Causes, symptoms and treatment of chronic pneumonia. Causes and treatment of chronic pneumonia

Pneumonia is an inflammation of the lungs caused by viruses in the human body. The disease is ageless and can affect people of both sexes. The disease is also geographically distributed throughout the world. In its form, inflammation of the respiratory system can have different stages of development. The most dangerous last stage, when the disease has a protracted course. In this case, it can develop into chronic inflammation in the respiratory system.

What is chronic pneumonia?

Chronic pneumonia is a constant inflammation of the respiratory organs, the consequence of which is pneumosclerosis of the lung tissue. With this type of inflammation, an irreversible development of bronchitis occurs, which also becomes chronic. In this case, bronchitis affects the same area of ​​\u200b\u200bthe lung.

At the moment, chronic pneumonia is not officially recognized as a separate type of disease. It is considered only as one of the cases of pneumonia. The medical world argues whether to classify it as a nosological unit or not. In medical practice, there have already been cases when the patient first developed an acute form of pneumonia, and then symptoms of chronic inflammation appeared. In order to distinguish between forms of the disease, behind the scenes, chronic pneumonia was divided.

The classification of the disease varies:

1. At the site of the lesion in the lung. So it can be segmental, lobar or focal.
2. According to the state of the disease process. There are two phases - remission of inflammation or exacerbation.
3. clinical manifestation. Chronic pneumonia may be bronchiectasis or without bronchiectasis.

Protracted pneumonia is constantly developing and has an exacerbation. With untimely treatment, it goes beyond the focus and affects the lung and bronchi completely. With such a disease, outwardly, the doctor can see a significant decrease in the size of the affected lung. The degree of manifestation of pneumosclerosis is determined microscopically. In some patients, carnification predominates as a result of fibrinous exudate. Carnification develops in the form of large dense nodes, the so-called spherical pneumonia. Interstitial sclerosis and carnication alternate with affected foci of emphysema. In the mucous layers there is a constant inflammatory process with a violation of the epithelium.

There is also a type of pneumonia called chronic eosinophilic pneumonia. It can appear in a person at any age. The development of eosinophilic pneumonia is rather slow. And its symptoms are characteristic of broncho-pulmonary diseases.

Features of chronic pneumonia in children

According to statistics, the chronic form of pneumonia manifests itself in only 1% of children. Often the development of the disease begins before 3 years. Usually, inflammation takes on an inflammatory character due to the severe course of acute pneumonia. Much less often, the causative agent of the disease is a viral infection, such as measles or influenza. Another cause may be metatuberculous pneumosclerosis. The disease can cause damage to the bronchi, develop purulent bronchitis. Also, prolonged inflammation can cause destruction of lung tissue. Congenital pathology of immunogenesis can contribute to the development of the disease in children. In children, one can trace the full dynamics of the development of the disease from inflammation to pneumosclerosis.

The defeat of chronic pneumonia in children entails deformation of the bronchi due to incomplete maturation of the lung. In this regard, in adulthood, a person who suffered a chronic form of pneumonia in childhood can become infected with bronchiectasis. But recently, with the development of medicine, the treatment of a protracted form of pneumonia is much easier. Therefore, the incidence of bronchiectasis in adults has decreased significantly.

Features of chronic pneumonia in adults

For adults, chronic pneumonia is accompanied by typical symptoms of bronchopulmonary diseases. In older people, prolonged inflammation can cause shortness of breath with a short movement. In almost half of the cases in an adult, a manifestation of bronchospasm begins. This form of pneumonia may be accompanied by expectoration with the presence of blood. The disease causes amyloidosis of the human internal organs.

The progressive course of chronic pneumonia in adults occurs in 15% of cases. However, only 10% have congenital or hereditary immunity deficiency. Inflammation can cause abscesses, which are revealed by x-rays. The disease contributes to the development of bronchial asthma, extrapulmonary and pulmonary complications. So, if asthma manifests itself due to local damage to the lung by pneumonia, then when the inflammation is eliminated, it disappears. and subsequent prognosis. Allocate extrapulmonary and pulmonary complications of prolonged pneumonia.

Symptoms

Chronic inflammation may not manifest itself constantly with a weak course. There is a "small form" and "bronchiectatic form" of prolonged pneumonia. At the first, severe exacerbations appear several times a year. At the same time, the patient has an elevated temperature, purulent sputum when coughing. In this case, severe intoxication of the body does not occur. A shortened sound appears above the affected area when tapped. When listening in the lungs, the doctor determines small or medium bubbling rales.

With bronchiectasis, the symptoms become more pronounced. Remissions become shorter, exacerbations occur up to 5 times a year. This form of chronic pneumonia proceeds much more severely than with the "small form". Patients show the following symptoms:

1. Elevated temperature, which does not decrease even when taking antipyretics.
2. Persistent cough with purulent sputum.
3. Intoxication of the body caused by endotoxins.
4. Secondary inflammation of the bronchi.
5. Wheezing in the lung can always be heard, regardless of whether remission occurs or not.
6. General disturbance of physical development.

Treatment

For the treatment of chronic pneumonia, it is taken into account that this form of inflammation is the result of untreated acute pneumonia. It is important not to confuse the manifestation of prolonged pneumonia with diseases such as:

• tuberculosis;
• disease of the bronchopulmonary system;
• lung anomaly;
• lung cysts.

Medicine offers many modern examination methods for an accurate diagnosis. When detecting chronic pneumonia, 3D radiography, bronchography, computed tomography and other latest methods are used.

The general picture of the treatment of chronic inflammation corresponds to the treatment of acute pneumonia. There are only small differences associated with the peculiarities of the course of prolonged pneumonia.

During an exacerbation of the disease, therapy is carried out against actively developing bacteria and viruses. Strong antibacterial drugs, taking into account the analysis of bacteria in humans, are considered the main therapy. It should be borne in mind that taking drugs should take place not only during an exacerbation of the disease, but also during periods of remission in order to reduce the possible risk of a recurrent inflammatory process.

Such therapy can significantly reduce the level of pathogens. Currently, in addition to bacteria, pneumotropic viruses become the causative agents of the disease. After taking antiviral drugs, the patient is assigned various tests. Sputum examinations are carried out, as well as bacteriological and bacterioscopic studies.

One of the best ways to reduce bacteria is eudobronchial therapy. It allows you to achieve the required concentration of medications directly in the area of ​​the lung lesion. Such treatment is especially important in the acute form of chronic pneumonia. In extreme severe forms of the disease, in addition to antibacterial agents, the patient is prescribed drugs to increase immunity. The doctor may prescribe the introduction of anti-staphylococcal-pseudomono-proteus plasma intravenously if the patient does not have an allergic reaction to any component.

For a full-fledged treatment, the doctor prescribes means that help restore the normal functioning of the bronchi. In the absence of contraindications, lung massage and physiotherapy are added to medical treatment. The doctor must prescribe ultraviolet or laser blood irradiation.

If a sick adult has persistent relapses of the disease, the doctor may suggest a lung resection. This will help prevent the spread of the infection, the affected area will be removed and it is likely that there will be no recurrence of the disease after that.

To reduce the risk of disease, a person must adhere to a healthy lifestyle. Alcohol and smoking weaken the immune system, respectively, the risk of infection is much greater. Also, to prevent the disease, it is necessary to treat other diseases of the respiratory system in a timely and effective manner. Environmental or occupational exposure should be reduced. People working in places with harmful substances must undergo mandatory medical examinations. This will help to identify the disease at an earlier stage, and not start its course to a chronic one.

Chronic inflammation of the lungs is recurrent exacerbations, the outcome of which is the restructuring and replacement of functional tissue with connective tissue, as well as deformation of the bronchial tree.

This includes nonspecific lung diseases that proceed in stages: the period of exacerbation is replaced by a period of remission. Dangerous is the constant progression of pathological changes in the lung tissue itself. On the one hand, in one focus, changes in the lung tissue gradually increase with the development of pneumosclerosis, necrosis, bronchiectasis. On the other hand, with each new inflammation, new areas of unchanged tissue are involved in the process. There is a qualitative and quantitative distribution.

Chronic pneumonia is characterized by the following characteristics:

1. Localized process - how pathology differs from diffuse lesions of the lung tissue;
2. The presence of at least one episode of acute pneumonia in history;
3. Mandatory identification of various areas of connective tissue in the lungs;
4. Undulating course with relapses and remissions.

Chronic pneumonia is always the outcome of an untreated severe acute process with complications. According to statistics, 1-3% of acute pneumonias become chronic.

The most significant factor is the patency of the bronchi at the time of pneumonia. Violation of the physiological properties of the bronchial wall leads to a decrease or complete absence of local protective reactions that do not prevent the periodic reproduction of pathogenic flora.

Increased sensitization of the body by various allergens contributes to the formation of a chronic course of pneumonia in children, especially in the presence of congenital anomalies in the structure or development of the cardiovascular and respiratory systems.

A hyperreactive immune response in the form of a massive increase in internal bronchopulmonary lymph nodes also leads to constant relapses of pneumonia.

External factors that contribute to the development of chronic pneumonia in children and adults:

• Active or passive smoking;
• High pollution, gas contamination of the place of residence;
• The presence of constant household allergens in the air;
• Harmful and dangerous volatile substances in production.

One of the reasons that can give symptoms of chronic pneumonia is the presence of a foreign body in the bronchi. Most often it occurs in children of the first years of life. Conventional X-ray examination may not always reveal obstruction in the primary process. And only repeated foci in the same place make it possible to suspect chronic pneumonia in children caused by aspiration.

Pathogenetic changes in the lung tissue

The basis is severe local changes in the alveoli and bronchi at the time of acute pneumonia. Massive necrotic changes cause irreversible consequences, a lung abscess develops. The alternation of small necrosis with relatively intact lung parenchyma leads to pneumosclerosis.

In addition to changes in the alveoli, there is a violation of the inner lining in the bronchi of small and medium sizes. Manifestations of local chronic bronchitis interfere with the main cleansing and drainage function. Hypersecretion of sputum and sclerotic changes against this background create a favorable environment for the reproduction of microorganisms.

What factors can serve as the basis:

• decrease in the reactivity of the body;
• untimely and inadequate treatment of the primary process;
• presence of chronic obstructive pulmonary disease.

Infectious agents that cause repeated relapses are represented by a mixed flora. Viruses, bacteria and protozoa with varying degrees of activity can support pneumonia. The diversity of pathogenic microorganisms involved in the etiology of chronic pneumonia causes great difficulties in the diagnosis and selection of treatment.

The most characteristic symptom is cough. In most patients, it manifests itself both in remission and in exacerbation. According to its characteristics, it is moist, with a small amount of discharge, usually mucopurulent in properties.

Percussion data are variegated, in the projection of the focus of inflammation, a shortening of the sound is noted. Important is the constancy of the auscultatory picture, in which different-sized moist rales are heard in the same place, regardless of the period of the disease.

Symptoms of exacerbation in chronic pneumonia in children appear inversely with age. That is, the older the child, the less exacerbations. In adults, during the period of remission, the symptoms of lung tissue involvement may even completely disappear.

There are two types of re-inflammation:

1. Bronchitis type - when a new inflammation captures mainly the bronchi. Clinical symptoms are more characteristic of acute bronchitis.
2. Pneumatic type - involvement in the process of alveolar tissue. Accompanied by severe intoxication, especially in young children.

On x-rays and CT scans, there is some reduction in the affected part of the lungs. Infiltrates against the background of sclerotic changes indicate a new outbreak of the infectious process. In terms of scale, changes can be focal or segmental in nature, rarely capture the entire share. From the side of the bronchi, thickening of the walls, deformation is revealed.

Taking into account the frequency of complications, their nature, the condition of patients without exacerbations, the level of respiratory failure and the presence of complications, mild, moderate and severe chronic pneumonia is distinguished.

What is the difference between chronic pneumonia and chronic pneumonia:

• manifestations do not go away more than a year from the onset of the acute phase;
• X-ray changes remain constant, there is no positive dynamics, regardless of the treatment;
• repeated outbreaks of infection in the same area of ​​\u200b\u200bthe lung speak in favor of a chronic chronic process.

Also, the differential diagnosis of chronic inflammation of the lungs is carried out with tuberculosis, chronic bronchitis, lung cancer, chronic abscess.

Features of the course with bronchiectasis

A distinctive feature is the periodic emptying of bronchiectasis. This is manifested by abundant sputum, mainly in the morning. The discharge is purulent in nature with an unpleasant, pungent odor. More pronounced manifestations of respiratory failure.

The general appearance is distinguished by pallor of the skin, dilated veins in the neck, and a barrel-shaped chest. In adults, typical forms of fingers and nails are additionally identified. Constant fatigue and low tolerance for physical activity in children can cause mental disorders, which manifest themselves in tearfulness, tantrums and reduced attention.

Complex treatment of protracted pneumonia

Depending on the severity of the exacerbation, treatment is carried out in a hospital or under the constant supervision of a visiting physician at home.

Massive antibacterial agents, taking into account bacteriological tests, are the basis of etiotropic therapy. Antihistamines, anti-inflammatory agents, immunomodulators and stimulants are needed not only in the acute phase, but also during periods of remission to reduce the likelihood of relapse.

Chronic pneumonia with bronchiectasis is treated with the active use of bronchosanation and physiotherapy to improve drainage function.

In children, with modern approaches to treatment, it is possible in most cases to achieve stabilization and prevent the progression of the pathological focus. In adults, the success of treatment directly depends on comorbidities and general immune status.

Immediately after discharge from the hospital, if possible, it is necessary to undergo sanatorium treatment. The provision of restorative measures, therapeutic exercises, physiotherapy has a beneficial effect on patients. The active use of traditional medicine, herbal medicine - are widely used and in the complex treatment are not the last.

Medical examination is mandatory 2 times a year. For patients with bronchiectasis, the number of preventive examinations and therapeutic measures to prevent relapse should be four times a year.

Pneumonia is the result of exposure to the patient's body of pathogens, which are called pneumococci, mycoplasmas and various viruses. In more than 50% of patients, the true source of chronic pneumonia and its causes cannot be identified.

Acute inflammation of the lungs occurs under the action of pathogenic bacteria. Fungi, rickettsia, viruses and simple organisms are much less likely to cause the disease.

Chronic inflammation of the lungs and its causes

A number of reasons lead to the development of chronic inflammation:

hypothermia;

various diseases of the respiratory organs;

physical exercise;

nervous stress;

intoxication.

Such reasons lower the body's resistance and contribute to the activation of microbes that are contained in the respiratory organs.

Acute and chronic inflammation of the lungs

In medical practice, there are only two types of inflammation: acute and chronic inflammation of the lungs. Acute appears suddenly: cough, fever, fever, chills. The cough is dry at first. And then sputum is released, it becomes difficult to breathe, there is a feeling of lack of air. The period of the disease is from 3-5 days to 2-4 weeks and ends with a complete recovery.

Chronic inflammation of the lungs begins with untreated acute pneumonia, when the patient, feeling relieved, quits the prescribed course of treatment and a focus of the inflammatory process remains in the lungs. Often in such areas, a relapse of the disease occurs, when part of the lung tissue is replaced by connective tissue, that is, pneumosclerosis is already forming in the lungs. In the course of such a process, lung function is impaired and they cannot fully supply oxygen to the body, so there is a significant load on the heart, and this will then affect its condition. With the disease, pulmonary heart failure develops over time.

Chronic inflammation of the lungs and its symptoms

With chronic inflammation of the lungs, the process either subsides or worsens. Signs of acute inflammation are very similar to those that are characteristic of an exacerbation of the disease, which include high fever, shortness of breath, chest pain. Frequent exacerbations of the disease lead to serious complications: pulmonary insufficiency occurs, lung ventilation is disturbed, serious changes in the cardiovascular system. Full recovery may not occur, as the painful symptoms are very slowly detected.

The treatment of chronic inflammation is very similar to that of acute pneumonia. As a preventive measure, antibiotics are prescribed. To liquefy sputum, ambroxol, bromhexine, acetylcysteine ​​are prescribed. In the treatment of chronic inflammation of the lungs, physiotherapy is mandatory. Breathing exercises, chest massage, physiotherapy exercises are carried out.

Types of pneumonia

Types of inflammation, according to the European Respiratory Society, are divided into four groups:

out-of-hospital;

atypical;

with weakened immunity;

sick leave.

Community-acquired pneumonia is an acute disease that occurs in a community setting and is accompanied by lower respiratory tract infection (dyspnea, chest pain, cough, fever, sputum production) and signs of focal infiltrative changes in the lungs on x-ray studies. Classification of the disease: aspiration pneumonia, with congenital immunodeficiency, nosocomial, community-acquired.

Atypical pneumonia: its causes and signs

Atypical pneumonia is a type of pneumonia caused by microorganisms. Today, there are the following atypical pneumonias: viral, legionella, chlamydial and mycoplasma. The disease occurs mainly in adolescents and toddlers.

Hospital-acquired pneumonia: its causes and symptoms

Hospital-acquired pneumonia appears 48 hours after the patient's hospitalization. It is provoked by staphylococcus, enterobacteria, very rarely anaerobic microflora.

The causes of pneumonia may seem banal and often arise from hypothermia, with an acute viral infection, and as a complication of other diseases. Pneumonia also occurs after prolonged exercise, smoking and malnutrition. Inflammation of the lungs of this type is not contagious, although it has an infectious nature. Often the disease occurs in the elderly, in patients who have undergone surgery, in people with weakened immune systems, with chronic diseases. The incubation period lasts 2-3 weeks. The main symptoms of the disease are hyperthermia, dry cough, sore throat, headache.

Inflammation of the lungs can be independent, or it can be a complication of other diseases, which most often occurs. Inflammation of the lungs cannot be contracted from another person.

Chronic pneumonia (chronic pneumonia) is a disease in which lung tissue becomes inflamed, and the inflammatory process is localized in a specific place, affecting the soft tissues of the lungs. Chronic pneumonia is a chronic, i.e., continuously recurring process. To prevent chronic pneumonia, you need to avoid cold infections.

The international medical community does not recognize such a disease as chronic pneumonia. That is why there is no chronic pneumonia in the international classifier of diseases. Despite this, chronic pneumonia exists.

Treatment of the lungs for chronic pneumonia should be accompanied by bed rest, proper nutrition, anti-inflammatory drugs, inhaled steroids, and other medical procedures. Hospitalization may also be indicated for treatment.

Chronic obstructive pulmonary pneumonia is a severe and incurable disease. In chronic obstructive pneumonia, bronchial patency decreases and pathological changes occur in lung tissues.

Chronic nonspecific pneumonia is a chronic inflammatory disease of the lungs, characterized by periodic outbreaks of inflammation that occur on the basis of structural changes in the tissues of the lungs and bronchi.

The reasons

The cause of the development of chronic pneumonia is unresolved. The development of the disease occurs in several stages: the acute form of the disease passes into a protracted one, and under adverse factors it develops into a chronic form.

The causes of the development of the disease lie in pathogenetic factors. The main reason is a violation of the function of the local bronchopulmonary protection system. This can occur with a decrease in the activity of alveolar macrophages and leukocytes, a decrease in phagocytosis, a deficiency of secretory IgA, a decrease in the concentration of bacteriolysins in the bronchial contents, etc. All these factors create a favorable environment for the development of an infectious inflammatory process in a separate area of ​​the lungs, which leads to such severe diseases such as focal pneumosclerosis and local deforming bronchitis. A fairly common cause of the disease is a weakened immune system. Often the disease develops due to alcohol abuse, poor nutrition.

Kinds

According to the prevalence of inflammatory processes, chronic pneumonia is:

1. focal form;
2. segmental form;
3. share form.

According to the phase of the process, pneumonia can be:

1. aggravated;
2. in remission.

According to the clinical form, they are divided into bronchiectasis pneumonia and without the presence of bronchiectasis.

Symptoms

The chronic form of the disease is always the result of an unresolved acute form of pneumonia. There is no strict time period after which it can be argued that the acute form of the disease has developed into a chronic form.

The decisive role in the diagnosis is played by the absence of positive X-ray dynamics and the appearance of repeated exacerbations of the inflammatory process in the same area of ​​the lung.

At the time of exacerbation, the patient may experience the following symptoms:

• increased sweating;
• weakness;
• decreased appetite;
• separation of sputum with an admixture of pus during a cough;
• body temperature above normal by several degrees;
• chest pain.

Warning signs of the development of the disease:

• weight loss;
• the appearance of moist small bubbling rales.

All these symptoms are signs of acute pneumonia, therefore, in order to make an accurate diagnosis, it is necessary to undergo a complete examination. X-ray examination of the lungs, blood test, bronchography, bronchoscopy, spirography, bacteriological examination of sputum will help to detect chronic pneumonia.

Medication treatment

For the treatment of chronic pneumonia, new penicillins are used - piceracillin, azlocillin, mezlocillin. German clinics are testing roxithromycin, which is better tolerated by patients than erythromycin.

If pneumonia is caused by pneumococci, then erythromycin will be quite effective, since pneumococcal resistance to erythromycin is rare. Of course, erythromycin is inferior to penicillin in its effect on pneumococcus. But the ongoing antibiotic therapy is empirical.
Erythromycin is preferred for patients with signs of penicillin allergy and for those patients in whom primary atypical pneumonia and legionnaires' disease are suspected.

Side effects from erythromycin are relatively rare - nausea, vomiting, diarrhea. Moreover, the latter is due to increased intestinal motility, especially when more than 2 g of the drug is taken per day. In single patients, allergic reactions occur, even less often - jaundice.

Chronic pneumonia in adults can develop due to weakened immunity, alcoholism. The most likely pathogens are pneumococcus, staphylococcus aureus, Haemophilus influenzae, Klebsiella. In this case, one cefamandol or mandol is used for treatment.

Chronic pneumonia, complicating chronic bronchitis - most of the pathogens are pneumococcus, Haemophilus influenzae. The drug of choice is ampicillin or a cephalosporin. Sometimes a doctor will prescribe penicillin or a cephalosporin in combination with an aminoglycoside.

The effectiveness of therapy can be determined after 2-3 days. Improvements will be indicated by a noticeable decrease in body temperature and the disappearance of signs of intoxication of the body, an improvement in the general condition of the patient. The ineffectiveness of the treatment during this time is the result of an incorrectly selected dose of an antibacterial agent and the extent of inflammatory changes in the lungs, the development of an infection that is insensitive to the selected drug.

Empiric therapy for pneumonia is continued for at least 5 days, until the body temperature is normal for 2-3 days. Usually, if penicillin, cephalosporins, or erythromycin have been prescribed, treatment rarely takes less than 10 days. Therapy of some patients lasts longer.

In the elderly and elderly, the duration of empiric therapy has not been established. But if pneumonia is not life threatening, treatment continues for at least 7-10 days. Patients in whom the disease is severe, it is necessary to give antibacterial drugs until the infiltrate in the lungs completely resolves.

At the same time, the remaining radiological changes in the lungs (strengthening, enrichment, deformation of the lung pattern, signs of peribronchial infiltration), with the patient's well-being completely normalized, cannot serve as an indication for continuing antibiotic therapy.

The prescription of antibiotics in excessive doses is fraught with pulmonary superinfection with the appearance of constant fever in the patient. To avoid this, it is advisable to prescribe antibacterial agents in the smallest effective doses. Preference should be given to one drug. Combination antibiotic therapy is justified for patients with a severe course of the disease, who must be treated immediately until the cause of the process in the lungs is established.

Herbal preparations for treatment

Plants have been used to treat human diseases since time immemorial. Information about this can be found in all cultural monuments - Sanskrit, European, Chinese, Greek, Latin, Russian, etc. Recently, interest in herbal medicine has increased in many countries of the world. It is widely used by doctors in Bulgaria, the Czech Republic and Slovakia, Poland, France, China, India, the CIS and other countries.

Along with traditional dosage forms from plants - infusions, decoctions, relatively new forms and methods are now used and applied (oxygen cocktails, aerosols, applications, herbal pastes, etc.).

Various biologically active substances have been found in medicinal plants, which determine their therapeutic value in the treatment of chronic pneumonia. Also, taking herbal remedies is necessary as a prevention of the development of chronic pneumonia.

Plants collected before flowering are included in many collections for the treatment of bronchial asthma. For the treatment of inflammatory chronic diseases of the lungs, bronchi and for the prevention of exacerbations, they are collected in early spring, when there is a shortage of vegetables, or the so-called spring desynchronosis, patients are prescribed plantain, fireweed, primrose, oats, borage, lungwort, oregano, marshmallow, which have a positive effect on the surfactant system of the lungs, prevent its vulnerability. From these plants, either vegetable salads are prepared (in which young stalks of horsetail, nettle leaves, young greens of shepherd's purse, yams, wood lice, gouts, etc.) or juices (from nettles, dandelions, chicory, cow parsnip, primrose).

Aerosol therapy

The following medicines are used in aerosols: antibacterial (taking into account the drug sensitivity of the sown nonspecific microbial flora), anti-inflammatory, thinning and deodorizing sputum (mucolytics, proteolytic enzymes, menthol, herb thyme, wild rosemary, chamomile flowers, turpentine), improving the motor function of the bronchi and blood flow in their vessels (plantain and coltsfoot leaves, St. .

Usually, treatment begins with inhalation of a bronchodilator mixture in combination with furacilin. Anti-tuberculosis drugs or broad-spectrum antibiotics are then added to the aerosol mixture.

Since the most common causative agents of acute pneumonia are pneumococci, which are usually sensitive to penicillins, along with the intramuscular administration of the sodium salt of benzylpenicillin or other antibiotics, it is advisable to additionally prescribe inhalation of aerosols of sulfanilamide preparations. Phytoncides can be included in aerosols simultaneously with antibiotics and sulfanilamide preparations.

For inhalation of phytoncides, special devices are required. In particular, fruit gruel should be placed in a glass or plastic vessel, from which phytoncides are inhaled through a tube. The course of treatment is 10-15 inhalations.

Patients in whom chronic pneumonia is severe are prescribed inhaled heparin aerosols. As a result of treatment, microcirculation in the pulmonary circulation will noticeably improve, bronchospasm will be eliminated, ventilation of the lungs will improve, and hypoxia will decrease.

- This is a local non-specific inflammation of the lung tissue, the morphological features of which are carnification, pneumosclerosis and deforming bronchitis. It is the outcome of not completely resolved acute pneumonia. It is clinically manifested by periodic recurrences of the inflammatory process (fever, sweating, weakness, cough with mucopurulent sputum). Chronic pneumonia is diagnosed taking into account radiological and laboratory signs, the results of bronchoscopy and spirography. During periods of exacerbation, antimicrobial therapy, bronchodilators, mucoregulators are prescribed; bronchoscopic sanitation, massage, FTL are carried out. With frequent exacerbations, a lung resection is indicated.

ICD-10

J18 Pneumonia without specification of the causative agent

General information

Pathogenesis

The morphological basis of chronic pneumonia is irreversible changes in the lung tissue (pneumosclerosis and / or carnification) and bronchi (deforming bronchitis). These changes lead to impaired respiratory function, predominantly of a restrictive type. Hypersecretion of mucus, combined with ineffective drainage capacity of the bronchi, as well as impaired aeration of the alveoli in the area of ​​pneumosclerosis, lead to the fact that the affected area of ​​the lung becomes the most vulnerable to various kinds of adverse effects. This finds expression in the occurrence of repeated local exacerbations of the broncho-pulmonary process.

Classification

The lack of common views on the essence of chronic pneumonia has led to the existence of many classifications, but none of them is generally accepted. "Minsk" (1964) and "Tbilisi" (1972) classifications are currently of historical interest and are not used in everyday practice.

Depending on the prevailing pathomorphological changes, chronic pneumonia is usually divided into carnifying (carnification prevails - overgrowing of the alveoli with connective tissue) and interstitial (interstitial pneumosclerosis prevails). These forms correspond to their own clinical and radiological picture.

According to the prevalence of changes, focal, segmental (polysegmental) and lobar chronic pneumonia are distinguished. Taking into account the activity of the inflammatory process, the phases of remission (compensation), sluggish inflammation (subcompensation) and exacerbation (decompensation) are distinguished.

Symptoms of chronic pneumonia

The criteria for the transition of acute pneumonia to chronic is the absence of positive X-ray dynamics in the period from 3 months to 1 year or longer, despite prolonged and intensive therapy, as well as repeated relapses of inflammation in the same area of ​​the lung.

During periods of remission, symptoms are scarce or absent. The general condition is satisfactory, an unproductive cough in the morning is possible. With an exacerbation of chronic pneumonia, subfebrile or febrile temperature, sweating, and weakness appear. The cough intensifies and becomes constant, the sputum acquires a mucopurulent or purulent character. There may be pain in the chest in the projection of the pathological focus, occasionally hemoptysis occurs.

The severity of exacerbations can vary significantly: from relatively mild forms to severe ones that occur with symptoms of cardiopulmonary insufficiency. In the latter case, patients have expressed intoxication, shortness of breath at rest, cough with a large amount of sputum. The exacerbation resembles a severe form of croupous pneumonia.

With insufficiently complete or too short treatment, the exacerbation does not go into remission, but is replaced by sluggish inflammation. In this phase, mild fatigue persists, occasional dry cough or phlegm, shortness of breath with physical effort. The temperature may be normal or subfebrile. Only after additional, carefully conducted therapy, the sluggish process is replaced by remission. The most important complications of chronic pneumonia, affecting its subsequent course, are emphysema, diffuse pneumosclerosis, bronchiectasis, asthmatic bronchitis.

Diagnostics

Mandatory methods of confirmatory diagnosis include X-ray (lung x-ray, bronchography), endoscopic (bronchoscopy), functional (spirometry), laboratory examination (OAC, blood biochemistry, microscopic and bacteriological analysis of sputum).

Radiography of the lungs in 2 projections is crucial in the verification of chronic pneumonia. On radiographs, the following signs can be detected: a decrease in the volume of a lung lobe, deformation and heaviness of the lung pattern, focal shadows (during carnification), peribronchial infiltration, pleural changes, etc. Fresh infiltrative shadows are found in the exacerbation phase against the background of pneumosclerosis. Bronchography data indicate deforming bronchitis (roughness of contours and uneven distribution of contrast are determined).

Bronchological examination may reveal catarrhal (without exacerbation) or purulent (with exacerbation) bronchitis, more pronounced in the corresponding segment or lobe. In uncomplicated forms of chronic pneumonia, the parameters of respiratory function may change insignificantly. With concomitant diseases (obstructive bronchitis, emphysema), FZhOL and VZhOL, the Tiffno index and other values ​​decrease.

Changes in general and biochemical blood tests are more characteristic of the exacerbation phase of chronic pneumonia. During this period, there is an increase in ESR, leukocytosis with a shift to the left, an increase in fibrinogen, alpha and gamma globulins, seromucoid, haptoglobin. Sputum microscopy reveals a large number of neutrophils; bakanalyst allows you to determine the nature of pathogenic microflora.