Cough is the main symptom of any bronchitis. Complaints on cough - dry or wet, parole or individual shames - always suggest the thought of bronchitis. But in order to figure it out, the bronchitis is and what kind of bronchitis, it is necessary to know the characteristics of the clinic of this disease.

Clinic and symptoms of acute bronchitis

Most often, the start of the disease is preceded by signs of ARVI: a breakdown and ailment, pain in the muscles and joints, a runny nose, sore throat, lifting the body temperature.

Immediately bronchitis begins with the lifting body temperature and cough appearance. Clinical features can be assumed than caused by acute bronchitis. So, for bronchitis of influenza and paragripping etiology, a sharp start and preservation of fever within 2-3 days is characterized. If the temperature does not fall about 7 days, this may indicate that adenoviruses or mycoplasmas were caused by the cause of bronchitis.

Cough may appear before the development of bronchitis, as a manifestation of damage to the larynx and trachea. This is either rude, barking cough (laryngitis), or dry painful cough, accompanied by painful sensations and burning behind the sternum (tracheitis). Quite often, the pathological process covers all the respiratory tract, laryngotracybrees occurs, in which the symptoms of bronchitis makes no sense. A comprehensive treatment is necessary.

At the beginning of the disease, cough is an approached character. It is unproductive, dry, obsessive cough. Sometimes the cough attacks are so intense that they lead to headache and to the pain in the chest. With auscultation of the lungs during this period, hearing hard breathing and scattered dry wheels.

Gradually, the cough becomes wet, the mucous-purulent sputum begins to move away, wet shabby wheezes are listened to the lungs. Laboratory tests may not detect any violations. But the radiograph will show the strengthening of the light pattern, the expansion of the roots of the lungs.

In cases of a serious flow of the disease to cough, shortness of breath is joined, breathing difficulty, abundant fine-ductrates are listened to the lungs against the background of breathing. With such a clinical picture in laboratory analyzes, there are signs of acute inflammatory reaction: leukocytosis, an increase in ESR.

It should be especially stopped on acute obstructive bronchitis, which arises, as a rule, in children and fraught with serious complications. In such cases, attention is drawn to the appearance of a noisy whistling breathing with a protracted exhalation. In the process of respiration, the auxiliary muscles are involved, there is a drawage of the fuel plots of the chest: over- and subclavian pits, interrochemical gaps. With auscultation, abundant dry whistling wheezing, testifying to bronchospasm, are heard.

Obstructive bronchitis is dangerous possible attack of choking and the development of bronchial asthma.

Clinic and diagnosis of chronic bronchitis

Unlike acute bronchitis, chronic begins imperceptibly and can remain unnoticed for a long time, manifested only with light shocking in the morning, without affecting well-being and efficiency. Gradually, the cough is read, becomes the patient's constant complaint, slightly "releasing" in the warm season. The amount of sputum increases and its properties are changed: it gradually becomes mucule-purulent or purulent. With auscultation, rigid breathing is marked. Dry or wet finely melted wheezes are possible.

In the later stages of chronic bronchitis, a characteristic symptom becomes shortness of breath, which arises first during exercise and with exacerbation, gradually receiving more permanent character. The appearance of shortness testifies to the spread of the process into small bronchi and the development of ventilation (obstructive) violations.

For chronic bronchitis, severe sweating is characterized, especially during exercise and at night; Warm acricyanosis - limbs slightly bluish, but at the same time warm.

The diagnosis of chronic bronchitis at the initial stage is based primarily on clinical symptoms, since laboratory and radiological research methods do not detect any deviations.

At later stages and in the aggravation phase of chronic bronchitis, a common blood test (leukocytosis, SE) may be informative; Biochemical blood test (the appearance of a CRH, change of protein fractions of blood (alpha-2-globulin), serumcoid, sialic acids); Survey study (increase in the number of leukocytes, epithelial cells, macrophages).

Confirm the presence of a diffuse inflammatory process and clarify the nature of morphological changes in bronchi helps bronchoscopy, which allows not only to conduct a visual inspection of bronchi from the inside, but also to take a bioptat for histological examination.

Functional methods of diagnostics make it possible to estimate the degree of respiratory disruption using pneumotheometry, spirography, picofloumetria. The patient with chronic bronchitis decreases the life capacity of light (jerking), the volume of the forced exhalation (OFV) and the peak volumetric rate of exhalation (PR), the residual volume of the lungs (OOL) increases.

The progression of chronic bronchitis inevitably leads to the emergence 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 an edema mucous membrane, secretion of the secret and cough. It may proceed in acute and chronic form.

The main factors caused by the disease:

• Infectious (viruses, bacteria and (or) their combination)
• Physical impacts (supercooling, inhalation of dust)
• Chemical agents (pairs of caustic substances)

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

• smoking,
• harmful production
• some heart diseases
• the presence of foci of infection in the nasopharynk, oral cavity and almonds.

Symptoms of acute bronchitis

• worried sadness for sternum,
• dry, sometimes wet cough,
• feeling of breakdown, weakness,
• increased temperature. With severe flow, the temperature can be high, the overall malaise is expressed, a strong dry cough with difficulty breathing and breath.
• the emerging pain in the lower departments of the chest and the abdominal wall is associated with the overvoltage of the muscles when coughing

As a rule, sharp bronchitis begins on the background of a runny nose, laryngitis. Over time, the cough becomes wet, the mucosa, mucous-purulent or purulent sputter begins to move away. When listened with lungs, hard breathing, dry and wet small-oxide univonous wheels are determined. The sharp symptoms of bronchitis usually subscribe to 3-4 day of the disease and with a favorable flow completely disappear by 7-10 days. The attachment of bronchospasm leads to the protracted flow of bronchitis, contributes to the transition of acute bronchitis in chronic and formation bronchial asthma.

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

Etiology

The disease causes viruses (influenza viruses, paragripping, adenoviruses, respiratory and sycitial, korilla, cough, etc.), bacteria (staphylococci, streptococci, pneumococci, etc.); Physical and chemical factors (dry, cold, hot air, nitrogen oxides, sulfur gas, etc.). Prehastages to the disease Cooling, tobacco smoking, alcohol consumption, chronic focal infection in the uniceringeal region, disruption of nasal respiration, thoracic deformation.

Pathogenesis

The damaging agent penetrates the trachea and bronchi with inhaled air, hematogenic or lymphogenic path (uremic bronchitis). The acute inflammation of the bronchial tree may be accompanied by a violation of the bronchial patency of the edema-inflammatory or bronchospast mechanism. Characterized hyperemia and swelling of the mucous membrane; On the walls of the bronchi in their lumen, the mucous, mucous-purulent or purulent secret; Degenerative changes in the family epithelium. With severe forms, the inflammatory process captures not only the mucous membrane, but also the deep tissues of the bronchi wall.

Classification

Posted by several forms: sharpness; acute prestructiveburhite; Bronchiolitis.

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

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

The localization of the process is distinguished:acute bronchitis of distal and proximal localization.

Clinic

Cough, isolation of sputum, rhinora, pain in the throat, weakness, headache, shortness of breath.

The cough is painful, he is accompanied by sore pain, can disturb in the night hours and lead to a breakdown of sleep. At the same time, the condition deteriorates even more due to constant lack of sleep. 2-3 days after the start of the disease, the cough becomes wet, with the release of sputum, which can be mucous (transparent) or purulent (greenish color). The last sign indicates the attachment of a bacterial infection. In cases where the cough is quite pronounced and is very long, traces of blood can appear in sputum.

Treatment .

Bedding, abundant warm drinking with honey, raspberry, lime color; Preheating alkaline mineral water; acetylsalicylic acid is 0.5 g 3 times a day, ascorbic acid up to 1 g per day, vitamin A 3 mg 3 times a day; mustard pieces, jars on the chest. With severe dry cough, codeine (0.015 g) is prescribed with sodium bicarbonate (0.3 g) 2-3 times a day. The drug selection can be Liebeksin 2 tablets 3-4 times a day. From expectorant means effective infusion of thermopsis (0.8 g per 200 ml 1 tablespoon 6-8 times a day); 3% solution of potassium iodide (1 tablespoon 6 times a day), bromgexine is 8 mg 3-4 times a day for 7 days, etc. The inhalation of expectorant means, mucolyts, heated mineral alkaline water, 2% sodium hydrocarbonate solution , eucalyptus, anise oil with a steam or pocket inhaler. Inhalations spend 5 minutes 3-4 times a day for 3-5 days. Bronchospasm is stopped by the appointment of Euphilline (0.15 g 3 times a day). Antihistamines are shown. With the ineffectiveness of symptomatic therapy for 2-3 days, and antibiotics and sulfonamides in the same doses are prescribed by the medium and severe course of the disease in the same doses as in pneumonia.

Amoxicillin 500 mg 3p / d

Doxycycline 100 mg 2 r / day

Trimethopris 160 mg 2p / day

33. Chronic bronchitis. Etiology, pathogenesis, classification, clinic, treatment and prevention.Chronic progressive diseasebased on which the degenerative inflammatory lesion of the mucous membrane of the tracheobronchial with the restructuring of the secretory apparatus and sclerosis of the bronchial wall, developing as a result of long-term inflammation, harmful agents and manifested by coughing, isolation of sputum and shortness of breath. The diagnosis is legitimate if there is a long cough at least 3 months per year at least 2 years.

Etiology. Caused Factors: Smoking, Infection (Viral or Bacterial), Toxic Impact, Professional Harmfulness, Insufficiency B-1-Antitrypsin, Home Air Pollution.

Pathogenesis: Mechanical and chemical irritation of the mucous membrane causes an increase in the formation of the bronchial secret and leads to a change in its viscosity properties. The toxic effect on cells and discrimination leads to a violation of the function of the fiscal epithelium, increasing the insufficiency of the mucociliary eccasetor. The prolonged effect of toxic B-B leads to dystrophy and the destruction of the college cells and the formation of sections of the mucous membrane free from the flicental epithelium. The same changes causes the action of respiratory viruses. The violation of the mukiciliary clearance leads to a drawing of its functions: secretory, cleansing, protective because of which plots of mucous loss lose the ability to prevent adhesion microorganism.

Inflammation in the mucosa of bronchi leads to the formation of oxidative stress, which leads to damage to the pulmonary tissue with the development of emphysema and peribrous fibrosis, causing irreversible bronchial obstruction and the transition of chronic bronchitis in COPD.

Classification:

By etiology: Viral, bacterial, from the effects of chemical and physical factors, dust.

According to morphological changes: catarrhal and purulent.

With the flow: Stage of remission and exacerbation.

According to functional changes: Unstructive and obstructive.

By complications: Respiratory failure, heart failure, chronic pulmonary heart and lung emphysema.

Classification HB: Simple (catarrhal), mucous - purulent, other chronic obstructive pulmonary diseases: chronic asthmatic bronchitis, emphysematous hb, obstructive hb, hb with difficulty breathing.

Emphysematous type (type A): the expiratory stenosis of small respiratory tract and the mechanism of the air trap develops by a sharp decrease in the portability of the physical activity, the shortness of cyanosis, puffing breathing. Auscultative: Dry wheezes may not be, the productive cough is not very characteristic. Bologna is called pink puffers.

Bronchic Type (type b): Productive cough, reduction of streaming indicators, early respiratory failure. Call blue wandes.

Clinic. With a simple chronic bronchitis, there is a cough, malaise, weakness, increased fatigue, auscultative: rigid breathing, sometimes weakened. With mucified-purulent chronic bronchitis, there may be a wet sonorous fine-pushed wheezing.

In chronic obstructive bronchitis, there is an increase in cough, sputum, shortness of breath, diffuse cyanosis (lips, uches, acricyanosis), rare deep breathing, barrel-shaped chest. Percussian Displacement of lung boundaries down, their low-speed, box sound. Auscultative - Uniform weakened breathing with elongated exhalation, scattered dry buzzes disappearing after shaking.

Treatment.

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

Anticholinergiki is the first line of therapy HB, blockade of polyaroreceptors 1 and 3 of the type of large bronchi aspects an increased afferent stimulation and leads to a decrease in bronchokonstriction, phenomena of tracheobronheal dyskinesia, hypercreene and discrimination.

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

Moorgulators and Mulcolics: Ambroxol - causes the depolymerization of acidic mucopolysaccharides of bronchial mucus, improves the rheological sv-va of sputum, increases the synthesis of surfactant. Average therapeutic dose \u003d 30 mg 3 times a day.

Acetylcisteine: destroys the disulfide bonds of sputum mucopolysaccharides and stimulates glass-shaped cells, due to an increase in glutathione synthesis, has antioxidant St. B and promotes detoxification process. It is assigned to 600 -1200 mg / day in the form of tablets or with a nebulizer at a dose of 300-400 mg 2 times / day.

GKS is used in the ineffectiveness of basic therapy in maximum dosages.

Antibiotics Zhmpirically. Use amoxicillin, macrolides (azithromycin), cephalosporins 2 generations.

PreventionWeight treatment of sharp bronchitis and respiratory diseases, early detection and treatment of initial stages of chronic bronchitis, hardening the body.

34. Bronchial asthma. Etiology, pathogenesis, classification, clinic, diagnosis, treatment.

Ba - chronic inflammatory The disease of the respiratory tract in which many cells and cellular elements take part - the development of bronchial hyperreactivity (increased sensitivity to various nonspecific stimuli compared to the norm); The leading role in inflammation belongs eosinophilas, fat cells and lymphocyte,) which leads to the repeated episodes of whistling wheezing, shortness of breath, feelings in breast and cough, especially at night or early in the morning (the obstruction of the respiratory tract is often reversible or spontaneously or under the action of treatment).

Etiology: Development factors: heredity, allergens, infections, professional sensitizers, tobacco smoking, air pollution, nutrition, physical activity, emotional factors.

Pathogenesis: Early asthmatic reaction is mediated histamine, leukotriene and manifests itself with a reduction in the smooth muscle of respiratory tract, hypersecretion of mucus, elemental mucous membrane.

Late asthmatic reaction develops in each second adult patient with bronchial asthma. Lymphokins And other humoral factors cause migration of lymphocytes, neutrophils and eosinophils and lead to the development of a late asthmatic reaction. Mediators produced by these cells are able to damage the epithelium of the respiratory tract, maintain or activate the process of inflammation, stimulate afferent nerve endings.

Clinical forms Ba:

Exogenous (atopic, allergic) - provoked by environmental allergens

Endogenous (neatopic, nonallergic) - provoking factor unknown

Aspirin - arises against the background of intolerance to the NSAID

Special forms - professional, asthma of physical effort, night asthma, Cashchal Asthma.

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

According to international classification, bronchitis is divided into acute and chronic. The first is distinguished by acute streams, increased sputum release, dry cough, reinforced at night. A few days later, the cough becomes wet, begins to move the sputum. Acute bronchitis lasts, as a rule, 2-4 weeks.

In accordance with the instructions of the World Health Organization, signs of bronchitis, allowing it to be attributed to chronic, is a cough with intense bronchial secretion, which has been on 3 months for 2 months in a row.

In the chronic process, the lesion spreads to the bronchial tree, the protective functions of the bronchi are broken, it is observed breathing, abundant formation of viscous sputum in the lungs, long cough. Cooks for coughing with sputtering is particularly intense in the morning.

The reasons for the development of bronchitov

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

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

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

More than half of all cases of disease development caused by viral pathogens. The causative agents of the viral form of the disease in most cases are rino-, adenoviruses, flu, paragripp, respiratory and interstitial.

From bacteria, the disease is more often caused by pneumococci, streptococci, hemophilic and cinema stick, Moraxella Catarlis, Klebsiella. The cinema stick and Klebsiella are more often detected in patients with immunodeficiencies, abusing alcohol. Smokers have a disease more often causes Moraxella or hemophilic wand. The aggravation of the chronic form of the disease often provoke a blue chopstick and staphylococci.

Very often there is a mixed etiology of bronchitis. The primary pathogen penetrates the body, reduces the protective functions of the immune system. Thereby, favorable conditions are created to attach a secondary infection.

The main causes of chronic bronchitis, in addition to bacteria and viruses, is the impact on bronet of harmful physical, chemical factors (irritation of the mucous membranes of coal, cement, quartz dust, sulfur, hydrogen sulfide, bromine, chlorine, ammonia, long-term contact with allergens. In rare cases, the development of pathology is due to genetic disorders. There is a link to the level of morbidity with climatic factors, the rise is observed in the cold raw period.

Atypical forms of bronchitis cause pathogens, occupying an intermediate niche between viruses and bacteria. These include:

• legionella;
• mycoplasma;
• chlamydia.

Atypical diseases are distinguished by uncharacteristic symptoms with the development of polyporositis, lesions of the joints and internal organs.

Features of the pathogenesis of inflammation of bronchi

The pathogenesis of bronchitis consists of neuro-reflex and infectious stages of the development of the disease. Under the action of provoking factors in the walls of the bronchi, trophic violations are noted. The infectious disease begins with the adhesion of the infectious pathogen to the cells of the epithelium of the mucous membrane of the airways of the lungs. In this case, local protective mechanisms are disturbed, such as air filtration, moisturizing, cleansing, the activity of the phagocytic function of alveolar macrophages, neutrophils decreases.

The penetration of pathogens in the tissues of lungs contributes to the violation of the work of the immune system, increasing the sensitivity of the body to allergens or toxic substances generated during the life of the inflammatory procedural process. With constant smoking or contact with harmful conditions, the purification of lungs from small irritants occurs.

With the further progression of the disease, the obstruction of the tracheobronchial tree is developing, redness, mucous membrane, reinforced desquamation of the coating epithelium begins. As a result, the exudate of the mucous membacity or mucule-purulent is produced. Sometimes there may be a complete blockage of the lumen of bronchiol, bronchi.

In severe cases, purulent wet yellowish or greenish color is formed. In case of hemorrhages from the blood vessels of the mucous membrane, the exudate acquires a hemorrhagic shape with brown lumps (rusting wet).

The lung degree of the disease is characterized by the lesion of only the upper layers of the mucous membrane, in serious cases, all layers of the bronchi wall are exposed to morphological changes. With a favorable outcome, the consequences of the inflammatory process pass in 2-3 weeks. In the case of polebronchite, the restoration of deep layers of the mucosa lasts about 3-4 weeks. If pathological changes become irreversible, the acute phase of the disease acquires a chronic course.

The conditions for the transition of pathology in chronic form are:

• reduction of the body's protective forces to diseases, the effects of allergens, hypothermia;
• virus respiratory diseases;
• foci of infectious processes in the organs of the respiratory system;
• allergic diseases;
• heart failure with stagnation in lungs;
• deterioration of the drainage function due to failures in motility and disorders of the family epithelium;
• the presence of tracheostas;
• socio-unfavorable living conditions;
• violations of the functioning of the neurohumoral regulation system;
• smoking, alcoholism.

The most significant at this form of pathology is the functioning of the nervous system.

A combination of the manifestation of bronchitis

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

Clinical picture of the sharp shape of the bronchitis

The clinic of acute bronchitis in the initial stage is manifested by the signs of the ARZ, a runny nose, general weakness, headache, a minor increase in body temperature, redness, flush in the throat). Simultaneously with these symptoms, dry painful cough occurs.

Patients complain of a chanting feeling behind the sternum. A few days later, the cough acquires a moist character, it becomes softer, the exudate mucosa (catarrhal form of illness) begins to move away. If the virus pathology is attached to the infection with a bacterial agent, the sputum acquires a mucous-purulent nature. Purulent springs in acute bronchitis is extremely rare. With strong bounces of cough, the exudate can be with streaks of blood.

If on the background of bronchitis develops inflammation of bronchiole, there may be symptoms of respiratory failure, such as shortness of breath, the formation of skin. Student breathing may indicate the development of broncho-construction syndrome.

When attacking the chest, percussion sound and trembling voices usually do not change. Listened hard breath. In the initial stage of the disease, dry wheels are celebrated when the sputum begins to move away, they become wet.

In the blood, a moderate increase in the number of leukocytes with a predominance of neutrophils is noted. The rate of sedimentation of erythrocytes can increase slightly. The likelihood of the appearance of C-reactive protein, an increased level of sialic acids, alpha 2-globulins is great.

The type of pathogen is determined by bacterioscopy of exudate with light or sowing sputum. For timely detection of blockage of bronchi or bronchioles are carried out with picofloometer or spirometry.

When acute bronchitis, the pathology of the structure of lungs is usually not observed.

With acute bronchitis, recovery occurs after 10-14 days. In patients with weakened immunity, the disease is distinguished by a protracted flow and can last more than a month. Children have more pronounced signs of bronchitis, but the tolerance of the disease in childhood patients is more easy than adults.

Symptoms of chronic bronchitis

Chronic unstructive or obstructive bronchitis is manifested in different ways, based on the duration of the morbidity, the likelihood of heart failure or emphysema. The chronic form of the disease has the same varieties as acute.

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

• increased secretion and release of purulent sputum;
• whistle during inhalation;
• difficult respiratory process, while listening to hard breath;
• strong painful cough;
• more often dry wheezing, wet with a large amount of viscous sputum;
• heat;
• sweating;
• tremor muscles;
• change in the frequency and duration of sleep;
• strong headaches at night;
• disorders of attention;
• rapid heartbeat, an increase in blood pressure;
• cramps.

The main sign of chronic bronchitis is a strong parlor cough, especially in the morning, with rich allocations of thick sputum. After a few days with such a cough there is a soreness of the chest.

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

• catarrhal;
• catarist-purulent;
• purulent;
• fibrinous;
• hemorrhagic (hemoplinary).

When progressing the patient's bronchitis begins to bother shortness of breath, even without exercise. Externally, this is manifested by the sinusiness of the skin. The chest takes the type of barrel, the ribs rise to a horizontal position, begin to drink holes over the claviers.

In a separate form, hemorrhagic bronchitis is isolated. The disease is unstructive in nature, the course of a perennial, distinctive feature - hemoptal, due to an increase in the permeability of the vascular wall. Pathology is quite rare to determine the diagnosis, it is necessary to exclude other factors for the formation of the mucous membacity of the fasteners with blood admits. For this, the bronchoscopy is determined by the thickness of the walls of blood vessels of the mucous membrane.

The fibrinous form of bronchitis is very rarely detected. A distinctive feature of this pathology is the presence of fibrin sediments, Kurshman's spirals, Characc-Leiden crystals. The clinic is manifested by a cough, when expecting the castors in the form of a bronchial tree.

Bronchitis is a common disease. With adequate therapy has a favorable forecast. Nevertheless, when self-treatment, the likelihood of developing serious complications or the transition of the disease in chronic form is great. Therefore, at the first symptoms characteristic of the inflammation of the bronchi, it is necessary to consult a doctor.

Bronchitis: Clinical manifestations, causes, development mechanism

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

According to international classification, bronchitis is divided into acute and chronic. The first is distinguished by acute streams, increased sputum release, dry cough, reinforced at night. A few days later, the cough becomes wet, begins to move the sputum. Acute bronchitis lasts, as a rule, 2-4 weeks.

In accordance with the instructions of the World Health Organization, signs of bronchitis, allowing it to be attributed to chronic, is a cough with intense bronchial secretion, which has been on 3 months for 2 months in a row.

In the chronic process, the lesion spreads to the bronchial tree, the protective functions of the bronchi are broken, it is observed breathing, abundant formation of viscous sputum in the lungs, long cough. Cooks for coughing with sputtering is particularly intense in the morning.

The reasons for the development of bronchitov

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

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

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

More than half of all cases of disease development caused by viral pathogens. The causative agents of the viral form of the disease in most cases are rino-, adenoviruses, flu, paragripp, respiratory and interstitial.

From bacteria, the disease is more often caused by pneumococci, streptococci, hemophilic and cinema stick, Moraxella Catarlis, Klebsiella. The cinema stick and Klebsiella are more often detected in patients with immunodeficiencies, abusing alcohol. Smokers have a disease more often causes Moraxella or hemophilic wand. The aggravation of the chronic form of the disease often provoke a blue chopstick and staphylococci.

Very often there is a mixed etiology of bronchitis. The primary pathogen penetrates the body, reduces the protective functions of the immune system. Thereby, favorable conditions are created to attach a secondary infection.

The main causes of chronic bronchitis, in addition to bacteria and viruses, is the impact on bronet of harmful physical, chemical factors (irritation of the mucous membranes of coal, cement, quartz dust, sulfur, hydrogen sulfide, bromine, chlorine, ammonia, long-term contact with allergens. In rare cases, the development of pathology is due to genetic disorders. There is a link to the level of morbidity with climatic factors, the rise is observed in the cold raw period.

Atypical forms of bronchitis cause pathogens, occupying an intermediate niche between viruses and bacteria. These include:

Atypical diseases are distinguished by uncharacteristic symptoms with the development of polyporositis, lesions of the joints and internal organs.

Features of the pathogenesis of inflammation of bronchi

The pathogenesis of bronchitis consists of neuro-reflex and infectious stages of the development of the disease. Under the action of provoking factors in the walls of the bronchi, trophic violations are noted. The infectious disease begins with the adhesion of the infectious pathogen to the cells of the epithelium of the mucous membrane of the airways of the lungs. In this case, local protective mechanisms are disturbed, such as air filtration, moisturizing, cleansing, the activity of the phagocytic function of alveolar macrophages, neutrophils decreases.

The penetration of pathogens in the tissues of lungs contributes to the violation of the work of the immune system, increasing the sensitivity of the body to allergens or toxic substances generated during the life of the inflammatory procedural process. With constant smoking or contact with harmful conditions, the purification of lungs from small irritants occurs.

With the further progression of the disease, the obstruction of the tracheobronchial tree is developing, redness, mucous membrane, reinforced desquamation of the coating epithelium begins. As a result, the exudate of the mucous membacity or mucule-purulent is produced. Sometimes there may be a complete blockage of the lumen of bronchiol, bronchi.

In severe cases, purulent wet yellowish or greenish color is formed. In case of hemorrhages from the blood vessels of the mucous membrane, the exudate acquires a hemorrhagic shape with brown lumps (rusting wet).

The lung degree of the disease is characterized by the lesion of only the upper layers of the mucous membrane, in serious cases, all layers of the bronchi wall are exposed to morphological changes. With a favorable outcome, the consequences of the inflammatory process pass in 2-3 weeks. In the case of polebronchite, the restoration of deep layers of the mucosa lasts about 3-4 weeks. If pathological changes become irreversible, the acute phase of the disease acquires a chronic course.

The conditions for the transition of pathology in chronic form are:

• reduction of the body's protective forces to diseases, the effects of allergens, hypothermia;
• virus respiratory diseases;
• foci of infectious processes in the organs of the respiratory system;
• allergic diseases;
• heart failure with stagnation in lungs;
• deterioration of the drainage function due to failures in motility and disorders of the family epithelium;
• the presence of tracheostas;
• socio-unfavorable living conditions;
• violations of the functioning of the neurohumoral regulation system;
• smoking, alcoholism.

The most significant at this form of pathology is the functioning of the nervous system.

A combination of the manifestation of bronchitov

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

Clinical picture of the sharp shape of the bronchitis

The clinic of acute bronchitis in the initial stage is manifested by the signs of the ARZ, a runny nose, general weakness, headache, a minor increase in body temperature, redness, flush in the throat). Simultaneously with these symptoms, dry painful cough occurs.

Patients complain of a chanting feeling behind the sternum. A few days later, the cough acquires a moist character, it becomes softer, the exudate mucosa (catarrhal form of illness) begins to move away. If the virus pathology is attached to the infection with a bacterial agent, the sputum acquires a mucous-purulent nature. Purulent springs in acute bronchitis is extremely rare. With strong bounces of cough, the exudate can be with streaks of blood.

If on the background of bronchitis develops inflammation of bronchiole, there may be symptoms of respiratory failure, such as shortness of breath, the formation of skin. Student breathing may indicate the development of broncho-construction syndrome.

When attacking the chest, percussion sound and trembling voices usually do not change. Listened hard breath. In the initial stage of the disease, dry wheels are celebrated when the sputum begins to move away, they become wet.

In the blood, a moderate increase in the number of leukocytes with a predominance of neutrophils is noted. The rate of sedimentation of erythrocytes can increase slightly. The likelihood of the appearance of C-reactive protein, an increased level of sialic acids, alpha 2-globulins is great.

The type of pathogen is determined by bacterioscopy of exudate with light or sowing sputum. For timely detection of blockage of bronchi or bronchioles are carried out with picofloometer or spirometry.

When acute bronchitis, the pathology of the structure of lungs is usually not observed.

With acute bronchitis, recovery occurs after 10-14 days. In patients with weakened immunity, the disease is distinguished by a protracted flow and can last more than a month. Children have more pronounced signs of bronchitis, but the tolerance of the disease in childhood patients is more easy than adults.

Symptoms of chronic bronchitis

Chronic unstructive or obstructive bronchitis is manifested in different ways, based on the duration of the morbidity, the likelihood of heart failure or emphysema. The chronic form of the disease has the same varieties as acute.

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

• increased secretion and release of purulent sputum;
• whistle during inhalation;
• difficult respiratory process, while listening to hard breath;
• strong painful cough;
• more often dry wheezing, wet with a large amount of viscous sputum;
• heat;
• sweating;
• tremor muscles;
• change in the frequency and duration of sleep;
• strong headaches at night;
• disorders of attention;
• rapid heartbeat, an increase in blood pressure;
• cramps.

The main sign of chronic bronchitis is a strong parlor cough, especially in the morning, with rich allocations of thick sputum. After a few days with such a cough there is a soreness of the chest.

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

• catarrhal;
• catarist-purulent;
• purulent;
• fibrinous;
• hemorrhagic (hemoplinary).

When progressing the patient's bronchitis begins to bother shortness of breath, even without exercise. Externally, this is manifested by the sinusiness of the skin. The chest takes the type of barrel, the ribs rise to a horizontal position, begin to drink holes over the claviers.

In a separate form, hemorrhagic bronchitis is isolated. The disease is unstructive in nature, the course of a perennial, distinctive feature - hemoptal, due to an increase in the permeability of the vascular wall. Pathology is quite rare to determine the diagnosis, it is necessary to exclude other factors for the formation of the mucous membacity of the fasteners with blood admits. For this, the bronchoscopy is determined by the thickness of the walls of blood vessels of the mucous membrane.

The fibrinous form of bronchitis is very rarely detected. A distinctive feature of this pathology is the presence of fibrin sediments, Kurshman's spirals, Characc-Leiden crystals. The clinic is manifested by a cough, when expecting the castors in the form of a bronchial tree.

Bronchitis is a common disease. With adequate therapy has a favorable forecast. Nevertheless, when self-treatment, the likelihood of developing serious complications or the transition of the disease in chronic form is great. Therefore, at the first symptoms characteristic of the inflammation of the bronchi, it is necessary to consult a doctor.

JMedic.ru.

Acute obstructive bronchitis is an inflammatory lesion of bronchial wood (mainly bronchial middle and small caliber), which is accompanied by obstruction (spasm) of smooth muscle cells located in the bronchi wall, which is accompanied by respiratory failure and oxygen fasting of internal organs and systems.
The main symptoms of the disease in adults are cough, expiratory shortness of breath (embroidery), the appearance of an abundant amount of sputum, wheezes and violation of the ventilation of the lungs.

Acute obstructive bronchitis is distributed throughout the terrestrial ball and is preferably found in the regions with a cold and humid climate, or in the autumn-winter months. This is due to the fact that during these periods, people are most often susceptible to viral and bacterial infection.

Forecast for the life and working capacity of patients favorable. Complete recovery is observed in 90% after 10-14 days.

The main causes of the disease

Viral infection in which such viruses play a major role as:

Bacterial damage to respiratory tract. The most frequent causative agents of infection in adults are:

• staphylococci;
• streptococci;
• pneumococci;
• singny wand;
• legionella;
• proteus.

The defeat of the broncho-pulmonary system by the simplest microorganisms:

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

• Immune system diseases:

1. HIV infection (human immunodeficiency virus);
2. AIDS (acquired immunodeficiency syndrome);
3. Mononucleosis;
4. Cytomegalovirus infection.

• Reducing immunity due to diseases of other organs and systems:

1. Frequent infections of the upper respiratory tract;
2. Oncological pathologies;
3. Diabetes;
4. Hypothyroidism;
5. Rheumatism;
6. Reactive arthritis;
7. Sclerodermia;
8. Dermatomyomy;
9. Systemic red lupus, etc.

1. Alcoholism;
2. Tobacocco;
3. Addiction.

• Lack of vitamins in the body.

Classification of the disease

• By severity, acute obstructive bronchitis is divided into:

1. Easy;
2. Moderate;
3. Heavy;
4. Extremely heavy.

• By the nature of inflammation in adults allocate:

1. Purulent obstructive bronchitis;
2. Catarrhal obstructive bronchitis;
3. Catarial-purulent obstructive bronchitis;
4. Fibrinous obstructive bronchitis;
5. Hemorrhagic obstructive bronchitis.

Signs of the disease

• Symptoms of the lesion of the broncho-pulmonary system:

1. The dry cough, which over time goes into a low-productive and productive with the allocation of plenty of sputum. The appearance of such a symptom as a sputum is the first stage to recover the body;
2. Expuratory shortness of breath - the difficulty of exhaust air from the lungs after inhale. This nature of shortness of breath is found solely for the diseases of the bronchi and is an important diagnostic criterion;
3. Feeling of lack of air.

1. Increasing body temperature;
2. Chills;
3. Cold sweat;
4. Fever;
5. Increased fatigue;
6. Sharp decline in performance;
7. Lubrication in the body;
8. Arthralgia (joint pain);
9. Malgia (pain in the muscles).

• Related syndromes, which indicate the defeat of other organs and systems:

1. Symptoms of damage to the cardiovascular system: pain in the heart area, the increase in the heart rate frequency, an increase in blood pressure numbers;
2. Symptoms of damage to the central nervous system: headaches, dizziness, decrease in visual acuity, convulsions, hallucinations (only in very difficult cases);
3. Symptoms of damage to the digestive system: nausea, vomiting in intestinal content, pain in the right hypochondrium, intestinal bloody, constipation;
4. Symptoms of damage to the urinary system: pain in the field of kidneys, swelling of the lower extremities.

Diagnosis of the disease

• Medical examination;

Patients with acute obstructive bronchitis are usually addressed to the clinic at the place of residence or work after the development of shortness of breath, i.e. Somewhere on the 3rd-4th day from the beginning of the development of the disease. Given the specific complaints and identification of an extended chest, a boxed sound over the pulmonary fields and dry wheels against the background of a weakened or hard breathing, determining the preliminary diagnosis - acute obstructive bronchitis of labor is not.

To confirm the diagnosis, generalization analyzes are prescribed, in which an inflammatory response, a sputum analysis, where characteristic changes, and the radiography of the chest organs will be traced.

1. A common blood test for which an increase in leukocytes, lymphocytes, monocytes, ESO (erythrocyte sedimentation velocity) and a leukocytic formula shift to the left will be characterized. With hemorrhagic obstructive bronchitis, an increased level of reticulocytes may be observed. Also in this analysis, a slight decrease in the number of erythrocytes and hemoglobin can be traced;
2. The overall analysis of urine, for which the increase in the cells of the flat epithelium and leukocytes in the field of view will be characterized. Often, along with these changes, there is an increase in the number of erythrocytes in the field of view, the appearance of mucus, bacteria and protein traces;
3. A general range of sputum, in which the appearance of a large number of cells of flickering cylindrical epithelium, alveolar macrophages, leukocytes and spirals of the closure (castle bronchioles of small caliber) in sight are noted.

• Instrumental examination.

X-ray organs of the chest, which will show a uniform increase in the transparency of pulmonary fields on both sides.

Treatment of the disease

• Medicia treatment

1. Protected penicillins (amoxiclav, Flexin-Soluteab, Augmentin) - have bacteriostatic (inhibit microbial cell division) action. Prescribed adults at 1000 mg 2 times a day or 625 mg 3 times a day for 7-14 days;
2. The cephalosporins of the 2nd generation (Cephamandol, Ciprofloxacin, Norfloxacin) have a pronounced bactericidal action (aimedly destroy the bacterial cell). Adults are prescribed 200 mg 2 times a day. The duration of treatment is up to 10-14 days.

Inosine Pranobex (Groprinosin) has a pronounced immunomodulatory (increases the formation, division and reproduction of cells of the human immune system - lymphocytes, interleukins, cytokines, immunoglobulins that are struggling with viral infection) and immunostimulating (increases the emission of the above cells from the depot (lymph nodes) into the bloodstream ) action.

Adults are prescribed for the first 3 days in the maximum dosage - 2 tablets 4 times a day, then the dose is reduced to 6 tablets per day. Preventive dose of 1 tablet 1 time in a day after 2 weeks from the beginning of the preparation of the drug.

1. Ambroxol (Lazolyvan, Flavmed), which has a pronounced musolitic and expectorant effect. It is assigned by 30 mg 3 times a day or 75 mg 1 time per day. The course of treatment for adults should be at least 10 days;
2. With an intense dry cough, the drug Erispal or Inspiron is often used, which locally eliminates the inflammatory hearth in the bronchi wall and contributes to the best coughing. Adults are prescribed 1 tablet 2 times a day. The course of treatment is 10 days. When taking the drug, it is possible to increase cardiac abbreviations up to 100 shots per minute.

Treating shortness of breath:

1. Beta2-agonists of short action (Salbutamol, Ventoline, Berodal) contribute to the elimination of bronchus spasm and thereby have an armored effect. Adults are prescribed 2 inhale 4-6 times a day;
2. Beta2-agonists of long-term action (Salmetterol, Formoterol) possess, like beta2 agonists, bronchorated action, but the effect, unlike the first, lasts longer and captures almost 12 hours. Preparations are prescribed 2 inhale 2 times a day (in the morning and evening).

Treatment of symptoms of intoxication:

1. Abundant drinking or intravenous administration of the Ringerger solution of 200.0 ml, Reosorbilact 200.0 ml or physiological solution of 5% glucose 200.0 ml - eliminates headaches, dizziness, nausea, vomiting;
2. Non-steroidal anti-inflammatory drugs (nimesulide, ibuprofen) have antipyretic, painful and anti-inflammatory effect. Appointed adults of 200 mg 1-2 times a day. The duration of treatment is up to 5-ta-7 months.

• Physiotherapeutic treatment:

Showed after the 7th-10th day of treatment with medicines and only when normalizing the temperature of the patient and the absence of symptoms of intoxication.

Lecture No. 19 of the disease of the respiratory organs. Acute bronchitis. Clinic, diagnostics, treatment, prevention. Chronical bronchitis. Clinic, diagnosis, treatment, prevention

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

1. Acute bronchitis

Acute bronchitis is an acute diffuse inflammation of the tracheobron-joyful tree. Classification:

1) acute bronchitis (simple);

2) acute obstructive bronchitis;

3) acute bronchiolitis;

4) acute obloring bronchiolite;

5) recurrent bronchitis;

6) recurrent obstructive bronchitis;

7) chronic bronchitis;

8) Chronic bronchitis with obliteration. Etiology. The disease cause viral infections (influenza viruses, paragripping, adenoviruses, respiratory-syntic-tial, korea, cough, etc.) and bacterial infections (staphylococci, streptococci, pneumococci, etc.); Physical and chemical factors (cold, dry, hot air, nitrogen oxides, sulfur gas, etc.). Prehastages to the disease Cooling, chronic focal infection of the uniceringeal region and impairment of nasal respiration, thoracic deformation.

Pathogenesis. The damaging agent hematogenic and lymphogen is in the trachea and bronchi with inhaled air acute inflammation of the bronchial tree is accompanied by a violation of the bronchial patency of the edema-inflammatory or bronchospast mechanism. Characterized hyperemia, swelling of the mucous membrane; on the wall of the bronchi and in its lumen, the mucous, mucous-purulent or purulent secret; Degenerative disorders of the family epithelium develop. With severe forms of acute bronchitis, inflammation is localized not only on the mucous membrane, but also in the deep tissues of the bronchi wall.

Clinical signs. The clinical manifestations of bronchitis of infectious ethiology begin with rhinitis, noodopharygitis, moderate intoxication, increasing body temperature, weakness, feelings of breakdown, sneakers for the sternum, dry, turning into a wet cough. Auscultative signs are missing or above the lungs are determined by hard breathing, dry wheels are listened. There are no changes in peripheral blood. Such a course is observed more often when defeating the trachea and bronchi. With the medium-wing current of the bronchitis, general malaise, weakness is significantly expressed, there is a strong dry cough 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 the overvoltage of the muscles during the cough. The cough gradually moves into wet, the wet acquires mucous-purulent or purulent. In the lungs, with auscultation, hard breathing, dry and wet small-oxide wheezing are listened. The temperature of the body is subfeb-rivor. There are no pronounced changes in peripheral blood. The difficult course of the disease is observed with a predominant damage to bronchiol. Sharp clinical manifestations of the disease begin to serve to 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 a protracted flow and transition to chronic bronchitis. Heavily flows acute bronchitis toxico-chemical etiology. The disease begins with a painful cough, which is accompanied by the release of mucosa or blood wet, quickly joins the bronchospasm (against the background of the elongated exhalation, with auscultation, you can listen dry whistling wheels), progresses shortness of breath (up to suffocation), the symptoms of respiratory failure and hypoxsemia are growing. With a radiographic study of the organs of the chest, the symptoms of the acute emphysema of the lungs can be determined.

Diagnostics: Based on clinical and laboratory data.

Treatment. Bed regime, abundant warm drink with raspberries, honey, lime color. Prescribed 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 pieces. With a strong dry cough - antitussive drugs: Codeine, Liebeksin, etc., with a wet cough - Mulitatic preparations: bromo hexin, ambroben, etc. Showing the inhalation of expectorant means, mucolyptus, heated mineral alkaline water, eucalyptus, anise oil with a steam inhaler duration Inhalation - 5 min 3-4 times a day for 3-5 days. Bronchospasm can be stopped when appointing Eufil Lina (0.25 g 3 times a day). Antihistamine preparations are shown, prevention. Elimination of the etiological factor of acute bronchitis (supercooling, chronic and focal infection in the respiratory tract, etc.).

2. Chronic bronchitis

Chronic bronchitis is a progressive diffuse inflammation of bronchi, not related to local or generalized lung damage, manifests itself a cough. You can talk about chronic bronchitis if the cough continues within 3 months in the 1st year - 2 years in a row.

Etiology. The disease is associated with long irritation of the bronchi by various harmful factors (inhalation of air contaminated with dust, smoke, carbon monoxide, sulfur anhydride, nitrogen oxides, and other compounds of chemical nature) and recurrent respiratory infection (a large role belongs to respiratory viruses, pfeiffer stick, pneumococcal), less It occurs when the fibrous sow. The predisposing factors are chronic inflammatory, incoding processes in the lungs, chronic foci of infection and chronic diseases localized in the upper respiratory tracts, reducing the body's reactivity, hereditary factors.

Pathogenesis. The main pathogenetic mechanism is hypertrophy and hyperfunction of bronchial glands with increased mucus selection, with a decrease in serous secretion and a change in secretion composition, as well as an increase in acidic mucopolysaccharides in it, which increases the viscosity of sputum. In these conditions, the camcorder epithelium does not improve the emptying of the bronchial tree, usually the update of the entire layer of the secret is normal (partial cleansing of the bronchi is possible only when coughing). Long-term hyperfunction is characterized by the depletion of the Mukiciliary Apparatus of Bronchi, the development of dystrophy and epithelium atrophy. In disruption of the drainage function of the bronchi, bronchiogenic infection occurs, the activity and recurrences of which depend on the local immunity of the bronchi and the occurrence of secondary immunological failure. With the development of bronchial obstruction due to hyperplasia of the epithelium of the mucous glands, swelling and inflammatory seals of the bronchial wall are observed, the obturation of the bronchi, an excess of viscous bronchial secret, bronchospasm. During the obstruction of small bronchi, the separation of alveoli on exhalation and disruption of the elastic structures of the alveolar walls and the appearance of hypoventiliated or non-ventilated zones is developing, and therefore the blood passing through them is not oxygenated and the development of arterial hypoxemia occurs. In response to alveolar hypoxia, the spasm of pulmonary arterioles and an increase in total pulmonary and pulmonary resistance are developed; Pericapillary pulmonary hypertension develops. Chronic hypoxhemia leads to an increase in blood viscosity, which is accompanied by metabolic acidosis, even more increasing vasoconstriction in a small circulation circle. Inflammatory infiltration in large bronchops superficial, and in medium and small bronchops, bronchioles - deep with the development of erosions and the formation of the meso and panberry. Phase remission is manifested by a decrease in inflammation and a large decrease in exudation, proliferation of connective tissue and epithelium, especially when the mucous membrane is ulcerated.

Clinical manifestations. The beginning of the development of the disease is gradual. The first and main symptom - cough in the morning with a latrine-deniem mucous sputum, cough gradually begins to occur at any time of the day, increased in cold weather and ages constant. The amount of sputum increases, the sputum becomes mucous-purulent or purulent. Dyspnea appears. With purulent bronchitis, purulent sputters may be distinguished periodically, but the bronchial obstruction is not very expressed. 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 wet weather intensified coughing, shortness of breath, phlegm increases, there is a malaise, fatigue. The body temperature is normal or subfebrile, it can be determined hard breathing and dry wheels over the entire pulmonary surface.

Diagnostics. Low leukocytosis is possible with a laid nuclear shear in the leukocyte formula. During exacerbation of purulent bronchitis occurs a slight change in biochemical parameters of inflammation (increased C-reactive protein, sialic acid, fibrinogen, seromucoid et al.). Wet research: macroscopic, cytological, biochemical. In a pronounced exacerbation of the sputum acquires purulent nature: a large amount of neutrophilic leukocytes, an increased content of sour mucopolysaccharides and DNA fibers nature, predominantly neutrophilic leukocytes, increasing the level of acid mucopolisaccharides and DNA fibers that enhance the viscosity of sputum, reduction of the amount of lysozyme, etc. bronchoscopy, With the help of which the endobronchial manifestations of the inflammatory process are estimated, the stage of development of the inflammatory process: catarrhal, purulent, arranging, hypertrophic, hemorrhagic and its severity, but mainly to the level of subsegimentary bronchi.

Differential diagnosis is carried out with chronic pneumonia, bronchial asthma, tuberculosis. In contrast, chronic pneumonia, chronic bronchitis is always evolving with a gradual start, with advanced airflow obstruction and emphysema often, respiratory failure and pulmonary hypertension with the development of chronic pulmonary heart disease. With a radiological study, the changes are also diffuse: peribrous sclerosis, increased transparency of pulmonary fields due to emphysema, expansion of the branches of the pulmonary artery. From asthma chronic bronchitis characterized by a lack of asthma attacks, with pulmonary tuberculosis is the presence or absence of symptoms of tuberculosis intoxication, Mycobacterium tuberculosis in sputum, the results of radiological and bronchoscopic studies tuberculin tests.

Treatment. In the exacerbation phase of chronic bronchitis, therapy is directed to the elimination of the inflammatory process, improving bronchial passability, as well as the restoration of impaired overall and local immunological reactivity. Prescribed antibiotic therapy, which is selected taking into account the sensitivity of the microflora of sputum, are prescribed inside or parenterally, sometimes combined with intracracial administration. Inhalation is shown. Apply expectorant, muco-lithic and bronchospaszolytic drugs, abundant drinking for restoring and improving bronchial patency. Phytotherapy with the use of altetic root, mother-and-stepmother leaves, plantain. Proteolytic enzymes (tripsin, chymotrypsin) are prescribed, which reduce sputum viscosity, but they are rarely applied. Acetylcysteine \u200b\u200bhas the ability to break the disulfide bonds of mucus proteins and contributes to a strong and rapid sputtering of sputum. Bronchial drainage is improving when using muggulators that affect the secret and on the production of glycoproteins in bronchial epithelium (bromgexine). In case of insufficiency of bronchial drainage and the existing symptoms of bronchial obstruction to treatment, bronchospasmolytic agents are added to the treatment: Eufillin, cholinoblocators (atropine in aerosols), adrenostimulants (ephedrine, salbutamol, Berothek). In the conditions of the hospital, intra-chemical washing with purulent bronchitis must be combined with sanitation bronchoscopy (3-4 reservation bronchoscopy with a break of 3-7 days). When restoring the drainage function of the bronchi, therapeutic physical culture, chest massage, physiotherapy are used. In the development of allergic syndromes, calcium chloride and antihistamines are used; In the absence of an effect, it is possible to prescribe a short Course of glucocorticoids to remove allergic syndrome, but the daily dose should not be more than 30 mg. The risk of activation of infectious agents does not allow the use of long glucic corticoids. In patients with chronic bronchitis, complicated respiratory failure and chronic pulmonary heart, the use of Veroshpiron (up to 150-200 mg / day) is shown.

Food of patients should be high-calorie, vitamined. Askorbinic acid is used 1 g per day, nicotine acid, vitamins of group B; If necessary, aloe, methyluracyl. When developing complications of such a disease, like pulmonary and pulmonary heart failure, apply OK-Sigen therapy, auxiliary artificial ventilation of the lungs.

Anti-relaxed and supporting therapy is prescribed in the phase of exacerbation amersion, it is carried out in local and climatic sanatoriums, this therapy is prescribed during dispensarization, it is recommended to highlight 3 groups of dispensary patients.

1 - I group. It includes patients with a pulmonary heart, with sharply pronounced respiratory failure and other complications, with disability. Patients are prescribed supporting therapy, which is carried out in the hospital or district doctor. The inspection of these patients is carried out at least 1 time per month.

2nd group. It includes patients with frequent exacerbations of chronic bronchitis, as well as moderate disorders of the function of respiratory organs. Inspection of such patients is carried out by a pulmonologist 3-4 times a year, anticorrdive therapy is appointed in the fall and spring, as well as with acute respiratory diseases. The effective method of administering drugs is the inhalation path, according to the indications, it is necessary to carry out a bronchial tree rehabilitation, using intraheurial washing, antibacterial drugs are prescribed during active infection.

3rd group. It includes patients who have contradiction-marvelous therapy led to the growing process and the absence of relapses over 2 years. Such a patient shows prophylactic therapy, which includes funds aimed at improving bronchial drainage and increase its reactivity.

Obstructive bronchitis

Obstructive bronchitis - diffuse inflammation of small and medium-sized bronchi, flowing with sharp bronchial spasms and progressive impaired pulmonary ventilation. Obstructive bronchitis is manifested by a cough with a moocroty, expiratory breath, whistling breathing, respiratory failure. The diagnosis of obstructive bronchitis is based on auscultative, radiological data, the results of the study of the function of external respiration. The therapy of obstructive bronchitis includes the appointment of spasmolitics, bronchodylators, mucolithics, antibiotics, inhaled corticosteroid drugs, respiratory gymnastics, massage.

Obstructive bronchitis

Bronchites (simple sharp, recurrent, chronic, obstructive) constitute a large group of inflammatory diseases of the bronchi, various in etiology, mechanisms for occurrence and clinical flow. The obstructive bronchitis in pulmonology includes cases of acute and chronic inflammation of bronchi, flowing with bronchial obstruction syndrome arising against the background of edema of mucous membranes, hypersection of mucus and bronchospasm. Acute obstructive bronchitis more often develop in young children, chronic obstructive bronchitis - in adults.

Chronic obstructive bronchitis, along with other diseases occurring with the progressive obstruction of the respiratory tract (emphysema lungs, bronchial asthma), is customary to the chronic obstructive pulmonary disease (COPD). In the UK and the United States to the COPD group also includes fibrosis, binding bronchiolitis and bronchiectic disease.

Causes of obstructive bronchitis

Acute obstructive bronchitis is etiologically associated with respiratory syncitial viruses, flu viruses, 3-type paragrippa virus, adenoviruses and rhinovirus, viral-bacterial associations. In the study of a flush with bronchi in patients with recurrent obstructive bronchitis, DNAs of persistent infectious pathogens are often distinguished - herpesvirus, mycoplasm, chlamydia. Acute obstructive bronchitis is mainly found in young children. The development of acute obstructive bronchitis is most susceptible to children, often suffering ARVIs having a weakened immunity and an increased allergic background, genetic predisposition.

The main factors contributing to the development of chronic obstructive bronchitis are smoking (passive and active), professional risks (contact with silicon, cadmium), air pollution (mainly sulfur dioxide), deficiency of antiprotease (alpha1-antitripxin) and others. The risk on the development of chronic obstructive bronchitis includes miners, works of construction specialties, metallurgical and agricultural industries, railway workers, office staff associated with seal on laser printers and other chronic obstructive bronchitis are more likely to make a man.

Pathogenesis of obstructive bronchitis

The sum of the genetic predisposition and environmental factors leads to the development of the inflammatory process, which is involved in the bronchi of small and medium caliber and peribroscial tissue. This causes a violation of the ciliary epithelium cilia, and then its metaplacia, the loss of cereal-type cells and an increase in the number of glazing cells. Following the morphological transformation of the mucous membrane, a change in the composition of the bronchial secret with the development of mucostasis and blockade of small bronchi, which leads to a violation of ventilation and perfusion equilibrium.

In the Secret of the Bronchi, the content of non-specific factors of local immunity, providing antiviral and antimicrobial protection: lactoferin, interferon and lysozyme. The thick and viscous bronchial secret with reduced bactericidal properties is a good nutrient medium for various pathogens (viruses, bacteria, fungi). In the pathogenesis of bronchial obstruction, a significant role is a significant role in the activation of the cholinergic factors of the vegetative nervous system, causing the development of bronchospastic reactions.

The complex of these mechanisms leads to an edema of the mucous membranes, hypersecretion of mucus and spasm of a smooth musculature, i.e. the development of obstructive bronchitis. In the case of irreversibility, the component of the bronchial obstruction should be thought of the COPD - the addition of emphysema and peribroscial fibrosis.

Symptoms of acute obstructive bronchitis

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

Infectious and toxic manifestations are characterized by a subfebrile body temperature, headache, dyspeptic disorders, weakness. Respiratory disorders leading in the clinic of obstructive bronchitis are. Children are worried about dry or wet obsessive cough, not bringing relief and amplifying at night, shortness of breath. Draws attention to the inflating of the wings of the nose on the breath, participation in the act of respiration of the auxiliary muscles (muscles of the neck, shoulder belt, the abdominal press), the increase in the compliant areas of the chest in respiration (intercostal intervals, jugs, the above and connectible area). For obstructive bronchitis, the elongated whistling exhalation and dry ("musical") wipes, hearing at a distance.

The duration of acute obstructive bronchitis is from 7-10 days to 2-3 weeks. In case of repeating episodes of acute obstructive bronchitis, three or more times a year, they are talking about recurrent obstructive bronchitis; When preserving the symptoms over the course of two years, a diagnosis of chronic obstructive bronchitis is established.

Symptoms of chronic obstructive bronchitis

The basis of the clinical picture of chronic obstructive bronchitis makes cough and shortness of breath. When coughing is usually separated by a slight amount of sputum mucosa; In periods of exacerbation, the amount of sputum increases, and its character becomes mucous-purulent or purulent. The cough is constant and accompanied by a whistling breath. Against the background of arterial hypertension, episodes of hemoptias may be marked.

The expiratory shortness of breath with chronic obstructive bronchitis is usually joined later, but in some cases the disease can debut immediately with shortness of breath. The severity of shortness of breath varies widely: from the sensations of the lack of air during the load to pronounced respiratory failure. The degree of shortness of breath depends on the severity of obstructive bronchitis, the presence of exacerbation, concomitant pathology.

The aggravation of chronic obstructive bronchitis can be provoked by respiratory infection, exogenous damaging factors, physical activity spontaneous pneumothorax, arrhythmia, the use of some medicines, decompensation of diabetes, and other factors. At the same time, signs of respiratory failure are growing, subfebilitation, sweating, fatigue, Malgia appears.

Objective status in chronic obstructive bronchitis is characterized by an elongated exhalation, the participation of additional muscles in breathing, remote whistling wheezes, swelling of the neck of the neck, a change in the shape of the nails ("hour glass"). When increasing hypoxia, cyanosis appears.

The severity of the flow of chronic obstructive bronchitis, according to the methodological recommendations of the Russian Society of Pulmonologists, is estimated according to the OTV1 indicator (volume of the forced exhalation of 1 sec.).

• Stage I Stage Chronic obstructive bronchitis is characterized by the value of FEV1, exceeding 50% of the regulatory value. In this stage, the disease slightly affects the quality of life. Patients do not need constant remover control of the pulmonologist.
• Stage II Chronic obstructive bronchitis is diagnosed with a decrease in FEV1 to 35-49% of the regulatory value. In this case, the disease significantly affects the quality of life; Patients require systematic observation at the pulmonologist.
• III Stage Chronic obstructive bronchitis corresponds to the OTV1 indicator of less than 34% of the proper value. At the same time, a sharp decrease in load tolerance is noted, stationary and outpatient treatment under conditions of pulmonary departments and cabinets is required.

Complications of chronic obstructive bronchitis are emphysema of light, pulmonary heart, amyloidosis, respiratory failure. For the diagnosis of chronic obstructive bronchitis, other reasons for shortness of breath and cough must be excluded, primarily tuberculosis and lung cancer.

Diagnosis of obstructive bronchitis

The program of examination of persons with obstructive bronchitis includes physical, laboratory, radiological, functional, endoscopic research. The nature of physical data depends on the form and stage of obstructive bronchitis. As the disease progresses, voice trembling weakens, a boxing percussion sound appears above the lungs, the mobility of pulmonary edges is reduced; Auscultatively revealed hard breathing, whistling wheezing with a forced exhalation, with exacerbation - wet wipes. The tonality or quantities of wheezing are changed after flipping.

Radiography of the lungs makes it possible to eliminate local and disseminated lung damage, detect concomitant diseases. Usually after 2-3 years, the flow of obstructive bronchitis is revealed to enhance the bronchial pattern, the deformation of the roots of the lungs, the emphysema of the lungs. Therapeutic diagnostic bronchoscopy during obstructive bronchitis allows you to inspect the bronchial mucosa, to carry out a wetting fence and bronchoalveolar lavage. In order to exclude bronchiectasis, the performance of bronchography may be required.

The necessary criterion for the diagnosis of obstructive bronchitis is the study of the function of external respiration. Spearometry data are most important (including inhalation tests), picoflaumetria, pneumotheometry. Based on the obtained data, the presence, degree and invertibility of bronchial obstruction, violation of pulmonary ventilation, the stage of chronic obstructive bronchitis are determined.

In the laboratory diagnostic complex, general blood and urine tests are investigated, blood biochemical indicators (total protein and protein fractions, fibrinogen, sialic acids, bilirubin, aminotransferase, glucose, creatinine, etc.). In immunological samples, the subpopulation functional ability of T-lymphocytes, immunoglobulins, CEC is determined. The definition of the brass and gas composition of blood allows us to objectively assess the degree of respiratory failure during obstructive bronchitis.

A microscopic and bacteriological study of sputum and a boating fluid is carried out, and in order to eliminate the pulmonary tuberculosis - the range of sputum by the PCR method and cube. The aggravation of chronic obstructive bronchitis should be differentiated from bronchiectatic disease, bronchial asthma, pneumonia, tuberculosis and lung cancer, Tel.

Treatment of obstructive bronchitis

With acute obstructive bronchitis, rest is prescribed, abundant drink, air humidification, alkaline and drug inhalations. Ethiotropic antiviral therapy is prescribed (interferon, ribavirin, etc.). With pronounced bronchorates, antispasmodic (papaverine, drootaverine) and musolitic (acetylcysteine, ambroxol) are used, bronchhalytic inhalers (salbutamol, orciprenaline, phenotherol hydrobromide). To facilitate sputum removal, peculiar massage of the chest, vibration massage, back muscles massage, respiratory gymnastics. Antibacterial therapy is prescribed only when the secondary microbial infection is connected.

The purpose of the treatment of chronic obstructive bronchitis is the slowdown in the progression of the disease, reducing the frequency and duration of exacerbations, improving the quality of life. The basis of pharmacotherapy of chronic obstructive bronchitis is basic and symptomatic therapy. Mandatory requirement is the cessation of smoking.

Base therapy includes the use of bronchus-sewing drugs: cholinolithics (bromide ryratopia), B2 agonists (phenoterol, salbutamol), xanthines (theophylline). In the absence of the effect of the treatment of chronic obstructive bronchitis, corticosteroid drugs are used. Mulitatic preparations are used to improve bronchial patency (ambroxol, acetylcysteine, bromhexine). Preparations can be introduced inside, in the form of aerosol inhalations, nebulizer therapy or parenterally.

When layering a bacterial component during periods of exacerbation of chronic obstructive bronchitis, macrolides, fluoroquinolones, tetracycles, B-lactams, cephalosporins, 7-14 days are prescribed. With hyperkapinia and hypoxemia, the mandatory component of the treatment of obstructive bronchitis is oxygen therapy.

Prognosis and prevention of obstructive bronchitis

Acute obstructive bronchitis are well treatable. 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 in chronic form is prognostically less favorable.

Adequate therapy helps to delay the progression of obstructive syndrome and respiratory failure. An unfavorable factors gagging the forecast serve as an elderly age of patients, concomitant pathology, frequent exacerbations, continuation of smoking, a bad response to therapy, the formation of a pulmonary heart.

The primary prevention measures of obstructive bronchitis are based on a healthy lifestyle, increasing the overall resistance to infections, improving working conditions and the environment. Principles of secondary prevention of obstructive bronchitis involve prevention and adequate treatment of exacerbations, which allows to slow down the progression of the disease.