Cough is the main symptom of any bronchitis. Complaints of cough - dry or wet, paroxysmal or occasional coughing - always suggest bronchitis. But in order to figure out whether it is bronchitis and what type of bronchitis, it is necessary to know the features of the clinic of this disease.

Clinic and symptoms of acute bronchitis

Most often, the onset of the disease is preceded by signs of SARS: weakness and malaise, pain in muscles and joints, runny nose, sore throat, rise in body temperature.

Bronchitis itself begins with a rise in body temperature and the appearance of a cough. Clinical signs suggest what causes acute bronchitis. So, for bronchitis of influenza and parainfluenza etiology, a sharp onset and persistence of fever is characteristic for 2-3 days. If the temperature does not drop for about 7 days, this may indicate that adenoviruses or mycoplasmas have become the cause of bronchitis.

A cough may appear before the development of bronchitis, as a manifestation of damage to the larynx and trachea. This is either a rough, barking cough (laryngitis), or a dry, excruciating cough, accompanied by pain and a burning sensation behind the sternum (tracheitis). Quite often, the pathological process covers all the respiratory tract, laryngotracheobronchitis occurs, in which there is no point in isolating the symptoms of bronchitis. Comprehensive treatment is needed.

At the onset of the disease, the cough is paroxysmal. This is an unproductive, dry, obsessive cough. Sometimes coughing fits are so intense that they lead to headaches and chest pain. At auscultation of the lungs during this period, hard breathing and scattered dry rales are heard.

Gradually, the cough becomes moist, mucopurulent sputum begins to recede, and moist fine bubbling rales are heard in the lungs. Laboratory tests may not reveal any abnormalities. But the radiograph will show an increase in the pulmonary pattern, expansion of the roots of the lungs.

In cases of a severe course of the disease, shortness of breath, difficulty in breathing join the cough, abundant fine bubbling rales are heard in the lungs against the background of weakening of breathing. With such a clinical picture, laboratory tests show signs of an acute inflammatory reaction: leukocytosis, increased ESR.

Special attention should be paid to acute obstructive bronchitis, which usually occurs in children and is fraught with serious complications. In such cases, the appearance of noisy wheezing with prolonged exhalation is noteworthy. In the process of breathing, auxiliary muscles are involved, retraction of the pliable areas of the chest is noted: supra- and subclavian fossae, intercostal spaces. On auscultation, abundant dry wheezing is heard, indicating bronchospasm.

Obstructive bronchitis is dangerous with a possible attack of suffocation and the development of bronchial asthma.

Clinical picture and diagnosis of chronic bronchitis

Unlike acute bronchitis, chronic bronchitis begins imperceptibly and can go unnoticed for a long time, manifesting itself only with a slight cough in the morning, without affecting in any way the state of health and performance. Gradually, the cough becomes more frequent, it becomes a constant complaint of the patient, slightly "letting go" in the warm season. The amount of sputum increases and its properties change: from the mucous membrane, it gradually becomes mucopurulent or purulent. On auscultation, hard breathing is noted. Dry or wet fine bubbling rales are possible.

In the later stages of chronic bronchitis, shortness of breath becomes a characteristic symptom, which occurs first with physical exertion and with an exacerbation, gradually becoming more permanent. The appearance of shortness of breath indicates the spread of the process to small bronchi and the development of ventilation (obstructive) disorders.

Chronic bronchitis is characterized by severe sweating, especially during exercise and at night; warm acrocyanosis - the limbs are slightly bluish, but warm.

Diagnosis of chronic bronchitis at the initial stage is based primarily on clinical symptoms, since laboratory and radiological research methods do not reveal any abnormalities.

At later stages and in the phase of exacerbation of chronic bronchitis, a general blood test (leukocytosis, ESR) can be informative; biochemical blood test (the appearance of CRP, changes in the protein fractions of the blood (alpha-2-globulin), seromucoid, sialic acids); sputum examination (an increase in the number of leukocytes, epithelial cells, macrophages).

Bronchoscopy helps to confirm the presence of a diffuse inflammatory process and to clarify the nature of morphological changes in the bronchi, which allows not only a visual examination of the bronchi from the inside, but also to take a biopsy for histological examination.

Functional diagnostic methods make it possible to assess the degree of breathing disorders using pneumotachometry, spirography, peak flowmetry. In a patient with chronic bronchitis, the vital capacity of the lungs (VC), the forced expiratory volume (FEV) and the peak volumetric expiratory flow (PIC) decrease, and the residual lung volume (ROL) increases.

The progression of chronic bronchitis inevitably leads to the appearance of clinical signs of respiratory and heart failure.

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Acute bronchitis- diffuse inflammation of the mucous membrane or the entire wall of the bronchi, accompanied by edema of the mucous membrane, secretion and coughing. It can be acute and chronic.

The main factors causing the disease:

Infectious (viruses, bacteria and (or) their combination)
Physical effects (hypothermia, dust inhalation)
Chemical agents (corrosive vapors)

It is impossible not to take into account the predisposing factors of acute bronchitis:

smoking,
harmful production,
some heart disease
the presence of foci of infection in the nasopharynx, oral cavity and tonsils.

Symptoms of acute bronchitis

bothersome soreness behind the breastbone,
dry, sometimes moist cough
feeling of weakness, weakness,
high temperature. In severe cases, the temperature can be high, general malaise is expressed, a strong dry cough with difficulty breathing and shortness of breath.
emerging pain in the lower chest and abdominal wall associated with muscle overstrain when coughing

As a rule, acute bronchitis begins against the background of a cold, laryngitis. Over time, the cough becomes moist, mucous, mucopurulent or purulent sputum begins to recede. When listening to the lung, hard breathing, dry and moist fine-bubbling, non-voiced rales are determined. Acute symptoms of bronchitis usually subside by 3-4 days of illness and, with a favorable course, completely disappear by 7-10 days. The accession of bronchospasm leads to a prolonged course of bronchitis, promotes the transition of acute bronchitis into chronic and the formation bronchial asthma.

Acute bronchitis is an inflammatory process of the airways that occurs due to a variety of reasons. These include inspection agents, viruses, chemical, physical or allergic factors.

Acute bronchitis is caused by viruses (influenza viruses, parainfluenza, adenoviruses, respiratory syncytial, measles, pertussis, etc.), bacteria (staphylococci, streptococci, pneumococci, etc.); physical and chemical factors (dry, cold, hot air, nitrogen oxides, sulfur dioxide, etc.).

Causes: Chilling, smoking tobacco, alcohol consumption, chronic focal infection in the nasopharyngeal region, impaired nasal breathing, deformation of the chest predispose to the disease. The damaging agent enters the trachea and bronchi with inhaled air, hematogenous or lymphogenous (uremic bronchitis).

Acute inflammation of the bronchial tree may be accompanied by a violation of the bronchial patency of the edematous-inflammatory or bronchospastic mechanism. Hyperemia and swelling of the mucous membrane are characteristic; on the walls of the bronchi in their lumen mucous, mucopurulent or purulent secretion; degenerative changes in the ciliated epithelium. In severe forms, the inflammatory process captures not only the mucous membrane, but also the deep tissues of the bronchial wall.

Clinical picture, diagnosis: The main symptom of bronchitis is cough (dry or wet). In acute bronchitis, the cough is predominantly paroxysmal, accompanied by a burning sensation or soreness behind the breastbone or in the pharynx. Sometimes a paroxysmal cough is so intense that it is accompanied by a headache. Patients are worried about weakness, chills, fever up to 37-38 ° C, headache, muscle pain. There are no percussion changes. On auscultation of the lungs, hard breathing, scattered dry rales are noted. The changes in the blood are minimal.

Radiographically inconsistently revealed strengthening of the pulmonary pattern and indistinctness of the roots of the lungs. After 2-3 days from the onset of the disease, a small amount of viscous sputum appears, the cough becomes less painful, and the state of health improves. The illness usually lasts 1 to 2 weeks, but the cough can last up to 1 month. These symptoms correspond to the mild course of acute bronchitis.

Treatment: Bed rest, an abundant warm drink with honey, raspberries, linden blossom; heated alkaline mineral water; acetylsalicylic acid 0.5 g 3 times a day, ascorbic acid up to 1 g a day, vitamin A 3 mg 3 times a day; mustard plasters, banks on the chest. With a pronounced dry cough, codeine (0.015 g) with sodium bicarbonate (0.3 g) is prescribed 2-3 times a day. The drug of choice may be libexin, 2 tablets 3-4 times a day. Of the expectorants, thermopsis infusion is effective (0.8 g per 200 ml, 1 tablespoon 6-8 times a day); 3% solution of potassium iodide (1 tablespoon 6 times a day), bromhexine 8 mg 3-4 times a day for 7 days, etc. Shown are inhalation of expectorants, mucolytics, heated alkaline mineral water, 2% sodium bicarbonate solution , eucalyptus, anise oil using a steam or pocket inhaler. Inhalation is carried out for 5 minutes 3-4 times a day for 3-5 days. Bronchospasm is stopped by the appointment of aminophylline (0.15 g 3 times a day). Antihistamines are indicated. With the ineffectiveness of symptomatic therapy for 2-3 days, as well as moderate and severe course of the disease, antibiotics and sulfonamides are prescribed in the same doses as for pneumonia.

5) Chronic bronchitis.Definition. Causes. Clinic, diagnostics. Treatment.

Chronic bronchitis is a diffuse progressive inflammation of the bronchi, not associated with local or generalized lung damage and manifested by a cough. It is customary to talk about the chronic nature of the process if the cough continues for at least 3 months in 1 year for 2 years in a row.

Priins: External causes include: environmental pollution, climatic conditions, smoking, work in harmful conditions, epidemics of viral diseases. Internal causes include diseases of the nasopharynx, acute respiratory viral infections, acute bronchitis.

Clinic, diagnosis: The features of the clinical picture of chronic bronchitis include its gradual onset. For a long time (sometimes 10 - 12 years), the disease does not bother the patient and does not affect his health. One of the first symptoms is a cough in the morning with a small amount of mucous sputum. Such a cough often occurs in smokers and in contact with occupational hazards (dust, vapors of acids and alkalis, etc.) men and is not perceived by them as a disease.

Chronic bronchitis is preceded by a condition when recurrent cough can no longer be ignored when assessing health, but the clinic does not yet meet the above definition of chronic bronchitis. Persons who have a condition preceding chronic bronchitis (conditionally called by us "pre-bronchitis" by analogy with the common term "pre-asthma") feel practically healthy. A recurring cough (less than 3 months a year) does not bother them. They don't even notice him. The sputum is released very little, or it is not released at all (it must be borne in mind that some patients swallow sputum).

There is no shortness of breath. There are no signs of an active inflammatory process in the lungs and bronchi. However, in the study of external respiration, already in this period, it is often possible to reveal a slight decrease in the speed indicators of ventilation.

Treatment: they are treated, then only with antibiotics, neglecting diet, massage, gymnastics and postural drainage treatment. An important place in the treatment of bronchitis is occupied by drugs that reduce inflammation of the bronchial mucosa, thinning phlegm and improving its discharge, as well as dilating the bronchi. The use of these drugs in the form of an aerosol is especially effective. To obtain highly effective aerosols, modern inhalers (jet and ultrasonic nebulizers) are used. Medicines for nebulizer therapy go directly to the diseased organ and are able to penetrate into the deep layers of the bronchi, which explains their high therapeutic effect. Unfortunately, there are no specially formulated diets for bronchitis sufferers. However, the diet is not only necessary, but also must correspond to the stage of the disease. So, with an exacerbation, accompanied by a cough with purulent sputum, the body needs protein food. Therefore, you need to lean on meat, fish and dairy products. Required vegetables and fruits.

Patients with many years of experience should not abuse sweets and other foods rich in carbohydrates. Such food increases the already elevated levels of carbon dioxide in the blood.

With severe shortness of breath, fluid and salt should be limited. The same goes for gymnastics. Very often the patient does the same exercises for many years. It is not right.

Able-bodied patients can do yoga gymnastics, but only under the guidance of an instructor.

Chest massage is very effective. But a patient with bronchitis needs a special vibration massage. An even more effective procedure, but stubbornly rejected by patients, is the so-called postural drainage. Drainage is based on the law of gravity acting on phlegm. Its difficulty lies in the fact that you need to lie for 20 minutes twice a day in a very uncomfortable position when the upper half of the body is tilted down. And while still turning from back to stomach and from side to side. Therefore, even the most disciplined people do not stand the test of the situation. But, believe me, the method very well helps to free the bronchi from phlegm.

Bronchitis: clinical manifestations, causes, mechanism of development

Bronchitis refers to diseases of the respiratory system, is a diffuse inflammation of the mucous membrane of the trachea and bronchi. The clinic of bronchitis may differ depending on the form of the pathological process, as well as the severity of its course.

According to the international classification, bronchitis is divided into acute and chronic. The first is characterized by an acute course, increased sputum production, dry cough, worse at night. After a few days, the cough becomes moist, phlegm begins to drain. Acute bronchitis usually lasts 2-4 weeks.

In accordance with the guidelines of the World Health Organization, the signs of bronchitis, which makes it possible to classify it as chronic, is a cough with intense bronchial secretion, lasting more than 3 months for 2 years in a row.

In a chronic process, the lesion spreads to the bronchial tree, the protective functions of the bronchi are disrupted, there is difficulty breathing, abundant formation of viscous sputum in the lungs, and a prolonged cough. The urge to cough with expectoration is especially intense in the morning.

The reasons for the development of bronchitis

Various forms of bronchitis differ significantly from each other for reasons of occurrence, pathogenesis and clinical manifestations.

The etiology of acute bronchitis is the basis for the classification, according to which diseases are divided into the following types:

infectious (bacterial, viral, viral-bacterial, rarely fungal infection);
stay in adverse harmful conditions;
unspecified;
mixed etiology.

More than half of all cases of disease development are caused by viral pathogens... The causative agents of the viral form of the disease in most cases are rhinos, adenoviruses, influenza, parainfluenza, respiratory-interstitial.

Of the bacteria, the disease is more often caused by pneumococci, streptococci, hemophilic and Pseudomonas aeruginosa, moraxella catarrhalis, klebsiella. Pseudomonas aeruginosa and Klebsiella are more often detected in immunocompromised patients who abuse alcohol. In smokers, the disease is more often caused by moraxella or Haemophilus influenzae. Exacerbation of the chronic form of the disease is often provoked by Pseudomonas aeruginosa and staphylococci.

Mixed etiology of bronchitis is very common. The primary pathogen enters the body, reduces the protective functions of the immune system. Thus, favorable conditions are created for the attachment of a secondary infection.

The main causes of chronic bronchitis, in addition to bacteria and viruses, is the effect on the bronchi of harmful physical, chemical factors (irritation of the bronchial mucosa with coal, cement, quartz dust, sulfur vapor, hydrogen sulfide, bromine, chlorine, ammonia), prolonged contact with allergens. In rare cases, the development of pathology is due to genetic disorders. The relationship between the incidence rate and climatic factors has been established; the rise is observed in the cold wet period.

Atypical forms of bronchitis are caused by pathogens that occupy an intermediate niche between viruses and bacteria. These include:

Atypical diseases are characterized by uncharacteristic symptoms with the development of polyserositis, damage to the joints and internal organs.

Features of the pathogenesis of bronchial inflammation

The pathogenesis of bronchitis consists of the neuro-reflex and infectious stages of the development of the disease. Under the influence of provoking factors, trophic disorders are noted in the walls of the bronchi. An infectious disease begins with the adhesion of the infectious pathogen to the epithelial cells of the mucous membrane of the airways of the lungs. At the same time, local defense mechanisms are violated, such as air filtration, humidification, purification, the activity of the phagocytic function of alveolar macrophages, neutrophils decreases.

The penetration of pathogens into the lung tissue is also facilitated by a disruption in the functioning of the immune system, an increase in the body's sensitivity to allergens or toxic substances formed during the vital activity of pathogens of the inflammatory process. With constant smoking or contact with harmful conditions, there is a slowdown in the cleansing of the lungs from small irritating substances.

With further progression of the disease, obstruction of the tracheobronchial tree develops, redness, edema of the mucous membrane is noted, and increased desquamation of the integumentary epithelium begins. As a result of this, exudate of a mucous or mucopurulent nature is produced. Sometimes there can be a complete blockage of the lumen of the bronchioles, bronchi.

In severe cases, purulent sputum of a yellowish or greenish color is formed. With hemorrhages from the blood vessels of the mucous membrane, the exudate takes on a hemorrhagic form with brown lumps (rusty sputum).

A mild degree of the disease is characterized by damage to only the upper layers of the mucous membrane, in severe cases, all layers of the bronchial wall undergo morphological changes. With a favorable outcome, the effects of the inflammatory process disappear in 2-3 weeks. In the case of panbronchitis, the restoration of deep layers of the mucous membrane takes about 3-4 weeks. If pathological changes become irreversible, the acute phase of the disease becomes chronic.

The conditions for the transition of pathology to a chronic form are:

decrease in the body's defenses to diseases, exposure to allergens, hypothermia;
viral respiratory diseases;
foci of infectious processes in the respiratory system;
allergic diseases;
heart failure with pulmonary congestion;
deterioration of drainage function due to disruptions in motor skills and disruption of the ciliated epithelium;
the presence of a tracheostomy;
socially unfavorable living conditions;
dysfunction of the neurohumoral regulation system;
smoking, alcoholism.

The most significant in this type of pathology is the functioning of the nervous system.

The set of manifestations of bronchitis

The symptomatology of bronchitis, depending on the form of the disease, has significant differences, therefore, in order to correctly assess the patient's condition, as well as prescribe the appropriate treatment, it is necessary to identify the distinctive features of the pathology in time.

The clinical picture of acute bronchitis

The clinic of acute bronchitis in the initial stage is manifested by signs of acute respiratory infections, a runny nose, general weakness, headache, a slight increase in body temperature, redness, sore throat). Simultaneously with these symptoms, a dry, excruciating cough occurs.

Patients complain of a sore feeling behind the breastbone. After a few days, the cough becomes moist, becomes softer, mucous exudate begins to recede (catarrhal form of the disease). If infection with a bacterial agent joins the viral pathology, the sputum acquires a mucopurulent character. Purulent sputum in acute bronchitis is extremely rare. With severe attacks of coughing, the exudate may be streaked with blood.

If, against the background of bronchitis, inflammation of the bronchioles develops, symptoms of respiratory failure may be observed, such as shortness of breath, blue skin. Rapid breathing may indicate the development of bronchial obstruction syndrome.

When the chest is tapped, the percussion sound and tremors of the voice usually do not change. Harsh breathing is heard. At the initial stage of the course of the disease, dry rales are noted, when sputum begins to leave, they become wet.

In the blood, there is a moderate increase in the number of leukocytes with a predominance of neutrophils. The erythrocyte sedimentation rate may increase slightly. There is a high probability of the appearance of C-reactive protein, an increased level of sialic acids, alpha 2-globulins.

The type of pathogen is determined by bacterioscopy of lung exudate or sputum culture. For the timely detection of blockage of the bronchi or bronchioles, peak flowmetry or spirometry is performed.

In acute bronchitis, the pathology of the lung structure is usually not observed on the X-ray.

In acute bronchitis, recovery occurs in 10-14 days. In immunocompromised patients, the disease is protracted and can last for more than a month. Children have more pronounced signs of bronchitis, but the tolerance of the disease in pediatric patients is easier than in adults.

Chronic bronchitis symptoms

Chronic non-obstructive or obstructive bronchitis manifests itself in different ways, based on the duration of the disease, the likelihood of heart failure or emphysema. The chronic form of the disease has the same varieties as the acute one.

In chronic bronchitis, the following clinical manifestations of the disease are noted:

increased secretion and discharge of purulent sputum;
whistling while inhaling;
shortness of breath, hard breathing when listening;
severe, excruciating cough;
more often dry wheezing, moist with a large amount of viscous sputum;
heat;
sweating;
muscle tremor;
change in the frequency and duration of sleep;
severe headaches at night;
attention disorders;
heart palpitations, increased blood pressure;
convulsions.

The main symptom of chronic bronchitis is a violent paroxysmal barking cough, especially in the morning, with profuse discharge of thick mucus. A few days later, with such a cough, soreness of the chest occurs.

The nature of the secreted sputum, its consistency, color, differ depending on the following types of chronic bronchitis:

catarrhal;
catarrhal-purulent;
purulent;
fibrinous;
hemorrhagic (hemoptysis).

With the progression of bronchitis, the patient begins to worry about shortness of breath, even without physical exertion.... Outwardly, this is manifested by the cyanosis of the skin. The ribcage takes the form of a barrel, the ribs rise to a horizontal position, the pits above the collarbones begin to bulge.

Hemorrhagic bronchitis is isolated in a separate form. The disease is non-obstructive, the course is perennial, a distinctive feature is hemoptysis due to an increase in the permeability of the vascular wall. Pathology is quite rare, in order to establish a diagnosis, it is necessary to exclude other factors in the formation of mucous secretions of the lungs with an admixture of blood. To do this, during bronchoscopy, the thickness of the walls of the blood vessels of the mucous membrane is determined.

The fibrinous form of bronchitis is very rare. A distinctive feature of this pathology is the presence of fibrin deposits, Kurshman spirals, Charcot-Leiden crystals. The clinic is manifested by a cough, with expectoration of casts in the form of a bronchial tree.

Bronchitis is a common condition. With adequate therapy, it has a favorable prognosis. Nevertheless, with self-medication, the likelihood of developing serious complications or the transition of the disease to a chronic form is high. Therefore, at the first symptoms characteristic of bronchial inflammation, it is necessary to consult a doctor.

JMedic.ru

Acute obstructive bronchitis is an inflammatory lesion of the bronchial tree (mainly of medium and small-sized bronchi), which is accompanied by obstruction (spasm) of smooth muscle cells located in the wall of the bronchi, which is accompanied by respiratory failure and oxygen starvation of internal organs and systems.
The main symptoms of the disease in adults are cough, expiratory shortness of breath (difficulty breathing out), the appearance of copious amounts of sputum, wheezing and impaired ventilation.

Acute obstructive bronchitis is common throughout the world and occurs mainly in regions with a cold and humid climate, or in the autumn-winter months. This is due to the fact that during these periods most often people are susceptible to viral and bacterial infections.

The prognosis for the life and working capacity of sick persons is favorable. Complete recovery is observed in 90% within 10-14 days.

The main causes of the disease

A viral infection in which viruses such as:

Bacterial infection of the respiratory tract. The most common pathogens in adults are:

staphylococci;
streptococci;
pneumococci;
Pseudomonas aeruginosa;
legionella;
Proteus.

Damage to the broncho-pulmonary system by the simplest microorganisms:

Predisposing factors that contribute to the development of a disease such as acute obstructive bronchitis:

Diseases of the immune system:

HIV infection (human immunodeficiency virus);
AIDS (acquired immunodeficiency syndrome);
Mononucleosis;
Cytomegalovirus infection.

Decreased immunity due to diseases of other organs and systems:

Frequent upper respiratory tract infections;
Oncological pathologies;
Diabetes;
Hypothyroidism;
Rheumatism;
Reactive arthritis;
Scleroderma;
Dermatomyositis;
Systemic lupus erythematosus, etc.

Alcoholism;
Smoking;
Addiction.

Lack of vitamins in the body.

Classification of the disease

According to the severity, acute obstructive bronchitis is divided into:

Easy;
Medium severity;
Heavy;
Extremely heavy.

By the nature of inflammation in adults, there are:

Purulent obstructive bronchitis;
Catarrhal obstructive bronchitis;
Catarrhal-purulent obstructive bronchitis;
Fibrinous obstructive bronchitis;
Hemorrhagic obstructive bronchitis.

Signs of the disease

Symptoms of damage to the broncho-pulmonary system:

Dry cough, which eventually becomes unproductive and productive with the release of copious amounts of sputum. The appearance of such a symptom as sputum is the first stage in the recovery of the body;
Expiratory shortness of breath - difficulty in exhaling air from the lungs after inhalation. This nature of shortness of breath occurs exclusively in diseases of the bronchi and is an important diagnostic criterion;
Feeling of lack of air.

Increased body temperature;
Chills;
Cold sweat;
Fever;
Increased fatigue;
A sharp decrease in performance;
Body aches;
Arthralgia (joint pain);
Myalgia (muscle pain).

Concomitant syndromes that indicate damage to other organs and systems:

Symptoms of damage to the cardiovascular system: pain in the heart, increased heart rate, increased blood pressure numbers;
Symptoms of damage to the central nervous system: headaches, dizziness, decreased visual acuity, convulsions, hallucinations (only in very severe cases);
Symptoms of damage to the digestive system: nausea, vomiting of intestinal contents, pain in the right hypochondrium, bloating, constipation;
Symptoms of urinary tract damage: pain in the kidney area, swelling of the lower extremities.

Diagnosis of the disease

Medical examination;

Patients with acute obstructive bronchitis usually go to the clinic at their place of residence or work after the development of shortness of breath, i.e. somewhere on the 3rd-4th day from the onset of the development of the disease. Considering the specific complaints and the detection of an enlarged chest, a boxed sound over the pulmonary fields and dry wheezing on the background of weakened or hard breathing during examination, the definition of a preliminary diagnosis - acute obstructive bronchitis is not difficult.

To confirm the diagnosis, general clinical tests are prescribed, in which the inflammatory reaction will be traced, sputum analysis, where there will be characteristic changes, and chest x-ray.

A general blood test, which will be characterized by an increase in leukocytes, lymphocytes, monocytes, ESR (erythrocyte sedimentation rate) and a shift in the leukocyte formula to the left. With hemorrhagic obstructive bronchitis, an increased reticulocyte count may be observed. Also in this analysis, a slight decrease in the number of erythrocytes and hemoglobin can be traced;
General urine analysis, which will be characterized by an increase in squamous epithelial cells and leukocytes in the field of view. Often, along with these changes, there is an increase in the number of red blood cells in the field of view, the appearance of mucus, bacteria and traces of protein;
General sputum analysis, in which a large number of ciliated columnar epithelium cells, alveolar macrophages, leukocytes and Kurshman's coils (casts of small-caliber bronchioles) will appear in the field of view.

Instrumental examination.

Chest x-ray, which will show a uniform increase in the transparency of the pulmonary fields on both sides.

Treatment of the disease

Drug treatment

Protected penicillins (Amoxiclav, Flemoxin-solutab, Augmentin) - have a bacteriostatic (inhibit microbial cell division) effect. Prescribed for adults 1000 mg 2 times a day or 625 mg 3 times a day for 7-14 days;
Cephalosporins of the 2nd generation (Cefamandol, Ciprofloxacin, Norfloxacin) have a pronounced bactericidal effect (targeted destruction of the bacterial cell). Adults are prescribed 200 mg 2 times a day. The duration of treatment is up to 10-14 days.

Inosine pranobex (Groprinosine) has a pronounced immunomodulatory (increases the formation, division and multiplication of cells of the human immune system - lymphocytes, interleukins, cytokines, immunoglobulins, which fight viral infection) and immunostimulating (increases the release of the above cells from the depot (lymph nodes) into ) action.

Prescribed to adults for the first 3 days at the maximum dosage - 2 tablets 4 times a day, then the dose is reduced to 6 tablets a day. Prophylactic dose of 1 tablet 1 time a day after 2 weeks from the start of taking the drug.

Ambroxol (Lazolvan, Flavamed), which has a pronounced mucolytic and expectorant effect. It is prescribed 30 mg 3 times a day or 75 mg 1 time a day. The course of treatment for adults should be at least 10 days;
With an intense dry cough, the drug Erespal or Inspiron is often used, which locally eliminates the inflammatory focus in the bronchial wall and promotes better coughing. Adults are prescribed 1 tablet 2 times a day. The course of treatment is 10 days. When taking the drug, an increase in heart rate up to 100 beats per minute is possible.

Shortness of breath treatment:

Beta2-short-acting agonists (Salbutamol, Ventolin, Berodual) help to eliminate bronchial spasm and thereby have a bronchodilatory effect. Adults are prescribed 2 breaths 4-6 times a day;
Long-acting beta2-agonists (Salmeterol, Formoterol), like beta2-agonists, have a bronchodilatory effect, but the effect, unlike the former, lasts several times longer and takes almost 12 hours. The drugs are prescribed 2 breaths 2 times a day (morning and evening).

Treatment of symptoms of intoxication:

Drinking plenty of fluids or intravenous administration of Ringer's solution 200.0 ml, Rheosorbilact 200.0 ml or physiological solution of 5% glucose 200.0 ml - eliminates headaches, dizziness, nausea, vomiting;
Non-steroidal anti-inflammatory drugs (Nimesulide, Ibuprofen) have antipyretic, analgesic and anti-inflammatory effects. Prescribed to adults 200 mg 1-2 times a day. The duration of treatment is up to 5-7 days.

Physiotherapy treatment:

It is indicated after the 7th-10th day of treatment with medicines and only when the patient's temperature is normalized and there are no symptoms of intoxication.

LECTURE № 19 Diseases of the respiratory system. Acute bronchitis. Clinic, diagnostics, treatment, prevention. Chronical bronchitis. Clinic, diagnostics, treatment, prevention

Respiratory diseases. Acute bronchitis. Clinic, diagnostics, treatment, prevention. Chronical bronchitis. Clinic, diagnostics, treatment, prevention

1. Acute bronchitis

Acute bronchitis is an acute diffuse inflammation of the tracheobronchial tree. Classification:

1) acute bronchitis (simple);

2) acute obstructive bronchitis;

3) acute bronchiolitis;

4) acute obliterating bronchiolitis;

5) recurrent bronchitis;

6) recurrent obstructive bronchitis;

7) chronic bronchitis;

8) chronic bronchitis with obliteration. Etiology. The disease is caused by viral infections (influenza viruses, parainfluenza viruses, adenoviruses, respiratory syncytial, measles, whooping cough, etc.) and bacterial infections (staphylococci, streptococci, pneumococci, etc.); physical and chemical factors (cold, dry, hot air, nitrogen oxides, sulfur dioxide, etc.). Cooling, chronic focal infection of the nasopharyngeal region and impaired nasal breathing, chest deformity predispose to the disease.

Pathogenesis. The damaging agent by the hematogenous and lymphogenous way enters the trachea and bronchi with inhaled air. Acute inflammation of the bronchial tree is accompanied by a violation of the bronchial patency of the edematous-inflammatory or bronchospastic mechanism. Hyperemia, swelling of the mucous membrane are characteristic; on the wall of the bronchus and in its lumen mucous, mucopurulent or purulent secretion; degenerative disorders of the ciliated epithelium develop. In severe forms of acute bronchitis, inflammation is localized not only on the mucous membrane, but also in the deep tissues of the bronchial wall.

Clinical signs. Clinical manifestations of infectious bronchitis begin with rhinitis, nasopharyngitis, moderate intoxication, fever, weakness, a feeling of weakness, soreness behind the breastbone, dry, turning into a wet cough. Auscultatory signs are absent or over the lungs hard breathing is determined, dry rales are heard. There are no changes in peripheral blood. This course is observed more often with damage to the trachea and bronchi. With a moderate course of bronchitis, general malaise, weakness are significantly expressed, a strong dry cough appears with difficulty breathing, the appearance of shortness of breath, the appearance of pain in the chest and in the abdominal wall, which is associated with muscle overstrain when coughing. The cough gradually becomes moist, the sputum acquires a mucopurulent or purulent character. In the lungs, during auscultation, hard breathing, dry and moist fine bubbling rales are heard. Body temperature is subfebrile. There are no pronounced changes in the peripheral blood. A severe course of the disease is observed with a predominant lesion of the bronchioles. Acute clinical manifestations of the disease begin to subside by the 4th day and, with a favorable outcome, almost completely disappear by the 7th day of the disease. Acute bronchitis with impaired bronchial patency has a tendency to protracted course and transition to chronic bronchitis. Acute bronchitis of toxic and chemical etiology is severe. The disease begins with a painful cough, which is accompanied by the release of mucous or bloody sputum, bronchospasm quickly joins (against the background of prolonged exhalation during auscultation, dry wheezing rales can be heard), shortness of breath progresses (up to choking), symptoms of respiratory failure and hypoxemia increase. X-ray examination of the chest organs can determine the symptoms of acute pulmonary emphysema.

Diagnostics: based on clinical and laboratory data.

Treatment. Bed rest, plentiful warm drink with raspberries, honey, linden blossom. Prescribe antiviral and antibacterial therapy, vitamin therapy: ascorbic acid up to 1 g per day, vitamin A 3 mg 3 times a day. You can use jars on the chest, mustard plasters. With a strong dry cough - antitussive drugs: codeine, libexin, etc. With a wet cough - mucolytic drugs: bromo-hexine, ambroben, etc. Shown are inhalation of expectorants, mucolytics, heated alkaline mineral water, eucalyptus, anise oil using a steam inhaler Duration inhalation - 5 minutes 3-4 times a day for 3-5 days. Bronchospasm can be stopped with the appointment of aminophylline (0.25 g 3 times a day). Antihistamines are indicated, Prevention. Elimination of the etiological factor of acute bronchitis (hypothermia, chronic and focal infection in the respiratory tract, etc.).

2. Chronic bronchitis

Chronic bronchitis is a progressive diffuse inflammation of the bronchi, not associated with local or generalized lung damage, manifested by a cough. Chronic bronchitis can be talked about if the cough continues for 3 months in the 1st year - 2 years in a row.

Etiology. The disease is associated with prolonged irritation of the bronchi with various harmful factors (inhalation of air contaminated with dust, smoke, carbon monoxide, sulfur dioxide, nitrogen oxides and other chemical compounds) and recurrent respiratory infection (a large role belongs to respiratory viruses, Pfeiffer's bacillus, pneumococci), less often occurs with cystic fibrosis. Predisposing factors - chronic inflammatory, suppurative processes in the lungs, chronic foci of infection and chronic diseases localized in the upper respiratory tract, decreased reactivity of the body, hereditary factors.

Pathogenesis. The main pathogenetic mechanism is hypertrophy and hyperfunction of the bronchial glands with increased mucus secretion, with a decrease in serous secretion and a change in the composition of secretion, as well as an increase in acidic mucopolysaccharides in it, which increases the viscosity of sputum. Under these conditions, the ciliated epithelium does not improve the emptying of the bronchial tree, usually the entire layer of secretion is normally renewed (partial cleansing of the bronchi is possible only with coughing). Long-term hyperfunction is characterized by depletion of the mucociliary apparatus of the bronchi, the development of dystrophy and atrophy of the epithelium. If the drainage function of the bronchi is impaired, a bronchogenic infection occurs, the activity and relapses of which depend on the local immunity of the bronchi and the occurrence of secondary immunological insufficiency. With the development of bronchial obstruction due to hyperplasia of the epithelium of the mucous glands, edema and inflammatory seals of the bronchial wall, obstruction of the bronchi, excess viscous bronchial secretion, bronchospasm are observed. With obstruction of the small bronchi, overstretching of the alveoli on exhalation and a violation of the elastic structures of the alveolar walls and the appearance of hypoventilated or non-ventilated zones develop, and therefore the blood passing through them is not oxygenated and arterial hypoxemia develops. In response to alveolar hypoxia, pulmonary arteriole spasm and an increase in total pulmonary and pulmonary arteriolar resistance develop; pericapillary pulmonary hypertension develops. Chronic hypoxemia leads to an increase in blood viscosity, which is accompanied by metabolic acidosis, which further increases vasoconstriction in the pulmonary circulation. Inflammatory infiltration in large bronchi is superficial, and in medium and small bronchi, bronchioles - deep with the development of erosions and the formation of meso- and panbronchitis. The remission phase is manifested by a decrease in inflammation and a large decrease in exudation, proliferation of connective tissue and epithelium, especially with ulceration of the mucous membrane.

Clinical manifestations. The onset of the development of the disease is gradual. The first and main symptom is a cough in the morning with discharge of mucous sputum, gradually a cough begins to occur at any time of the day, intensifies in cold weather and becomes constant over the years. The amount of sputum increases, the sputum becomes mucopurulent or purulent. Shortness of breath appears. With purulent bronchitis, purulent sputum may periodically be released, but bronchial obstruction is not very pronounced. Obstructive chronic bronchitis is manifested by persistent obstructive disorders. Purulent obstructive bronchitis is characterized by the release of purulent sputum and obstructive ventilation disorders. Frequent exacerbations during periods of cold damp weather: cough increases, shortness of breath, the amount of sputum increases, there is malaise, rapid fatigue. Body temperature is normal or subfebrile, hard breathing and dry wheezing over the entire pulmonary surface can be determined.

Diagnostics. Possible small leukocytosis with a rod-nuclear shift in the leukocyte formula. With an exacerbation of purulent bronchitis, there is a slight change in the biochemical parameters of inflammation (increased C-reactive protein, sialic acids, fibronogen, seromucoid, etc.). Sputum examination: macroscopic, cytological, biochemical. With a pronounced exacerbation, sputum becomes purulent: a large number of neutrophilic leukocytes, an increased content of acidic mucopolysaccharides and DNA fibers, the nature of sputum, mainly neutrophilic leukocytes, an increase in the level of acidic mucopolysaccharides and DNA fibers, which increase the viscosity of sputum, a decrease in the amount of lysozyme, etc. Bronchoscopy, with the help of which the endobronchial manifestations of the inflammatory process are assessed, the stages of development of the inflammatory process: catarrhal, purulent, atrophic, hypertrophic, hemorrhagic and its severity, but mainly to the level of subsegmental bronchi.

Differential diagnosis is carried out with chronic pneumonia, bronchial asthma, tuberculosis. Unlike chronic pneumonia, chronic bronchitis always develops from a gradual onset, with widespread bronchial obstruction and often emphysema, respiratory failure and pulmonary hypertension with the development of chronic cor pulmonale. On X-ray examination, the changes are also diffuse in nature: peribronchial sclerosis, increased transparency of the pulmonary fields due to emphysema, expansion of the branches of the pulmonary artery. Chronic bronchitis differs from bronchial asthma by the absence of asthma attacks, with pulmonary tuberculosis associated with the presence or absence of symptoms of tuberculosis intoxication, mycobacterium tuberculosis in sputum, results of X-ray and bronchoscopic studies, tuberculin tests.

Treatment. In the phase of exacerbation of chronic bronchitis, therapy is directed at eliminating the inflammatory process, improving the patency of the bronchi, as well as restoring the impaired general and local immunological reactivity. Prescribe antibiotic therapy, which is selected taking into account the sensitivity of the sputum microflora, administered orally or parenterally, sometimes combined with intratracheal administration. Inhalation is shown. Use expectorant, mucolytic and bronchospasmolytic drugs, drinking plenty of fluids to restore and improve bronchial patency. Herbal medicine using marshmallow root, leaves of coltsfoot, plantain. Proteolytic enzymes (trypsin, chymotrypsin) are prescribed, which reduce the viscosity of sputum, but are rarely used now. Acetylcysteine has the ability to break the disulfide bonds of mucus proteins and promotes strong and rapid sputum liquefaction. Bronchial drainage is improved with the use of mucoregulators, which affect the secretion and the production of glycoproteins in the bronchial epithelium (bromhexine). In case of insufficiency of bronchial drainage and existing symptoms of bronchial obstruction, bronchospasmolytic agents are added to the treatment: aminophylline, anticholinergics (atropine in aerosols), adrenostimulants (ephedrine, salbutamol, berotek). In a hospital setting, intra-cheal lavage for purulent bronchitis must be combined with sanitation bronchoscopy (3-4 sanitation bronchoscopy with an interval of 3-7 days). When restoring the drainage function of the bronchi, exercise therapy, chest massage, and physiotherapy are also used. With the development of allergic syndromes, calcium chloride and antihistamines are used; in the absence of effect, a short course of glucocorticoids can be prescribed to relieve the allergic syndrome, but the daily dose should not exceed 30 mg. The danger of activating infectious agents does not allow the use of gluco-corticoids for a long time. In patients with chronic bronchitis, complicated by respiratory failure and chronic cor pulmonale, the use of verospiron (up to 150-200 mg / day) is indicated.

The food of patients should be high-calorie, fortified. Apply ascorbic acid 1 g per day, nicotinic acid, B vitamins; if necessary aloe, methyluracil. With the development of complications of such a disease as pulmonary and pulmonary heart failure, oxygenotherapy, auxiliary artificial ventilation of the lungs are used.

Anti-relapse and supportive therapy is prescribed in the phase of exacerbation subsiding, carried out in local and climatic sanatoriums, this therapy is prescribed during clinical examination. It is recommended to distinguish 3 groups of dispensary patients.

1st group. It includes patients with pulmonary heart disease, with pronounced respiratory failure and other complications, with disability. Patients are prescribed supportive therapy, which is carried out in a hospital or by a local doctor. Examination of these patients is carried out at least once a month.

2nd group. It includes patients with frequent exacerbations of chronic bronchitis, as well as moderate respiratory dysfunctions. Examination of such patients is carried out by a pulmonologist 3-4 times a year, anti-relapse therapy is prescribed in autumn and spring, as well as in acute respiratory diseases. An effective method of administering drugs is the inhalation route; according to indications, it is necessary to sanitize the bronchial tree using intratracheal lavages, sanitizing bronchoscopy. With active infection, antibacterial drugs are prescribed.

3rd group. It includes patients in whom anti-contradictory therapy led to the process subsiding and the absence of relapses for 2 years. Such patients are shown preventive therapy, which includes funds aimed at improving bronchial drainage and increasing its reactivity.

Obstructive bronchitis

Obstructive bronchitis- diffuse inflammation of the bronchi of small and medium caliber, proceeding with a sharp bronchial spasm and progressive impairment of pulmonary ventilation. Obstructive bronchitis is manifested by cough with phlegm, expiratory dyspnea, wheezing, and respiratory failure. Diagnosis of obstructive bronchitis is based on auscultatory, radiological data, and the results of a study of the function of external respiration. Therapy of obstructive bronchitis includes the appointment of antispasmodics, bronchodilators, mucolytics, antibiotics, inhaled corticosteroid drugs, breathing exercises, massage.

Obstructive bronchitis

Bronchitis (simple acute, recurrent, chronic, obstructive) constitutes a large group of inflammatory diseases of the bronchi, different in etiology, mechanisms of occurrence and clinical course. Obstructive bronchitis in pulmonology includes cases of acute and chronic inflammation of the bronchi, occurring with the syndrome of bronchial obstruction, which occurs against the background of mucosal edema, mucus hypersecretion and bronchospasm. Acute obstructive bronchitis often develops in young children, chronic obstructive bronchitis - in adults.

Chronic obstructive bronchitis, along with other diseases occurring with progressive airway obstruction (emphysema, bronchial asthma), is usually referred to as chronic obstructive pulmonary disease (COPD). In the UK and USA, the COPD group also includes cystic fibrosis, bronchiolitis obliterans and bronchiectasis.

Causes of obstructive bronchitis

Acute obstructive bronchitis is etiologically associated with respiratory syncytial viruses, influenza viruses, parainfluenza virus type 3, adenoviruses and rhinoviruses, viral-bacterial associations. When examining the lavage from the bronchi in patients with recurrent obstructive bronchitis, the DNA of persistent infectious pathogens is often isolated - herpesvirus, mycoplasma, chlamydia. Acute obstructive bronchitis occurs predominantly in young children. The development of acute obstructive bronchitis is most susceptible to children, often suffering from acute respiratory viral infections, with weakened immunity and an increased allergic background, a genetic predisposition.

The main factors contributing to the development of chronic obstructive bronchitis are smoking (passive and active), occupational risks (contact with silicon, cadmium), air pollution (mainly sulfur dioxide), deficiency of antiproteases (alpha1-antitrypsin), etc. The risk for the development of chronic obstructive bronchitis includes miners, construction workers, metallurgical and agricultural industries, railway workers, office workers associated with printing on laser printers, etc. Men are more likely to develop chronic obstructive bronchitis.

Pathogenesis of obstructive bronchitis

The summation of genetic predisposition and environmental factors leads to the development of an inflammatory process, in which the bronchi of small and medium caliber and peribronchial tissue are involved. This causes a disruption in the movement of cilia of the ciliated epithelium, and then its metaplasia, loss of ciliated cells and an increase in the number of goblet cells. Following the morphological transformation of the mucous membrane, the composition of the bronchial secretion changes with the development of mucostasis and blockade of small bronchi, which leads to a violation of the ventilation-perfusion balance.

In the secretion of the bronchi, the content of nonspecific factors of local immunity decreases, providing antiviral and antimicrobial protection: lactoferin, interferon and lysozyme. A thick and viscous bronchial secretion with reduced bactericidal properties is a good breeding ground for various pathogens (viruses, bacteria, fungi). In the pathogenesis of bronchial obstruction, an essential role belongs to the activation of cholinergic factors of the autonomic nervous system, which cause the development of bronchospastic reactions.

The complex of these mechanisms leads to edema of the bronchial mucosa, hypersecretion of mucus and spasm of smooth muscles, i.e., the development of obstructive bronchitis. If the component of bronchial obstruction is irreversible, one should think about COPD - the addition of emphysema and peribronchial fibrosis.

Symptoms of Acute Obstructive Bronchitis

As a rule, acute obstructive bronchitis develops in children during the first 3 years of life. The disease has an acute onset and proceeds with symptoms of infectious toxicosis and bronchial obstruction.

Infectious and toxic manifestations are characterized by subfebrile body temperature, headache, dyspeptic disorders, and weakness. Respiratory disorders are leading in the clinic for obstructive bronchitis. Children are worried about dry or moist obsessive cough, which does not bring relief and worsens at night, shortness of breath. Attention is drawn to the inflation of the wings of the nose during inhalation, participation in the act of breathing of the auxiliary muscles (muscles of the neck, shoulder girdle, abdominal press), retraction of the compliant sections of the chest during breathing (intercostal spaces, jugular fossa, supra- and subclavian region). For obstructive bronchitis, an elongated wheezing exhalation and dry ("musical") wheezing, heard from a distance, are typical.

The duration of acute obstructive bronchitis is from 7-10 days to 2-3 weeks. In case of recurrence of episodes of acute obstructive bronchitis three or more times a year, they speak of recurrent obstructive bronchitis; if symptoms persist for two years, chronic obstructive bronchitis is diagnosed.

Chronic obstructive bronchitis symptoms

The basis of the clinical picture of chronic obstructive bronchitis is cough and shortness of breath. When coughing, a small amount of mucous sputum is usually excreted; during periods of exacerbation, the amount of sputum increases, and its character becomes mucopurulent or purulent. The cough is persistent and accompanied by wheezing. Against the background of arterial hypertension, episodes of hemoptysis may occur.

Expiratory shortness of breath in chronic obstructive bronchitis usually joins later, but in some cases the disease can debut immediately with shortness of breath. The severity of shortness of breath varies widely: from feelings of lack of air during exertion to severe respiratory failure. The degree of dyspnea depends on the severity of obstructive bronchitis, the presence of an exacerbation, and concomitant pathology.

An exacerbation of chronic obstructive bronchitis can be provoked by a respiratory infection, exogenous damaging factors, physical exertion, spontaneous pneumothorax, arrhythmia, the use of certain medications, decompensation of diabetes mellitus, and other factors. At the same time, signs of respiratory failure are increasing, subfebrile condition, sweating, fatigue, and myalgia appear.

Objective status in chronic obstructive bronchitis is characterized by prolonged expiration, the participation of additional muscles in breathing, distant wheezing, swelling of the neck veins, and a change in the shape of the nails ("watch glasses"). With an increase in hypoxia, cyanosis appears.

The severity of the course of chronic obstructive bronchitis, according to the methodological recommendations of the Russian society of pulmonologists, is assessed by the FEV1 indicator (forced expiratory volume in 1 sec.).

Stage I chronic obstructive bronchitis is characterized by an FEV1 value exceeding 50% of the standard value. At this stage, the disease does not significantly affect the quality of life. Patients do not need constant follow-up by a pulmonologist.
Stage II chronic obstructive bronchitis is diagnosed with a decrease in FEV1 to 35-49% of the standard value. In this case, the disease significantly affects the quality of life; patients require systematic observation by a pulmonologist.
Stage III chronic obstructive bronchitis corresponds to an FEV1 index of less than 34% of the proper value. At the same time, there is a sharp decrease in stress tolerance, inpatient and outpatient treatment is required in the conditions of pulmonary departments and offices.

Complications of chronic obstructive bronchitis are pulmonary emphysema, cor pulmonale, amyloidosis, respiratory failure. For a diagnosis of chronic obstructive bronchitis, other causes of dyspnea and cough must be ruled out, most notably tuberculosis and lung cancer.

Diagnosis of obstructive bronchitis

The examination program for persons with obstructive bronchitis includes physical, laboratory, radiological, functional, endoscopic examinations. The nature of the physical findings depends on the form and stage of obstructive bronchitis. As the disease progresses, the voice tremor weakens, a boxed percussion sound appears over the lungs, the mobility of the pulmonary edges decreases; auscultation reveals hard breathing, wheezing with forced expiration, with exacerbation - wet wheezing. The tone or amount of wheezing changes after coughing.

Radiography of the lungs allows you to exclude local and disseminated lesions of the lungs, to detect concomitant diseases. Usually, after 2-3 years of the course of obstructive bronchitis, an increase in the bronchial pattern, deformation of the roots of the lungs, and emphysema of the lungs are revealed. Therapeutic and diagnostic bronchoscopy for obstructive bronchitis allows you to examine the bronchial mucosa, collect sputum and bronchoalveolar lavage. In order to exclude bronchiectasis, bronchography may be required.

A necessary criterion for the diagnosis of obstructive bronchitis is the study of the function of external respiration. The data of spirometry (including with inhalation tests), peak flowmetry, pneumotachometry are of the greatest importance. Based on the data obtained, the presence, degree and reversibility of bronchial obstruction, impaired pulmonary ventilation, and the stage of chronic obstructive bronchitis are determined.

The complex of laboratory diagnostics examines general blood and urine tests, blood biochemical parameters (total protein and protein fractions, fibrinogen, sialic acids, bilirubin, aminotransferases, glucose, creatinine, etc.). In immunological tests, the subpopulation functional ability of T-lymphocytes, immunoglobulins, CEC is determined. Determination of CBS and blood gas composition makes it possible to objectively assess the degree of respiratory failure in obstructive bronchitis.

Microscopic and bacteriological examination of sputum and lavage fluid is carried out, and in order to exclude pulmonary tuberculosis - sputum analysis by PCR and CFB. Exacerbation of chronic obstructive bronchitis should be differentiated from bronchiectasis, bronchial asthma, pneumonia, tuberculosis and lung cancer, PE.

Obstructive bronchitis treatment

In acute obstructive bronchitis, rest, drinking plenty of fluids, humidifying the air, alkaline and drug inhalations are prescribed. Etiotropic antiviral therapy is prescribed (interferon, ribavirin, etc.). With severe bronchial obstruction, antispasmodic (papaverine, drotaverine) and mucolytic (acetylcysteine, ambroxol) agents, bronchodilator inhalers (salbutamol, orciprenaline, fenoterol hydrobromide) are used. To facilitate the discharge of sputum, percussion massage of the chest, vibration massage, massage of the back muscles, breathing exercises are performed. Antibiotic therapy is prescribed only when a secondary microbial infection is attached.

The goal of treating chronic obstructive bronchitis is to slow down the progression of the disease, reduce the frequency and duration of exacerbations, and improve the quality of life. The basis of the pharmacotherapy of chronic obstructive bronchitis is the basic and symptomatic therapy. Smoking cessation is a mandatory requirement.

Basic therapy includes the use of bronchodilators: anticholinergics (ipratropium bromide), b2-agonists (fenoterol, salbutamol), xanthines (theophylline). In the absence of an effect on the treatment of chronic obstructive bronchitis, corticosteroid drugs are used. To improve bronchial patency, mucolytic drugs (ambroxol, acetylcysteine, bromhexine) are used. The drugs can be administered orally, in the form of aerosol inhalation, nebulizer therapy, or parenteral.

When the bacterial component is layered during periods of exacerbation of chronic obstructive bronchitis, macrolides, fluoroquinolones, tetracyclines, b-lactams, cephalosporins are prescribed for a course of 7-14 days. With hypercapnia and hypoxemia, oxygen therapy is a mandatory component of the treatment of obstructive bronchitis.

Prognosis and prevention of obstructive bronchitis

Acute obstructive bronchitis responds well to treatment. In children with an allergic predisposition, obstructive bronchitis can recur, leading to the development of asthmatic bronchitis or bronchial asthma. The transition of obstructive bronchitis to the chronic form is prognostically less favorable.

Adequate therapy helps to delay the progression of obstructive syndrome and respiratory failure. Adverse factors aggravating the prognosis are the elderly age of patients, concomitant pathology, frequent exacerbations, continued smoking, poor response to therapy, and the formation of cor pulmonale.

Primary prevention measures for obstructive bronchitis include maintaining a healthy lifestyle, increasing overall resistance to infections, and improving working conditions and the environment. The principles of secondary prevention of obstructive bronchitis involve the prevention and adequate treatment of exacerbations to slow the progression of the disease.

Acute bronchitis- an inflammatory disease of the bronchi, mainly of an infectious nature, manifested by a cough (dry or with sputum) and lasting no more than 3 weeks.

Etiology

The disease is caused by viruses (influenza viruses, parainfluenza viruses, adenoviruses, respiratory syncytial, measles, whooping cough, etc.), bacteria (staphylococci, streptococci, pneumococci, etc.); physical and chemical factors (dry, cold, hot air, nitrogen oxides, sulfur dioxide, etc.). Chilling, tobacco smoking, alcohol consumption, chronic focal infection in the nasopharyngeal region, nasal breathing disorder, chest deformity predispose to the disease.

Pathogenesis

The damaging agent enters the trachea and bronchi with inhaled air, hematogenous or lymphogenous (uremic bronchitis). Acute inflammation of the bronchial tree may be accompanied by a violation of the bronchial patency of the edematous-inflammatory or bronchospastic mechanism. Hyperemia and swelling of the mucous membrane are characteristic; on the walls of the bronchi in their lumen mucous, mucopurulent or purulent secretion; degenerative changes in the ciliated epithelium. In severe forms, the inflammatory process captures not only the mucous membrane, but also the deep tissues of the bronchial wall.

Classification

Presented in several forms: acute simple; acute obstructive bronchitis; bronchiolitis.

Types depending on the nature of the inflammation: catarrhal, purulent and purulent-necrotic.

From causes of acute bronchitis allocate: infectious bronchitis, which develops under the influence of infectious agents (most often viruses, less often bacteria), as well as non-infectious bronchitis (chemical and physical).

By localization of the process, there are: acute bronchitis of distal and proximal localization.

Clinic

Cough, phlegm, rhinorrhea, sore throat, weakness, headache, shortness of breath.

The cough is excruciating, it is accompanied by pain behind the sternum, can disturb at night and lead to sleep disturbance. In this case, the condition worsens even more due to constant lack of sleep. 2-3 days after the onset of the disease, the cough becomes moist, with the release of sputum, which can be mucous (transparent) or purulent (greenish). The last sign indicates the addition of a bacterial infection. In cases where the cough is strong enough and is very prolonged, traces of blood may appear in the sputum.

Treatment .

Bed rest, plentiful warm drink with honey, raspberries, linden blossom; heated alkaline mineral water; acetylsalicylic acid 0.5 g 3 times a day, ascorbic acid up to 1 g a day, vitamin A 3 mg 3 times a day; mustard plasters, banks on the chest. With a pronounced dry cough, codeine (0.015 g) with sodium bicarbonate (0.3 g) is prescribed 2-3 times a day. The drug of choice may be libexin, 2 tablets 3-4 times a day. Of the expectorants, thermopsis infusion is effective (0.8 g per 200 ml, 1 tablespoon 6-8 times a day); 3% solution of potassium iodide (1 tablespoon 6 times a day), bromhexine 8 mg 3-4 times a day for 7 days, etc. Shown are inhalation of expectorants, mucolytics, heated alkaline mineral water, 2% sodium bicarbonate solution , eucalyptus, anise oil using a steam or pocket inhaler. Inhalation is carried out for 5 minutes 3-4 times a day for 3-5 days. Bronchospasm is stopped by the appointment of aminophylline (0.15 g 3 times a day). Antihistamines are indicated. With the ineffectiveness of symptomatic therapy for 2-3 days, as well as moderate and severe course of the disease, antibiotics and sulfonamides are prescribed in the same doses as for pneumonia.

Amoxicillin 500 mg 3R / d

Doxycycline 100 mg 2 times a day

Trimethoprim 160 mg 2r / day

33. Chronic bronchitis. Etiology, pathogenesis, classification, clinical picture, treatment and prevention.Chronic progressive disease which is based on a degenerative inflammatory lesion of the mucous membrane of the tracheobronchial tree with restructuring of the secretory apparatus and sclerosis of the bronchial wall, developing as a result of prolonged inflammation, harmful agents and manifested by cough, sputum and shortness of breath. The diagnosis is justified if there is a prolonged cough for at least 3 months a year for at least 2 years.

Etiology. Causal factors: smoking, infection (viral or bacterial), toxic effects, occupational hazards, β-1-antitrypsin deficiency, indoor air pollution.

Pathogenesis: mechanical and chemical irritation of the mucous membrane causes an increase in the formation of bronchial secretions and leads to a change in its viscous properties. Toxic effects on cells and discrimination lead to dysfunction of the ciliated epithelium, increasing the insufficiency of the mucociliary escalator. Prolonged exposure to toxic substances leads to degeneration and destruction of ciliated cells and the formation of mucosal areas free of ciliated epithelium. The same changes are caused by the action of respiratory viruses. Violation of mucociliary clearance leads to impairment of its functions: secretory, cleansing, protective, due to which the mucosal areas lose their ability to interfere with the adhesion of microorganisms.

Inflammation in the bronchial mucosa leads to the formation of oxidative stress, which leads to damage to the lung tissue with the development of emphysema and peribronchial fibrosis, causing irreversible bronchial obstruction and the transition of chronic bronchitis to the trunk.

Classification:

By etiology: viral, bacterial, from exposure to chemical and physical factors, dust.

According to morphological changes: catarrhal and purulent.

With the flow: stage of remission and exacerbation.

By functional changes: non-obstructive and obstructive.

For complications: respiratory failure, heart failure, chronic cor pulmonale and pulmonary emphysema.

HB classification: simple (catarrhal), mucopurulent, other chronic obstructive pulmonary diseases: chronic asthmatic bronchitis, emphysematous CP, obstructive CP, CP with shortness of breath.

Emphysematous type (type A): expiratory stenosis of small airways and an air trap mechanism develops, manifested by a sharp decrease in exercise tolerance, dyspnea, cyanosis, panting breathing. Auscultation: dry wheezing may not be present, productive cough is not typical. Patients are called Pink Puffers.

Bronchitic type (type B): productive cough, decreased flow rates, early respiratory failure. They are called blue puffy ones.

Clinic. With simple chronic bronchitis, there is a cough, malaise, weakness, fatigue, auscultatory: hard breathing, sometimes weakened. With mucopurulent chronic bronchitis, moist, sonorous fine-bubbling rales may appear.

In chronic obstructive bronchitis, there is an increase in cough, sputum, shortness of breath, diffuse cyanosis (lips, earlobes, acrocyanosis), rare deep breathing, a barrel-shaped chest. Percussion displacement of the boundaries of the lungs downward, their inactivity, box sound. Auscultatory- even weakened breathing with prolonged exhalation, scattered dry buzzing rales that disappear after coughing.

Treatment.

Beta - 2 agonists - relax the smooth muscles of the bronchi and increase the frequency of beating of the cilia of the epithelium.

Anticholinergics are the first line of CB therapy, blockade of m-cholinergic receptors of types 1 and 3 of large bronchi does not level the increased afferent stimulation and leads to a decrease in bronchoconstriction, tracheobroncheal dyskinesia, hypercrinia and discrinia.

Theophylline: - helps to improve mucociliary clearance, stimulates the respiratory center, reduces the likelihood of hypoventilation and carbon dioxide accumulation. The therapeutic concentration range is 5-15 μg / ml.

Mucoregulators and mucolytics: ambroxol - causes depolymerization of acidic mucopolysaccharides of bronchial mucus, improves rheological properties of sputum, increases surfactant synthesis. Average therapeutic dose = 30 mg 3 times a day.

Acetylcysteine: destroys the disulfide bonds of mucopolysaccharides in sputum and stimulates goblet cells by increasing the synthesis of glutathione, has antioxidant properties and promotes the detoxification process. It is prescribed at 600-1200 mg / day in the form of tablets or with a nebulizer at a dose of 300-400 mg 2 times / day.

GCS is used when basic therapy is ineffective at maximum dosages.

Antibiotics empirically use amoxicillin, macrolides (azithromycin), 2nd generation cephalosporins.

Prophylaxis.timely treatment of acute bronchitis and respiratory diseases, early detection and treatment of the initial stages of chronic bronchitis, hardening of the body.

34. Bronchial asthma. Etiology, pathogenesis, classification, clinical picture, diagnosis, treatment.

BA - chronic inflammatory respiratory tract disease, in which many cells and cellular elements are involved - the development of bronchial hyperreactivity ( hypersensitivity to various nonspecific stimuli compared to the norm); leading role in inflammation belongs eosinophils, mast cells and lymphocytes,) which leads to repeated episodes of wheezing, shortness of breath, chest congestion and coughing, especially at night or in the early morning (airway obstruction - often reversible either spontaneously or with treatment).

Etiology: Developmental factors: heredity, allergens, infections, occupational sensitizers, tobacco smoking, air pollution, nutrition, exercise, emotional factors.

Pathogenesis: Early asthmatic reaction is mediated by histamine, leukotrienes and is manifested by contraction of smooth muscles of the respiratory tract, hypersecretion of mucus, edema mucous membrane.

Late asthmatic reaction develops in every second adult patient with bronchial asthma. Lymphokines and other humoral factors cause the migration of lymphocytes, neutrophils and eosinophils and lead to the development of a late asthmatic reaction. Mediators produced by these cells are capable of damaging the epithelium of the respiratory tract, maintaining or activating the inflammation process, and stimulating afferent nerve endings.

Clinical forms of asthma:

Exogenous (atopic, allergic) - triggered by environmental allergens

Endogenous (non-atopic, non-allergic) - the provoking factor is unknown

Aspirin - occurs against the background of intolerance to NSAIDs

Special forms are occupational, exercise-induced asthma, nocturnal asthma, cough asthma.