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

There are diseases, because of which, according to statistics, people most often seek help from a doctor, many have encountered them once in their lives. One such disease is bronchitis.

Bronchitis: what is it

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

As a rule, the disease proceeds without any special complications, recovery occurs quickly. However, if the acute form is not treated in a timely manner, it is likely that it will turn into a chronic one, dangerous for the elderly. In them, it can lead to pulmonary heart failure and death.

Causes

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

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

smoking;
constant contact with toxic substances or allergens;
unfavorable ecological situation;
unstable, too humid climate.

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

Types of bronchitis

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

Acute bronchitis

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

Important! Despite the relative safety of acute bronchitis, without treatment or with a decrease in immunity, it can become chronic or cause pneumonia.

Signs of acute bronchitis in an adult

At the time of illness, you should give up strong tea and coffee, they dehydrate the body, which, on the contrary, needs more fluid. But herbal decoctions will be very useful:, chamomile. They can be drunk with honey.

At home, you can be treated with expectorants prescribed by a doctor. The most popular, affordable and effective drugs:

Lazolvan;
Bromhexine;
Herbion.

There are also many chest cough preparations, allergy sufferers need to be more careful with them. From folk remedies for bronchitis, malt syrup, thermopsis are good.

Inhalations

Well, if there is a nebulizer. At the moment, inhalations are recognized as one of the most effective remedies for respiratory diseases, they allow medicinal substances to reach the foci of inflammation in the lungs.

Important! Inhalations should not be done at high temperature and heart palpitations.

There are a lot of solutions and recipes for inhalation. There are medications produced specifically for the treatment of bronchitis and other diseases of the respiratory system: Lazolvan, Ambrobene, Berodual and others.

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

Massage and physiotherapy

After passing the peak of the disease, when the patient's condition returns to normal, the doctor may prescribe a course of massage, breathing exercises or physiotherapy. There are many methods, you just need to choose the right one and follow all the recommendations of experts.

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

What not to do with bronchitis

In case of illness, you should not use warming ointments and mustard plasters, especially for children. In a warm environment, inflammation develops even faster, more likely to develop complications and a bacterial infection.

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

Prevention of the disease is quite simple. You should avoid colds, prevent their development and not carry them "on your feet" if you eventually get sick. Quitting smoking will reduce the risk of chronic bronchitis.

Bronchitis often affects people with reduced immunity. To prevent this, you should play sports, eat a balanced diet and consume enough vitamins and nutrients, especially in the cold season.

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

If the form of the disease is allergic, it is worth keeping your house clean. In the apartment of an allergic person there should not be an abundance of soft toys, carpets, fabric curtains, on which dust accumulates perfectly. You should often arrange wet cleaning and ventilate.

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

By following the simple rules of prevention, you can avoid bronchitis and its complications or achieve remission if the disease has already passed into the chronic stage.

Bronchitis is an inflammatory disease of the bronchi, which is manifested by a strong cough with sputum discharge. The development of this condition is facilitated by a respiratory infection and prolonged hypothermia. If a person for a long time ...

Pathologies of an inflammatory nature in the respiratory organs occupy one of the leading positions among diseases diagnosed in people of different ages. Antibiotics for bronchitis in adults are prescribed practically ...

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

Causes of chronic bronchitis

In case of improper treatment of an acute disease, a chronic form of bronchitis may develop. In addition, chronic inflammatory diseases of the nasal cavity, chronic pneumonia, bronchiectasis, cystic fibrosis can be the cause of chronic inflammation.

There are the following factors influencing the development of the disease:

smoking;
air pollution;
professional hazards;
climatic impacts;
infectious effects.

The development of chronic bronchitis can contribute to obesity, kyphoscoliosis, limiting respiratory movements, alcoholism, which increases the secretion of the bronchi. Insufficient reactivity of the bronchial vessels, for example, after a hot summer or during unaccustomed cooling, followed by congestion and increased secretion, contributes to bronchitis, probably by increasing susceptibility to infections. This is confirmed by the fact that in polar explorers bronchitis, like a cold, is a completely unusual phenomenon and occurs only in patients with chronic catarrh of the respiratory tract.

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

The pathogenesis of chronic bronchitis

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

In pathogenesis diseases, violations of the cleansing, secretory and protective functions of the bronchi acquire a leading role. The role of infection and such environmental factors as the impact on the mucous membrane of the bronchial tree of critical temperatures of inhaled air, its dustiness and gas content, in maintaining the pathological process, is undoubted. It is impossible to single out the determining effect of any one cause on any link in the pathogenetic process. Under the influence of particles and substances inhaled with atmospheric air, structural changes occur and progress in the mucous layer of the bronchial tree, which lead to an increase in the amount of bronchial mucus, a deterioration in its evacuation from the bronchial tree, and the processes of resistance to bronchogenic infection are disrupted. As in any long-term pathological process, at first there is a hyperfunction of the body's defense reactions, then their extinction is gradually observed. An excessive amount of bronchial mucus, deterioration of its rheological properties, together with a deterioration in the evacuation function of the ciliated epithelium, contribute to the creation of conditions for slowing down the evacuation of mucus from the bronchial tree, especially its lower parts. Defense mechanisms in small bronchi are less effective compared to large bronchi. Part of the bronchioles becomes obstructed with bronchial mucus. Changes in local immunity have been proven, which contributes to the attachment or activation of the pre-existing bronchogenic microbial flora. The spread of infection and inflammation inside the bronchial wall leads to the progression of bronchitis and peribronchitis, resulting in the formation of deforming bronchitis.

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

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

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

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

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

Classification

chronic simple;
chronic purulent;
chronic obstructive;
chronic purulent-obstructive;
chronic hemorrhagic;
chronic fibrous.

Symptoms and signs of chronic bronchitis

Patients complain of cough, often paroxysmal; for general malaise, slight fever during exacerbations of bronchitis; with a sluggish chronic course, bronchitis can occur almost without common phenomena.

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

Current with constant exacerbations in the cold season (winter cough). Patients become sensitive to drafts, perspiration, cooling of the legs, which makes them wrap themselves up, avoid movement; thus, even with uncomplicated bronchitis, a vicious circle is created.

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

Two main variants of the course of the disease should be distinguished:

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

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

In an objective study of the patient, his general condition and symptoms depend not only on the influence of endotoxicosis, but also on the presence and severity of broncho-obstructive syndrome, the degree of DN, decompensation of the right heart in patients with chronic pulmonary heart disease.

On examination, the position of the patient in bed is assessed, the respiratory rate is determined. The timbre of wheezing increases as they originate in smaller bronchi. When coughing and auscultation of the same area, the timbre and the number of dry rales change.

Diagnosis of chronic bronchitis

To diagnose the disease, it is necessary to identify the patient's complaints, anamnesis data, conduct an objective examination and laboratory and instrumental examination. Of the special research methods, X-ray examination, bronchoscopy, and bronchography are mandatory. In some cases, spirography, pneumotachometry, determination of the content of gases in the blood are required.

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

It is very important to differentiate uncomplicated chronic bronchitis from bronchitis associated with pneumosclerosis, emphysema, bronchial asthma, bronchogenic cancer and other tumors, pneumoconiosis, bronchiectasis, to distinguish specific forms of tuberculosis, actinomycosis of the bronchi, etc. Chronic bronchitis is especially often incorrectly recognized in cases of bronchiectasis , which must be borne in mind primarily with the so-called putrefactive bronchitis, bronchitis with hemoptysis, etc.

Laboratory research are not sufficiently reliable for a clear distinction between the phases of exacerbation and remission. The appearance of neutrophilic leukocytosis is not always noted. ESR values do increase during an exacerbation of the disease, however, it should be remembered that compensatory erythrocytosis is possible with DN, which causes low ESR numbers.

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

Prognosis of chronic bronchitis

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

Treatment and prevention of chronic bronchitis

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

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

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

Chronic simple bronchitis

The pathogenesis of chronic simple bronchitis

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

Pathomorphology. There is an inflammatory edema of the mucous membrane of the proximal respiratory tract, a relative decrease in the number of ciliated and an increase in the number of goblet cells, and the participation of squamous epithelial metaplasia.

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

Symptoms and signs of chronic simple bronchitis

There is a cough (mainly in the morning) with the discharge of a small amount of serous sputum ("smoker's cough"). After hypothermia and colds, the cough intensifies, the amount of sputum secreted increases, it can acquire a mucopurulent character. During auscultation during this period, hard vesicular breathing and single dry rales are detected, subfebrile condition and inflammatory changes in the blood may appear. Bronchoscopy confirms catarrhal or mucopurulent endobronchitis. Other physical and instrumental studies are uninformative. X-ray and computed tomography of the lungs can exclude other diseases accompanied by cough with sputum.

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

Diagnosis of chronic simple bronchitis

The anamnesis is taken into account (continuous heavy smoking, exposure to occupational and household pollutants, alcoholism, drug addiction), prolonged (at least 2 years) productive cough, clinical examination data, bronchoscopy, absence of dyspnea and signs of obstruction according to spirometry and noticeable progression of the disease.

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

Forecast. Chronic simple bronchitis proceeds relatively favorably.

Treatment of chronic simple bronchitis

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

Prevention. Includes smoking cessation, rehabilitation of foci of chronic infection, careful hardening. In the event of chronic simple bronchitis, observation by a therapist and control of PSV, a study of FEV are necessary.

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

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

Disease types

There are 3 types of bronchitis in children:

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

In adults, there are 2 types of the disease:

acute form
chronic form.

Symptoms of acute simple bronchitis in children

The main symptom of acute bronchitis is a cough, which is usually dry and obsessive at the onset of the disease. Coughing may be accompanied by a feeling of pressure or chest pain. In the second week of illness, the cough becomes soft, productive. Cough and other symptoms may persist for more than 2 weeks. Simple bronchitis is also characterized by hard breathing and moist rales, the amount of which changes with coughing. With deeper bronchitis, small bubbling rales can be heard. The duration of acute bronchitis usually does not exceed two weeks, although in some cases a dry cough lasts longer, without being accompanied by a violation of the general condition.

Symptoms of obstructive bronchitis

Often in preschool children there is bronchitis with broncho-obstructive syndrome, which is usually called obstructive bronchitis. Obstruction is caused by a combination of several factors, including: an initially narrow bronchial lumen, massive mucosal edema, which further narrows this lumen, profuse viscous and poorly discharged sputum, and (in older children) bronchospasm (additional narrowing of the bronchial lumen). As a result, instead of moving freely along the "wide highway", the air has to "squeeze" through narrow openings. All this is accompanied by wheezing wheezing, which can be heard by putting your ear to the baby's chest. Whistling wheezing is the most distinctive feature of obstructive bronchitis.

Symptoms of acute bronchiolitis

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

Symptoms of acute bronchitis

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

Symptoms of chronic bronchitis

The term "chronic bronchitis", in contrast to acute bronchitis, is used by physicians to refer to a long-term illness that sometimes does not go away for several months. Cough and sputum production may recur every year and last longer each time. Chronic bronchitis is often caused by prolonged inhalation of various irritants such as cigarette smoke.

The main difference between the processes in the lungs in acute and chronic bronchitis is that in chronic bronchitis the bronchial mucosa produces more sputum, which causes coughing, while in infectious bronchitis cough occurs mainly due to inflammation of the respiratory tract. One of the most common causes of chronic bronchitis is chronic smoking.

The meaning of sputum color in bronchitis

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

Green sputum. Green sputum indicates an existing chronic infection. The green color is the result of the process of decay of neutrophils, which tried to cope with pathogenic agents. If the disease is infectious in nature, then a green tint of sputum can also indicate the presence of a large amount of pus in the sputum. If the disease is non-infectious, then there will be more mucus in the sputum than greenery.
White sputum. When the color of sputum is white, the patient's condition is regarded as the normal course of the disease. Nevertheless, it is worth paying attention to the amount of sputum discharge, the presence of foam in it. So, with foamy, abundant white sputum, pulmonary edema, tuberculosis or asthma can be suspected.
Yellow mucus. It indicates the presence in it of white blood cells, namely neutrophils. They are always found in large numbers in allergic, infectious and chronic inflammations. According to the yellow color of the discharge of the bronchi, doctors most often determine: asthma, sinusitis, acute stage of pneumonia or bronchitis.

If yellow sputum is discharged, you should not hesitate to go to the doctor, as its morning analysis allows you to determine the presence of a bacterial infection.

Black (dark gray) sputum. If a patient has black or dark gray sputum, then most often this indicates the presence of dust from smoking tobacco in it. Also, blackening of sputum can be observed when taking certain medications.
Brown sputum. Brown sputum is a serious sign that requires medical attention. A similar color of mucus indicates the breakdown of a large number of red blood cells and the release of hemosiderin.
Red sputum (with blood). The presence of blood in the sputum may indicate a serious infection or open pulmonary bleeding.

Bronchitis treatment

Treatment of acute bronchitis is reduced to the appointment of bed rest, heavy drinking and distracting procedures. Drug therapy consists in prescribing drugs that relieve cough and promote rapid recovery (expectorants and mucolytics). With a dry cough without secretions, antitussive combination medicines are taken. At high temperatures, antipyretics are prescribed. When pneumonia is attached, antibiotic therapy is performed.

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

Possible Complications

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

the transition of acute bronchitis to the chronic form of the disease;
the development of pneumonia;
inflammation of the lungs with the possible onset of a septic process;
the occurrence of cardiopulmonary insufficiency;
the appearance of bronchial asthma or obstructive bronchitis. Especially often this complication is observed in people prone to allergic reactions.

Prevention of bronchitis

Primary prevention of the disease is reduced to the following rules:

Refusal of bad habits and, first of all, from smoking and drinking alcohol.
Avoiding activities that are associated with the inhalation of harmful vapors of lead, aluminum, chlorides.
Getting rid of sources of chronic infection.
Avoidance of low temperatures.
Immunity strengthening: rational nutrition, hardening, compliance with the regime of work and rest, dosing of physical activity.
Seasonal flu vaccination.
Frequent airing of premises.
Walks in the open air.

When the first symptoms of the disease occur, it is necessary to contact a therapist. It is he who performs all diagnostic measures and prescribes treatment. It is possible that the therapist will refer the patient to narrower specialists such as: a pulmonologist, an infectious disease specialist, an allergist.

information about disease and treatment

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

CHRONIC BRONCHITIS - diffuse progressive inflammation of the bronchi, not associated with local or generalized lung damage and manifested by cough. It is customary to talk about the chronic nature of the process if the cough lasts at least 3 months in 1 year for 2 years in a row. Chronic bronchitis is the most common form of chronic nonspecific lung disease (COPD) and tends to increase.

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

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

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

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

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

a slight leukocytosis with a stab shift in the leukocyte count is possible. Only with exacerbation of purulent bronchitis, biochemical indicators of inflammation (C-reactive protein, sialic acids, seromucoid, fibrinogen, etc.) change slightly. In the diagnosis of the activity of chronic bronchitis, the study of sputum is of relatively great importance: macroscopic, cytological, biochemical. So, with a pronounced exacerbation, a purulent nature of sputum is detected, mainly neutrophilic leukocytes, an increase in the content of acid mucopolysaccharides and DNA fibers that increase the viscosity of sputum, a decrease in the content of lysozyme, etc. Exacerbations of chronic bronchitis are accompanied by increasing respiratory disorders, and in the presence of pulmonary hypertension - and disorders circulation.

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

However, in chronic bronchitis, the main lesion is localized most often in the smaller branches of the bronchial tree; therefore, broncho- and radiography are used in the diagnosis of chronic bronchitis. In the early stages of chronic bronchitis, changes in bronchograms are absent in most patients. With long-term chronic bronchitis, bronchograms may show breaks in medium-sized bronchi and the absence of filling of small branches (due to obstruction), which creates a picture of a "dead tree". In the peripheral sections, bronchiectasis can be found in the form of small cavity formations filled with contrast, up to 5 mm in diameter, connected to small bronchial branches. On radiographs, deformation and strengthening of the pulmonary pattern in the form of diffuse reticular pneumosclerosis, often with concomitant pulmonary emphysema, can be detected.

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

5) data of functional diagnostic methods. Improvement in ventilation and respiratory mechanics when using bronchodilators indicates the presence of bronchospasm and the reversibility of bronchial obstruction. In the late period of the disease, violations of the ventilation-perfusion ratios, the diffusion capacity of the lungs, and the gas composition of the blood are added.

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

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

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

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

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

In case of insufficiency of bronchial drainage and the presence of symptoms of bronchial obstruction, bronchospasmolytic agents are added to therapy: eufillin rectally (or intravenously) 2-3 times a day, anticholinergics (atropine, platifillin orally, s / c; atrovent in aerosols), adrenostimulators ( ephedrine, isadrine, novodrin, euspiran, alupent, terbutaline, salbutamol, berotek). In a hospital, intratracheal lavages for purulent bronchitis are combined with sanitation bronchoscopy (3-4 sanitation bronchoscopy with a break of 3-7 days). Restoration of the drainage function of the bronchi is also facilitated by physiotherapy exercises, chest massage, and physiotherapy. If allergic syndromes occur, calcium chloride is prescribed orally and intravenously with antihistamines; in the absence of effect, it is possible to conduct a short (until the allergic syndrome is removed) course of glucocorticoids (daily dose should not exceed 30 mg). The risk of infection activation does not allow recommending long-term use of glucocorticoids.

With the development of the syndrome of bronchial obstruction in a patient with chronic bronchitis, etimizol (0.05-0.1 g 2 times a day orally for 1 month) and heparin (5000 IU 4 times a day 4 times a day s / c for 3-4 weeks) with the gradual withdrawal of the drug. In addition to the antiallergic effect, heparin at a dose of 40,000 IU / day has a mucolytic effect. In patients with chronic bronchitis complicated by respiratory failure and chronic cor pulmonale, the use of veroshpiron (up to 150-200 mg / day) is indicated.

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

Anti-relapse and maintenance therapy begins in the phase of subsiding exacerbation, can be carried out in local and climatic sanatoriums, it is also prescribed during medical examination. It is recommended to allocate 3 groups of dispensary patients. The first group includes patients with severe respiratory failure, cor pulmonale and other complications of the disease, with disability; patients need systematic maintenance therapy, which is carried out in a hospital or by a local doctor. The goal of therapy is to combat the progression of pulmonary heart failure, amyloidosis and other possible complications of the disease. Inspection of these patients is carried out at least once a month. The second group consists of patients with frequent exacerbations of chronic bronchitis and moderate respiratory dysfunction. Examination of patients is carried out by a pulmonologist 3-4 times a year, anti-relapse courses are prescribed in spring and autumn, as well as after acute respiratory diseases. A convenient method of drug administration is inhalation; according to the indications, the bronchial tree is sanitized by intratracheal lavage, sanitation bronchoscopy. With active infection, antibiotics are used. An important place in the complex of anti-relapse drugs is occupied by measures aimed at normalizing the reactivity of the body: referral to sanatoriums, dispensaries, exclusion of occupational hazards, bad habits, etc. for 2 years. They are shown seasonal preventive therapy, including funds aimed at improving bronchial drainage and increasing reactivity.

- inflammation of the bronchial mucosa. All bronchi depart from the main respiratory canal of the human body - the trachea. In the lungs, they diverge into countless branches (bronchial tree), the diameter of which gradually decreases. The mucous membrane of the bronchi is covered with a special epithelium, or the so-called cilia, which vibrate in the mucus, creating an upward movement in it (like an escalator). This does not allow germs to move down.

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

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

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In acute bronchitis, half-bed or bed rest, enhanced nutrition, plentiful warm drink (tea with raspberry jam or honey, milk with soda or half with mineral water, raspberry infusion, lime blossom) are needed. Smoking is strictly prohibited. It will not be superfluous to put cans, mustard plasters, pepper plaster on the chest and back. But these procedures can be carried out only with the permission of the attending physician. Treatment of acute bronchitis is mainly symptomatic: lowering the temperature, inhalation, expectorants. Acute bacterial bronchitis may require a course of antibiotic treatment.

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

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In the case of mild forms of bronchitis and during the recovery period, use is welcome.

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

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

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

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

With bronchitis, drainage exercises are very effective, which facilitates the discharge of sputum. Breathing exercises are also useful - breathing with the "belly", exhaling through closed lips.

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

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

In any case, the treatment program should be agreed with the attending physician, since pneumonia can be masked behind the exacerbation of chronic bronchitis, which requires special treatment.