Symptoms and treatment of purulent bronchitis. Chronic purulent bronchitis medical history Chronic purulent bronchitis treatment

Purulent bronchitis– inflammatory changes in the bronchial tree, occurring with the formation and release of purulent secretion. The etiology of purulent bronchitis is always associated with a layer of bacterial infection. With purulent bronchitis, patients are bothered by a wet cough with thick yellow-green sputum, low-grade fever, sweating, and shortness of breath. The diagnosis is established by X-ray of the lungs, bronchoscopy, examination of bronchial lavage water and sputum. Treatment of purulent bronchitis includes courses of antimicrobial therapy, mucolytic and expectorant medications, sanitary bronchoscopy, exercise therapy and breathing exercises, and physiotherapy.

Purulent bronchitis

Purulent bronchitis is a clinical type of acute or chronic bronchitis, characterized by coughing up purulent sputum. Depending on the type of inflammatory process, pulmonology distinguishes catarrhal and purulent bronchitis, as well as rare variants of inflammation (hemorrhagic and fibrinous bronchitis). In this case, purulent bronchitis can act as a primary, independent disease, or secondary, arising against the background of concomitant inflammatory pathology of the respiratory tract (bronchiectasis, respiratory tuberculosis, chronic pneumonia, etc.). In view of the latter circumstance, it is not possible to judge the true prevalence of purulent bronchitis.

Causes of purulent bronchitis

In the development of purulent bronchitis, a combination of non-infectious and infectious, exogenous and endogenous factors is important. Among non-infectious exogenous influences, household and industrial pollutants, atmospheric air pollution, inhalation of tobacco smoke during active and passive smoking, climatic and weather conditions (overheating, hypothermia) are primarily distinguished. The listed factors have an irritating and damaging effect on the bronchial mucosa, thereby opening the way for the penetration of microbial flora. Recurrent acute respiratory infections (influenza, parainfluenza, rhinovirus and respiratory syncytial infection) contribute to disruption of local reactivity. Endogenous causes predisposing to the development of purulent bronchitis include old age, alcohol abuse, obesity, hypovitaminosis, and immunodeficiency.

At the same time, the leading role in the occurrence of purulent bronchitis is given to bacterial infection, mainly pneumococcus, Pseudomonas aeruginosa and Haemophilus influenzae. The course of the purulent-inflammatory process in the bronchi can be supported by foci of infection in the nasopharynx (sinusitis, chronic tonsillitis), COPD (bronchiectasis, chronic abscess, smoker's bronchitis, chronic pneumonia) and specific processes (pulmonary tuberculosis). Purulent bronchitis can develop as a result of improper treatment of acute bronchitis (with inadequate selection of antibiotics and insensitivity of the microflora to them), but more often this clinical form occurs in chronic bronchitis.

Long-term irritation of the bronchial tree by mechanical, physical or chemical agents or adhesion of viral pathogens to the epithelial cells of the bronchi cause disruption of the secretory function and self-purification (mucociliary clearance) of the latter. Due to the hyperfunction of secretory cells, the nature of bronchial secretion changes; hypercrinia (increased mucus production) and discrinia (changes in its viscosity and composition) occur. Such metamorphoses contribute to a decrease in the protective properties of bronchial secretions, retention and proliferation of bacterial flora in the bronchi. With microbial inflammation, the cellular composition of the contents of the bronchial tree undergoes changes - the number of neutrophilic leukocytes in it increases; sputum becomes purulent, viscous and difficult to cough up.

Symptoms of purulent bronchitis

The first episode of acute purulent bronchitis or exacerbation of a chronic process is usually facilitated by a cold, cooling, allergic reaction, stress, activation of a chronic source of infection, etc. Since bronchial infection is usually descending in nature, the appearance of symptoms of purulent bronchitis is often preceded by symptoms of rhinitis, tonsillitis, tracheitis.

In the clinical picture of purulent bronchitis, the leading role is played by intoxication syndrome, cough and shortness of breath. In the acute period, low-grade fever, weakness, and sweating appear. A wet cough with the release of thick yellow or greenish sputum, sometimes with an unpleasant odor, is a concern. In chronic bronchitis, purulent sputum can be released constantly or occasionally (during periods of exacerbation of the inflammatory process); in the acute phase, its amount can reach 250 ml per day. When performing physical activity, a patient with purulent bronchitis experiences shortness of breath and fatigue. The medical history of some patients contains indications of hemoptysis, which is explained by the increased vulnerability of the bronchial mucosa.

With a protracted course of the purulent process, due to the accumulation of secretions, hyperplastic and fibrous changes in the walls of the bronchi, bronchial obstruction can develop - purulent bronchitis takes on the character of obstructive. In this case, shortness of breath becomes more pronounced, the cough becomes persistent and less productive, and breathing becomes wheezing. The addition of an obstructive component aggravates the course of purulent bronchitis and contributes to the formation of emphysema and cor pulmonale.

Diagnosis of purulent bronchitis

Diagnosis of purulent bronchitis is based on an assessment of the medical history, symptoms (mainly the nature of sputum), physical and instrumental data. Often, patients clearly associate purulent inflammation in the bronchi with an episode of acute respiratory viral infection or indicate a history of chronic bronchitis. It is typical to hear moist rales, which may disappear after productive coughing up of sputum.

Indicators of a general blood test change towards moderate leukocytosis, a shift of the leukocyte leukocyte formula to the left, and an acceleration of ESR. A biochemical study in the blood serum reveals hyper-α1- and α2-globulinemia, increased CRP, seromucoid, haptoglobin and sialic acids.

X-ray data of the lungs are not indicative in the diagnosis of purulent bronchitis. Radiographs may show increased pattern and expansion of the roots of the lungs, signs of emphysema and peribronchial pneumosclerosis. Much greater importance is attached to the results of bronchoscopy. During an endoscopic examination of the bronchi, signs of purulent endobronchitis are revealed: hyperemia and swelling of the mucous membrane, an abundance of purulent contents in the bronchi (after aspiration, the purulent secretion again fills the lumen of the bronchi).

Bronchoscopy is necessarily supplemented by sampling of bronchial secretions for subsequent microscopic, cytological and bacteriological examination. This is especially valuable when patients (especially children) for some reason cannot independently submit sputum for analysis. Instrumental and laboratory tests make it possible to distinguish purulent bronchitis from secondary bronchitis with EBD, tuberculosis, endobronchial cancer, and pneumonia.

Treatment of purulent bronchitis

In the acute period, it is necessary to maintain bed rest, avoid smoking and other bronchial irritants. Hospitalization is advisable for severe intoxication and respiratory failure, especially in elderly patients.

The main method of treatment for purulent bronchitis is empirical antibiotic therapy with drugs from the aminopenicillin group (ampicillin, amoxicillin), combination drugs of amoxicillin with clavulanic acid and ampicillin with sulbactam, macrolides (azithromycin, clarithromycin), fluoroquinolones (sparfloxacin, levofloxacin), third generation cephalosporins (ce fotaxime, cefepime) . These drugs are active against the most common pathogens of purulent bronchitis (S. Pneumoniae, H. influenzae, M. catarrhalis) and the ability to create a high concentration of the active substance in bronchial secretions.

In order to increase sputum hydration and improve its evacuation from the bronchial tree, mucolytics and expectorants (acetylcysteine, ambroxol, bromhexine, etc.), and medicinal inhalations are prescribed. The speedy elimination of the purulent process in the bronchi is facilitated by sanitary bronchoscopy with bronchoalveolar lavage, local administration of antimicrobial and secretolytic drugs.

Pathogenetic treatment is combined with the use of biostimulants and multivitamins, exercise therapy and breathing exercises. After the acute manifestations of purulent bronchitis subside, chest massage and physical therapy methods (inductothermy, microwave therapy, electrophoresis) are added. In severe forms of purulent bronchitis, extracorporeal hemocorrection (UVR of blood, hemosorption, plasmapheresis) may be required.

Forecast and prevention of purulent bronchitis

The prognosis for life with purulent bronchitis is relatively favorable; ability to work is lost only during periods of exacerbation. However, a long course of purulent bronchitis significantly reduces the quality of life and can lead to repeated pneumonia, the development of DN, emphysema, and pulmonary hypertension.

Primary prevention measures for purulent bronchitis include banning smoking, improving working conditions, reducing dust and gas pollution in the environment, seasonal vaccination against influenza, treatment of nasopharyngeal infections, etc. Secondary prevention is aimed at preventing exacerbations of chronic bronchitis under the supervision of a pulmonologist.

How to treat chronic purulent bronchitis in the acute stage and what the patient’s problems may be

If bronchitis is accompanied by a severe cough with copious discharge of purulent sputum, doctors diagnose purulent bronchitis of an acute inflammatory form with bacterial damage to the organ mucosa.

In case of unfavorable developments purulent bronchitis develops into a chronic stage.

Is this situation dangerous?

Chronic purulent bronchitis - features of the disease

The main difference between chronic purulent bronchitis and the simple form is the sluggish nature of the disease. The pathology occurs with hidden symptoms and clearly manifests itself with annual relapses. Exacerbations last more than 3 months. They pass with a painful cough and increased mucus secretion.

Symptoms of chronic purulent bronchitis

Chronic purulent bronchitis is characterized by a protracted process and increased blockage of the bronchi (obstruction). Bronchial obstruction causes increased production and accumulation of sputum. During an exacerbation of the disease, up to 250-300 ml of mucus can be released daily when coughing.

Symptoms of chronic purulent bronchitis vary and depend on the type and duration of the inflammatory process. These include:

• tachycardia;
• lack of appetite;
• pallor of the epidermis;
• change in taste sensations;
• unpleasant odor from the mouth;
• painful cough with attacks of shortness of breath;
• slight increase in body temperature;
• increased sweating, especially at night;
• constant fatigue with asthenic signs;
• soreness in the sternum area, aggravated by coughing.

Relapse of chronic purulent bronchitis can begin even after the slightest hypothermia of the body. This situation is especially dangerous for elderly and frail people. In such individuals, the process causes a sharp deterioration in respiratory function and the development of obstructive bronchitis.

The complication is manifested by lengthening the inhalation and strained breathing, accompanied by bulging veins and dry whistling sounds when breathing.

Chronic mucopurulent bronchitis in the acute stage - risk factors

The frivolity of the patient himself is involved in the transition of purulent bronchitis to a chronic form.

Illiterate treatment, and sometimes even lack of therapy, becomes the main basis for the development of a chronic form of pathology.

The following provoking factors add to the threat:

• sudden climate change;
• chest injury;
• diseases of the immune system;
• long-term smoking (and passive smoking as well);
• prolonged stress, overwork;
• long course of chemotherapy;
• additionally developed infection;
• predisposition to allergic manifestations;
• past infectious diseases: whooping cough, influenza, measles;
• living in areas with unfavorable environmental conditions.

Chronic purulent bronchitis develops over a long period of time, gradually covering all organs of the respiratory system. This process is dangerous and insidious, especially during the period of relapse. The infection easily provokes the development of pneumonia and emphysema.

If you notice any alarming symptoms, you should immediately consult a doctor and begin treatment for the disease.

Treatment of chronic purulent obstructive bronchitis

Before starting basic drug therapy, doctors find out the cause that led to the development of a chronic form of purulent bronchitis.

For example, if purulent chronic bronchitis of a smoker is detected, therapy will be useless until the patient gives up the addiction.

When choosing medications, doctors are guided by the patient’s age, duration of the disease and factors that caused the transition of purulent bronchitis to the chronic form.

Antibiotics. Prescribed if the disease was caused by a bacterial infection. Before prescribing antibacterial treatment, sputum is examined to determine its sensitivity to antibiotics.

If there is no time for sputum analysis, and chronic purulent bronchitis is in the relapse stage, doctors give preference to broad-spectrum antibiotics of the penicillin group: Amoxiclav, Amoxicar, Amoxicillin Sandoz, Flemoxin, Augmentin.

Expectorants. To improve the patency of the bronchi and cope with the difficulties that arise during the removal of sputum, the patient is prescribed expectorants of a number of mucolytics.

Mucolytics affect the structure of mucus and destroy negative compounds that make mucus sticky.

The following mucolytic drugs are most often prescribed: Carbocysteine, Acetylcysteine, Ambroxol, Bromhexine.

Antiviral drugs. Used if the pathological process is viral in nature. This treatment makes sense during periods of remission of the pathology. Most often, doctors prescribe the following drugs: Leukocyte interferon, Amiksin, Tsitovir-3, Lokferon, Remantadine.

When treating chronic purulent bronchitis in the acute stage, therapeutic bronchoscopy is performed using endotracheal infusion. Sanitation of the bronchi is carried out using a rubber catheter or a special laryngeal syringe. The frequency of procedures depends on the volume of mucus discharge and the severity of suppuration.

After sanitation and coughing up sputum, antiseptic drugs are injected into the bronchi: solutions of dioxidin, furatsilin or Kalanchoe juice. If the pathology is accompanied by dilation of the bronchi (bronchiectasis), after treatment with antiseptics, an antibiotic solution (3-5 ml) is also injected into the bronchi.

Therapy of the pathological process is a comprehensive measure, including physiotherapeutic methods: electrophoresis, UHF, inhalation, ICV therapy, massages and physical therapy. Treatment of chronic bronchitis at home can be combined with the use of traditional medicine methods.

Problems of a patient with chronic purulent bronchitis - advice from healers

Traditional healers It is recommended to use animal fat as an effective means of removing phlegm. Fats can be taken internally as rich broths and as external rubs.

Herbs. Medicinal infusions with sage, chamomile, thyme, plantain, licorice and linden blossom will be a good help in the fight for health. Herbs can be used together or separately. To prepare a healing drink, you need to steam a tablespoon of herb with ½ liter of boiling water, leave for a quarter of an hour and drink three times a day.

Healing tea. Tea made from bran helps to cope with the manifestations of purulent bronchitis. Take bran (400 g), brew with boiling water (1.5 l) and leave the mixture for half an hour. The medicine should be taken after meals 3-4 times a day.

Amazing aloe. This recipe is for use by adults only (it is not recommended for pregnant women). Four large leaves of the plant should be poured with a bottle of strong red wine and the container should be placed in a dark place for 4-5 days. Take the finished medicine 30 ml before meals 3-4 times a day.

Miracle figs. Take 10 figs, pour hot milk (500 ml). Simmer the mixture over low heat until thickened for 10-15 minutes. Take a tablespoon three times a day. This medicine perfectly relieves attacks of painful cough and helps remove phlegm.

Famous radish. The cough recipe of black radish and honey is known to many. This medicine restores the functioning of the bronchi and removes mucus. The top of the vegetable is cut off and a hole is made into which honey is poured.

The cavity filled with sweet mass must be closed with the cut off top and left for 3-4 days (or baked in the oven). Take the mass one teaspoon 4-5 times a day. You can use beets instead of radishes.

A competent approach to combating the manifestations of purulent chronic bronchitis includes preventive measures. Paying close attention to your health will help you avoid recurrent conditions and get rid of the disease as soon as possible.

Prevention measures

Whatever measures are used in the treatment of chronic purulent bronchitis, to achieve effective results the patient should follow the following recommendations:

1. Treat otolaryngeal diseases in a timely manner.
2. During the off-season, take vitamin complexes.
3. Be sure to get vaccinated during seasonal epidemics.
4. Protect your body from hypothermia and drafts.
5. Forget about bad habits (smoking, excessive alcohol consumption).
6. Maintain a nutritious diet with limited carbohydrate and salt intake.
7. Drink more warm liquids. It is better to opt for decoctions, herbal teas and freshly squeezed juices.
8. Be in the fresh air every day, do not forget to carry out wet cleaning and regularly ventilate living spaces.

If you have chronic purulent bronchitis, be sure to go for spa treatment, preferably on the Black Sea coast with the opportunity to visit salt caves and conduct mud therapy. If you follow all the advice and a competent approach to therapy, you can forget about the pathology after 1-1.5 months of treatment.

Features of the treatment of chronic purulent bronchitis

Treatment of chronic purulent bronchitis responds quite well to antibiotic therapy. But in some cases, surgery may be necessary to combat this disease. It all depends on the etiology and stage of development of the pathology.

What is purulent bronchitis?

Chronic purulent bronchitis is a disease of the respiratory system that is inflammatory in nature and characterized by diffuse damage to the bronchial wall, abundant and permanent discharge of purulent sputum with bronchiectasis present in it. Often, pathology develops with illiterate, insufficient or completely absent treatment of acute bronchitis or as a complication accompanying colds.

The following provoking factors contribute to the appearance of purulent bronchitis in chronic form:

• chest injuries;
• infectious processes in the body;
• climate change;
• sudden change in temperature;
• prolonged exposure to cold or, on the contrary, dry air;
• long course of chemotherapy treatment;
• smoking;
• exposure to pathogenic bacteria and microorganisms;
• general hypothermia of the body;
• disorders and disorders in the functioning of the immune system;
• exposure to chemicals and toxic substances;
• unfavorable environmental factors and harsh climatic conditions;
• previous illnesses: influenza, whooping cough or measles;
• pathologies in the structure of the nasopharynx;
• hereditary predisposition;
• the presence of chronic infectious foci in the nasopharynx;
• alcohol abuse;

Exacerbation of the disease can be caused by the following factors:

• tendency to allergic reactions;
• overwork;
• psycho-emotional shock and frequent stressful situations;
• the appearance and development of concomitant pathologies;
• activation of a chronic infectious focus.

The pathological process develops gradually, however, in the absence of timely measures taken, it spreads to the entire respiratory system, affecting nearby organs and tissues. Therefore, it is extremely important to be able to recognize this serious, insidious disease in time in order to ensure prompt and competent treatment.

Main signs of pathology

Symptoms of purulent bronchitis differ somewhat depending on the duration and form of the disease. In general, the following signs and manifestations are characteristic of the pathology in question:

• persistent cough;
• copious sputum production (up to 250 ml) of a purulent-mucous nature;
• development of shortness of breath;
• general weakness;
• increased sweating;
• asthenia;
• increased body temperature;
• chronic fatigue syndrome;
• pain in the chest area, occurring mainly during the coughing process;
• the appearance of bad breath;
• permanent lack of appetite;
• dulling of taste buds;
• chest myalgia;
• general intoxication of the body;
• tachycardia;
• pallor of the skin.

Another characteristic feature that allows one to identify purulent chronic bronchitis is a cough with purulent discharge, the duration of which exceeds a period of 3 months.

During an exacerbation of this disease, the patient experiences the following painful symptoms:

• fever;
• development of broncho-obstructive syndrome;
• difficulty breathing;
• increase in the size of the bronchi;
• the appearance of bloody streaks in the discharged purulent sputum;
• changes in blood composition, manifested in an increase in the number of neutrophils, leukocytes, as well as the level of ESR;
• the appearance of characteristic wheezing when breathing.

It should be emphasized that purulent bronchitis is a rather serious pathology, especially in the acute stage, it poses a potential danger not only to the health, but also to the life of the patient. Therefore, if you detect at least a few of the above signs, you should immediately seek medical help.

Diagnostic methods

Diagnosis of chronic purulent bronchitis is carried out on the basis of a thorough analysis of the general clinical picture and the results of the anamnesis, in addition, during a physical examination. However, given the fact that the pathology in question does not have pronounced, specific symptoms, and its symptoms are quite typical for a number of other diseases of the respiratory system, then to establish an accurate diagnosis, the patient is prescribed the following studies:

• general and biochemical blood test;
• fluorographic examination;
• X-ray of the chest area;
• bronchoscopy;
• study of bronchial patency;
• sputum analysis;
• bronchography;
• computed tomography of the chest;
• conducting serological tests;
• bacterial and microscopic examination of sputum;
• ultrasonography.

After diagnosis, identification of the form and etiology of the disease, you can proceed to the immediate treatment process.

Treatment methods

Treatment of chronic purulent bronchitis requires a comprehensive and systematic approach, including several therapeutic areas. A number of techniques are used to combat this pathology.

Drug treatment. The choice of drugs used largely depends on the main causative agent of the disease, which is identified during sputum examinations. So, if the development of pathology was provoked by the action of pathogenic bacteria, then the patient is prescribed antibiotics. The drugs most often used in this case include: Tienam, Sumamed, Ofloxacin, Amoxiclav, Azitrox, Cefazolin, Ciprofloxacin, Ceftriaxone.

If the disease is viral in nature, the following antiviral drugs are used to combat it: Amiksin, Groprinosin, Arbidol, Acetylcysteine.

In addition, mucolytics, antispasmodics, antihistamines and immunostimulants are used to combat chronic purulent bronchitis.

In order to clean the pulmonary esculapium from purulent contents, therapeutic bronchoscopy and endotracheal infusion techniques are used.

When treating the disease in question, the following methods are also used:

• vitamin therapy;
• carrying out inhalations;
• physiotherapy;
• ICV - therapy;
• electrophoresis of bronchial and pulmonary roots using Dimexide solution;
• phytotherapy;
• massage that stimulates the process of sputum discharge;
• physiotherapy;
• carrying out thermal procedures.

In particularly severe and complex cases, surgical intervention may be indicated.

What contributes to favorable results?

Whichever therapeutic method is used, to achieve the fastest and most favorable results, the patient is recommended to follow the following rules:

• drink as much fluid as possible, giving preference to herbal teas and decoctions;
• give up cigarettes and alcohol;
• avoid hypothermia;
• take vitamin and mineral complexes;
• observe the rules of personal hygiene;
• adhere to a certain diet, with a limited content of table salt and carbohydrates in the daily diet;
• spend more time in the fresh air and ventilate the room.

It should be emphasized that in the absence of the necessary therapy, the chronic form of purulent bronchitis invariably leads to the development of complications and concomitant diseases such as infectious pneumonia, abscess formation, pulmonary pathologies, bronchiectasis, disorders in the functioning of the cardiovascular system, tuberculosis and others. Therefore, it is extremely important to provide the patient with timely and correct treatment.

– this is an inflammation of the bronchial tree, occurring with the formation and release of purulent secretion. The etiology of purulent bronchitis is always associated with a layer of bacterial infection. With purulent bronchitis, patients are bothered by a wet cough with thick yellow-green sputum, low-grade fever, sweating, and shortness of breath. The diagnosis is established by X-ray of the lungs, bronchoscopy, examination of bronchial lavage water and sputum. Treatment of purulent bronchitis includes courses of antimicrobial therapy, mucolytic and expectorant medications, sanitary bronchoscopy, exercise therapy and breathing exercises, and physiotherapy.

ICD-10

J41 J41.1 J41.8

General information

Purulent bronchitis is a clinical type of acute or chronic bronchitis, characterized by coughing up purulent sputum. Depending on the type of inflammatory process, pulmonology distinguishes catarrhal and purulent bronchitis, as well as rare variants of inflammation (hemorrhagic and fibrinous bronchitis). In this case, purulent bronchitis can act as a primary, independent disease, or secondary, arising against the background of concomitant inflammatory pathology of the respiratory tract (bronchiectasis, respiratory tuberculosis, chronic pneumonia, etc.). In view of the latter circumstance, it is not possible to judge the true prevalence of purulent bronchitis.

Causes

In the development of purulent bronchitis, a combination of non-infectious and infectious, exogenous and endogenous factors is important. Among non-infectious exogenous influences, household and industrial pollutants, atmospheric air pollution, inhalation of tobacco smoke during active and passive smoking, climatic and weather conditions (overheating, hypothermia) are primarily distinguished. The listed factors have an irritating and damaging effect on the bronchial mucosa, thereby opening the way for the penetration of microbial flora. Recurrent acute respiratory infections (influenza, parainfluenza, rhinovirus and respiratory syncytial infection) contribute to disruption of local reactivity. Endogenous causes predisposing to the development of purulent bronchitis include old age, alcohol abuse, obesity, hypovitaminosis, and immunodeficiency.

At the same time, the leading role in the occurrence of purulent bronchitis is given to bacterial infection, mainly pneumococcus, Pseudomonas aeruginosa and Haemophilus influenzae. The course of the purulent-inflammatory process in the bronchi can be supported by foci of infection in the nasopharynx (sinusitis, chronic tonsillitis), COPD (bronchiectasis, chronic abscess, smoker's bronchitis, chronic pneumonia) and specific processes (pulmonary tuberculosis). Purulent bronchitis can develop as a result of improper treatment of acute bronchitis (with inadequate selection of antibiotics and insensitivity of the microflora to them), but more often this clinical form occurs in chronic bronchitis.

Pathogenesis

Long-term irritation of the bronchial tree by mechanical, physical or chemical agents or adhesion of viral pathogens to the epithelial cells of the bronchi cause disruption of the secretory function and self-purification (mucociliary clearance) of the latter. Due to the hyperfunction of secretory cells, the nature of bronchial secretion changes; hypercrinia (increased mucus production) and discrinia (changes in its viscosity and composition) occur. Such metamorphoses contribute to a decrease in the protective properties of bronchial secretions, retention and proliferation of bacterial flora in the bronchi. With microbial inflammation, the cellular composition of the contents of the bronchial tree undergoes changes - the number of neutrophilic leukocytes in it increases; sputum becomes purulent, viscous and difficult to cough up.

Symptoms of purulent bronchitis

The first episode of acute purulent bronchitis or exacerbation of a chronic process is usually facilitated by a cold, cooling, allergic reaction, stress, activation of a chronic source of infection, etc. Since bronchial infection is usually descending in nature, the appearance of symptoms of purulent bronchitis is often preceded by pharyngitis, rhinitis, tracheitis.

In the clinical picture of purulent bronchitis, the leading role is played by intoxication syndrome, cough and shortness of breath. In the acute period, low-grade fever, weakness, and sweating appear. A wet cough with the release of thick yellow or greenish sputum, sometimes with an unpleasant odor, is a concern. In chronic bronchitis, purulent sputum can be released constantly or occasionally (during periods of exacerbation of the inflammatory process); in the acute phase, its amount can reach 250 ml per day. When performing physical activity, a patient with purulent bronchitis experiences shortness of breath and fatigue. The medical history of some patients contains indications of hemoptysis, which is explained by the increased vulnerability of the bronchial mucosa.

Complications

With a protracted course of the purulent process, due to the accumulation of secretions, hyperplastic and fibrous changes in the walls of the bronchi, bronchial obstruction can develop - purulent bronchitis takes on the character of obstructive. In this case, shortness of breath becomes more pronounced, the cough becomes persistent and less productive, and breathing becomes wheezing. The addition of an obstructive component aggravates the course of purulent bronchitis and contributes to the formation of emphysema and cor pulmonale.

Diagnostics

Diagnosis of purulent bronchitis is based on an assessment of the medical history, symptoms (mainly the nature of sputum), physical and instrumental data. Often, patients clearly associate purulent inflammation in the bronchi with an episode of acute respiratory viral infection or indicate a history of chronic bronchitis. It is typical to hear moist rales, which may disappear after productive coughing up of sputum.

Indicators of a general blood test change towards moderate leukocytosis, a shift of the leukocyte leukocyte formula to the left, and an acceleration of ESR. A biochemical study in the blood serum reveals hyper-α1- and α2-globulinemia, increased CRP, seromucoid, haptoglobin and sialic acids.

X-ray data of the lungs are not indicative in the diagnosis of purulent bronchitis. Radiographs may show increased pattern and expansion of the roots of the lungs, signs of emphysema and peribronchial pneumosclerosis. Much greater importance is attached to the results of bronchoscopy. During an endoscopic examination of the bronchi, signs of purulent endobronchitis are revealed: hyperemia and swelling of the mucous membrane, an abundance of purulent contents in the bronchi (after aspiration, the purulent secretion again fills the lumen of the bronchi).

Bronchoscopy is necessarily supplemented by sampling of bronchial secretions for subsequent microscopic, cytological and bacteriological examination. This is especially valuable when patients (especially children) for some reason cannot independently submit sputum for analysis. Instrumental and laboratory tests make it possible to distinguish purulent bronchitis from secondary bronchitis with EBD, tuberculosis, endobronchial cancer, and pneumonia.

Treatment of purulent bronchitis

In the acute period, it is necessary to maintain bed rest, avoid smoking and other bronchial irritants. Hospitalization is advisable for severe intoxication and respiratory failure, especially in elderly patients.

The main method of treatment for purulent bronchitis is empirical antibiotic therapy with drugs from the aminopenicillin group (ampicillin, amoxicillin), combination drugs of amoxicillin with clavulanic acid and ampicillin with sulbactam, macrolides (azithromycin, clarithromycin), fluoroquinolones (sparfloxacin, levofloxacin), third generation cephalosporins (ce fotaxime, cefepime) . These drugs are active against the most common pathogens of purulent bronchitis (S. Pneumoniae, H. influenzae, M. catarrhalis) and the ability to create a high concentration of the active substance in bronchial secretions.

In order to increase sputum hydration and improve its evacuation from the bronchial tree, mucolytics and expectorants (acetylcysteine, ambroxol, bromhexine, etc.), and medicinal inhalations are prescribed. The speedy elimination of the purulent process in the bronchi is facilitated by sanitary bronchoscopy with bronchoalveolar lavage, local administration of antimicrobial and secretolytic drugs.

Pathogenetic treatment is combined with the use of biostimulants and multivitamins, exercise therapy and breathing exercises. After the acute manifestations of purulent bronchitis subside, chest massage and physical therapy methods (inductothermy, microwave therapy, electrophoresis) are added. In severe forms of purulent bronchitis, extracorporeal hemocorrection (UVR of blood, hemosorption, plasmapheresis) may be required.

Prognosis and prevention

The prognosis for life with purulent bronchitis is relatively favorable; ability to work is lost only during periods of exacerbation. However, a long course of purulent bronchitis significantly reduces the quality of life and can lead to repeated pneumonia, the development of DN, emphysema, and pulmonary hypertension.

Primary prevention measures for purulent bronchitis include banning smoking, improving working conditions, reducing dust and gas pollution in the environment, seasonal vaccination against influenza, treatment of nasopharyngeal infections, etc. Secondary prevention is aimed at preventing exacerbations of chronic bronchitis under the supervision of a pulmonologist.

This is one of the most severe and dangerous types of this disease.

Purulent bronchitis is a disease characterized by an inflammatory process localized in the bronchi, in which the patient produces exudate (sputum) containing pus during a cough.

This form of the disease can be acute or chronic. However, most often it does not occur immediately. In this case, it is the chronic form of purulent bronchitis that develops.

The obstructive form of purulent bronchitis is the most severe. As a rule, it develops in older people over 60-65 years of age.

Causes of occurrence

Purulent bronchitis is directly related to bacterial infection. It is the activity of pathogenic (disease-causing) bacteria that explains the appearance of pus in the sputum.

Most often, the purulent form of bronchitis is a complication that occurs when the disease is not treated correctly. Its development can be caused by attempts to independently cure a severe and prolonged cough. Moreover, the longer such self-medication lasts, the higher the likelihood of developing chronic purulent bronchitis in an adult patient or child. Also, one of the reasons leading to its appearance may be a flu or acute respiratory infection.

It is also worth mentioning the risk factors that can directly affect the appearance of this form of the disease. These include:

• unfavorable environment;
• chronic runny nose;
• frequent colds;
• smoking cigarettes and tobacco;
• weak immune system.

Often, when talking with a patient, a doctor can build a chain of events that led to the appearance of purulent bronchitis. In general, it can be accurately described in words – inattention to one’s own health.

Symptoms and signs

Purulent bronchitis has bright and unambiguous symptoms, the main of which are shortness of breath and pus that appears in the expectorated sputum.

If you observe such a picture in yourself or someone close to you, you should visit a qualified doctor as soon as possible.

He will make an accurate diagnosis and prescribe treatment appropriate to the case.

• Other symptoms of purulent bronchitis are:
• moist cough;
• body temperature 37-38 degrees;
• decreased performance;

increased sweating.

Some patients may experience pain in the pectoral muscles. This manifestation of the disease is associated with their overexertion, which occurs with frequent coughing.

In the most advanced cases, patients may experience obstruction or, in other words, disruption of the normal patency of the bronchi. This situation is caused by the accumulation of an excessive amount of mucous secretion. This pathological condition suggests that the patient has developed purulent obstructive chronic bronchitis.

If in this case you do not consult a doctor, then after a short period of time the patient will develop full-fledged pneumonia.

Correct treatment Since purulent bronchitis is associated with the activity of pathogenic bacteria, its treatment can never be done without the prescription of antibiotic drugs.

This is due to the fact that there is no antibiotic agent that has an equally good effect on any pathogenic bacterium. Thus, only a qualified doctor can prescribe the right antibiotic.

Also, in the drug treatment of chronic purulent bronchitis, mucolytic or expectorant drugs are often used. The task of mucolytics is to thin the sputum. This will make it easier to remove during coughing and will alleviate the patient’s condition.

Antihistamines may be prescribed. Most often this is done when purulent bronchitis simultaneously has an allergic origin. In this case, there is a need to relieve tissue swelling and eliminate other allergy symptoms.

Physiotherapeutic procedures may be prescribed along with drug treatment. These include:

• carrying out inhalations;
• warming up the chest and back;
• electrophoresis;
• ICR and UHF.

This comprehensive approach in most cases gives good results.

If the patient is treated on an outpatient basis (at home), then compliance with the regimen established by the attending physician is very important. Its requirements may be:

• plenty of warm and sweet drinks;
• proper diet;
• regular walks in the fresh air.

Possible complications

First of all, they can be expressed in the development of pneumonia and obstructive pulmonary disease.

Purulent bronchitis is an inflammatory disease that affects the bronchial tree. This pathological process, most often, is a consequence of an acute or chronic form. However, it is not excluded that such a pathological process can act as an independent disease.

Treatment is prescribed only by a doctor, after all necessary laboratory and diagnostic measures have been carried out. If therapeutic measures are started in a timely manner, complications can be avoided.

Etiology

The etiological factors for the development of this inflammatory process can be divided into external and internal. Internal etiological reasons include:

• damage to the body by a bacterial infection - and hemophilus influenzae;
• chronic abscess;
• acute respiratory infections;
• various allergic reactions.

External etiological factors that can provoke the development of acute or chronic forms of purulent bronchitis include the following:

• a weakened immune system, against the background of which there is frequent infection of the body with various diseases;
• active or passive smoking;
• frequent hypothermia;
• recurrent respiratory infections.

Separately, predisposing factors for the development of this disease should be highlighted:

• elderly age;
• frequent abuse of alcoholic beverages, as this reduces the body’s protective functions;
• long-term treatment with “heavy” medications;
• genetic predisposition to such diseases;
• living in an environmentally unfavorable area;
• a history of otolaryngological diseases in a chronic form;

Regardless of what caused the development of purulent bronchitis, treatment only with antibiotics at home, without a doctor’s prescription, is strongly not recommended, as this is fraught with the development of associated complications.

Symptoms

At the initial stages of development of the pathological process, the clinical picture is almost identical, which is why many patients do not seek medical help in a timely manner, which ultimately leads to complications.

Symptoms of purulent bronchitis are characterized by the following clinical manifestations:

• wet cough, in which the sputum has a thick, mucopurulent consistency;
• increased sweating;
• dyspnea;
• difficult, in more complex cases, shallow, wheezing breathing;
• low-grade or elevated body temperature;
• weakness, almost constant malaise;
• drowsiness;
• muscle pain, which may be caused by a strong, frequently recurring cough.

It should be noted that in the absence of correct therapeutic measures, the purulent form of bronchitis turns into bronchitis, which has extremely negative prognoses for human health. The situation gets worse if the disease is diagnosed in a child.

It should be noted that a similar clinical picture may be present in other otolaryngological diseases that have a similar etiology, but radically different treatment tactics. Based on this, it should be understood that independent treatment, without an accurate diagnosis, can lead to the development of serious complications.

Diagnostics

Only a qualified doctor can tell you how to treat purulent bronchitis in adults and children, after carrying out all the necessary diagnostic measures and making an accurate diagnosis.

Initially, a physical examination of the patient is carried out with the collection of a general history and clarification of the current clinical picture. It is important that if the patient took any medications to eliminate symptoms without a doctor’s prescription, the clinician should be notified about this before starting diagnostic measures.

The diagnostic program may include the following research methods:

• general clinical and biochemical blood test;
• sputum collection for microscopic, bacteriological and cytological examination;
• endoscopic examination of the bronchi.

In some cases, differential diagnosis may be required to exclude or confirm the following diseases:

• endobronchial cancer.

Treatment tactics are selected only after receiving the results of diagnostic measures and an accurate diagnosis.

Treatment

As a rule, treatment of this disease is carried out using conservative methods. Regardless of the etiology of the disease, antibiotics are used in the treatment of purulent bronchitis, which are selected individually.

In addition, drug therapy may include the following drugs:

• mucolytics;
• expectorants;
• restorative.

It is imperative to prescribe medications to improve sputum removal.

Particular attention should be paid to the fact that antibiotics for purulent bronchitis should only be used strictly as prescribed by a doctor.

As for treatment with folk remedies, they can also be used, but only after consultation with your doctor and as a supplement to the main course of treatment.

Provided that therapeutic measures are started in a timely manner, the prognosis is favorable and the risk of complications is minimized. Otherwise, the purulent form of the disease may become obstructive with attendant complications.

Prevention

The development of such a disease in the upper respiratory tract can be prevented by following these recommendations:

• promptly and correctly treat all otolaryngological ailments;
• strengthen the immune system;
• do not self-medicate.

At the first clinical manifestations, you should seek medical help.

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Diseases with similar symptoms:

Asthma is a chronic disease characterized by short-term attacks of breathlessness caused by spasms in the bronchi and swelling of the mucous membrane. This disease has no specific risk group or age restrictions. But, as medical practice shows, women suffer from asthma 2 times more often. According to official data, today there are more than 300 million people living with asthma in the world. The first symptoms of the disease most often appear in childhood. Elderly people suffer from the disease much more difficult.

Chronic obstructive bronchitis is a disease of the bronchi and lungs, characterized by a partially irreversible restriction of air flow in the bronchopulmonary system, which is constantly progressing. The main symptoms of this pathology in the lungs are shortness of breath and cough with viscous sputum.

Chronic obstructive bronchitis is common throughout the globe and occurs on average in 250–330 persons per 100,000 population.

The lowest incidence of reported cases is less than 110 per 100,000 and covers countries such as Canada, Alaska, southwestern South America, France, Germany, Bulgaria, the Arabian Peninsula, Asian Russia and Japan.

The average prevalence of the disease is the USA, Argentina, Uruguay, Brazil, Great Britain, Norway, Poland, Czech Republic, Slovakia, and African countries, where the incidence of cases is 110–550 per 100,000 population.

The highest incidence of chronic obstructive bronchitis occurs in Europe (Ukraine, Belarus, Russia), Asia (China, Mongolia, Tibet, Nepal, India, Indonesia, Iran, Iraq), Australia, Oceania and is 550–1350 or more per 100,000 population.

Middle-aged and elderly people are more often affected; in men, chronic obstructive bronchitis occurs 3–4 times more often than in women.

The prognosis for work capacity and life is unfavorable. As the pathological process progresses in the lungs, efficiency is gradually lost. Adequate, timely treatment only stops the course of the disease for a short time. Death occurs from complications (cor pulmonale, emphysema, etc.).

Chronic obstructive bronchitis in adults occurs due to many negative influences on the lungs, both from the environment and directly from the body, and therefore the causes of the disease are conventionally divided into two groups:

1. External factors:

High-risk professions:

1. mining industry;
2. builders;
3. miners;
4. metallurgists;
5. pulp and paper industry workers;
6. railway workers;
7. pharmaceutical industry workers.

• Frequent ARVI (acute respiratory viral infections);
• Adenoviral infection;
• Chronic vitamin C deficiency;
• Previously suffered mononucleosis.

1. Internal factors:

• Hereditary predisposition, the basis of which is a deficiency of alpha1-antitrypsin - a substance that blocks enzymes that break down protein in the bronchial tree and thereby prevent the destruction of lung tissue;
• Prematurity - the lungs fully develop only by 38–39 weeks of pregnancy (9 months);
• HIV infection (human immunodeficiency virus);
• Bronchial asthma, which is accompanied by an increase in the level of immunoglobulin E;
• Bronchial hyperreactivity is a persistent increase in the formation of mucus in the bronchial tree.

Classification of the disease

Degree of severity depending on symptoms:

• 0 degree – no severity – shortness of breath occurs with intense stress on the body;
• 1st degree – mild severity – shortness of breath occurs when climbing or while walking relatively quickly;
• 2nd degree – moderate severity – shortness of breath forces patients to move at a slower speed compared to healthy people of the same age group;
• 3rd degree – severe – shortness of breath requires patients to stop during normal walking every 100 m;
• Grade 4 – very severe – shortness of breath occurs when eating, changing clothes or turning in bed. Such patients do not leave the room.

Stages of the disease depending on the study of external respiration function using spirometry - measurement of volume and speed parameters of breathing. (This method will be described in detail in the section “Modern methods of examination,” i.e., diagnosing the disease).

Stage I – mild.

• Tiffno index is less than 70%;
• FEV 1 greater than 80%;
• Absence of the main symptoms of the disease - sputum, shortness of breath and cough.

Stage II – middle.

• Tiffno index is less than 70%;
• FEV 1 is less than 80%;
• The presence or absence of the main symptoms of the disease - sputum, shortness of breath and cough.

Stage III – severe.

• Tiffno index is less than 70%;
• FEV 1 is less than 50%;

Stage IV is extremely severe.

• Tiffno index is less than 70%;
• FEV 1 is less than 30%;
• Chronic respiratory failure;
• The presence of the main symptoms of the disease is sputum, shortness of breath and cough.

Symptoms of the disease

Chronic obstructive bronchitis occurs with a constant alternation of 2 phases of the disease - exacerbation and remission, and symptoms vary depending on the phase.

Signs during an exacerbation:

• slight increase in body temperature;
• general weakness;
• headache;
• dizziness;
• nausea;
• aches, chills, increased sweating;
• decreased ability to work;
• shortness of breath with minimal physical exertion;
• cough with the release of viscous sputum of a purulent nature (yellow).

Symptoms during remission:

• shortness of breath with increased exertion;
• cough, mainly in the morning, sputum is serous (transparent or white).

Concomitant symptoms of damage to other organs from oxygen starvation resulting from damage to the bronchopulmonary system:

• Signs of damage to the cardiovascular system - increased blood pressure, increased heart rate, pain in the heart, palpitations, blueness of the nose, lips, fingertips;
• Signs of damage to the urinary system - pain in the lumbar region, swelling of the lower extremities;
• Signs of damage to the central nervous system - impaired consciousness, shallow breathing, decreased memory and attention, blurred vision, hallucinations;
• Signs of damage to the digestive system are yellowness of the skin, lack of appetite, bloating, and abdominal pain.

Modern examination methods

Adult patients with a disease such as chronic obstructive bronchitis are observed at their place of residence or work by a general practitioner. When visiting a clinic for diagnosis and treatment, they can be observed by local therapists, family doctors or pulmonologists. For inpatient treatment, they should be in specialized pulmonology departments.

Algorithm for examining such patients:

1. Diagnostic survey and collection of complaints;
2. Diagnostic examination of the patient, including percussion (tapping) and auscultation (listening) of the chest.

During percussion, a boxy sound appears, which means increased airiness of the lungs.

On auscultation, harsh breathing and dry, whistling or buzzing rales are observed.

1. Diagnostic laboratory examination:

• A general blood test, which will be characterized by an increase in leukocytes, a shift in the leukocyte formula to the left and an increase in ESR (erythrocyte sedimentation rate);
• A general urine test, in which an increase in squamous epithelial cells and leukocytes in the field of view will be observed, as well as the possible appearance of mucus and traces of protein;
• General sputum analysis, which will be characterized by the presence of a large number of neutrophils and leukocytes.

1. Diagnostic instrumental examination:

The patient is asked to breathe into a tube connected to a computer program that immediately displays a graph of inhalation and exhalation. During the examination, the doctor gives commands to patients, which involve changing the speed and depth of breathing.

The main indicators that can be determined using spirometry:

1. Vital capacity (vital capacity of the lungs) is the total amount of air inhaled and exhaled from the lungs during quiet deep breathing;
2. FVC (forced vital capacity) is the total amount of air inhaled and exhaled from the lungs during deep, rapid breathing;
3. FEV 1 (forced expiratory volume in 1 second) - the volume of air during a sharp exhalation after a calm, deep inhalation;
4. Tiffno index – the ratio of FEV 1 to vital capacity. This parameter is a diagnostic criterion for determining the severity of the disease;
5. PSV (peak volumetric velocity) is the maximum speed of air flow achieved with a sharp exhalation after a deep inhalation.

• X-ray of the chest cavity, which is characterized by the presence of dilated bronchi and increased airiness of the lung tissue.

Main types of treatment

For a disease such as chronic obstructive bronchitis, treatment is prescribed only by qualified specialists in a hospital or outpatient setting. Therapy should be combined, i.e. Drug treatment must necessarily be supplemented by physiotherapeutic treatment, which includes aromatherapy, inhalations, massages, warming and exercise therapy (therapeutic exercises).

Drug treatment

The main goals of treatment are to prevent frequent exacerbations of chronic obstructive bronchitis, relieve symptoms of the disease, improve the body's tolerance to physical activity and reduce mortality.

Bronchodilators are drugs that dilate the bronchi:

• M-cholinergic blockers (ipratropium bromide) - Atrovent, Ipravent have a bronchodilator effect by blocking m-cholinergic receptors in the smooth muscles of the bronchi. The drug is prescribed to adults in the form of an aerosol of 40 mcg (2 puffs) 4–6 times a day;
• Short-acting beta2-agonists (salbutamol) - Salbuvent, Volmas, Ventolin - have a bronchodilator effect by stimulating beta2-adrenergic receptors, which are located in the bronchial wall. For adults, the drug is prescribed by inhalation at 2–4 mg (1–2 puffs) up to 6 times a day;
• Long-acting beta2-agonists (formoterol) - Atimos, Foradil have a pronounced bronchodilator effect. Prescribed for adults: 2 breaths 2 times a day (morning and evening).

Glucocorticosteroids (hormonal drugs):

Combination drugs containing long-acting beta2-agonists and glucocorticosteroids:

Antibacterial drugs act on chronic foci of infection in the bronchi due to the accumulation of copious amounts of sputum, which serves as a breeding ground for them. These drugs are prescribed only during the period of exacerbation of the disease.

• 2nd generation cephalosporins (cefuroxime, cefamandole);
• 3rd generation cephalosporins (cefotaxime, ceftriaxone);
• 2nd generation fluoroquinolones (ciprofloxacin, ofloxacin);
• Respiratory fluoroquinolones (levofloxacin);
• Aminoglycosides (amikacin).

Mucolytic drugs are drugs that stimulate the discharge of sputum from the bronchial tree:

• Bromhexine (Solvin, Bronchostop) has antitussive, mucolytic and expectorant effects. Prescribed in tablets of 8–16 mg 3–4 times a day;
• Ambroxol (Abrol, Ambrotard) stimulates the liquefaction of sputum by reducing viscosity, which contributes to its better excretion. Prescribed 30 mg (1 tablet) 3 times a day;
• Acetylcysteine ​​(ACC) has antitussive and mucolytic effects. Prescribed 200–400 mg 2–3 times a day or 800 mg 1 time a day.

Physiotherapeutic treatment

Essential oils used for aromatherapy include:

• pine oil;
• eucalyptus;
• juniper;
• sandalwood;
• tea tree;
• bergamot.

Complications of the disease

• Pulmonary emphysema is increased airiness of the lung tissue, in which the elasticity of the bronchi is completely lost. With this complication, inhalation is easy, but to exhale it is necessary to make a significant effort;
• Pulmonary heart - in conditions of oxygen starvation of the body, the myocardium (heart muscle) begins to contract more intensely in order to improve blood supply to the internal organs and deliver the required amount of oxygen. Over time, the myocardium wears out, the chambers of the heart enlarge, the muscle layer becomes thin, which leads to disruption of the heart;
• Pulmonary hypertension - increased pressure in the bronchi and alveoli due to narrowing of blood vessels;
• Lungs' cancer.

Prevention of disease

• giving up bad habits, especially smoking;
• moving to environmentally friendly areas of cities;
• combating occupational hazards or switching to work that is not related to heavy industry in conditions of increased air dust;
• balanced diet;
• playing sports;
• timely diagnosis and treatment of respiratory system diseases;
• annual preventive examinations with mandatory FLG (fluorography).

Video: Program “Live Healthy”, topic: “COPD - chronic obstructive pulmonary disease”