What to do with a protracted cold. Protracted course of pneumonia

If pneumonia, despite ongoing therapy, lasts more than 4 weeks, then they talk about its protracted course. According to statistics, this development of the disease is observed in 30% of cases, in older people - in 50% of cases.

Factors contributing to the protracted course of pneumonia

1. Heavy accompanying illnesses. Especially often COPD, alcoholism, congestive heart failure, chronic kidney failure, diabetes, malignant tumors different localization, AIDS, some neurological diseases in which the cough reflex is suppressed.
2. Age over 50 years. At this age, resolution of pneumonia occurs much later even in the absence of concomitant diseases.
3. Initial severity. The more severe the inflammatory process in the lungs, the more likely that the disease will prolong.
4. The virulence of the pathogen (the degree of its ability to infect the body). According to the accumulated data of scientists, most often the causative agent of prolonged pneumonia is pneumococcus, less often legionella, chlamydia, Haemophilus influenzae, Staphylococcus aureus and etc.
5. state of the humoral and cellular immunity. Protracted pneumonia in adults often occurs against the background of secondary, and in children - against the background of congenital immunodeficiency.
6. Microbial resistance to antibiotics.

Features of the clinical picture of prolonged pneumonia

The clinic of prolonged pneumonia practically does not differ from the usual one. The difference is only in the time of disappearance of symptoms and radiological signs inflammation.

In the normal course of pneumonia, the febrile period lasts from 2 to 4 days, the cough disappears on days 4-9, wheezing ceases to be heard in the lungs by the end of 1 week, the number of leukocytes normalizes by 4 days, C-reactive protein- on the 3rd day.

With prolonged pneumonia, these periods increase. So, in typical cases of pneumococcal pneumonia, the period of temperature rise above 38 ° C does not exceed 2-3 days. But with extensive damage lung tissue the disease becomes protracted, and the temperature can rise to high numbers for 3 or more weeks.

Diagnosis of the disease

Usually, when it becomes clear that pneumonia has taken a protracted course, the doctor already has the results of a number of studies: blood and urine tests, an x-ray of the lungs, sputum microscopy with Gram stain. The task of further diagnostic tests is an exception large group diseases that can occur under the guise of prolonged pneumonia. These include tuberculosis, fungal diseases respiratory organs, malignant neoplasms lungs and bronchi, systemic vasculitis, some forms of sarcoidosis, drug-induced damage to the lung tissue, thromboembolism in the system pulmonary artery etc.

If necessary, to clarify the diagnosis are used CT scan, function study external respiration and immunological status, bronchoscopy and bronchoalveolar lavage, lung scintigraphy, invasive methods for biopsy of lung tissue.

Treatment

The mainstay of treatment for chronic pneumonia is antibiotic therapy. When choosing antibacterial drug the doctor focuses on the effectiveness of previous treatment and the result of sputum culture.

To restore the drainage function of the bronchi, according to indications, expectorants and bronchodilators, massage are used. chest, positional drainage, sanitation of the bronchi with the help of fiberoptic bronchoscopy. Physiotherapy is widely used in treatment, breathing exercises, exercise therapy, acupuncture, various methods immunocorrection.

Possible complications and prognosis

The disease can be complicated by a purulent-destructive process: abscess or gangrene of the lung, pleural empyema. But such cases are very rare. As a rule, prolonged pneumonia ends with a complete recovery. Its average terms are from 3 months to a year.

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currents

WATER FLOW IN THE RIVER- the movement of water particles in the river along the channel under the influence of gravity. As the slope of the water surface increases, the speed of the current increases. The energy of the river flow is spent on the internal friction of the water and on overcoming friction on the bottom and banks. Therefore, in general, no acceleration of water movement in the river flow is observed, however, local acceleration may occur, for example, on riffles and rapids.

The flow of water in the river has features, sometimes they are called wrong currents. Quiet water - a slow current that forms behind convex banks, large sandy deposits in the channel, etc. When moving the vessel upwards, to increase speed, where possible, you should go in a slow way. Suvod - a body of water with a rotational movement of water, usually located behind the ledges of the banks, capes, convex banks, strongly protruding into the channel (Fig. 1). In these places, the current, flowing around the coast at high speed, meets a ledge on its way and creates water backwater and a rise in level in front of it. Passing the ledge, the water flow deviates from it and travels a certain distance by inertia. Behind the ledge, the water level is lowered, due to which, in the lower part of the suvodi, water is drawn from the main stream, and in the upper part, on the contrary, from the suvodi area into the main stream of the stream. This process occurs continuously and causes the rotational movement of water.

When the water rotates in the suvody, the bottom has a braking effect. As a result, closer to the surface of the river, the speed of rotation of water and centrifugal forces increase. Under the influence of centrifugal forces, there is a greater ejection of water from the axis of the river near the surface and less - at the bottom. From bottom to top along the axis of the suvodi, an upward flow is formed, replenishing the discarded water. It erodes the bottom, captures the erosion products, creating a funnel-shaped bottom depression (Fig. 1). With a decrease in speed, the water smoothly flows around the ledge, forming a quiet water behind it.

Near the concave banks, in the steep bends of the riverbed, suvodi also form (Fig. 2). In contrast to the swedes located behind the ledges of the banks, here the descending currents of water descend into the ascending flow of water in the swaddle center of the swaddle to the bottom and spread to the sides. This type of suvodi with a distinct funnel on the surface of the water is sometimes called a whirlpool. Suvodi near concave banks are formed in cases where the smooth flow around the banks of the bend is disturbed.

Suwodi can exist permanently or appear only during high water. On the big rivers large swedes are created, having a sphere of action of tens of meters and a speed of rotation of water in the central part - several meters per second. In some basins, the suvod has its own local name, for example, on the Yenisei - a catch, on the Irtysh - a backwater. Suwodi present a serious difficulty for navigation. Vessels lose control in them, shift sharply towards the shore, and the ropes of the ships' moorings and towing cables are often torn, rudders break, etc.

Maidan is a random rotational movement of water in the form of mobile vortices ranging in size from several centimeters to several meters in diameter. Maidans are formed above large underwater objects at a shallow depth above them (Fig. 3), during high water and high water in those places where a stream going through the floodplain meets at an angle with another stream going along a low-water channel, with intensive local reformations of the channel and at rifts, at abrupt changes bottom shapes, etc. Maidans are unfavorable for navigation, as they cause the ships to yaw.

Disputed waters - Maidans, formed at the mouths of tributaries and at their confluence. The closer the meeting angle is to a straight line, the stronger the vortices develop, which reach several meters in diameter.

The downstream is created near the shore in the section of the river where the water discharge is directed towards the shore. For example, on the curvature of the channel, the downstream flow occurs near the concave bank, since the water, due to inertia, tends to maintain its former rectilinear direction, but, encountering an obstacle in the form of a concave bank on its way, it presses against it (Fig. 4). In areas with a downstream flow, ships roll towards the shore.

Stall current - water discharge directed at an angle to the ship's course (Fig. 5). Stall current occurs due to the difference in water levels across the width of the river. On the riffles, such currents are created as a result of the backwater of the flow by the saddle of the rift, so they are directed from the upper pool hollow to the backwater part of the lower pool hollow (see Roll). By displacing ships from the axis of the ship's passage, stall currents can cause ships and rafts to pile up on the shallows, bridge supports, etc.

lingering current occurs at the entrance to the ducts (Fig. 6). Protracted currents are especially strong during floods, when the flow of water in the channels increases significantly. A lingering current can cause a bulk of ships on the island. The nature of the flow is also influenced by bridges, dams, dams, structures in the channel, etc.

whirlpool- constant rotational movement of water in the channel. V. often create deep pits (pools) and are typical for mountain and semi-mountain rivers.

The incidence of pneumonia is about 1% among the adult population, and children suffer from it twice as often. And in a third of cases, the pathology proceeds for a longer time than with acute pneumonia. But nevertheless, the disease has not yet passed into chronic form. If it proceeds for 1-1.5 months, eventually ending in recovery, then we are talking about chronic pneumonia. Why does it happen, how does it manifest pulmonary pathology and what should be done to effective treatment These are questions for the doctor. Only a specialist can provide competent information.

Pneumonia is an infectious and inflammatory disease of the lung tissue. It usually resolves within 3 weeks, but a protracted process is quite common. This development of events indicates a decrease in immune reactivity. Violations relate to various links of natural protection: a decrease in the intensity of alveolar phagocytosis and inhibition of the activity of complement components, a decrease in the number of T- and B-lymphocytes, suppression of the production of interferon and antibodies. Cellular and humoral factors, which leads to a drop in the level of protection and allows inflammation to acquire a protracted course. This situation may arise in the following cases:

• Congenital and acquired immunodeficiencies (including HIV infection).
• Chronic diseases of infectious and inflammatory nature (tuberculosis, hepatitis).
• Common tumor processes.
• Metabolic and metabolic pathology (diabetes mellitus).
• Reception medicines(immunosuppressants, cytostatics, glucocorticoids).
• Chemical intoxication (including smoking and alcohol abuse).
• Prematurity in children and age-related changes in the elderly.

But in addition to the reduced reactivity of the body, other factors also take part in the origin of prolonged pneumonia. Additional Negative influence for permission inflammatory process provide:

• Irrational and delayed antibiotic therapy.
• Violation of bronchial drainage (foreign bodies, developmental anomalies).
• Complications acute pneumonia(abscess formation, pulmonary atelectasis, pleural empyema).
• Atypical pathogens (mycoplasmas, pneumocystis).

Based on the foregoing, the origin of prolonged pneumonia is most often associated with general disorders in the body, local structural and functional changes and defects in medical tactics. And in order to prevent such a development of events, all possible factors should be taken into account.

A key role in prolonged inflammation of the lungs belongs to the weakening defensive forces organism, but there are other predisposing factors.

Classification

Pneumonia that lasts longer than usual can have a different distribution. The classification of the disease is based on the extent of inflammation. So, prolonged pneumonia happens:

1. Segmental.
2. Polysegmental.
3. Equity.

It should be noted that the process is one- or two-sided, the lower, middle (right) and upper (lingual segments) lobes of the lungs can be affected. The severity of the clinical picture also depends on the prevalence of the process.

Symptoms

Inflammation of the lung tissue, which has a long course, is manifested by almost the same symptoms as acute pneumonia. We can talk about a protracted character if, after 2-3 weeks after the onset of the disease, the patient's condition worsens again, the previously occurring symptoms intensify:

• Cough.
• Dyspnea.
• Fever.
• Sweating.
• Malaise and weakness.

The defeat of one segment corresponds to the lightest Clinical signs, but for multiple inflammation of the lobes, especially bilateral, it is more characteristic severe course. Such pneumonia often relapses and is accompanied by complications. During a physical examination, the doctor reveals signs of an infiltrative process in the lung tissue: wheezing, weakened breathing, dullness of percussion sound.

Effects

If pneumonia is prolonged, then the risk of adverse outcomes is significantly higher than with rapid resolution. inflammatory infiltrate. Complications of the disease can be local and extrapulmonary. The first ones include:

• Abscess and gangrene.
• Pulmonary edema.
• Pleurisy (dry or exudative).
• pneumosclerosis and fibrosis.
• Respiratory failure.

Extrapulmonary conditions are associated with dissemination of the pathogen, toxic, hematological and immune disorders in the patient's body. Prolonged inflammation can cause septic shock, anemia, endo- and myocarditis, meningoencephalitis, glomerulonephritis, hepatitis. But as a rule, with adequate medical care complications are not observed, but recovery can last from several weeks to months.

Protracted pneumonia should be treated as soon as possible so that it does not develop dangerous violations at the pulmonary or systemic level.

Additional diagnostics

Regardless of whether a child has developed pneumonia or an adult, a protracted inflammatory process needs to be verified. The first arguments in its favor are clinical characteristics, but further confirmation is needed. For this purpose, the doctor prescribes laboratory and instrumental studies:

1. Complete blood count: leuko-, erythro- and platelets, ESR.
2. Urinalysis: protein, shaped elements, salt.
3. Blood biochemistry: protein fractions, inflammation markers (C-reactive protein, glycopeptides, sialic acids, ceruloplasmin, seromucoids), coagulogram ( prothrombin index, fibrin).
4. Immunogram: antibodies or immunoglobulins (A, M, G), lymphocytes (T and B), complement protein activity (C3, C4 and C9).
5. Sputum analysis (clinical and bacteriological).
6. Chest X-ray.
7. Tomography.
8. Bronchoscopy.

An important criterion, besides laboratory signs persisting inflammation and immunosuppression is the absence of regression of infiltrative changes on x-rays and the appearance of peribronchitis on endoscopic examination.

Treatment

Therapeutic tactics for prolonged pneumonia is formed on the basis of individual characteristics: prevalence of inflammation, activity of immunity, concomitant diseases. After evaluating all the nuances, the doctor will offer the patient the optimal therapeutic program to speed up recovery.

Medicines

Prolonged pneumonia in children and adults, as well as acute process without the use of drugs. For liquidation infectious factor, suppressing inflammation, improving the discharge of pathological exudate and increasing the body's defenses, use the following medicines:

• Antibiotics (protected penicillins, aminoglycosides, fluoroquinolones, macrolides, cephalosporins).
• Mucolytics and expectorants (Mukolvan, ACC, Bronchocode).
• Anti-inflammatory (Erespal, Glyciram).
• Immunocorrectors (Polyoxidonium, Cycloferon, Laferon).
• Vitamins and microelements.

Any drug should be prescribed only by a doctor. Medications are taken under his supervision and without deviations from the prescribed course. This is especially important, because inadequate treatment can nullify all efforts.

It is impossible to treat prolonged pneumonia without drugs that affect the cause of the disease and the factors contributing to its long-term development.

Physiotherapy

Great importance in treatment regimens is given to methods of non-drug effects on the body. In order for inflammation in the lung tissue to resolve as soon as possible, the following procedures are prescribed:

1. Respiratory and general medical gymnastics.
2. Chest massage.
3. postural drainage.
4. Reflexology.
5. Electrophoresis.
6. Inhalations.

For an additional local effect with severe forms can carry out the so-called bronchoalveolar lavage, i.e. washing with solutions and evacuation of pathological exudate during bronchoscopy. And you can increase the reactivity of the body by irradiating the blood (laser or infrared).

Operation

Sometimes lingering pneumonias require surgical correction. Most often, we are talking about the removal of foreign bodies or the treatment of certain complications (pleural puncture for empyema). And when frequent relapses segmental resection of the affected lung may be considered. But in most cases, they still try to help with conservative means.

Prolonged pneumonia is not an uncommon situation. It occurs in both adults and children. And the main role in correcting this problem should be given to preventive measures aimed at early and complete cure acute inflammation lungs. And when pneumonia has passed into a protracted form, a mandatory review of therapy and its intensification is required.

You should not take treatment into your own hands - here you can not do without the help of a specialist. In order to correct therapeutic process the doctor prescribes an examination to identify the cause of the disease. Many begin to self-treat an infection that does not go away for two weeks with antibiotic therapy. This cannot be done, since antibiotics against ARVI, even if it lasts a long time, are powerless.

Usually their reception leads to the final oppression of the already affected immunity. Before engaging in self-medication, it is necessary to identify the true reason for the development and continuation of the disease. And only then decide what to do.

Often SARS takes chronic course due to concomitant diseases that have similar symptoms (for example, intoxication, allergies). Therefore, with a protracted course of pathology, mandatory diagnostics with laboratory tests is recommended.

So what to do:

In order for the infection not to last for a long time (2 weeks or a month), it is necessary to constantly maintain immunity at the proper level. To do this, it is recommended to take multivitamins, multivitamins, etc. It has been scientifically proven that B-group vitamins and D contribute to the acceleration of immune processes. Of course, you can revise the diet and eat more fruits, lean meat and vegetables, but it is still much better to take specialized vitamin complexes, then the disease will not disturb at all.

• To sleep more

If you have not let go for a month, try to sleep more so that the body rests. An adult normally needs 7 hours night sleep per day. And this is healthy, but the patient is recommended to sleep for 2 or more hours longer. During sleep, the air in the room should be cool, so in the evening the room where the patient is resting must be ventilated.

• drink more

Any cold, it passes in a week or two - it does not matter, it requires a plentiful drinking regime. If, at the first manifestations, such as temperature, water helps to avoid dehydration, then in a prolonged case, it helps to thin the mucus and discharge it from the bronchi.

• Maintain hygiene

Be careful about washing your hands. They have an incredible amount pathogenic microorganisms, spreading which we independently prolong our disease by touching our mouth, nose or eyes with our hands. So be sure to wash your hands with soap!

Dangerous Complications

A protracted cold can turn out to be very undesirable consequences, and if the patient has chronic foci cause them to aggravate.

In particular serious cases the consequences can affect (meningoencephalitis) or the heart (myocarditis), which can even be fatal.

But most often complications are associated with pathologies like:

Manifested strong cough, which does not go away for a long time and is accompanied by green-yellow sputum. If the patient has SARS, chronic sinusitis or bronchitis, their exacerbation occurs.

• Acute otitis media

This complication is associated with pathological condition middle ear and is manifested by sharp, shooting or numbing pain, may be observed purulent discharge from the ears.

• pneumonia

The most dangerous, also known as pneumonia. Accompanied by convulsive cough with wheezing and wheezing, making breathing difficult, and fever.

• Acute sinusitis

These are inflammatory processes in the sinuses, characterized by headache, nasal congestion, fever, disturbing the patient for more than ten days.

A protracted cold requires a strictly individual research and therapeutic approach, so it must be treated under strict medical supervision.