antiviral drugs are prescribed to treat the disease in adults, and only they are followed by anti-inflammatory drugs, mucolytics, antitussives, antihistamines, hormones and bronchodilators.

Medicines in tablets and for injections

One of the very first drugs for the treatment of chronic bronchitis in adults are antibiotics that act against the bacteria that caused an exacerbation of the disease in the bronchi. It should be remembered that if within 3 days after the start of antibiotic treatment the general condition has not improved, and the temperature has not returned to normal, then another antibiotic should be prescribed, since this one did not give the desired effect.

The following antibiotics are used to treat chronic bronchitis:

Antibiotics of the penicillin series: Amoxicillin (Amoxil, Flemoxin), Amoxicillin with clavulanic acid (Augmentin, Flemoxin Solutab), which have a broad spectrum of antibacterial activity, i.e. effective for gram-positive (staphylococcal, streptococcal, pneumococcal flora) and gram-negative (legionella, proteus, mycoplasma, ureaplasma, Pseudomonas aeruginosa) infections. Antibiotics of the penicillin series are prescribed 1000 mg, they must be taken 2 times a day. They need to treat chronic bronchitis for 7-14 days.

Antibiotics of the cephalosporin series - Norfloxacin, Ciprofloxacin, Ofloxacin have a pronounced antibacterial and bacteriostatic effect only for gram-negative flora, such a narrow focus on bacteria makes their action much stronger than simply broad-spectrum antibacterial drugs. For adults, the drug is prescribed 200 mg 2 times a day. The course of treatment is on average 10-14 days.

Antibiotics from the group of macrolides - Klabaks, Fromilid, Azithromycin, Rovamycin have a bacteriostatic effect and are effective mainly for intracellular forms of infections, which makes them indispensable in the treatment of chronic bronchitis. For adults, drugs are prescribed at 500 mg, it should be taken at the same time, on an empty stomach 1-2 times a day. It takes 3-7 days to treat this disease.

Antibiotics from the group of fluoroquinolones - Ciprofloxacin, Levofloxacin, Leflok belong to broad-spectrum antibacterial drugs, but these drugs are effectively used only for the treatment of the bronchopulmonary system, another name for this group is respiratory fluoroquinolones. It is necessary to treat chronic bronchitis in adults with these drugs for no more than 7 days at a dose of 500 mg 1 time per day. Leflok has an injectable form of release, which allows you to perform intravenous or intramuscular injections. It is also necessary to remember that antibiotic injections should be taken only for severe exacerbations.

If viruses contributed to the exacerbation of the disease, then drugs against viruses are prescribed:

Mucolytics are substances that promote expectoration of sputum. Depending on which cough prevails in the patient, different drugs are prescribed:

When a dry cough predominates, drugs are prescribed that help thin the sputum, i.e. reduce its viscosity - this is Acetylcysteine (Acysteine, Mukobene, Mukoneks) 200 mg 4 times a day, 400 mg 2 times a day or 800 mg 1 time per day. You can also use plantain syrup, which is taken 1 tablespoon 3 times a day. Cough at first becomes unproductive, and then productive with the release of a large amount of sputum. It takes a long time to treat a cough, up to 10-15 days.

When a wet cough immediately appears during the disease, drugs from the ambroxol group (Flavamed, Abrol, Ambroxol) are prescribed for adults. The drugs are prescribed 75 mg 1 time per day or 30 mg 3 times a day. If coughing with big amount sputum, then Erespal should be added to this group of drugs, which should be taken 1 tablet 2 times a day, if you cough with a small amount of sputum, then such a drug is not needed. Cough should be treated for 10-20 days.

One of the representatives of this group, Lasolvan, has an injectable form of release and allows you to perform intramuscular injections. Due to the speed of action of the therapeutic substance, injections are considered more effective.

Inhalation therapy

Inhalations with the delivery of medicinal substances through inhalers directly into the bronchi are one of the effective methods of treating chronic bronchitis.

Inhalations are done with drugs - hormones, antihistamines, mucolytics and bronchodilators. With the help of inhalation, the active substances enter in sufficient quantities directly into the focus of the inflammatory process, and do not require the initial passage of the gastrointestinal tract and absorption into the blood. Inhalations deliver unchanged drugs in active forms.

Also, inhalations can be carried out with soda and aromatic oils, which have antibacterial and bronchodilatory effects. For inhalation, such oils are suitable: pine, lavender, tea tree, eucalyptus and thyme.

For inhalation, you can use special inhalers - nebulizers, as well as, albeit less effective inhalers, but at home from a pot or kettle.

Non-traditional methods

Alternative methods of treatment are well suited for chronic bronchitis in remission. Alternative methods reduce the frequency of exacerbations of the disease, as well as improve overall well-being, increase immunity and give strength.

Alternative methods of treatment with the use of decoctions and infusions of herbs help the body in the fight against cough and reduce the amount of sputum secreted by the bronchi. Suitable for decoctions: plantain grass, medicinal chamomile, licorice root, sage leaves, mint, linden, marshmallow root.

Alternative methods of treatment with the use of rubbing contribute to a better purification of the bronchi from bacteria, viruses and sputum, normalize the function of the lungs and bronchi in general. Honey, goose, mutton or badger fat is suitable for rubbing.

Video: Chronic bronchitis. Description, symptoms and treatment

I chose inhalation treatment for myself. Since childhood, I remember how potatoes and herbs quickly put me and my brother on their feet. For the family, I bought a nebulizer and Prospan drops. I dilute 20 drops in saline and let my son breathe for 10 minutes several times a day. So we treated bronchitis a month ago.

A post about serious medical research.

Pubmed recently published a meta-analysis comparative efficiency different methods treatment of anxiety disorders. Randomized controlled trial, all things. In total, almost 40,000 patients participated in this. Three "diagnoses" were investigated: panic disorder, generalized anxiety disorder and social phobia. The effectiveness of several drug treatment options and various "psychological" methods was evaluated and compared.

Among other things, when summing up the results in Pabmed's publication, there was such a phrase: "Pre-post ES for psychotherapies did not differ from pill placebos; this finding cannot be explained by heterogeneity, publication bias or allegiance effects" (c). Seeing her, some agitated personalities with attention deficit disorder began to joyfully exclaim in capslock: I knew, I believed, I hoped that psychotherapy is ineffective, it's all a swindle, the effect is like a placebo ... Say "who would doubt it" (c).

Since these enthusiastic cries began to diverge in reposts across the network, even on the pages of quite serious people related to both science and medicine, I consider it necessary to analyze in detail the essence of the study. Since the topic is interesting, and a lot of work has been done by researchers to simply skim through the text without bothering to try to understand the essence of what is written. But this essence can be quite unexpected for someone who reads inattentively >: 3

In the first lines, a little obligatory skepticism. Publication in pubmed is the so-called abstract, only brief results are indicated there and that's it. There is no description of research methods and other important details on which the interpretation of the results depends.

For example, there is no description of the exact clinical picture of anxiety disorders. Agree that to evaluate the effectiveness of therapy:
- in a person experiencing psychological discomfort from large crowds of people in public transport or in the crowd ...
- an agarophobe who panics if it is necessary to cross the threshold of his house ...
-to a terry persecuted schizophrenic who is experiencing panic anxiety from the fact that huge orangutans from the future with lasers in their hands are chasing him right now across the roofs of houses ...

These are three big differences, although in all three variants it is possible to diagnose "anxiety disorder" as well. In all three options, the effectiveness of the same techniques will be completely different - and this is not surprising, darling. That's the way it should be.
There is no description of the universal indicator of effectiveness and the method of its calculation for different methods of therapy.
There is also no detailed description of the research methodology, that is, for example, it is not known how the researchers formulated and defined the "psychological placebo" - yes, they have a similar indicator in the publication.

But - chu! I do not want the post to look like an attempt to justify by looking for a mote in someone else's eye. Yes, it is not clear from the abstract what conditions were studied (the form of the clinic, the severity of anxiety, and so on), it is not clear how the analysis was carried out and by what criteria. This is a moment of mandatory skepticism. Let's take it as an axiom that this study was organized correctly, the indicators were formulated accurately and reliably, and the methods were fully consistent with the clinic.

So, the researchers evaluated the effectiveness of therapy. For this, the universal indicator "effect sizes" (hereinafter ES) was used.

Treatment success rates for anxiety disorders are as follows:

ES not selective inhibitors serotonin reuptake = 2.25
ES of selective serotonin reuptake inhibitors = 2.09
ES of benzodiazepines = 2.15
ES of tricyclic antidepressants = 1.83

Mindfulness Cognitive Psychotherapy ES = 1.56
ES "relaxation" (no explanation, take it as you wish) = 1.36
ES of individual cognitive behavioral therapy = 1.30
ES of group cognitive behavioral therapy = 1.22
ES of psychodynamic therapy = 1.17
ES of remote impersonal psychotherapy (for example, psychotherapeutic correspondence on the Internet) = 1.11
Francine Shapiro's ES Method for Processing Emotional Trauma with Eye Movements = 1.03
ES of interpersonal (interpersonal) therapy = 0.78

ES of a combination of cognitive psychotherapy and "drugs" (that is, medications without specifying which ones) = 2.12

ES of "exercise" (whatever that means) = 1.23

ES of drug placebo = 1.29
ES of psychological placebo = 0.83
ES waitlists = 0.20

Here are all the main figures that can be compared and analyzed.

These data show that indeed individual cognitive psychotherapy is more effective than drug placebo, and group therapy is slightly less effective than drug placebo.

But let's remember for a second what a drug placebo is. The "placebo effect" refers to a situation where, in the course of medical research, patients are quietly fed pacifiers - and the patients still get better. That is, the patient from the control group is sure that he is being treated with real medicines, like everyone else, but he is secretly given a dummy. placebo. This is done with patients in the control groups to compare the result of treatment with the drug and no treatment.

The placebo effect is pronounced psychological effect. A classic example is when patients of group 1 are given a dummy by an ugly, vicious, rude and always irritated nurse, and patients of group 2 are given a dummy by a kind and smiling manager. department. The nurse rudely makes you drink and show your tongue, and the head of the department talks about the achievements of medicine and describes the dummy given as the newest, unique and very effective remedy. And in the second group, the placebo effect is significantly higher than in the first.

When a person receives a medical placebo, he is sure that he is participating in the study of the drug, and a new one at that (the person was notified, he signed the consent to participate). A person is convinced that he is fully treated with the latest medicines, all the conditions, all the treatment, all the events, actions, the environment - point to this. And his conviction helps him recover. This is nothing but an element of "suggestion", that is, it is an element of psychotherapeutic influence.

Thus an ecstatic shriek" PSYCHOTHERAPY WAS AS EFFECTIVE AS PLACEBO DRUG" actually makes sense " PSYCHOTHERAPY WAS THE SAME EFFICIENCY AS PSYCHOTHERAPY IS EFFECTIVE".
It was not in vain that the researchers separated the medical placebo from the psychological placebo (no matter how they defined the latter, but the skepticism was higher).

The effectiveness of drug therapy is higher than the effectiveness of psychotherapy, especially when it comes to a generalized clinic of psychiatric conditions
- the effectiveness of cognitive psychotherapy is 1.5-2 times higher than the effectiveness of "psychological placebo". Drug therapy is also about one and a half times more effective than drug placebo.
- the total effectiveness of cognitive psychotherapy and drug therapy exceeds almost all isolated methods in efficiency.
- the effectiveness of cognitive psychotherapy is much higher compared to the Shapiro method and interpersonal ( interpersonal) psychotherapy

If these conclusions are expressed in simple human language:

-In severe cases, medication helps better than psychotherapy
-Psychotherapy is proven effective.
-Psychotherapy and medication are more effective together than alone.
-Psychotherapy is the more effective, the less "dance with a tambourine" in it. The more of these dances, the less result.

And now, with your hand on the fifth intercostal space on the left, tell me: did these conclusions turn out to be breaking news for you, or did you yourself guess about something like that before?)))

I can't say enough about the effectiveness of exercise. Go understand what they mean: active image life and physical labor in the fresh air, regular fitness in a club, yoga meditation in a Tibetan monastery, the author's semi-secret program for the recovery of special forces and athletes ... A detailed text of the study would help here, for sure there is "physical exercises" at least somewhat more described >:3

We write a lot about psychological trauma, but usually somehow vaguely. What is psychological trauma, why it is psychological, why trauma is absolutely impossible to understand.

Simply - "everyone has psychological trauma, everyone needs to be treated." In fact, everything is much more interesting. Everyone may have psychological traumas, but they rarely turn into something serious. This serious is called PTSD (post-traumatic stress disorder) and it is PTSD that is actually the object of attention of psychologists. All other “psychological traumas” pass by themselves, like a runny nose. A little longer, of course, but — themselves.

Another thing is PTSD. Here I quote the book: In a study by Breslau et al. (Breslau et al., 1991) showed that approximately 25% of people who survived a traumatic event subsequently developed PTSD, leading to a long-term illness in about 9%. Norris (Norris, 1992) found PTSD at 5%, while Resnick and colleagues report 9% of women with PTSD, 12% of whom had chronic PTSD. Population-wide assessments also showed high levels of PTSD. In the National Incidence Study, Kessler et al. (Kessler et al., 1995) found that PTSD occurs during the lifetime in 8% of the adult population".

PTSD is indeed a serious problem, but it is not found in everyone. Here you, for example, most likely do not have it.

It's not hard to see for yourself (another quote): “PTSD is characterized by the constant experience of symptoms that include (1) recurring and intrusive memories of the event, (2) recurring dreams about the event, (3) acting as if the event were happening again, (4) intense distressing experiences that were triggered an external or internal situation that is reminiscent of or symbolizes the traumatic event; and (5) physiological reactivity to stimuli or situations that are reminiscent of the event.

The disorder also involves symptoms of avoidance and emotional numbness. These may include (1) efforts to avoid thinking, feeling, or talking about the event; (2) efforts to avoid activities, places, or people associated with the event; (3) inability to recall important aspects of the event; (4) a marked decrease in interest in what used to be enjoyable; (5) feeling alienated, detached from other people; (6) limiting the spectrum of emotional experiences; and (7) a sense of reduced life perspective, accompanied by a significant lack of planning for the future.

Completing the picture are symptoms of arousal that were not present prior to the traumatic event. It can be the following symptoms: (1) difficulty falling asleep or bad dream, (2) irritability or outbursts of anger, (3) difficulty concentrating, (4) heightened levels of alertness, hypervigilance, constant anticipation of danger or re-experiencing a life-threatening situation, and (5) exaggerated fear response".

The vast majority of people who come to psychologists do not show even half of these symptoms. So I hasten to console you - you have no psychological trauma.

If we talk about the book itself, then although it is old, it is still excellent. The authors-compilers approached the matter extremely seriously. The first hundred pages are a story about how the book was prepared, what got into it, what didn’t, why, and so on. People did not write from the ceiling, but generalized the experience of research.

Moreover, as conscientious researchers, they pointed out all the time that the methodology was violated here, there is a small sample, there is such a jamb, here it is. In general, it is clear that a gigantic work has been done.

Unfortunately, the book is somewhat outdated and can no longer serve as the most reliable reference book. But this is normal - science does not stand still, and in the book itself, the authors indicated that they only give a cut that was relevant at the time of preparing the book, and hoped that their work would be further refined and refined. And so it turns out.

This file is associated 50 file(s). Among them: strukturirovannie_tehniki_terapii_sherman.doc, Effektivnaya_terapia_posttravmaticheskogo_stressovogo.pdf, A_Lengle_Yavlyaetsya_li_lyubov_schastyem.pdf, Gorbatova E.A. - Theory and practice of psychological training (Ps and 40 more file(s).
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Effective Therapy post-traumatic stress
disorders
Edited by
Edna B. Foa Terence M. Keane Matthew J. Friedman
Moscow
"Cogito-Center"
2005

UDC 159.9.07 BBK88 E 94
All rights reserved. Any use of the material in this book, in whole or in part
without the permission of the copyright holder is prohibited
Edited by E
DAYS
Foa. Terence M. Keane, Matthew Friedman
Translation from English under general editorship N. V. Tarabrina
Translators: V.A. Agarkov, SA. pitt- chapters 5, 7, 10, 17, 19, 22, 27 O.A. Crow - chapter 1,
2,11,12,14,15,16, 23, 24, 26 E.S. Kalmykov- chapters 9, 21 EL. misco- chapters 6, 8, 18, 20 ML.
Padun- chapters 3, 4, 13, 25
E 94 Effective therapy for post-traumatic stress disorder / Ed. Edna Foa,
Terence M. Keane, Matthew Friedman. - M.: "Kogito-Center", 2005. - 467 p. (Clinical psychology)
UDC 159.9.07 BBK88
This guide is based on an analysis of the results of studies on the effectiveness of psychotherapy for adults, adolescents and children with post-traumatic stress disorder (PTSD). The purpose of the manual is to assist the clinician in the management of such patients.
Since PTSD therapy is carried out by specialists with different professional backgrounds, the authors of the chapters of the manual took an interdisciplinary approach to the problem. The book as a whole brings together the efforts of psychologists, psychiatrists, social workers, art therapists, family counselors, and others. The chapters of the guide are addressed to a wide range of professionals involved in the treatment of PTSD.
The book consists of two parts. The chapters of the first part are devoted to reviewing the results of the most important studies. The second part provides a brief description of the use of different therapeutic approaches for the treatment of PTSD.
© Translation into Russian "Cogito-Center", 2005 © The Guilford Press, 2000
ISBN 1-57230-584-3 (English) ISBN 5-89353-155-8 (Russian)

Content i. Introduction.............................................................................................................7
2. Diagnosis and evaluation...........................................................................................28
Terence M. Keane, Frank W. Wethers and Edna B. Foa
I. Treatment approaches for PTSD: a review of the literature
3. Psychological debriefing...................................................................51
Jonathan I. Bisson, Alexander S. McFarlane, Susanna Ros
4. ...............................................75
5. Psychopharmacotherapy......................................................................... 103
6. Treatment of children and adolescents................................................................ 130
7. Desensitization and processing through eye movements.... 169
8. group therapy...................................................................................189
David W. Foy, Shirley M. Glynn, Paula P. Schnurr, Mary K. Jankowski, Melissa S. Wattenberg,
Daniel S. Weiss, Charles R. Marmar, Fred D. Guzman
9. Psychodynamic Therapy..............................................................212
10. Treatment in a hospital.............................................................................239
AND. Psychosocial rehabilitation.......................................................270
12. Hypnosis.............................................................................................................298
Etzel Cardena, José Maldonado, Otto van der Hart, David Spiegel
13. ....................................................336
David S. Riggs
^.Art therapy..............................................................................................360
David Reid Johnson

II. Therapy Guide
15. Psychological debriefing................................................................377
Jonathan I. Bisson, Alexander MacFarlane, Suzanne Ros
16. Cognitive Behavioral Therapy............................................381
Barbara Olasow Rothbaum, Elizabeth A. Meadows, Patricia Resick, David W. Foy
17. Psychopharmacotherapy.........................................................................389
Matthew J. Friedman, Jonathan R.T. Davidson, Thomas A. Mellman, Stephen M. Southwick
18. Treatment of children and adolescents...............................................................394
Judith A. Cohen, Lucy Berliner, John S. March
19. Desensitization and recycling
with eye movements......................................................................398
Cloud M. Chemtob, David F. Tolin, Bessel A. van der Kolk, Roger C. Pitman
20. group therapy...................................................................................402
David W. Foy, Shirley M. Glynn, Paula P. Schnurr, Mary K. Jankowski, Melissa S. Wattenberg,
Daniel S-Weiss, Charles R. Marmar, Fred D. Guzman
21. Psychodynamic Therapy..............................................................405
Harold S. Cudler, Arthur S. Blank Jr., Janice L. Krapnick
22. Treatment in a hospital.............................................................................408
Christine A. Kurti, Sandra L. Bloom
23. Psychosocial rehabilitation.......................................................414
Walter Penk, Raymond B. Flannery Jr.
24. Hypnosis.............................................................................................................418
Etzel Cardena, José Maldonado, Otto van der Hart, David Spiegel
25. Marriage and family therapy....................................................423
David S. Riggs
26. Art therapy..............................................................................................426
David Reid Johnson
27. Conclusion and Conclusions.............................................................................429
Arie W. Shalev, Matthew J. Friedman, Edna B. Foa, Terence M. Keane
Subject index
457

1
Introduction
Edna B. Foa, Terence M. Keane, Matthew J. Friedman
Members of a special commission set up to develop guidelines for the treatment of PTSD took direct part in the preparation of the materials presented in this book. This commission was organized by the Board of Directors of the International Society for Traumatic Stress Studies (ISTSS) in November 1997.
Our goal was to describe various ways therapy based on a review of the extensive clinical and research literature prepared by experts in each specific field. The book consists of two parts. The chapters of the first part are devoted to reviewing the results of the most important studies. The second part provides a brief description of the use of different therapeutic approaches in the treatment of PTSD. This guideline aims to inform clinicians of the developments we have identified as the best for treating patients diagnosed with post-traumatic stress disorder (PTSD). PTSD is complicated mental condition that develops as a result of experiencing a traumatic event. Symptoms that characterize PTSD are repetitive reproduction of a traumatic event or its episodes; avoidance of thoughts, memories, people or places associated with the event; emotional numbness; increased arousal. PTSD is often accompanied by other psychiatric disorders and is complex disease, which may be associated with significant soreness, disability and impaired vital functions.

8
In developing this practice guide, the Task Force confirmed that traumatic experiences can lead to the development of various disorders such as general depression, specific phobias; disorder caused by acute stress, nowhere else defined (disorders of extreme stress not otherwise specified, DESNOS), personality disorders such as borderline anxiety disorder and panic disorder. However, the main topic of this book is the treatment of PTSD and its symptoms, which are listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Illness. (Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, 1994)
American Psychiatric Association.
The authors of the guidelines acknowledge that the diagnostic scope for PTSD is limited and that these limitations may be particularly evident in the case of patients who experienced childhood sexual or physical abuse. Often, patients diagnosed with DESNOS have a wide range of problems in relationships with others that contribute to impaired personal and social functioning. Relatively little is known about the successful treatment of these patients. The consensus of clinicians, supported by empirical data, is that patients with this diagnosis require long-term and complex treatment.
The Task Force also recognized that PTSD is often accompanied by other psychiatric disorders, and these accompanying illnesses demand from medical personnel sensitivity, attention, as well as clarification of the diagnosis throughout the entire treatment process.
Disorders requiring particular attention are substance abuse and general depression as the most commonly reported comorbid conditions.
Practitioners may refer to the guidelines for these disorders to develop treatment plans for individuals presenting with multiple disorders and to the comments in Chapter 27.
This guide is based on cases of adults, adolescents and children with PTSD. The purpose of the manual is to assist the clinician in the management of these individuals. Since the treatment of PTSD is carried out by clinicians with different professional backgrounds, these chapters have been developed on the basis of a multidisciplinary approach. Psychologists, psychiatrists, social workers, art therapists, family counselors and other professionals. Accordingly, these chapters are directed to a wide range professionals involved in the treatment of PTSD.
The Special Commission excluded from consideration those individuals who are currently subjected to violence or insults. These individuals (children who live with an abusive person, men

9 and women who are abused and abused in their home), as well as those who live in war zones, may also meet the criteria for diagnosis.
PTSD. However, their treatment, as well as the associated legal and ethical issues significantly different from the treatment and problems of patients who have experienced traumatic events in the past. Patients who are directly in a traumatic situation need special attention from clinicians. These circumstances require the development of additional practical guides.
Very little is known about the treatment of PTSD in industrialized regions. Research and development on these topics is carried out mainly in Western industrialized countries.
The Special Commission is clearly aware of these cultural limitations. There is a growing belief that PTSD is a universal response to traumatic events that is seen across many cultures and societies. However, there is a need for systematic research to determine whether treatments, both psychotherapeutic and psychopharmacological, that have proven effective in Western society will be effective in other cultures.
In general, professionals should not limit themselves to only those approaches and techniques that are outlined in this manual. The creative integration of new approaches that have been shown to be effective in the treatment of other disorders and have a sufficient theoretical basis, in order to improve the results of therapy.
THE GUIDANCE PROCESS
The development process for this guide was as follows. Co-Chairs
A special commission identified specialists in those main therapeutic schools and methods of therapy that are currently used in working with patients suffering from
PTSD. As new effective methods of therapy were found, the composition of the Special Commission expanded. Thus, the Special Commission included specialists of various approaches, theoretical orientations, therapeutic schools, and professional training. The focus of the Guide and its format were determined by the Special Commission during a series of meetings.
The co-chairs instructed the members of the Special Commission to prepare an article for each area of therapy. Each article was to be written by a recognized expert with the support of an assistant, whom he independently chose from among other members of the commission or clinicians.

10
Articles were to contain a review of the literature on research in this area and clinical practice.
Literature reviews for each topic were compiled using online search engines such as Published International Literature on Traumatic Stress (Published
International Literature on Traumatic Stress, PILOTS), MEDLINE, and PsycLIT In the final draft, articles were standardized and limited in length. Authors cited relevant literature, presented clinical developments, critically reviewed the scientific basis for a particular approach, and presented papers to the chair. The completed articles were then distributed to all members of the Special Commission for comments and active discussion. The results of the reviews with modifications turned into articles and subsequently became the chapters of this book.
Based on the articles and a careful study of the literature, a set of brief practical advice for each therapeutic approach. It can be found in Part II.
Each therapeutic approach or modality in the guidelines was assigned a rating according to the effectiveness of its therapeutic intervention. These ratings have been standardized according to a coding system adapted by the Agency for Health Care Policy and Research (AHCPR).
The rating system below is an attempt to formulate recommendations for practitioners based on existing scientific advances.
The guidelines were reviewed by all members of the Special Commission, agreed upon and then presented to the ISTSS Board of Directors, submitted for review to a number of professional associations, presented at the ISTSS Annual Convention Public Forum and posted on the website.
ISTSS for comments from lay members of the scientific community. Materials resulting from this work have also been included in the manual.
Published research on PTSD, as well as other mental disorders, contain certain restrictions. In particular, most studies apply inclusion and exclusion criteria to determine if a diagnosis is appropriate for a particular case; therefore, each study may not fully represent the spectrum of patients seeking treatment. Studies of PTSD, for example, very often do not include patients with drug addictions. chemical substances, suicidal risk, neuropsychological impairment, developmental delays, or cardiovascular vascular diseases. This guideline covers studies that do not address these patient populations.

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CLINICAL PROBLEMS Type of injury
Most randomized clinical trials conducted on veterans of the wars (mainly Vietnam) showed that for this population, treatment was less effective compared with people who did not participate in combat operations, whose PTSD was associated with other traumatic experiences (for example, with rape, accidents incidents, natural disasters). Therefore, some experts believe that war veterans with PTSD respond less well to treatment than those who have experienced other types of trauma. Such a conclusion is premature. The difference between veterans and other PTSD patients may be due to the greater severity and chronic nature of their PTSD than to the specific features of war trauma. Besides, low rates the effectiveness of treating veterans may be related to the characteristics of the sample, since groups are sometimes formed from volunteers - veterans, chronic patients with multiple disorders. In general, on this moment it cannot be definitively concluded that PTSD after certain traumas may be more resistant to treatment.
Single and multiple injuries
In patients with PTSD, no clinical studies have been conducted to answer the question of whether the number of previous injuries can affect the course of treatment for PTSD. Since most of the research has been done on either war veterans or sexually abused women, most of whom have experienced multiple traumas, it has been found that much of what is known about the effectiveness of treatment applies to people who have had multiple traumatic experiences. Studies of individuals with single and multiple traumatization could be of great interest, since it could be found out how much better the former are expected to respond to treatment. However, such studies can be difficult to conduct, as factors such as concomitant diagnoses, severity, and chronicity of PTSD would have to be controlled for, and each of these factors may be a more significant predictor of treatment outcome than the number of traumas experienced.