Bronchopulmonary infection symptoms. Expectorants in the treatment of bronchopulmonary diseases. A new form of sustained release ciprofloxacin in the treatment of patients with bronchopulmonary diseases

1. Bronchitis

Classification of bronchitis (1981)

Acute (simple) bronchitis

Acute obstructive bronchitis

Acute bronchiolitis

Recurrent bronchitis, obstructive and non-obstructive

With the flow:

exacerbation,

remission

1.1. Acute (simple) bronchitis- This is usually a manifestation of a respiratory viral infection. The general condition of the patients was slightly disturbed. Typical cough, fever for 2-3 days, maybe more than 3 days (the duration of the temperature reaction is determined by the underlying viral disease). There are no percussion changes in the lungs.

Auscultatory-common (scattered) dry, coarse and medium bubbling wet rales. The duration of the disease is 2-3 weeks.

Examination methods: patients with acute bronchitis do not need X-ray and laboratory examinations in most cases. A chest x-ray and blood test are needed if pneumonia is suspected.

Treatment of patients with bronchitis is carried out at home. Hospitalization is required for young children and patients with a persistent temperature reaction. Children are in bed for 1-2 days, at a low temperature, a general regimen can be resolved. Treatment table 15 or 16 (depending on age). Drinking regimen with sufficient fluid intake; compotes, fruit drinks, water, sweet tea, screams, older children - warm milk with Borjomi.

Drug therapy is aimed at reducing and alleviating cough. In order to reduce cough, they are prescribed:

libexin 26-60 mg per day, i.e. 1/4-1/2 tablets 3-4 times a day to swallow without chewing);

tusuprex 6-10 mg per day, i.e. 1/4-1/2 tablets 3-4 times a day or Tusuprex syrup 1/2-1 tsp. (in 1 tsp - 6 ml);

glauvent 10-25 mg, i.e. 1/1-1/2 tablets 2-3 times a day after meals.

Bromhexine and mucolytic drugs relieve cough, contribute to sputum thinning, improve the function of the ciliated epithelium, Bromhexine is recommended for children aged 3 to 6 years - at a dose of 2 mg, i.e. 1/4 tablet 3 times a day, from 6 to 14 years - 4 mg, i.e. 1/2 tablet 3 times a day. Bromhexine is not prescribed for children under the age of 3! Ammonia-anise drops and breast elixir have a mucolytic effect (to take as many drops as the child's age), percussion (to take from 1/2 tsp to 1 des.l 3 times a day) and chest preparations (No. 1 : marshmallow root, coltsfoot leaf, oregano herb - 2:2:1; No. 2: coltsfoot leaf, plantain, licorice root - 4:3:3; No. 3: sage herb, anise fruit, pine buds, marshmallow root, licorice root - 2:2:2:4:4). Prepared decoctions give 1/4-1/3 cup 3 times a day.

In the hospital, from the first days of illness, steam inhalations are prescribed (for children over 2 years old!) With a decoction of breast preparations or infusions of chamomile, calendula, mint, sage, St. , inhalations are carried out 3-4 times a day). You can use ready-made tinctures of mint, eucalyptus, calendula, plantain juice, kolanchoe from 15 drops to 1-3 ml per inhalation, depending on age. Thermal procedures: mustard plasters on the chest, warm baths.

Dispensary observation for 6 months. In order to prevent recurrence of bronchitis, the nasopharynx is sanitized in persons surrounding a sick child. After 2-3 months. prescribe (for children over 1.6-2 years old) inhalations with decoctions of sage, chamomile or St. John's wort daily for 3-4 weeks and a complex of vitamins. Preventive vaccinations are carried out after 1 month. subject to full recovery.

1.2. Acute obstructive bronchitis is the most common form of acute bronchitis in young children. Obstructive bronchitis has all the clinical signs of acute bronchitis in combination with bronchial obstruction. Observed; prolonged exhalation, expiratory noise ("whistling" exhalation), wheezing on exhalation, participation in the act of breathing of auxiliary muscles. At the same time, there are no signs of severe respiratory failure. Cough dry, infrequent. The temperature is normal or subfebrile. The severity of the condition is due to respiratory disorders with mild symptoms of intoxication. The current is favorable. Respiratory disorders decrease within 2-3 days, wheezing wheezes are heard for a longer time.

Young children with bronchial obstruction syndromes must be hospitalized.

Examination methods:

General blood analysis

ENT specialist consultation

Allergy examination of children after 3 years of age for the purpose of early diagnosis of allergic bronchospasm

Consultation with a neurologist if there is a history of perinatal CNS injury.

1. Euphyllin 4-6 mg/kg IM (single dose), with a decrease in symptoms of bronchial obstruction, continue to give euphyllin 10-20 mg/kg per day evenly every 2 hours orally.

2. If eufillin is ineffective, administer a 0.05% solution of alupent (orciprenaline) 0.3-1 ml IM.

3. In the absence of effect and deterioration of the condition, administer prednisolone 2-3 mg/kg IV or IM.

In the following days, antispasmodic therapy with eufillin is indicated for those children in whom the first administration of the drug was effective. A 1-1.5% solution of etimizole IM 1.5 mg/kg (single dose) can be used.

Dispensary observation is to prevent repeated episodes of bronchial obstruction and recurrence of bronchitis. For this purpose, inhalations of decoctions of sage, St. John's wort, chamomile are prescribed daily for 3-4 weeks in the autumn, winter and spring seasons of the year.

Preventive vaccinations are carried out after 1 month. after obstructive bronchitis, subject to complete recovery.

1.3. Acute bronchiolitis is a widespread lesion of the smallest bronchi and bronchioles, leading to the development of severe airway obstruction with the development of symptoms of respiratory failure. Mostly children of the first months of life are ill (parainfluenza and respiratory syncytial bronchiolitis), but children of the second or third year of life can also be ill (adenoviral bronchiolitis).

Obstructive syndrome often develops suddenly, accompanied by a sonorous dry cough. The increase in respiratory disorders is accompanied by a sharp anxiety of the child, low-grade (with parainfluenza and respiratory syncytial infection) or febrile (with adenovirus infection) temperature. The severe and extremely serious condition of the patient is due to respiratory failure. Chest distention, a boxed shade of percussion sound is determined, a mass of finely bubbling and crepitating rales is heard during auscultation of the lungs. Diffuse changes in the lungs against the background of severe obstruction with a very high probability (up to 90-95%) rule out pneumonia. Radiographically determined swelling of the lungs, increased bronchovascular pattern, possible microatelectasis. Complications of bronchiolitis can be reflex respiratory arrest, the development of pneumonia, repeated episodes of bronchial obstruction (in almost 50% of patients).

Examination methods:

Radiography of the lungs in two projections

General blood analysis

Determination of the acid-base state of the blood (KOS)

Mandatory hospitalization for emergency care

oxygen inhalation. Humidified oxygen supply through nasal catheters, children over 1-1.6 years old in the oxygen tent DPC-1 - 40% oxygen with air

Removal of mucus from the respiratory tract

Infusion therapy in the form of intravenous drip infusions is indicated only taking into account hyperthermia and fluid loss during shortness of breath

Antibiotic therapy is indicated, since it is difficult to exclude pneumonia on the first day of the increase in the severity of the patient's condition. Semi-synthetic penicillins are prescribed, in particular, ampicillin 100 mg / kg per day in 2-3 injections (it should be noted that antibiotic therapy does not reduce the degree of obstruction!)

Eufillin 4-5 mg/kg IV or IM (single dose), but not more than 10 mg/kg per day (reduction in the severity of obstruction is observed only in 50% of patients!!)

If eufillin is ineffective, inject a 0.05% solution of adupent (orciprenaline) 0.3-0.5 ml / m. You can use inhalations of Alupent 1 silt for one inhalation, the duration of inhalation is 10 minutes.

Obstructive syndrome, which is not stopped for a long time by the administration of aminophylline, alupent, requires the appointment of corticosteroids: prednisolone 2-3 mg / kg parenterally (in / in or / m)

Cardiotonic drugs for tachycardia!) - intravenous drip of a 0.05% solution of corglycone 0.1-0.6 ml every 6-8 hours.

Antihistamines are not indicated! Their drying, atropine-like action may exacerbate bronchial obstruction.

In severe cases of respiratory failure, mechanical ventilation is prescribed.

Dispensary observation of children who have had bronchiolitis is aimed at preventing further sensitization and recurrent episodes of bronchial obstruction. For children with repeated obstructive episodes, after the age of 3 years, skin tests with the most common allergens (dust, pollen, etc.) are recommended.

Positive skin tests, as well as attacks of obstructive boa virus infection, indicate the development of bronchial asthma.

Preventive vaccinations for patients with bronchiolitis. carried out no earlier than 1 month. subject to full recovery.

1.4. Recurrent bronchitis - bronchitis that recurs 3 times or more during the year with an exacerbation duration of at least 2 weeks, occurring without clinical signs of bronchospasm, with a tendency to a protracted course. It is characterized by the absence of irreversible, sclerotic changes in the bronchopulmonary system. The onset of the disease can be in the first or second year of life. This age is of particular importance in the occurrence of relapses of bronchitis due to the weak differentiation of the epithelium of the respiratory tract and the immaturity of the immune system. However, the diagnosis can be made with certainty only in the third year of life. Recurrent bronchitis affects mainly children of early and preschool age.

The clinical picture of bronchitis recurrence is characterized by an acute onset, an increase in temperature to high or subfebrile numbers. Recurrence of bronchitis is possible at normal temperatures. At the same time, a cough appears or intensifies. Cough has the most diverse character. More often it is wet, with mucous or mucopurulent sputum, less often dry, rough, paroxysmal. It is the cough that grows in intensity that often serves as a reason for going to the doctor. Cough can be provoked by physical activity.

Percussion sound above the lungs is not changed or with a slight box shade. The auscultatory picture of bronchitis recurrence is diverse: against the background of harsh breathing, wet coarse and medium bubbles are heard. as well as dry rales, variable in nature and localization. Wheezing is usually heard for a shorter time than cough complaints. It should be noted that in patients with recurrent bronchitis, increased coughing is often detected, i.e. children begin to cough after a slight cooling, physical activity, with the next SARS.

Forecast. In the absence of adequate therapy, children get sick for years, especially those who fell ill at an early and preschool age. There may be a transformation of recurrent bronchitis into asthmatic and bronchial asthma. A favorable course of recurrent bronchitis is observed in children in whom it is not accompanied by bronchospasm.

Examination methods:

Blood analysis

Bacteriological examination of sputum

X-ray of the lungs (in the absence of an X-ray examination during periods of previous relapses of bronchitis and if pneumonia is suspected)

Bronchoscopy to diagnose the morphological form of endobronchitis (catarrhal, catarrhal-purulent, purulent)

Cytological examination of bronchial contents (smears-prints from the bronchi)

Examination of the function of external respiration; pneumotachotomy to determine the state of airway patency, spirography to assess the ventilation function of the lungs

Immunogram

Patients with exacerbation of recurrent bronchitis are desirable to be hospitalized, but treatment is also possible on an outpatient basis.

It is necessary to create an optimal air regime with an air temperature of 18-20C and a humidity of at least 60%

Antibacterial therapy, including antibiotics, is prescribed if there are signs of bacterial inflammation, in particular, purulent sputum. Courses of antibiotic therapy (ampicillin 100 mg/kg, gentamicin Z-5 mg/kg, etc.) are prescribed for 7-10 days

Inhalation therapy is one of the most important types of therapy in the medical complex, prescribed to eliminate the violation of bronchial patency.

It is carried out in three stages. At the first stage, he prescribes inhalations of solutions of salts, alkalis and mineral waters. The mixture prepared from equal volumes of 2% sodium bicarbonate solution and 5% ascorbic acid solution is effective for thinning and sputum discharge, the volume of the inhalation mixture by age. In the presence of mucopurulent sputum, enzyme preparations are administered by inhalation (Appendix No. 1). The duration of the first stage is 7-10 days.

At the second stage, antiseptics and phytoncides are administered by inhalation. For this purpose, onion and garlic juice, decoctions of St. The duration of the second stage is 7-10 days.

At the third stage, oil inhalations are prescribed. Uses vegetable oils with a protective effect. The duration of the third stage is also 7-10 days.

Mucolytic (secretolytic) agents (see section acute simple bronchitis) are prescribed only at the first stage of inhalation therapy

Expectorant (secretory) means; decoctions and infusions of herbs (thermopsis, plantain, coltsfoot, thyme, wild rosemary, oregano), marshmallow root, licorice and elecampane, anise fruits, pine buds. Of these medicines are medicinal fees used to relieve coughs.

Physiotherapeutic procedures: microwaves on the chest (electromagnetic oscillations of the ultra-high frequency of the centimeter range, SMV, the Luch-2 apparatus and the decimeter range, UHF, the Romashka apparatus.

Treatment of patients with exacerbation of recurrent bronchitis is carried out (at home or in a hospital) for 3-4 weeks. Patients with recurrent bronchitis should be registered with the dispensary. Children are supervised by local pediatricians. The frequency of examinations depends on the duration of the disease and the frequency of relapses, but at least 2-3 times a year. If there is no recurrence of bronchitis within 2-3 years, the patient can be deregistered. Consultations of specialists are carried out according to indications: a pulmonologist in case of suspected development of a chronic bronchopulmonary process; an allergist in case of bronchospasm; otolaryngologist to monitor the condition of the ENT organs.

Rehabilitation of patients with recurrent bronchitis is carried out according to the principle of improvement of frequently ill children:

1. Sanitation of foci of chronic infection in the upper respiratory tract: chronic tonsillitis, sinusitis, adenoiditis

2. Elimination of concomitant diseases of the digestive system: dyskinesia of the biliary system, intestinal dysbacteriosis, etc.

3. Correction of metabolic disorders is prescribed during the year. Approximate scheme:

August - riboxin and potassium orotate;

September - vitamins B1, B2, calcium pantetonate and lipoic acid;

October - Eleutherococcus tincture;

November multivitamin preparations (decamevit, aerovit, undevit, hexavit, kvadevit, etc.), lipoic acid;

December - tincture of aralia, inhalation with a decoction of plantain;

January - vitamins B1, B2. calcium pantetonate and lipoic acid;

February - riboxin and potassium orotate;

March - multivitamin preparations;

April - vitamins B1, B2, calcium pantetonate, lipoic acid;

May - Eleutherococcus tincture (Pantocrine).

Complexes are prescribed in age dosages for 10-day courses

4. Adaptogen preparations: methyluracil 0.1-0.6 orally 3-4 times a day after or during meals, 3-4 weeks. Dibazol 0.003-0.03 1 time per day. 3-4 weeks

b. Inhalations with sage decoction, 25-30 inhalations daily in winter, spring

6. Reaferon (genetically engineered - interferon) intranasally in doses of 300 and 600 IU for 6 days (winter, spring)

7. Speleotherapy for children over 5 years of age to normalize mucociliary clearance and improve sputum evacuation, daily, 20 sessions

8. Therapeutic exercise

9. Massage: acupressure, classic, vibration

10. Hardening procedures.

During the rehabilitation period, an immunological examination of patients is carried out. In cases of detection of immunodeficiency syndrome, immunocorrective therapy is indicated after consultation with a clinical immunologist.

1.6. Recurrent obstructive bronchitis has all the clinical symptoms of recurrent bronchitis, accompanied by episodes of bronchial obstruction. Like recurrent bronchitis, it refers to pre-asthma.

Examination methods:

Functional ventilation test with bronchodilators. The following indicators are used: lung capacity (VC). maximum lung ventilation (MVL), expiratory pneumotachometry (PTV), forced vital capacity (FVC).

The listed ventilation parameters are recorded before and after the introduction of a bronchodilator (ephedrine, aminophylline). The presence of bronchospasm in the examined patients is indicated by an increase in 2-3 out of 4 indicators, more often VC and MVL. A positive functional ventilation test with bronchodilators, indicating bronchospasm, requires differential diagnosis of recurrent obstructive bronchitis with asthmatic bronchitis.

Other methods of examination of patients with obstructive recurrent bronchitis are similar to examination of children with recurrent bronchitis.

Treatment of patients with recurrent obstructive bronchitis is carried out according to the same principle as in patients with recurrent obstructive bronchitis. In addition, bronchospasmolytics are prescribed - eufillin, alupent (see Treatment of acute obstructive bronchitis). Dispensary observation of patients is aimed at preventing recurrence of bronchial obstruction and bronchitis. Rehabilitation of patients is based on the same principle as for patients with recurrent bronchitis. Rehabilitation measures are planned taking into account the results of an allergological examination with the most common allergens. In the process of dispensary observation and according to the allergological examination, the diagnosis of "recurrent obstructive bronchitis" can be verified. Probable diagnoses may be asthmatic bronchitis, and in the presence of typical attacks of suffocation - bronchial asthma.

1.6. Bronchial asthma is a chronic allergic disease in which the immunopathological process is localized in the bronchopulmonary system and is clinically characterized by recurrent, reversible asthma attacks caused by an acute violation of bronchial patency.

Classification of clinical forms of bronchial asthma (S.S. Kaganov, 1963)

Form of the disease

1. Atopic

2. Infectious-allergic

3. Mixed

Typical:

1. Severe attacks of bronchial asthma

2. Asthmatic bronchitis

Atypical:

Attacks of acute emphysematous swelling of the lungs

Severity

2. Moderate

3. Heavy

Severity indicators:

1. Frequency, nature and duration of seizures

2. The presence and severity of changes in the interictal period from:

a) respiratory systems;

b) cardiovascular system;

c) nervous system;

d) metabolic processes:

e) physical development;

1. With individual attacks, with an asthmatic condition, with asphyxia syndrome

2. With bronchopulmonary infection, with inflammatory changes in the nasopharynx

3. With concomitant allergic diseases:

a) with allergic dermatoses (eczema, urticaria, Quincke's edema);

b) with other clinical forms of respiratory allergies (allergic rhinitis, sinuitis, tracheitis, bronchitis, pneumonia, eosinophilic pulmonary infiltrate)

4. With complications:

a) chronic (persistent) pulmonary emphysema;

b) cor pulmonale;

c) lung atelectasis;

d) pneumothorax;

e) mediastinal and subcutaneous emphysema;

e) neurological disorders;

With a mild degree of the course of the disease, exacerbations are rare and short-lived, with moderate-severe bronchial asthma, exacerbations are monthly. The severe course of bronchial asthma is characterized by frequent exacerbations. Attacks of suffocation occur weekly, and often daily with the transition to an asthmatic state. An attack of bronchial asthma, lasting from several minutes to several hours and days, is determined by acute bronchospasm. There is expiratory dyspnea with noisy wheezing. Patients are concerned about coughing with difficult to separate viscous sputum. Percussion of the lungs reveals a boxy shade of percussion sound, auscultation reveals multiple dry rales. In young children, different-sized moist rales are heard in the lungs, since at this age during an attack of bronchial asthma, not bronchospasm prevails, as in older children, but inflammatory swelling of the bronchial mucosa and excessive production of mucus.

The atopic form of bronchial asthma is characterized by an acute development of an attack, and in mild cases, bronchial patency can be restored fairly quickly.

Exacerbation of infectious-allergic bronchial asthma begins slowly and gradually. Obstructive syndrome, with the appointment of bronchospasmolytic agents, is stopped slowly.

In the lungs for a long time, not only dry, but also various wet rales are heard.

With a mild attack of bronchial asthma, the well-being of patients suffers little. A moderately severe attack has a clinical picture of asthmatic suffocation. Auxiliary muscles are involved in the act of breathing, tachycardia and an increase in blood pressure are observed. A severe attack is characterized by clinical symptoms of respiratory failure against the background of severe asthmatic suffocation.

An intractable attack of bronchial asthma lasting 6 hours or more is classified as an asthmatic condition that can turn into status asthmaticus. With asthmatic status II and III Art. there comes a total obstruction of the bronchi as a result of filling them with a thick viscous secret, a pronounced inflammatory infiltration of the mucous membrane and spasm of smooth muscles. Breathing noises disappear in the lungs ("silence" syndrome), there is a decrease in blood pressure, muscle hypotension, and a drop in cardiac activity.

Forecast: the course of bronchial asthma is difficult to predict. Parents of sick children should not count on a speedy recovery. Their energy should be directed to long-term treatment, which would prevent the occurrence of new attacks, and alleviate their severity. The atopic form of bronchial asthma is prognostically more favorable with the timely detection of causally significant allergens and specific hyposensitization. Infectious-allergic and mixed forms of bronchial asthma more often than atopic, remain throughout childhood, adolescence and become a disease of an adult.

Examination methods:.

1. Complete blood count

2. Immunogram (determination of T-I B-lymphocytes, Tn-helpers, Ts-suppressors, Tn / Ts index, serum immunoglobulins, circulating immune complexes (CICs)

3. Study of the acid-base state of the blood (KOS)

5. Consultation of an ENT specialist with subsequent sanitation of foci of chronic infection in the ENT organs

6. In the interictal period, skin prick tests with non-infectious allergens.

7. Radioallergosorbent test (RAST), which allows to detect specific immunoglobulins (class E-IgE) in blood serum.

A mild asthma attack can be relieved at home. For this purpose, bronchospasmolytics are prescribed orally or in the form of inhalation: ephedrine (for children from 2 to 6 years old, 0.003-0.01 g each, from 6 to 12 years old, 0.01-0.02 g each), eufillin 3-4 mg / kg (single dose) up to 12-16 mg / kg per day. Combined preparations can be used: theofedrin, antasman (children from 2 to 6 years old 1/4-1/3 tablets per dose, children from 6 to 12 years old 1/2-3/4 tablets), solutan at a dosage of 1 drop for 1 year life. It is also recommended orciprenaline (0.76 mg per inhalation or 1/4-1/2 tablets orally), alupent (1-2 inhalations or 1/4 tablets for children under 6 years old, from 6 years and older 1/2 tablets), 1 5% solution of Asthmopent and Berotek 1-2 inhalations, salbutamol (inhalation pack - 0.1 mg of the drug, children from 4 to 7 years old 1 inhalation, school-age children 1-2 inhalations), ventolin (in inhalation packs are prescribed in the same dosage, like salbutamol, orally for children 3-4 years old 1/6 tablet, 6-7 years old 1/3 tablet, 7-14 years old 1/2 tablet).

Patients with moderate to severe asthma attacks should be hospitalized immediately. The following activities should be carried out in the hospital.

A moderate attack can be stopped with fast-acting sympathomimetics, for example, parenteral administration of a 0.1% solution of adrenaline s / c at the rate of 0.01 mg / kg in combination with a 5% solution of ephedrine 0.6-0.75 mg / kg. The action of adrenaline occurs after 15 minutes, ephedrine after 45 minutes, the duration of the action of these drugs is 4-6 hours. 6 mg/kg single dose). After the removal of acute manifestations of a moderate attack, in order to stabilize the condition of patients, it is advisable to conduct a 5-7-day course of treatment with eufillin or ephedrine, prescribing a single dose of drugs orally 3-4 times a day.

Antihistamines are used if there is no difficulty in sputum discharge. Obligatory oxygen therapy!

A severe attack of bronchial asthma requires immediate intravenous administration of aminophylline at the rate of 6-8 mg/kg (single dose) or 1 ml per year of life, but not more than 10 ml. Outside the hospital, the drug can be injected in a jet, but slowly, over 5-10 minutes. in 10-15 ml of 15-20% glucose solution. In the hospital, it is necessary to administer aminophylline IV, drip into 150-250 ml of isotonic sodium chloride solution. Severe respiratory failure and resistance to previously used sympathomimetics require intravenous administration of prednisolone (1-2 mg/kg) or hydrocortisone (5-7 mg/kg).

Oxygen therapy in a somatic hospital: humidified oxygen for 20-30 minutes. every 2 hours, in a specialized department, an oxygen-air mixture containing 35-40% oxygen.

After the removal of an attack of bronchial asthma, treatment with eufillin should be continued until the obstructive syndrome is completely eliminated, but the method of administration of the drug can be changed by administering it intramuscularly or orally, or in suppositories. The treatment is supplemented by the appointment of mucolytic drugs (mucaltin, bromhexine, decoctions of herbs: thyme, elecampane, plantain, infusions of birch buds, pine needles, etc.).

Treatment of patients with stage I asthmatic status, which is a prolonged severe attack of bronchial asthma, is carried out according to the same program with the addition of antibiotic therapy due to the activation of bronchopulmonary infection. Semi-synthetic penicillins or aminoglycoside are recommended, cephalosporins may be prescribed.

If metabolic acidosis is detected, in order to correct it, a 4% sodium bicarbonate solution is prescribed at the rate of 2-2.5 ml / kg under the control of blood pH (required level 7.25); heparin 180-200 units / kg (under the control of a coagulogram); 1% solution of lasix 0.5 mg/kg per day (with insufficient diuresis); cardiotonic drugs - 0.06% solution of corglicon for children aged 2 to 5 years 0.2-0.5 ml, from 6 to 12 years 0.5-0.75 ml. Repeated drip introduction of aminophylline! Continue the introduction of prednisolone, but inside 5-7 days with a gradual withdrawal within two weeks. Treatment of asthmatic status should be carried out with the appointment of a hypoallergenic diet or fasting day with kefir.

Asthmatic status II Art. requires expanding the scope of therapeutic intervention aimed at restoring bronchial patency. In this state, the dosage of prednisolone is increased to 3-5 mg/kg, which is administered intravenously along with zufillin. Metabolic acidosis needs to be corrected. Clinical signs of heart failure require the appointment of cardiotonic agents with simultaneous intravenous administration of 50-100 mg of cocarboxylase and potassium preparations. Shown therapeutic bronchoscopy with the removal of mucus and the introduction of sodium bicarbonate solutions into the lumen of the bronchi. As the patient's condition improves, the dose of prednisolone is reduced to 1-1.5 mg / kg with the appointment of it inside for 2-2.5 weeks, followed by cancellation.

Asthmatic status III Art. requires the transfer of the child to the intensive care unit and the appointment of mechanical ventilation. It is possible to carry out plasmapheresis or hemosorption. The dose of prednisolone is increased to 6-10 mg/kg, of which 4-8 mg/kg is administered intravenously, 2 mg/kg orally. At the same time, aminofillin and cardiotonic drugs are prescribed according to the previous program. Treatment with corticosteroids is carried out with their gradual abolition within 3-4 weeks. During the period of withdrawal of corticosteroids, it is advisable to prescribe calcium pantetonate (vitamin B5). vitamin B6, etimizol, glyceram, inductothermy on the adrenal region. Withdrawal syndrome can be prevented by administering hormone aerosols: becotide, beclamat.

Rehabilitation

1. Home regimen with the exclusion of causally significant allergens. Complete prohibition in the apartment and house of smoking, keeping animals, fish, birds, refusal of drugs to which an allergic reaction was noted

2. Medical nutrition with the exclusion of obligate food allergens

3. Sanitation of foci of chronic infection of the upper respiratory tract in the patient and in those surrounding the sick child

4. Identification and treatment of chronic diseases of the digestive system (dyskinesia of the biliary system and cholecystitis, duodenogastric reflexes and gastroduodenitis), deworming, treatment of giardiasis, intestinal dysbacteriosis. The appointment of biologically active drugs (lacto-, coli-, bifidumbacterin, sour-milk bifidumbacterin) for 1-1.5 months, enzyme preparations for 2 weeks, enterosorbents (activated charcoal from 10 to 30 g per day, cholestyramine according to 4-8 g per day for 5-7 days and vazazan-r at the same dosage for 5-7 days at night; enterodez 10% solution up to 150-200 ml orally, in 3-4 doses during the day

5. Courses of vitamin B6 50-100 mg for 1-2 months.

6. Intal or ifiral inhalations 2-4 times a day for 2-4 months. It is also possible to use intal for a longer period (from 1 year to 3 years) if it maintains a stable remission.

7. Zaditen (ketotifen), a single dose of 0.025 mg / kg, 2 times a day or 0.125 ml / kg as a syrup 2 times a day, in the morning and in the evening, 6-9 months; astafen 1 mg twice daily with food for several weeks

8. Teopec - first 1/2 tablet 1-2 times a day, and then 1 tablet 2 times a day, orally after meals with water for 1-2 months. Do not chew or dissolve in water!!

9. Histoglobulin: a course of treatment of 5 injections with an interval of 3-4 days, starting with 0.5 ml, then 1 ml. Repeated courses in 2-3 months.

human placental blood 6 ml 2 times a month for 2 months.

11. Acupuncture 15-20 sessions daily / or every other day, 2-3 courses per year

12. Speleotherapy

13. Patients with hormone-dependent bronchial asthma are prescribed prednisolone in a maintenance dosage of 5-15 mg per day. Against the background of treatment with zaditen (ketotifen, astafen), it is sometimes possible to cancel corticosteroids or reduce their dosage

14. In atopic form of bronchial asthma 15% solution of dimephosphone 75-100 mg/kg (10-15 ml 3 times a day. Orally, for one month.)

15. Inhalations of 5% solution of unithiol (0.1 ml/kg) in combination with oil inhalations of vitamin E 2-3 mg/kg, 10-15 inhalations per course of treatment. Repeated prophylactic courses 2-3 times a year, 10 inhalations of each drug every other day (the best effect with medium-severe mixed and atopic forms of bronchial asthma)

16. Possible long-term (from several months to a year), continuous use of theophylline

17. Vilozen electrophoresis on the chest, 8-10 procedures daily. Repeated courses in autumn-winter-spring

18. Specific hyposensitization (SG-therapy) is carried out mainly by household and pollen allergens

19. Regular physical therapy, 2-3 times a day, for a long time

20. Various forms of massage (general, vibration, acupressure)

21. Sanatorium treatment in mountain-climatic conditions. Volunteers with bronchial asthma are not removed from the dispensary. They are subject to the supervision of the local doctor and the doctor of the adlergological office. During the rehabilitation period, an immunological examination of patients is carried out and, according to indications, immunocorrective therapy is prescribed.

Asthmatic bronchitis is a type of bronchial asthma. The development of asthmatic bronchitis is based on allergic edema of the bronchial mucosa and blockage of the airways with mucous secretions. In asthmatic bronchitis, an allergic reaction develops mainly in the bronchi of medium and large caliber, in contrast to bronchial asthma, in which small bronchi and bronchioles are involved in the pathological process. This is associated with the peculiarities of clinical symptoms: with an exacerbation of asthmatic bronchitis, there are no typical attacks of suffocation (!), mixed-type dyspnea with a predominance of the expiratory component, with the participation of auxiliary muscles, frequent wet cough, remote wheezing.

The classification of asthmatic bronchitis is identical to that of bronchial asthma. Treatment and rehabilitation of patients is carried out according to the same program as for bronchial asthma.

1.7. Acute pneumonia is an acute inflammatory process in the lung tissue that occurs as an independent disease or as a manifestation or complication of a disease.

Classification of acute pneumonia

Focal (including focal-confluent)

Segmental

Croupous

Interstitial

2. Current

lingering

3. Manifestations (complications)

Respiratory failure

Cardiovascular insufficiency

Pulmonary edema

Destruction of lung tissue

Pneumothorax

Meningitis etc.

It is characterized by an acute onset of the disease with an increase in temperature to febrile numbers. High temperature lasts for at least 3 days, accompanied by chills. Pneumonia can occur not only suddenly, but also against the background of a current respiratory viral infection. Cough - less often dry, more often - wet. There are violations of the general condition in the form of a decrease in appetite, changes in behavioral reactions (excitation or, conversely, apathy), sleep, a decrease in emotional tone, indicating pneumonic toxicosis. From the first days of the disease, shortness of breath appears in patients, in severe cases, groaning or grunting breathing is observed. When examining patients, a change in breathing over the affected area of ​​\u200b\u200bthe lung is revealed: hard or bronchial, very often weakened breathing. With percussion in the zone of the inflammatory process, a shortening of the percussion sound is observed. Auscultation of moist small bubbling rales over a limited area of ​​the lung makes the diagnosis of pneumonia very likely, but in patients with acute pneumonia, rales may not be heard throughout the illness.

Infants and young children with pneumonia require immediate hospitalization. Duration of stay in the hospital 20-21 days, in complicated cases 1-1.5 months. Patients of preschool age and schoolchildren, at the request of their parents, can be treated at home, subject to all the recommendations of the local doctor.

Examination methods:

1. Radiography of the lungs in two projections, taking into account the localization of the inflammatory broncho-pulmonary process (right- or left-sided pneumonia)

2. Complete blood count.

1. Organization of a medical and protective regimen.

2. Treatment table 16 or 15 (depending on age). Additional introduction of liquid in the amount of 300-500 ml in the form of tea, berry and fruit decoctions, fruit drinks, juices, mineral water, oralit (oralit recipe: for 1 liter of water 3.5 g of sodium chloride, 2.5 g of sodium bicarbonate, 1, 6 g potassium chloride, 20-40 g glucose). With properly organized oral rehydration, in almost all cases, it is possible to refuse intravenous infusion therapy. In an uncomplicated course of pneumonia, it should be limited to parenteral administration (im) of one antibiotic, preferably a penicillin series (benzyl-penicillin 150 mg / kg, semi-synthetic penicillins - ampicillin, ampiox 150-200 mg / kg, carbenicillin 200 mg / kg).

The absence of a positive effect after 24-49 hours, namely: lowering the temperature to normal or subfebrile numbers, reducing or eliminating the symptoms of intoxication, improving the general condition and the appearance of appetite, as well as an increase in pulmonary changes require therapeutic correction in the form of prescribing a second antibiotic (in / in the introduction) or changing antibiotics with the appointment of cephalosporil 100 mg/kg, aminoglycosides (gentamicin 3-5 mg/kg), lincomycin 30-50 mg/kg, chloramphenicol 50 mg/kg, erythromycin 20 mg/kg. Enteral use of antibiotics is not recommended due to the risk of dysbactoria development!

4. Infusion therapy (in / in) includes the introduction of glucose-salt solutions: 1056 solution of glucose in a ratio of 1: 1 with saline, hemodez, reopoliglyukin (glucose 50 ml / kg, reopoliglyukin 10 ml / kg, gemodez 10-20 ml / kg ), plasma or albumin 5-10 ml/kg. The calculation of the infusion fluid is based on pathological losses, which in pneumonia are limited by high fever and shortness of breath, while the volume of fluid, as a rule, does not exceed 30 ml / kg.

5. Cardiotonic means; 0.065% solution of corglicon 0.1-0.15 ml per year of life or 0.05% solution of strophanthin 0.1 silt per year of life, i.v. You can use digoxin 0.007-0.01 mg / kg per day on the first day of the course of pneumonia complicated by pneumonic toxicosis

6. Corticosteroids (prednisolone) are used as a means of combating toxic-infectious shock, cerebral edema, secondary cardiopathy, pulmonary edema and microcirculation disorders. It is prescribed for severe condition of patients and willows at the rate of 4-6 mg/kg IV for 1-3 days

7. If you suspect a destructive form of pneumonia and the threat of DIC, prescribe: antiproteases (kontrykal 1000 units / kg, but more than 15 thousand), heparin 200-250 units / kg (under the control of a coagulogram)

8. Immunotherapy is indicated for severe, complicated course of staphylococcal pneumonia, Pseudomonas aeruginosa. proteic etiology. It is recommended to use immunoglobulin at the rate of 1-2 ml/kg IM, hyperimmune anti-staphylococcal immunoglobulin 100 mE daily for 3-5 days, hyperimmune plasma with high titers of the corresponding antitoxin at a dose of 5-15 ml/kg

9. Attention! Hemotransfusions (!) Are indicated for a long-term purulent-destructive process in a child with a hemoglobin content of 65 g / l

10. Oxygen therapy: the administration of humidified oxygen through a nasal catheter or in an oxygen tent DPK-1

11. Physiotherapy: SMT-phoresis on the chest No. 7-10, intraorgan electrophoresis of antibiotics No. 5-6 daily in acute inflammatory process, calcium electrophoresis No. 10, daily during the period of resolution of pneumonia

12. Symptomatic therapy, including a complex of vitamins, enzyme preparations, biologically active preparations, is prescribed after an improvement in general well-being, elimination of clinical symptoms of intoxication and respiratory failure. The duration of stay of patients in the hospital is 21-24 days, with a complicated form up to 1-1.5 months.

Rehabilitation. Rehabilitation activities are carried out within 3 months.

Children are removed from the register after a year. In the first month after discharge from the hospital, they are examined weekly, in the second or third month of observation once every 2 weeks, then monthly.

Repeated x-ray examination is recommended in cases where patients are discharged with residual pneumonia. In autumn-winter-spring time, inhalation therapy is carried out with the appointment of inhalations of St. John's wort (Novoimanin), chamomile, calendula, plantain, phytoncides (see Rehabilitation of recurrent bronchitis). Seasonal courses of prescribing vitamins and biologically active drugs. Chest massage No. 15-20.

Classes in the office of physiotherapy exercises for 1-1.5 months. Schoolchildren can continue their classes in sports sections after 1-1.5 months. after the control ECG.

Preventive vaccinations are carried out no earlier than after 2 months. after recovery (in cases of uncomplicated form), after 6 months. after suffering destructive pneumonia. If the course of pneumonia was accompanied by neurotoxicosis, preventive vaccinations are carried out after consulting a neurologist.

1.8. Chronic pneumonia is a chronic non-specific bronchopulmonary process, which is based on irreversible morphological changes in the form of bronchial deformation and pneumosclerosis in one or more segments and is accompanied by recurrent inflammation in the lung tissue and (or) in the bronchi. Chronic pneumonia with deformation of the bronchi (without their expansion) and with bronchiectasis is distinguished. The severity of the course of chronic pneumonia is determined by the volume and nature of bronchial lesions, the frequency and duration of exacerbation, and the presence of complications.

In children with chronic pneumonia, a history of acute pneumonia is revealed, often its complicated course or destructive form. Repeated pneumonia, increased incidence of SARS, bronchitis are noted.

Clinical symptoms of chronic pneumonia are determined by the localization and prevalence of the pathological process. Most often, the bronchopulmonary process is localized in the lower lobe of the left lung, then in the reed segments, then in the lower and middle lobes of the right lung, and only in some cases in the segments of the upper lobe. Exacerbation of chronic pneumonia proceeds, as a rule, according to the bronchitis type. The onset of exacerbation is gradual. The temperature rises, a wet cough intensifies, the amount of sputum increases, which acquires a mucopurulent or purulent character. The amount of sputum is small (20-50 silt), and only with the bronchiectasis variant of chronic pneumonia there is a large amount of sputum "mouthful" (up to 100-150 ml per day). Physical changes in the lungs are increasing in the form of the appearance of a large number of wet rales of various sizes or dry rales both in the zone of previously diagnosed chronic pneumonia and in places where they have not previously been heard. It is important to emphasize precisely the increase in the auscultatory picture in the lungs, since the constant presence of wet or dry rales in the area of ​​the affected segment or segments is one of the most characteristic signs of chronic pneumonia. Mixed dyspnea (inspiratory-expiratory) intensifies, which, before exacerbation, was observed only during physical exertion. The exacerbation lasts from 2-3 to 4-6 weeks.

Exacerbation of chronic pneumonia may occur with symptoms of acute pneumonia. The onset of exacerbation is acute, with an increase in temperature to febrile numbers. The severity of the general condition, signs of intoxication, shortness of breath, cyanosis increase, cough intensifies. Wet, finely bubbling and crepitant rales are heard, first in the primary lesion zone, and then in neighboring areas, and in the unaffected lung. The period of exacerbation lasts from 3 weeks to 2-3 mods.

Currently, it is proposed to distinguish 2 variants of the course of chronic pneumonia. The first - "small" forms, in which the general condition of children, their physical development does not suffer. Exacerbations are rare, 1-2 times a year, with a short-term increase in temperature, a meager amount of sputum, and an increase in the physical picture. Outside of exacerbation, children feel quite satisfactory, in the affected area, wheezing is heard only with a deep breath and forced exhalation. The second option is bronchiectasis. It has been rare in recent years. With this option, exacerbation is observed 2-3 times a year. The cough is wet, with purulent sputum, almost constant. These children always show signs of intoxication. They lag behind in physical development. Physical symptoms in the form of weakened breathing, wet and dry rales in the affected area are observed almost constantly.

Examination methods:

1. X-ray of the lungs

2. Bronchoscopy

3. Complete blood count in dynamics

4. Bacteriological examination of the lavage fluid, i.e. bronchial washings during bronchoscopy with the determination of sensitivity to antibiotics

5. Immunogram

6. Consultation with an ENT specialist

1. Hospitalization of patients during an exacerbation

2. Mode depending on the general condition of the patient

3. Table 15 with the additional introduction of protein: meat, cottage cheese, eggs, cheese. Fruits and vegetables unlimited

4. Antibiotic therapy is carried out according to the same principle as in acute pneumonia and recurrent bronchitis. Duration of antibiotic therapy 7-12 days

5. Inhalation therapy (see. Recurrent bronchitis) is carried out in 3 stages

6. Mucolytic (secretolytic) and expectorant (secretomotor) drugs are prescribed in the same way. as in recurrent bronchitis

7. Physiotherapy: in case of exacerbation, ozokerite, paraffin applications, calcium-, magnesium-, copper-, iodine-electrophoresis, 10-12 procedures (2-55% solutions, galvanic current density 0.03-0.06 ml/cm3).

When the exacerbation subsides, high-frequency electrotherapy; microwaves - apparatus "Chamomile", 10 procedures, 7-12 W, duration of the procedure 8-10 minutes. apparatus "Luch-3", 9-10 procedures, 48 ​​W, duration of the procedure 6-10 minutes. Inductothermy - apparatus IKV-4, 8-10 procedures, 160-200 mA, procedure duration 8-12 minutes.

8. Therapeutic bronchoscopy, course 2-6 bronchoscopy

9. Therapeutic exercise: postural drainage 2-3 times a day (Quincke's position: in the morning after waking up, hanging the torso from the bed with hands on the floor, 5-10 minutes, making coughing movements). Performing a handstand against the wall, 5-10 minutes, 1-2 times a day. Vibration massage.

Attention! These types of physical therapy are prescribed only after the elimination of the exacerbation (!) And during the rehabilitation period.

Rehabilitation

1. Examination by a pediatrician 2-3 times a year

2. Sanitation of foci of chronic infection in the upper respiratory tract

3. Immunological examination with immunotherapy (according to indications)

4. Treatment of concomitant diseases of the digestive system, the appointment of biologically active drugs in courses of 2-4 weeks, 2-3 times a year

5. Inhalation therapy in unfavorable seasons of the year - spring-autumn-winter and during epidemic outbreaks of SARS

6. Sanatorium treatment in local sanatoriums, in the Crimea, Anapa, Kislovodsk. Balneotherapy: mineral baths, chloride, sodium, carbonic, radon, sulfide. oxygen. Therapeutic mud in the form of applications on the chest (in the absence of respiratory and cardiovascular system disorders)

7. Physiotherapy exercises not earlier than a month after the exacerbation! Postural drainage and vibration massage 3-4 times a year. A set of measures is appointed by the methodologist of the exercise therapy cabinet

8. Hardening procedures, swimming, skiing, taking into account individual tolerance

9. A complex of vitamins and adaptogen preparations according to the program used in patients with recurrent bronchitis (see Rehabilitation of patients with recurrent bronchitis)

10. Consultation of a thoracic surgeon to determine the indication for surgical treatment. The decision on surgical intervention can be made after repeated X-ray and bronchological examination, a full course of conservative therapy and observation of the patient for at least a year.

The prognosis for most patients with chronic pneumonia is favorable, provided that conservative therapy is methodically carried out. Children are not removed from the dispensary register and are transferred to doctors of adolescent rooms.

Types of bronchopulmonary diseases

Bronchopulmonary diseases - the collective name of diseases caused by the destabilization of the functioning of the bronchi and lungs. They can be chronic, acute, congenital or hereditary.

Types of bronchopulmonary diseases:

¦ acute bronchitis is a disease caused by inflammation of the bronchial mucosa.

¦ asbestosis - a disease caused by the accumulation of asbestos fibers in the tissues of the lungs.

¦ pneumonia is an inflammatory process in the tissues of the lung.

¦ bronchial asthma is an acute disease, the dominant signs of which are periodic conditions or attacks of expiratory suffocation caused by bronchial hyperactivity.

¦ atelectasis - pathology of the lung, in which it is not completely straightened out. In some cases, atelectasis leads to lung collapse (complete or partial). Ultimately, this becomes the cause of oxygen deficiency.

The main symptoms of bronchopulmonary diseases

The clinical picture is characterized by repeated (several times a year) inflammatory processes in the lungs. The severity of clinical manifestations depends on the volume and prevalence of pathological and inflammatory changes. The physical development of patients suffers little. Signs of intoxication may be expressed: malaise, pallor, "shadows" under the eyes, loss of appetite. Changes in the shape of the nails and terminal phalanges of the fingers in children are rare. With extensive lesions, flattening and barrel-shaped deformity of the chest, retraction in the sternum or its keeled bulging can develop. An increase in body temperature is a non-permanent symptom that usually accompanies an exacerbation of the bronchopulmonary process.

The most persistent symptoms are cough, sputum production and persistent wheezing in the lungs.

* Cough is the main clinical sign. Without exacerbation, it can be rare, unstable, dry, appearing only in the morning. With extensive lesions, patients can cough up sputum, often mucous or mucopurulent. With exacerbation, the cough, as a rule, becomes wet, "productive", sputum acquires a mucopurulent or purulent character, its amount increases.

* Wheezes are constantly heard, their localization corresponds to the affected areas, and moist, medium - and finely bubbling persist during remission. Along with wet, dry wheezing rales can also be heard. With exacerbation, the number of wheezing increases, they are heard outside the affected areas.

General principles of treatment of bronchopulmonary diseases

bronchopulmonary disease prevention spirometry

In acute bronchitis, artificial ventilation may be required; in pneumonia, antibiotics cannot be dispensed with.

Particular attention in the treatment of bronchial asthma is paid to maintenance. The main rule that must be observed when faced with these diseases is to start treatment immediately! Otherwise, you can miss the initial stage of the disease, which can lead to disastrous consequences.

Treatment of diseases of this group is symptomatic, in particular, in the treatment of bronchitis, first of all, it is necessary to ensure that sputum is fully discharged. In the treatment of bronchopulmonary diseases, there are general recommendations, for example, such as steam inhalation, plentiful hot drinking, and others.

Also, each disease of this group has its own characteristics of treatment. disease in remission. After all, as you know, the disease is easier to prevent than to treat. It is this expression that is most applicable to bronchial asthma - it is easier to prevent an attack than to fight for a patient in a state of lung obstruction.

Today, pulmonology has a sufficient set of therapeutic methods and medications that allow you to successfully deal with bronchopulmonary diseases, the main thing is to seek help from a doctor at the time.

Treatment of diseases of the respiratory system has achieved great success. This is due to the introduction into medical practice of various highly effective antibiotics, anti-inflammatory, anti-allergic drugs, hormones, the development of new methods to combat respiratory failure and the improvement of surgical methods of treatment. Currently, the treatment is more effective than in the recent past, however, if the patient already had far-reaching changes at the first visit to the doctor, it is not always possible to achieve complete healing. In inflammatory diseases of the respiratory tract and lungs, especially those accompanied by high fever, general malaise, chest pain, cough, in addition to medicines, other means are widely used to alleviate the condition of patients (jars, mustard plasters, warm alkaline drink, etc.). All these drugs are prescribed by a doctor. Self-administration by patients of the so-called running drugs is usually not effective, and often harmful. There are many cases when patients, on their own initiative, took antitussives, at a time when copious sputum discharge was required to restore bronchial patency and, therefore, not suppression, but, on the contrary, stimulation of the cough reflex. Uncontrolled intake of antipyretics, anti-inflammatory drugs, antibiotics and sulfanilamide drugs also usually ends sadly: either the condition quickly worsens, or patients, mistakenly regarding the temporary disappearance of the painful manifestation of the disease as a recovery, stop any treatment and after a while are forced to consult a doctor already with a running or chronic form of the disease.

In causal treatment, the main place is given to antibacterial agents: sulfa drugs and antibiotics. The extreme popularity of these medicines among the population is fraught with considerable dangers. The inefficiency of the application, adverse reactions, the protracted course of the disease and often the transition to a chronic form may also be the result of an inept choice of the drug and its dosage. In accordance with strictly established biological laws, to suppress a particular pathogen of an infectious disease, a certain constant concentration of drugs in the blood and tissues of the body is required, taking into account the sensitivity of microorganisms to them and the individual characteristics of the patient's body. Only a doctor prescribes antibacterial drugs. Careless attitude to medical recommendations can lead to very serious complications. Often, the population seeks to acquire new antibiotics for treatment, including for diseases of the respiratory system. Achievements in medicine and health care make it possible to constantly introduce new effective antibiotics into practice, not at all in order to replace the previously proposed ones, but for a more rational medical choice. In the complex treatment of a number of patients with certain chronic diseases of the respiratory system, an important place is occupied by the use of hormonal drugs. Independent, without a doctor's prescription, the use of hormones also sometimes leads to serious consequences. Strict medical control over the intake and withdrawal of hormones is a prerequisite for their successful use. Inhalation of oxygen is widely prescribed with the help of special devices or from oxygen pillows in case of significant violations of gas exchange in the lungs. Medical practice has been enriched with new means of combating respiratory failure. With suppurative processes in the lungs, weakened patients are given an infusion of blood, blood substitutes, protein-containing liquids and medicinal mixtures that correct the disturbed metabolic balance.

Diseases of the bronchopulmonary system

Diseases of the bronchopulmonary system

Diseases of the bronchopulmonary system occupy about 40–50 percent of all diseases of modern man. The main of them is considered bronchial asthma, its share in the total number of diseases of the bronchi and lungs accounts for a fourth. The rest include inflammatory diseases: pneumonia, bronchitis, chronic obstructive pulmonary disease and others. Most often, people from 20 to 40 years old get sick with diseases of the bronchopulmonary system.

It is very important to monitor the state of the respiratory system and treat diseases of the bronchopulmonary system in time, even if it is an ordinary cold. This is evidenced by the high incidence of these diseases and the number of deaths. The most significant factors that provoke the occurrence of diseases of the bronchopulmonary system are:

• Low standard of living.
• Profession.
• Smoking.

Types of diseases of the bronchi and lungs

Bronchial asthma caused by an allergic factor, and is a hereditary disease. It begins in childhood and persists throughout life with periodic exacerbations and blunting of symptoms. This disease is treated throughout life, an integrated approach is applied, hormonal drugs are often used in treatment. The disease - significantly worsens the patient's quality of life, makes him dependent on a large number of medicines and reduces his ability to work.

Inflammatory diseases include bronchitis and pneumonia.

Inflammation of the bronchial mucosa is called bronchitis. With a viral and bacterial infection, it can proceed in an acute form, chronic bronchitis is more often associated with fine particles, for example, dust. Statistics show that every third person who applied with a cough or asthma attacks has bronchitis. About 10% of the population suffer from this disease - chronic bronchitis. One of the main reasons is. Almost 40 percent of people addicted to this habit in Russia, most of them are men. The main danger of the disease is a change in the structure of the bronchus and its protective functions. This disease is also referred to as occupational diseases, it affects painters, miners, quarry workers. should not be left to chance, timely action is required to prevent complications.

Inflammation of the lungs is pneumonia. It is often the leading cause of death in young children. A fairly common and frequently occurring disease, on average, about three million people a year suffer from it, while every fourth disease acquires severe forms and consequences, up to a threat to human life. Reduced immunity, infection in the lungs, risk factors, lung pathologies - these reasons give rise to the development of the disease -. Complications can be pleurisy, abscess or gangrene of the lung, endocarditis and others. Treatment of pneumonia should begin at the earliest stages, under the supervision of a doctor in a hospital. It should be complex with the subsequent rehabilitation of the patient.

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The defeat of the respiratory system is often observed in various infectious diseases with a predominance of changes in the respiratory tract. Depending on the etiology, rhinovirus diseases are distinguished with a predominance of symptoms of rhinitis, rhinopharyngitis (adenoviral diseases), laryngitis (parainfluenza), tracheitis (influenza), bronchitis (respiratory syncytial infection), lung lesions (ornithosis, mycoplasmosis, etc.). Pneumonia can be a clinical sign of an infectious disease, it is one of the most common complications (various bacterial and viral infections). Most often, secondary pneumonia occurs against the background of COPD.

The final manifestation of respiratory diseases is a violation of gas exchange in the lungs and tissues. The main pathogenetic factors of acute pneumonia: toxemia, an increase in the concentration of fibrinogen, the aggregation ability of platelets, erythrocytes, fibrinization of the lesion, impaired microcirculation and the development of DIC, "alveolar-capillary block", hypoxemia, bronchial obstruction, impaired drainage function, change in the immune hemostasis system.

Universal manifestations of respiratory distress are hyperventilation and hypoxia. During hyperventilation, the frequency, rhythm and nature of breathing change - this is the most mobile compensatory reaction during oxygen starvation (hypoxia). It is accompanied by mobilization of blood circulation, in particular, an increase in blood flow rate and cardiac output, which accelerates the delivery of oxygen to tissues and the removal of carbon dioxide.

In diseases of the lungs, various types of hypoxia occur. Hypoxic hypoxia (decrease in the amount of oxygen in the blood) is most often caused by insufficient ventilation of the lungs or impaired diffusion of gases. Circulatory, or congestive, hypoxia occurs in lung diseases, when gas exchange insufficiency becomes a consequence of circulatory disorders. Anemic hypoxia is caused by a decrease in the oxygen capacity of the blood due to a decrease in hemoglobin in it.

Means of exercise therapy (physical exercises, walking, swimming, jogging, training on simulators, massage, etc.), reflexively and humorally stimulating the respiratory centers, help to improve ventilation and gas exchange. Under the influence of LH and massage, the general tone increases and the psychological state of the patient improves, the functions of the central nervous system, nervous processes in the cerebral cortex, the interaction of the cortex and subcortex, the body's defenses are activated, and an optimal background is created for the use of all therapeutic factors.

Systematic physical exercises, improving blood and lymph circulation in the lungs and pleura, contribute to faster resorption of exudate. The structures of regenerating tissues adapt to functional requirements. Atrophic and degenerative changes may be partially reversed. This applies equally to the lung tissue, respiratory muscles, articular apparatus, chest and spine.

Physical exercises help prevent a number of complications that can develop in the lungs and pleural cavity (adhesions, abscesses, emphysema, sclerosis), and secondary deformities of the chest. An essential result of the trophic effects of physical exercise is the restoration of lung elasticity and mobility. Improving blood oxygenation during breathing exercises activates metabolic processes in organs and tissues.

With any disease of the respiratory system that causes disorders of the respiratory function, spontaneous compensations are formed in order to adapt. When combined with various conditioned stimuli, they can be fixed. In the early period of the disease, using exercises with arbitrarily rare and deep breathing, it is possible to quickly form rational compensation. More perfect compensation for diseases with irreversible changes in the respiratory apparatus (emphysema, pneumosclerosis, etc.) arise with the help of exercises that emphasize individual phases of breathing, providing training for diaphragmatic breathing, strengthening the respiratory muscles, and increasing the mobility of the chest.

Physical exercise mobilizes the auxiliary mechanisms of blood circulation, increasing the utilization of oxygen by tissues (the fight against hypoxia), facilitating the removal of pathological contents (mucus, pus, tissue breakdown products) from the airways or lungs. Physical exercise can help normalize impaired respiratory function. The mechanism of normalization is based on the restructuring of the pathologically altered regulation of the function of the external respiratory organs. The terminal apparatus of the interoreceptors, which is restored during regeneration, creates the preconditions for the normalization of the reflex regulation of respiration. By arbitrary control of all available components of the respiratory act, it is possible to achieve complete uniform breathing, the proper ratio of inhalation and exhalation with an emphasis on exhalation, the required depth (level) of breathing, full expansion (elimination of atelectasis) and uniform ventilation of the lungs. An arbitrarily controlled full-fledged respiratory act is gradually formed, which is fixed in the process of systematic training according to the mechanism of formation of conditioned reflexes. Normalization of gas exchange in this case occurs as a result of the impact not only on external, but also on tissue respiration (increase in oxidative processes in the periphery and the coefficient of oxygen utilization under the influence of physical exercises).

With lung disease, all body systems are affected, primarily the cardiovascular system. Physical exercises have a normalizing effect on blood circulation, have a positive effect on the dynamics of nervous processes in the cerebral cortex and the body's adaptation to various physical loads.

Massage relieves spasm of the respiratory muscles, restores the mobility of the chest, diaphragm, increases the excursion of the lungs, improves gas exchange, activates microcirculation, promotes the resorption of infiltrates and exudates. The impact is exerted on the paravertebral and reflexogenic zones of the chest. Massage techniques are the same as for respiratory diseases.

Physiotherapy treatment should be prescribed in the period of fever. With the development of bronchitis, depending on the motor regimen, the following are used in the treatment: physical factors (hot drinks, compresses, wraps, mustard plasters), hot foot and hand baths with medicinal substances and herbs, inhalations (furacillin, shit water, saline-alkaline, etc.), aerotherapy. For pneumonia: inhalation aerosol (antibacterial, bronchodilator, mucolytic, anti-inflammatory) and rehabilitation therapy using ultrasonic inhalers and electric aerosol generators that allow drug solutions to penetrate into the alveoli. In addition, electrophoresis of medicinal substances is used that promotes anti-inflammatory, absorbable action, relieves bronchospasm, and improves sputum discharge.

The choice of medicine is determined by the clinical picture of the disease and the pharmacological properties of the substance. During the period of exudative-andfiltrative inflammation (in the absence of contraindications), ultrahigh-frequency (UHF) therapy is changed; with allergic manifestations - ultraviolet (UV) irradiation of the chest, short-wave ultraviolet (UV) irradiation of the nose, throat (hyposensitization); in order to resolve inflammatory changes - "decimeter wave (UHF) and centimeter wave (CMW) therapy, a high-frequency magnetic field (inductothermia) is recommended for" root and central pneumonia. Ultrasound therapy has proven itself well. Laser therapy (pulsed, repetitively pulsed infrared laser radiation) is widely used, which helps to reduce their hypercoagulable potential, improves microcirculation in the vascular bed of the lungs, has a vasodilator and bronchodilator effect, promotes sibilizing, analgesic effects, stimulates recovery processes, enhances nonspecific immunity.

We are talking about patients with chronic inflammatory diseases of the lungs and bronchi. Diseases united by this term (chronic obstructive pulmonary disease, chronic bronchitis, bronchiectasis, pneumonia, etc.) proceed for a long time and require maximum attention, since they are unpleasant with recurring exacerbations and are fraught with a gradual aggravation of secondary changes in the lungs. We are talking about exacerbations. Exacerbations are always the starting point in the progression of the entire pathological process.

To some extent, it is not the doctor who is the first, but the patient himself, if he suffers from a chronic process for a long time, is called upon to determine the beginning of an exacerbation in himself, knowing the sensations from previous periods of deterioration. Usually, the signal is gradually appearing signs of intoxication (fatigue, weakness, loss of appetite, sweating), increased cough and shortness of breath (especially in obstructive conditions - with wheezing during breathing), a change in the nature of sputum (from purely mucous it turns into opaque with yellowish or greenish shade). Unfortunately, body temperature does not always rise. You need to study yourself in order to start therapy in the event of an exacerbation not in the morning or evening of the next day after the examination by a therapist or pulmonologist, but immediately.

The regime for exacerbations is not strict bed, that is, you can walk, do light household chores (if there is no excessive weakness), but it is advisable to stay close to the bed, go to bed periodically. Going to work or school is strictly prohibited.

Appetite is reduced, so nutrition should be as complete as possible, contain more proteins, easily digestible fats (sour cream, vegetable oils), vitamins. An extremely important recommendation is to drink a lot if there are no serious contraindications to this (a sharp increase in blood or eye pressure, severe heart or kidney failure). Intensive water exchange promotes the removal of bacterial toxins from the body and facilitates the separation of sputum.

One of the most important points in treatment is adequate sputum drainage. Sputum must be actively coughed up from different positions ("positional drainage"), especially those that provide the best drainage. In each new position, you need to stay for a while, and then try to clear your throat. First they lie on their back, then turn on their side, then on their stomach, on the other side, and so on, in a circle, each time making a quarter turn. Last position: lying on the edge of the bed, on the stomach with the shoulder lowered below the level of the bed (“as if reaching for a slipper”). This is done several times a day. What is coughed up should always be spit out.

Expectorants make sputum more liquid, but they cannot be used indiscriminately. All expectorants are endowed with nuances in the mechanism of action, so a doctor should prescribe them. Everyone knows expectorant herbs (coltsfoot, thyme, thermopsis, as well as herbal preparations - bronchicum, doctor mom cough syrup etc.) act reflexively, irritating the gastric mucosa, and have no practical significance in chronic processes in the bronchi - they should not be used, and they are contraindicated in case of peptic ulcer.

For obstructive bronchitis (bronchitis that occurs with narrowing of the bronchi - popularly known as "bronchitis with an asthmatic component"), doctors usually prescribe bronchodilators during exacerbations. These are aerosols that relieve suffocation. Important warning: there are old bronchodilators containing ephedrine(for example, broncholithin, solutan) - such drugs are categorically contraindicated in hypertension, heart disease.

Each patient with chronic bronchitis should have an electric compressor-type inhaler - a nebulizer (the compressor delivers a pulsating stream of air that forms an aerosol cloud from the drug solution). During exacerbations, such a device is indispensable. Inhalations are carried out in the morning and in the evening (inhalations should not be made by means not provided for this, for example, mineral waters, home-made decoctions of herbs; use plain boiled water to dilute solutions!). Inhalation should be followed by positional drainage, since the solutions used for inhalation effectively thin the sputum.

The problem of antibiotic therapy in chronic processes in the lungs is very complex. On the one hand, the decision to prescribe an antibiotic must be made by the doctor. On the other hand, a speedy recovery can only lead to the fastest possible start of therapy with the appropriate drug. In the interests of the patient, one has to deviate from the rules and give the following recommendation: for a patient suffering from chronic bronchitis and knowing about his disease, it makes sense to have at home a package of a reliable antibacterial agent (which one - the doctor will tell you) with a good expiration date and start taking it immediately, as soon as there will be signs of exacerbation. Most likely, the sick person, having taken the first antibiotic pill, will do the right thing, since the onset of an exacerbation in itself indicates that the body has taken a step back in its resistance to microbes, and it needs help.

Indeed, the occurrence of an exacerbation is a breakdown of the body's immune defenses. The reasons can be very different, among them hypothermia, stressful situations, the beginning of flowering of plants to which there is an allergy, etc. A very common option is the aggravation of a chronic process in response to a respiratory viral infection. In this regard, reasonable preventive measures, for example, warmer clothes in the cold season, avoiding long waits for transport in the cold, having an umbrella in case of rain, a huge cup of hot tea with honey after hypothermia, etc. will not interfere. Partially preventing a virus attack can be limited contact with other people (especially those already infected). During epidemics, all Japanese wear gauze masks even on the street - they reject complexes and do the right thing: prevention is expensive. Now masks are available, they can be bought at every pharmacy. Wear a mask at least at work, and answer puzzled questions and glances that you have a slight runny nose.

It is not necessary to “stimulate the immune system” with drugs. This is unattainable and can be harmful. It would be nice not to harm! Warmth can enhance protection against germs. An increase in body temperature, if it is not excessive (no more than 38.5-39 ° C), is a factor that ensures the most active interaction of the elements of immunity. Even if the patient does not feel well, but he does not have an excruciating headache, it is advisable to refrain from taking antipyretic, painkillers. A vicious practice - to take "3 times a day" medicines "for colds" - with a viral infection in a previously healthy person, it increases the recovery time and contributes to the development of complications, and in a patient with chronic bronchitis it inevitably leads to exacerbation. Moreover, with a sluggish infection and a very weak temperature reaction, repeated, for example, in the evenings, moderately hot baths or showers will contribute to recovery. Hot baths are contraindicated for the elderly; those who do not tolerate them at all or suffer from hypertension, heart disease, atherosclerosis of cerebral vessels. You can limit yourself to a warm water procedure. After it - tea with honey or jam.

All questions concerning further measures in the treatment of a particular patient, of course, are called upon to decide the doctor. After the exacerbation subsides, the problem of preventing a new one arises, and therefore it is necessary to pay more attention to your health. Hardening and regular adequate physical activity have a good effect. Prophylactic inhalations with the help of a home nebulizer are very useful. They are done from time to time (especially when there is a feeling of sputum retention); it is enough to use a physiological solution of sodium chloride and, after inhalation, cough well. For a person suffering from chronic bronchitis, it is very important to avoid influences that irritate the mucous membrane of the bronchial tree. If possible, it is necessary to reduce the impact of air pollutants (dust, exhaust gases, chemicals, including household chemicals). It is recommended to wear a respirator during repair work, refuse to do painting work on your own, avoid doing physical education near motorways, standing in traffic jams, etc. It is useful to use humidifiers at home and in the office, especially in winter and when the air conditioner is running.

We have to raise the issue of smoking. From the point of view of logic, a smoking patient suffering from chronic respiratory diseases is an unnatural phenomenon, but ... terribly common. Smoking, harmful to everyone, is triple dangerous for our patient, as it provokes exacerbations and accelerates the progression of secondary changes in the lungs, which inevitably lead to respiratory failure. At first, this is not obvious to a person, but when shortness of breath begins to torment even at rest, it will be too late. It must be pointed out that quitting smoking during an exacerbation is not worth it, as this can make it difficult for sputum to pass. However, as soon as there has been an improvement, stop smoking!