Bronchitis. Description, types, causes, prevention and treatment of bronchitis. Bronchitis, acute and chronic What is bronchitis of the lungs

The Latin name of the disease consists of two parts: " bronze» – bronchus and "itis" – inflammation which means inflammation of the bronchi. In most cases, bronchitis is seasonal. With the first rays of the sun, the days become warm, and the evenings are extremely cold. A sharp contrast in temperatures, clothes not matched to the weather, and the person is already sick. As you can imagine, we are talking about spring. However, make no mistake - bronchitis has nothing to do with a cold, it just makes it easier to manifest itself against its background. The next "favorable" factor is autumn. The disease is infectious.

During the peak of illness, doctors advise visiting hospitals with a protective mask, or at least wear it within the walls of a medical institution. Now it's time to learn more about what bronchitis is. The essence of the disease lies in the inflammatory lesion of the mucous membrane of the so-called bronchial tree, resulting from the aggressive impact of a wide variety of factors on the human body.

Causes of bronchitis

There are a large number of viral infections, the entry of which into our body does not cause an increase in temperature. Even if "yes", it is insignificant. That is why people prefer to visit work, thereby falling into the risk group of patients with complications. As a rule, bronchitis begins exclusively with a dry cough, which occurs only in the morning with a feeling of dryness or spasm of the larynx. Quite often, the disease is accompanied by shortness of breath. Subsequent progression is accompanied by coughing up colorless transparent or gray-yellow sputum. It is not uncommon for mucus to contain, in small quantities, blood.

Adults can suffer from bronchitis due to excessive smoking habits. It is worth noting that it is tobacco smoke that is the most basic and dominant factor in this disease, which can gradually develop into a chronic one, which in turn provokes severe pulmonary disease and heart disease.

Bronchitis - symptoms of the disease

The most important symptom of bronchitis has always been and remains a cough during which a yellowish-gray or greenish sputum is released. It may contain blood stains. Cough is a protective function of our body, during which the airways are cleared. However, only a wet cough is useful, which removes liquid sputum. The normal functioning of the bronchi consists in the daily production of about 30 gr. secretion, which prevents them from overheating, moisturizes, warms the air we inhale and performs a barrier function.

Dry cough, as a rule, manifests itself in the first days and indicates the viral factor of the disease. A cough that produces greenish mucus indicates bacterial bronchitis. However, in this case, the cough will evolve from dry to wet. In the case of an acute course of the disease, a paroxysmal cough is possible, accompanied by pain in the chest or even headaches. The disease may be accompanied by an increase, up to 38 degrees and above, in body temperature or its jumps. Based on the exacerbation of the disease, the gaps between the jumps will be reduced.

To summarize all the symptoms indicating the presence of the disease:

• cough;
• temperature increase: significant or insignificant;
• spasm of the throat, pain;
• wheezing, difficulty breathing.

Types of bronchitis

Viral

Viral - affects the lower respiratory tract. Basically, this disease occurs in children and is associated with a weak immune system and a huge crowding of children's groups. It is provoked by the infection entering the body through the nasopharynx, which has settled in the bronchi. Reproduction leads to damage to the internal mucosa, which in turn destroys the body's defense system.

Risk factors:

• dampness and cold;
• hostels, kindergartens and schools (large crowds of people);
• nasopharyngeal infection;
• disturbed nasal breathing

Infection:

Personal contact. Airborne. Inhalation of saliva particles during an infected person's cough or nasal secretions will ensure infection. A handkerchief in this case is not an obstacle.

Symptoms:

• significant body temperature (about 38);
• wet cough with difficult expectoration;

Acceptable treatments:

• warm plentiful drink;
• air humidification;
• steam inhalation;
• jars, mustard plasters, rubbing (if there is no temperature);
• vitamin therapy and immunostimulation.

Food:

• protein-rich food;
• fractional portions up to five times a day;
• eating foods rich in vitamins A, C and E;
• drinking: tea with raspberries, lemon, linden, fruit and vegetable juices, milk with honey and mineral alkaline water;
• the use of fresh antimicrobial onions also thins sputum.

Bacterial

A rare but extremely serious disease. Symptoms are the same as in cases of viral, but differ in the appearance of thick and dark sputum. Treatment occurs through the use of antibiotics, which will depend on the strain of the infecting bacterium. The method of viral treatment is powerless here. It is necessary to adhere to bed rest. Painkillers may be used. Favorable inhalations and hot showers. Smoking is contraindicated - completely.

Fungal

Allergic

It is provoked by a localization immune conflict of allergen-antibodies in large and medium bronchi. It is not accompanied by asthma attacks or pronounced bronchospastic components, since both bronchi and bronchioles do not take any part in the disease, remaining intact.

The reasons:

• dust;
• saliva or animal hair;
• plant pollen;
• household chemicals;
• Food;
• vaccine;
• household chemicals

Symptoms:

• dry paroxysmal cough;
• difficult breathing, shortness of breath on exhalation;
• periods of exacerbation and remission alternate;
• rales in the lungs: sometimes dry, sometimes moist;
• elevated blood levels of eosinophils;
• significant presence of immunoglobulin E.

Treatment:

• diet (elimination of irritating foods);
• antihistamines;
• alkaline inhalations;
• physiotherapy procedures;
• the use of herbal preparations;
• physiotherapy exercises, hardening;

Treatment cannot be carried out on your own because the consequences can be extremely negative and serious.

Chemical

They cause inhaled, soluble in the moisture of the lungs, toxic-chemical compounds, leading to damage to cellular structures or cell metabolites, accompanied by impaired microcirculation and the development of an acute inflammatory reaction.

Symptoms:

• irritating-suffocating acute action;
• rawness;
• burning;
• bronchospasm;
• acute laryngospasm;
• coughing;
• slight choking;
• other lesions of the upper respiratory tract.

This form of the disease is fraught with severe pulmonary edema.

Types of bronchitis

Spicy- accompanied by high fever, low chest cough, general malaise. It manifests itself against the background of acute viral respiratory diseases. Without complications, it lasts no more than 7 or 10 days, after which complete recovery occurs.

Chronic- provoke numerous episodes of acute bronchitis or prolonged exposure to any kind of irritating factors: gases, dust, smoking. It usually affects teenagers and adults. Among its symptoms is a pronounced prolonged cough from several months to two or more years. During the period of exacerbation of the disease, it is productive and deep, and in other cases: dry, wet or unproductive.

obstructive- a kind of acute or chronic, in which the patency of the air stream through the bronchi or damage to their walls is disturbed, which leads to absolute air obstruction.

Professional- a special type of inflammation of the bronchial tree under the influence of industrial irritants.
It has three forms of gravity.

I stage- persistent prolonged cough for 2 or 3 years.

Shortness of breath during physical exertion. Harsh breathing, dry rales, forced exhalations. Exacerbations are extremely rare. In x-rays, the pattern of the lungs is enhanced. There is no heart failure.

II stage- Persistent, prolonged paroxysmal cough with sputum production. Physical activity causes difficulty in breathing. There are rare attacks of suffocation. Breathing is hard and weak. In the lower parts of the lungs whistling dry, sometimes wet, wheezing. Frequent exacerbations. Exhaust sputum with pus. Changes in the lung pattern are moderately pronounced. The patient is assigned the third group of disability.

ІІІ stage- Persistent cough. Shortness of breath at rest. In case of slight physical stress - suffocation. Exacerbations are frequent and prolonged. Often develops into bronchial asthma. The change in the lung pattern is extremely significant. The second group of disability is assigned.

Each of the above types of bronchitis may differ in accordance with the leading factors that form the disease: the severity of its course and treatment methods.

The course of the disease and possible complications

Basically, the disease proceeds without complications and ends with an absolute recovery. Untimely access to a doctor can cause a number of complications, including pneumonia and bronchial ecstasy. The presence of blood clots in the sputum may indicate the onset of tuberculosis.

Bronchitis in children. Treatment

The reasons:
Insufficiently strengthened respiratory organs of the child quickly become infected. Such infection can lead to inflammation of the bronchi or bronchitis.

Symptoms:
If you notice that your child has symptoms of a cold, and he is also tormented by a strong dry cough, then most likely the disease is present. If breathing is accompanied by whistling, obstructive bronchitis is possible.

Treatment of bronchitis in children:
Its cunning lies in the exhaustion of the bronchi and the approach of asthma. Treatment must begin immediately. It is always important to start the treatment of any cough without delay and until it completely disappears. The doctor will definitely prescribe decongestants or antispasmodics. Removing spasms of the bronchus is the first thing. Perhaps there will be recommendations regarding mustard plasters for the calf muscles or steam legs. In the case of a wet cough, a compress will not be superfluous, which is contraindicated in case of temperature or wheezing.

Treatment of bronchitis in adults

The patient needs to provide bed rest and drink plenty of herbal teas and honey. In the absence of fever, thermal procedures on the chest are possible. Inhalations from anise, eucalyptus, menthol will be useful. In the case of acute forms of bronchitis, expectorants, antitussives and necessarily anti-allergic drugs are prescribed, which are aimed at expanding the lumen in the bronchi. Vitamins, as well as micro and macro elements are mandatory.

Acute bronchitis

traditional medicine

Treatment occurs against the background of the treatment of SARS. Increasingly, the disease is caused by atypical pathogens: microplasma and chlamydia. There is no specific treatment. In total, the treatment is based on the principle of a cold. General care, fever control, cough treatment, sputum thinning. The use of antibiotics is possible only in case of a bacterial infection or based on the patient's condition and is decided solely by the attending physician.

Alternative treatment of bronchitis

1. A decoction of the root of the primrose officinalis. 30 or 40 gr. For 1 liter of water 3 tbsp. spoons of the mixture. Take three times a day.

2. Knotweed (grass) highlander bird. It has a strong expectorant and anti-inflammatory effect. It is used in a decoction of the 1st tbsp. spoon or 20 drops of fresh juice in the summer 3 times a day.

3. Mother and stepmother. Expectorant. It is used inside in the form of a decoction of the 2nd or 3rd tbsp. spoons after two hours or a compress from the remaining cake on the chest.

Chronical bronchitis

traditional medicine

It is a prolonged or recurrent inflammation of the bronchi, which is not associated with a general or local lesion of a mild or manifested cough. Cough for 3 months a year or two years in a row is considered chronic. Runs slowly and for a long time. They treat inflammation in the bronchi, improving their patency. Restore immunity. As a rule, sulfonamides or antibiotics are prescribed. Plentiful drinking, inhalation with phytoncides contained in onions and garlic are attributed. Bronchospasmolytic, mucolytic and expectorant drugs are used. Food should be highly vitaminized and high-calorie.

Alternative treatment of bronchitis

1. Chopped onions - 500 gr., Sugar - 400 gr., Honey - 50 gr. diluted in 1 liter of water. Boil the mixture over low heat for 3 hours. Filter. Take 1 tbsp. spoon from 4 to 6 times a day.

2. Mandarin peel (dry, chopped) - 10 gr., Boiling water - 100 ml. Insist and strain. Take 5 times a day for the 1st tbsp. spoon before meals.

Acute bronchitis- acute diffuse inflammation of the mucous membrane (endobronchitis) or the entire wall of the bronchi (panbronchitis).

The etiology of acute bronchitis is a number of pathogenic factors affecting the bronchi:

1) physical: hypothermia, dust inhalation

2) chemical: inhalation of vapors of acids and alkalis

3) infectious: viruses - 90% of all acute bronchitis (rhinoviruses, adenoviruses, respiratory syncytial viruses, influenza), bacteria - 10% of all acute bronchitis (Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordetella pertusis, Streptococcus pneumoniae) and their associations.

The main etiological factor is infectious, the rest play the role of a trigger. There are also predisposing factors: smoking, alcohol abuse, heart disease with congestion in the pulmonary circulation, the presence of foci of chronic inflammation in the nasopharynx, oral cavity, tonsils, genetic inferiority of the bronchial mucociliary apparatus.

The pathogenesis of acute bronchitis:

Adhesion of pathogens on epithelial cells lining the trachea and bronchi + decrease in the effectiveness of local protective factors (the ability of the upper respiratory tract to filter the inhaled air and free it from coarse mechanical particles, change the temperature and humidity of the air, cough and sneeze reflexes, mucociliary transport) Þ pathogen invasion Þ hyperemia and edema of the bronchial mucosa, desquamation of the cylindrical epithelium, the appearance of mucous or mucopurulent exudate Þ further violation of mucociliary clearance Þ edema of the bronchial mucosa, hypersecretion of bronchial glands Þ development of an obstructive component.

Classification of acute bronchitis:

1) primary and secondary acute bronchitis

2) according to the level of damage:

a) tracheobronchitis (usually against the background of acute respiratory diseases)

b) bronchitis with a primary lesion of medium-sized bronchi

c) bronchiolitis

3) according to clinical symptoms: mild, moderate and severe severity

4) according to the state of bronchial patency: obstructive and non-obstructive

Clinic and diagnosis of acute bronchitis.

If bronchitis develops against the background of SARS, hoarseness of voice, sore throat when swallowing, a feeling of soreness behind the sternum, an irritating dry cough (manifestations of tracheitis) appear first. Cough intensifies, may be accompanied by pain in the lower chest and behind the sternum. As the inflammation in the bronchi subsides, the cough becomes less painful, abundant mucopurulent sputum begins to separate.

Symptoms of intoxication (fever, headaches, general weakness) vary greatly and Most often determined by the causative agent of the disease(with adenovirus infection - conjunctivitis, with parainfluenza virus - hoarseness of voice, with influenza virus - high fever, headache and meager catarrhal phenomena, etc.).

Objectively Percussion: clear pulmonary sound, auscultatory: hard breathing, dry rales of various heights and timbres, and when a sufficient amount of liquid sputum is released - moist rales in a small amount; wheezing increases with forced breathing of the patient.

Laboratory data are not specific. Inflammatory changes in the blood may be absent. In a cytological examination of sputum, all fields of view are covered by leukocytes and macrophages.

Treatment of acute bronchitis.

1. Home mode, drinking plenty of water

2. Mucolytic and expectorant agents: acetylcysteine ​​(fluimucil) orally 400-600 mg / day in 1-2 doses or 10% solution in inhalation 3 ml 1-2 times / day for 7 days, bromhexine orally 8-16 mg 3 times / day for 7 days, Ambroxol 30 mg, 1 tab. 3 times / day 7 days.

3. In the presence of broncho-obstructive syndrome: short-acting beta-agonists (salbutamol in a dosing aerosol, 2 puffs).

4. In uncomplicated acute bronchitis, antimicrobial therapy is not indicated; The effectiveness of prescribing antibiotics to prevent bacterial infection has not yet been proven. In acute bronchitis against the background of influenza, the earliest possible use of rimantadine according to the scheme is indicated. ABs are used most often in the elderly with serious comorbidities and in children of the first years of life. AB of choice - amoxicillin 500 mg 3 times / day for 5 days, alternative AB - cefaclor 500 mg 3 times / day for 5 days, cefuroxime axetil 500 mg 2 times / day for 5 days, if intracellular pathogens are suspected - clarithromycin 500 mg 2 times / day or josamycin 500 mg 3 times a day for 5 days.

5. Symptomatic treatment (NSAIDs, etc.).

Chronic bronchitis (CB) is a chronic inflammatory disease of the bronchi, accompanied by a persistent cough with sputum for at least 3 months a year for 2 or more years, while these symptoms are not associated with any other diseases of the bronchopulmonary system, upper respiratory tract or other organs and systems.

Allocate HB:

BUT) Primary- an independent disease that is not associated with damage to other organs and systems, often has a diffuse character

B) secondary- etiologically associated with chronic inflammatory diseases of the nose and paranasal sinuses, lung diseases, etc., more often it is local.

Etiology of chronic bronchitis:

1) Smoking:

- nicotine, polycyclic aromatic hydrocarbons of tobacco (benzpyrene, cresol) - strong carcinogens

- dysfunction of the ciliated epithelium of the bronchi, mucociliary transport

- components of tobacco smoke reduce the phagocytic activity of macrophages and neutrophils of the respiratory tract

- tobacco smoke leads to metaplasia of the ciliated epithelium and Clara cells, forming precursors of cancer cells

– stimulation of the proteolytic activity of neutrophils, hyperproduction of elastase –> destruction of the elastic fibers of the lungs and damage to the ciliated epithelium –> emphysema

– ACE activity of alveolar macrophages –> ATII synthesis –> pulmonary hypertension

– nicotine increases the synthesis of IgE and histamine, predisposing to allergic reactions

2) Inhalation of polluted air- Inhaled aggressive substances (nitrogen and sulfur dioxide, hydrocarbons, nitrogen oxides, aldehydes, nitrates) cause irritation and damage to the bronchopulmonary system.

3) The influence of occupational hazards- various types of dust (cotton, wood flour), toxic fumes and gases (ammonia, chlorine, acids, phosgene), high or low air temperature, drafts, etc. can lead to chronic bronchitis.

4) Damp and cold climate- contributes to the development and exacerbation of HB.

5) Infection- more often it is secondary, joining when the conditions for infection of the bronchial tree are already formed. The leading role in exacerbations of chronic bronchitis is played by pneumococcus and Haemophilus influenzae, as well as a viral infection.

6) Past acute bronchitis(most often untreated lingering or recurrent)

7)genetic factors and hereditary predisposition

The pathogenesis of chronic bronchitis.

1. Dysfunction Systems of local bronchopulmonary protection and immune systems

A. dysfunction of mucociliary transport (ciliated epithelium)

B. impaired function of the surfactant system of the lungs –> increased sputum viscosity; violation of non-ciliary transport; collapse of the alveoli, obstruction of the small bronchi and bronchioles; colonization of microbes in the bronchial tree

C. violation of the content of humoral protective factors in the bronchial contents (deficiency of IgA, complement components, lysozyme, lactoferrin, fibronectin, interferons

D. violation of the ratio of proteases and their inhibitors (a1-antitrypsin and a2-macroglobulin)

D. decreased function of alveolar macrophages

E. dysfunction of local broncho-associated lymphoid tissue and the immune system of the body as a whole

2. Structural reorganization of the bronchial mucosa– a significant increase in the number and activity of goblet cells, hypertrophy of the bronchial glands –> excessive production of mucus, deterioration of the rheological properties of sputum –> mucostasis

3. Development of the classical pathogenetic triad(hypercrinia - increased mucus production, dyscrinia - mucus becomes viscous, thick, mucostasis - mucus stagnation) and the release of inflammatory mediators and cytokines (histamine, arachidonic acid derivatives, TNF, etc.) -> a sharp violation of the drainage function of the bronchi, good conditions for microorganisms –> penetration of the infection to the deep layers and further damage to the bronchi.

Clinical picture of chronic bronchitis.

Subjectively:

1) Cough- at the beginning of the disease, periodic, worries patients in the morning shortly after waking up, the amount of sputum discharge is small; cough increases in the cold and damp season, and in the summer it may completely stop. As HB progresses, the cough becomes constant, disturbing not only in the morning, but also during the day and even at night. With an exacerbation of the process, the cough increases sharply, becomes hoarse, painful. In the late stage of the disease, the cough reflex may fade away, while the cough ceases to bother the patient, but the drainage of the bronchi is sharply disturbed.

2) Sputum department- it can be mucous, purulent, mucopurulent, sometimes with streaks of blood; in the early stages of the disease, sputum is light, mucous, easily separated, as the process progresses, it acquires a mucopurulent or purulent character, it is separated with great difficulty, with an exacerbation of the process, its amount increases sharply. Hemoptysis may be due to damage to the blood vessels of the bronchial mucosa during a hacking cough (requires differential diagnosis with tuberculosis, lung cancer, bronchiectasis).

3) shortness of breath- begins to disturb the patient with the development of bronchial obstruction and emphysema.

Objectively:

1) when examining significant changes are not detected; during the period of exacerbation of the disease, sweating, an increase in body temperature to subfebrile numbers can be observed.

2) percussion clear pulmonary sound, with the development of emphysema - a boxed sound.

3) auscultatory prolongation of expiration, hard breathing (“roughness”, “roughness” of vesicular breathing), dry rales (due to the presence of viscous sputum in the lumen of the bronchi, in the large bronchi - low-pitched bass, in the middle bronchi - buzzing, in the small bronchi - whistling) . In the presence of liquid sputum in the bronchi - wet rales (large bubbling in the large bronchi, medium bubbling in the middle bronchi, fine bubbling in the small bronchi). Dry and wet rales are unstable, may disappear after vigorous coughing and sputum discharge.

Variants of the clinical course of CB: with symptoms of bronchial obstruction and without them; latent course, with rare exacerbations, with frequent exacerbations and continuously relapsing course of the disease.

Clinical and diagnostic signs of exacerbation of CB:

- increased general weakness, the appearance of malaise, a decrease in overall performance

- the appearance of severe sweating, especially at night (symptom of a damp pillow or sheet)

- subfebrile body temperature

- tachycardia at normal temperature

- increased cough, increased amount and "purulence" of sputum

- the appearance of biochemical signs of inflammation

- a shift in the leukocyte formula to the left and an increase in ESR to moderate numbers

Diagnosis of chronic bronchitis.

1. Laboratory data:

BUT) UAC- little changed, inflammatory changes are characteristic during exacerbation of the process

B) Sputum analysis- macroscopic (white or transparent - mucous or yellow, yellow-green - purulent; streaks of blood, mucous and purulent plugs, bronchial casts can be detected) and microscopic (a large number of neutrophils, bronchial epithelial cells, macrophages, bacteria), bacteriological examination of sputum and determination of the sensitivity of pathogens to antibiotics.

AT) TANK- biochemical indicators of inflammation activity allow us to judge its severity (decrease in albumin-globulin coefficient, increase in haptoglobin, sialic acids and seromucoid).

2. Instrumental research:

BUT) Bronchoscopy- bronchoscopically distinguish diffuse (inflammation covers all endoscopically visible bronchi) and limited (inflammation captures the main and lobar bronchi, segmental bronchi are not changed) bronchitis, determine the intensity of inflammation of the bronchi (I degree - the bronchial mucosa is pale pink, covered with mucus, does not bleed; II degree - bronchial mucosa is bright red, thickened, often bleeds, covered with pus; III degree - bronchial and tracheal mucosa is thickened, purplish-cyanotic, bleeds easily, covered with purulent secretion).

B) Bronchography- carried out only after the rehabilitation of the bronchial tree; chronic bronchitis is characterized by:

- bronchi of IV-VII orders are cylindrically expanded, their diameter does not decrease towards the periphery, as is normal; the lateral branches are obliterated, the distal ends of the bronchi are blindly cut off (“amputated”);

- in a number of patients, the dilated bronchi in some areas are narrowed, their contours are changed (the shape of the "rosary"), the inner contour of the bronchi is jagged, the architectonics of the bronchial tree is disturbed.

AT) X-ray of the lungs- signs of chronic bronchitis are detected only in long-term ill patients (strengthening and deformation of the lung pattern according to the looped-cellular type, increased transparency of the lung fields, expansion of the shadows of the roots of the lungs, thickening of the walls of the bronchi due to peribronchial pneumosclerosis).

G) Examination of the function of external respiration(spirography, peak flowmetry) - to detect obstructive disorders

Complications of HB.

1) directly caused by infection: a) pneumonia b) bronchiectasis c) broncho-obstructive syndrome d) bronchial asthma

2) due to the evolution of bronchitis: a) hemoptysis b) pulmonary emphysema c) diffuse pneumosclerosis d) respiratory failure e) cor pulmonale.

Treatment of HB is different in the period of remission and during the period of exacerbation.

1. During remission: with chronic bronchitis of mild severity - the elimination of foci of infection (caries, tonsillitis, etc.), hardening of the body, therapeutic physical culture, breathing exercises; in case of moderate and severe chronic bronchitis, pathogenetic treatment is additionally carried out with courses aimed at improving bronchial patency, reducing pulmonary hypertension and combating right ventricular heart failure.

2. During an exacerbation:

BUT) Etiotropic treatment: orally AB taking into account the sensitivity of the flora sown from sputum (semi-synthetic penicillins: amoxicillin 1 g 3 times / day, protected penicillins: amoxiclav 0.625 g 3 times / day, macrolides: clarithromycin 0.5 g 2 times / day, respiratory fluoroquinolones: levofloxacin 0.5 g 1 time / day, moxifloxacin 0.4 g 1 time / day) for 7-10 days. If treatment is ineffective, parenteral administration of III-IV generation cephalosporins (cefepime intramuscularly or intravenously, 2 g 2 times / day, cefotaxime intramuscularly or intravenously, 2 g 3 times / day).

B) Pathogenetic treatment aimed at improving pulmonary ventilation, restoring bronchial patency:

- mucolytic and expectorant drugs: ambroxol orally 30 mg 3 times / day, acetylcysteine ​​orally 200 mg 3-4 times / day for 2 weeks, herbal preparations (thermopsis, ipecac, mucaltin)

– therapeutic bronchoscopy with bronchial sanitation

- bronchodilators (M-anticholinergics: ipratropium bromide 2 breaths 3-4 times / day, beta-agonists: fenoterol, their combination - atrovent inhalation, prolonged eufillins: teotard, teopek, theobilong inside 1 tab. 2 times / day)

- drugs that increase the body's resistance: vitamins of groups A, C, B, immunocorrectors (T-activin or thymalin 100 mg subcutaneously for 3 days, ribomunil, bronchomunal inside)

– physiotherapy treatment: diathermy, calcium chloride electrophoresis, quartz on the chest area, chest massage, breathing exercises

AT) Symptomatic treatment: drugs that suppress the cough reflex (with an unproductive cough - libexin, tusuprex, with a hacking cough - codeine, stoptussin)

Outcome of chronic bronchitis: in obstructive form or chronic bronchitis with lesions of the distal lung, the disease quickly leads to the development of pulmonary insufficiency and the formation of cor pulmonale.

ITU: VN in acute bronchitis and exacerbation of chronic bronchitis without obstruction - an average of 6-8 days. Rehabilitation: exercise therapy, breathing exercises, treatment in sanatoriums of the pulmonary profile (Crimea, mountain resorts, in the Republic of Belarus - sanatoriums "Borovoe", "Sosny", "Belarus", "Bug", "Berezina", "Alesya", etc.

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is bronchitis?

Pathogenesis (mechanism of development) of bronchitis

The air inhaled through the nose enters the trachea - a straight tube 10 - 14 cm long, which is a continuation of the larynx. In the chest, the trachea divides into 2 main bronchi (right and left), which lead to the right and left lungs, respectively. Each main bronchus is divided into lobar bronchi (directed to the lobes of the lungs), and each of the lobar bronchi, in turn, is also divided into 2 smaller bronchi. This process is repeated more than 20 times, resulting in the formation of the thinnest airways (bronchioles), the diameter of which does not exceed 1 millimeter. As a result of the division of the bronchioles, the so-called alveolar ducts are formed, into which the lumens of the alveoli open - small thin-walled bubbles in which the process of gas exchange occurs.

The wall of the bronchus consists of:

• Mucous membrane. The mucous membrane of the respiratory tract is covered with a special respiratory (ciliated) epithelium. On its surface are the so-called cilia (or threads), the vibrations of which ensure the purification of the bronchi (small particles of dust, bacteria and viruses that have entered the respiratory tract get stuck in the bronchial mucus, after which they are pushed up into the throat with the help of cilia and swallowed).
• muscle layer. The muscle layer is represented by several layers of muscle fibers, the contraction of which ensures the shortening of the bronchi and a decrease in their diameter.
• cartilage rings. These cartilages are a strong framework that provides airway patency. The cartilaginous rings are most pronounced in the region of the large bronchi, but as their diameter decreases, the cartilages become thinner, completely disappearing in the region of the bronchioles.
• Connective tissue sheath. Surrounds the bronchi from the outside.

The development and progression of the inflammatory process is characterized by the migration to the focus of inflammation of the cells of the immune (protective) system of the body (neutrophils, histiocytes, lymphocytes, and others). These cells begin to fight the cause of inflammation, as a result of which they are destroyed and release many biologically active substances (histamine, serotonin, prostaglandins and others) into the surrounding tissues. Most of these substances have a vasodilating effect, that is, they expand the lumen of the blood vessels of the inflamed mucosa. This leads to its edema, resulting in a narrowing of the lumen of the bronchi.

The development of the inflammatory process in the bronchi is also characterized by increased formation of mucus (this is a protective reaction of the body that helps to cleanse the respiratory tract). However, in conditions of an edematous mucous membrane, mucus cannot be normally secreted, as a result of which it accumulates in the lower respiratory tract and clogs smaller bronchi, which leads to impaired ventilation of a certain area of ​​the lung.

With an uncomplicated course of the disease, the body eliminates the cause of its occurrence within a few weeks, which leads to a complete recovery. In more severe cases (when the causative factor affects the airways for a long time), the inflammatory process can go beyond the mucous membrane and affect the deeper layers of the bronchial walls. Over time, this leads to structural rearrangement and deformation of the bronchi, which disrupts the delivery of air to the lungs and leads to the development of respiratory failure.

Causes of bronchitis

It is also worth noting that the penetration of infectious and non-infectious agents into the respiratory tract can be facilitated by various factors that reduce the general and local protective properties of the body.

Bronchitis is promoted by:

• Hypothermia. Normal blood supply to the bronchial mucosa is an important barrier to viral or bacterial infectious agents. When cold air is inhaled, a reflex narrowing of the blood vessels of the upper and lower respiratory tract occurs, which significantly reduces the local protective properties of tissues and contributes to the development of infection.
• Wrong nutrition. Malnutrition leads to a lack of proteins, vitamins (C, D, group B and others) and trace elements in the body, which are necessary for normal tissue renewal and the functioning of vital systems (including the immune system). The consequence of this is a decrease in the body's resistance in the face of various infectious agents and chemical irritants.
• Chronic infectious diseases. Foci of chronic infection in the nasal or oral cavity create a constant threat of bronchitis, since the location of the source of infection near the airways ensures its easy penetration into the bronchi. Also, the presence of foreign antigens in the human body changes the activity of its immune system, which can lead to more pronounced and destructive inflammatory reactions during the development of bronchitis.

• viral bronchitis;
• bacterial bronchitis;
• allergic (asthmatic) bronchitis;
• smoker's bronchitis;
• professional (dust) bronchitis.

Viral bronchitis

By themselves, acute viral bronchitis does not pose a threat to the patient's life, however, a viral infection leads to a decrease in the protective forces of the bronchial tree, which creates favorable conditions for the attachment of a bacterial infection and the development of formidable complications.

Bacterial bronchitis

In response to the aggressive action of bacteria and their toxins, the body's immune system is activated and a large number of neutrophils and other leukocytes migrate to the site of infection. They absorb bacterial particles and fragments of damaged mucosal cells, digest them and break down, resulting in the formation of pus.

Allergic (asthmatic) bronchitis

In cases where plant pollen is the allergen, bronchitis is seasonal and occurs only during the flowering period of a certain plant or a certain group of plants. If a person is allergic to other substances, the clinical manifestations of bronchitis will persist throughout the entire period of contact of the patient with the allergen.

smoker's bronchitis

In addition, the toxins contained in tobacco smoke negatively affect the activity of the respiratory epithelium, reducing the mobility of cilia and disrupting the process of removing mucus and dust particles from the respiratory tract. Also, nicotine (which is part of all tobacco products) causes narrowing of the blood vessels of the mucous membrane, which leads to a violation of local protective properties and contributes to the attachment of a viral or bacterial infection.

Over time, the inflammatory process in the bronchi progresses and can move from the mucous membrane to the deeper layers of the bronchial wall, causing an irreversible narrowing of the airway lumen and impaired lung ventilation.

Occupational (dust) bronchitis

Occupational bronchitis is usually characterized by a long, slowly progressive, but irreversible course. That is why it is extremely important to detect the development of this disease in time and start treatment in a timely manner.

The following are predisposed to the development of professional bronchitis:

• wipers;
• miners;
• metallurgists;
• cement industry workers;
• chemical plant workers;
• employees of woodworking enterprises;
• millers;
• chimney sweeps;
• railway workers (inhale a large amount of exhaust gases from diesel engines).

Bronchitis symptoms

• cough;
• expectoration of sputum;
• wheezing in the lungs;
• shortness of breath (feeling short of breath);
• an increase in body temperature;

Cough with bronchitis

Cough with bronchitis can be:

• Dry (without sputum discharge). Dry cough is typical for the initial stage of bronchitis. Its occurrence is due to the penetration of infectious or dust particles into the bronchi and damage to the cells of the mucous membrane. As a result of this, the sensitivity of cough receptors (nerve endings located in the wall of the bronchi) increases. Their irritation (by dust or infectious particles or fragments of the destroyed bronchial epithelium) leads to the appearance of nerve impulses that are sent to a special section of the brain stem - to the cough center, which is a cluster of neurons (nerve cells). From this center, impulses along other nerve fibers enter the respiratory muscles (diaphragm, abdominal wall muscles and intercostal muscles), causing their synchronous and sequential contraction, manifested by coughing.
• Wet (accompanied by sputum). As bronchitis progresses, mucus begins to accumulate in the lumen of the bronchi, which often sticks to the bronchial wall. During inhalation and exhalation, this mucus is displaced by the air flow, which also leads to mechanical irritation of the cough receptors. If, during coughing, mucus breaks away from the bronchial wall and is removed from the bronchial tree, the person feels relieved. If the mucous plug is attached tightly enough, during coughing it fluctuates intensely and irritates the cough receptors even more, but does not come off the bronchus, which is often the cause of prolonged bouts of painful coughing.

Sputum discharge in bronchitis

With bronchitis, it can stand out:

• Slimy sputum. They are a colorless transparent mucus, odorless. The presence of mucous sputum is characteristic of the initial periods of viral bronchitis and is due only to an increased secretion of mucus by goblet cells.
• Mucopurulent sputum. As mentioned earlier, pus is cells of the immune system (neutrophils) that have died as a result of fighting a bacterial infection. Therefore, the release of mucopurulent sputum will indicate the development of a bacterial infection in the respiratory tract. Sputum in this case is lumps of mucus, inside which streaks of gray or yellowish-green pus are determined.
• Purulent sputum. Isolation of purely purulent sputum in bronchitis is rare and indicates a pronounced progression of the purulent-inflammatory process in the bronchi. Almost always, this is accompanied by the transition of a pyogenic infection to the lung tissue and the development of pneumonia (pneumonia). The resulting sputum is a collection of gray or yellow-green pus and has an unpleasant, fetid odor.
• Sputum with blood. Blood streaks in sputum may result from injury or rupture of small blood vessels in the bronchial wall. This can be facilitated by an increase in the permeability of the vascular wall, observed during the development of the inflammatory process, as well as a prolonged dry cough.

Wheezing in the lungs with bronchitis

Wheezing with bronchitis can be:

• Dry whistling (high pitch). They are formed as a result of narrowing of the lumen of small bronchi, as a result of which, when air flows through them, a kind of whistle is formed.
• Dry buzzing (low pitch). They are formed as a result of air turbulence in large and medium bronchi, which is due to the narrowing of their lumen and the presence of mucus and sputum on the walls of the respiratory tract.
• Wet. Wet rales occur when there is fluid in the bronchi. During inhalation, the flow of air passes through the bronchi at high speed and foams the liquid. The resulting foam bubbles burst, which is the cause of wet rales. Wet rales can be finely bubbling (heard with lesions of small bronchi), medium bubbling (with lesions of medium-sized bronchi) and large bubbling (with lesions of large bronchi).

Shortness of breath with bronchitis

In the initial stages of the disease, shortness of breath is usually absent, since the patency of the airways is preserved. As the inflammatory process progresses, swelling of the mucous membrane increases, as a result of which the amount of air that can penetrate into the pulmonary alveoli per unit of time decreases. The deterioration of the patient's condition is also facilitated by the formation of mucous plugs - accumulations of mucus and (possibly) pus that get stuck in the small bronchi and completely clog their lumen. Such a mucous plug cannot be removed by coughing, since during inhalation air does not penetrate through it into the alveoli. As a result, the area of ​​lung tissue ventilated by the affected bronchus is completely switched off from the gas exchange process.

For a certain time, the insufficient supply of oxygen to the body is compensated by the unaffected areas of the lungs. However, this compensatory mechanism is very limited, and when it is depleted, hypoxemia (lack of oxygen in the blood) and tissue hypoxia (lack of oxygen in the tissues) develop in the body. At the same time, a person begins to experience a feeling of lack of air.

To ensure normal delivery of oxygen to tissues and organs (first of all, to the brain), the body triggers other compensatory reactions, which consist in increasing the respiratory rate and heart rate (tachycardia). As a result of an increase in the respiratory rate, more fresh (oxygenated) air enters the pulmonary alveoli, which penetrates into the blood, and as a result of tachycardia, oxygen-enriched blood spreads faster throughout the body.

It should be noted that these compensatory mechanisms also have their limits. As they are depleted, the respiratory rate will increase more and more, which, without timely medical intervention, can lead to the development of life-threatening complications (up to death).

Shortness of breath with bronchitis can be:

• Inspiratory. It is characterized by difficulty in inhaling, which may be due to blockage of medium-sized bronchi with mucus. Inhalation is noisy, heard at a distance. During inhalation, patients tense the accessory muscles of the neck and chest.
• expiratory. This is the main type of shortness of breath in chronic bronchitis, characterized by difficulty exhaling. As mentioned earlier, the walls of the small bronchi (bronchioles) do not contain cartilage rings, and in the straightened state they are supported only due to the elastic force of the lung tissue. With bronchitis, the mucous bronchioles swell, and their lumen can become clogged with mucus, as a result of which, in order to exhale air, a person needs to make more efforts. However, pronounced tense respiratory muscles on exhalation contribute to an increase in pressure in the chest and lungs, which can cause the bronchioles to collapse.
• Mixed. It is characterized by difficulty in inhaling and exhaling of varying severity.

chest pain with bronchitis

Also, the progression of the inflammatory process contributes to the development of hypersensitivity of nerve endings located in the large bronchi and trachea. As a result, any increase in pressure or airflow velocity in the airways can lead to pain. This explains the fact that pain in bronchitis occurs mainly during coughing, when the speed of air passing through the trachea and large bronchi is several hundred meters per second. The pain is sharp, burning or stabbing, aggravated during a coughing fit and subsides when the airways are at rest (that is, during calm breathing with humidified warm air).

temperature in bronchitis

A direct increase in body temperature during viral and bacterial infections is due to the contact of infectious agents with cells of the immune system (leukocytes). As a result, leukocytes begin to produce certain biologically active substances called pyrogens (interleukins, interferons, tumor necrosis factor), which penetrate the central nervous system and affect the center of temperature regulation, which leads to an increase in heat generation in the body. The more infectious agents have penetrated the tissues, the more leukocytes are activated and the more pronounced the temperature reaction will be.

With viral bronchitis, the body temperature rises to 38 - 39 degrees from the first days of the disease, while with the addition of a bacterial infection - up to 40 degrees or more. This is explained by the fact that many bacteria in the course of their life activity release a large amount of toxins into the surrounding tissues, which, along with fragments of dead bacteria and damaged cells of their own body, are also strong pyrogens.

Sweating with bronchitis

To prevent the development of these complications, the body needs to increase heat transfer. This is done through the evaporation of sweat, in the process of which the body loses heat. Under normal conditions, about 35 grams of sweat per hour evaporates from the surface of the skin of the human body. This consumes about 20 kilocalories of thermal energy, which leads to cooling of the skin and the whole body. With a pronounced increase in body temperature, the sweat glands are activated, as a result of which more than 1000 ml of fluid per hour can be released through them. All of it does not have time to evaporate from the surface of the skin, as a result of which it accumulates and forms drops of sweat in the back, face, neck, torso.

Features of the course of bronchitis in children

Infectious bronchitis in a child can cause overly pronounced immune and systemic inflammatory reactions, which is due to the underdevelopment of the regulatory mechanisms of the child's body. As a result, the symptoms of the disease can be expressed from the first days of bronchitis. The child becomes lethargic, whiny, body temperature rises to 38 - 40 degrees, shortness of breath progresses (up to the development of respiratory failure, manifested by pallor of the skin, cyanosis of the skin in the nasolabial triangle, impaired consciousness, and so on). It is important to note that the younger the child, the sooner the symptoms of respiratory failure may occur and the more severe the consequences for the baby.

Features of the course of bronchitis in the elderly

At the same time, it is worth noting that the clinical manifestations of bronchitis in the elderly can be very poorly expressed (a weak dry cough, shortness of breath, slight chest pain may be noted). Body temperature may be normal or slightly elevated, which is explained by a violation of thermoregulation as a result of reduced activity of the immune and nervous systems. The danger of this condition lies in the fact that when a bacterial infection is attached or when the infectious process moves from the bronchi to the lung tissue (that is, with the development of pneumonia), the correct diagnosis can be made too late, which will greatly complicate treatment.

Types of bronchitis

Depending on the clinical course, there are:

• acute bronchitis;
• Chronical bronchitis.

• catarrhal bronchitis;
• purulent bronchitis;
• atrophic bronchitis.

Acute bronchitis

The first symptoms of acute bronchitis can be:

• general weakness;
• increased fatigue;
• lethargy;
• perspiration (irritation) of the mucous membrane of the throat;
• dry cough (may occur from the first days of the disease);
• chest pain;
• progressive shortness of breath (especially during exercise);
• increase in body temperature.

When a bacterial infection is attached (which is usually observed 2 to 5 days after the onset of the disease), the patient's condition worsens. The body temperature rises, shortness of breath progresses, with a cough, mucopurulent sputum begins to stand out. Without timely treatment, inflammation of the lungs (pneumonia) can develop, which can lead to the death of the patient.

Chronical bronchitis

As a result of exposure to causative factors, a chronic, sluggish inflammatory process develops in the mucous membrane of the bronchial tree. Its activity is not enough to cause the classic symptoms of acute bronchitis, and therefore, at first, a person rarely seeks medical help. However, prolonged exposure to inflammatory mediators, dust particles and infectious agents leads to the destruction of the respiratory epithelium and its replacement by a multi-layered epithelium, which normally does not occur in the bronchi. Also, the deeper layers of the bronchial wall are damaged, leading to a violation of its blood supply and innervation.

Stratified epithelium does not contain cilia, therefore, as it grows, the excretory function of the bronchial tree is disturbed. This leads to the fact that inhaled dust particles and microorganisms, as well as the mucus formed in the bronchi, do not stand out, but accumulate in the lumen of the bronchi and clog them, leading to the development of various complications.

In the clinical course of chronic bronchitis, periods of exacerbation and a period of remission are distinguished. During the period of exacerbation, the symptoms correspond to those in acute bronchitis (cough with sputum production, fever, deterioration in general condition, and so on). After treatment, the clinical manifestations of the disease subside, but cough and shortness of breath usually persist.

An important diagnostic feature of chronic bronchitis is the deterioration of the patient's general condition after each successive exacerbation of the disease. That is, if earlier the patient had shortness of breath only during severe physical exertion (for example, when climbing to the 7th - 8th floor), after 2 - 3 exacerbations, he may notice that shortness of breath occurs already when climbing to the 2nd - 3rd floor. This is explained by the fact that with each exacerbation of the inflammatory process, a more pronounced narrowing of the lumen of the bronchi of small and medium caliber occurs, which makes it difficult to deliver air to the pulmonary alveoli.

With a long course of chronic bronchitis, ventilation of the lungs can be so disturbed that the body begins to experience a lack of oxygen. This can be manifested by severe shortness of breath (which persists even at rest), cyanosis of the skin (especially in the area of ​​​​the fingers and toes, since the tissues most distant from the heart and lungs suffer from a lack of oxygen), moist rales when listening to the lungs. Without appropriate treatment, the disease progresses, which can lead to the development of various complications and death of the patient.

catarrhal bronchitis

Catarrhal bronchitis is a mild form of the disease and usually resolves within 3 to 5 days with adequate treatment. However, it is important to remember that the protective properties of the mucous membrane of the respiratory tract are significantly reduced, therefore it is extremely important to prevent the attachment of a bacterial infection or the transition of the disease to a chronic form.

Purulent bronchitis

Since the bronchial mucosa is destroyed by the inflammatory process, bacteria easily penetrate through it and infect the tissues of the bronchial wall. The development of the infectious process is also facilitated by high air humidity and temperature in the respiratory tract, which are optimal conditions for the growth and reproduction of bacteria.

In a short time, a bacterial infection can affect large areas of the bronchial tree. This is manifested by pronounced symptoms of general intoxication of the body (the temperature can rise to 40 degrees or more, lethargy, drowsiness, palpitations, and so on) and a cough, accompanied by the release of a large amount of purulent sputum with a fetid odor.

If untreated, the progression of the disease can lead to the spread of pyogenic infection into the pulmonary alveoli and the development of pneumonia, as well as the penetration of bacteria and their toxins into the blood. These complications are very dangerous and require urgent medical intervention, otherwise the patient may die within a few days due to progressive respiratory failure.

Atrophic bronchitis

Atrophy of the mucous membrane is accompanied by a pronounced violation of all the functions of the bronchi. During inhalation, the air passing through the affected bronchi is not moistened, warmed up and not cleaned of dust microparticles. The penetration of such air into the respiratory alveoli can lead to damage and disruption of the process of oxygen enrichment of the blood. In addition, with atrophic bronchitis, the muscular layer of the bronchial wall is also affected, as a result of which the muscle tissue is destroyed and replaced by fibrous (scar) tissue. This significantly limits the mobility of the bronchi, the lumen of which under normal conditions can expand or narrow depending on the body's need for oxygen. The consequence of this is the development of shortness of breath, which initially occurs during physical exertion, and then may appear at rest.

In addition to shortness of breath, atrophic bronchitis can be manifested by a dry, painful cough, pain in the throat and chest, a violation of the general condition of the patient (due to insufficient oxygen supply to the body) and the development of infectious complications due to a violation of the protective functions of the bronchi.

Diagnosis of bronchitis

• auscultation (listening) of the lungs;
• general blood analysis ;
• sputum analysis;
• X-rays of light;
• spirometry;
• pulse oximetry;

Auscultation of the lungs with bronchitis

When listening to the lungs of a healthy person, a soft vesicular breathing noise is determined, resulting from the stretching of the pulmonary alveoli when they are filled with air. In bronchitis (both acute and chronic), there is a narrowing of the lumen of the small bronchi, as a result of which the air flow moves through them at high speed, with swirls, which is defined by the doctor as hard (bronchial) breathing. Also, the doctor can determine the presence of wheezing over various parts of the lungs or on the entire surface of the chest. Wheezes can be dry (their occurrence is due to the passage of air flow through the narrowed bronchi, in the lumen of which there may also be mucus) or wet (occurring in the presence of fluid in the bronchi).

Blood test for bronchitis

With purulent bronchitis, an increase in the total number of leukocytes over 9.0 x 10 9 / l will be noted, and the number of neutrophils, especially their young forms, will increase in the leukocyte formula. Neutrophils are responsible for the process of phagocytosis (absorption) of bacterial cells and their digestion.

Also, a blood test reveals an increase in ESR (erythrocyte sedimentation rate placed in a test tube), which indicates the presence of an inflammatory process in the body. With viral bronchitis, ESR can be slightly increased (up to 20-25 mm per hour), while the addition of a bacterial infection and intoxication of the body is characterized by a pronounced increase in this indicator (up to 40-50 mm per hour or more).

Sputum analysis for bronchitis

When examining sputum, it can be found:

• Cells of the bronchial epithelium (epithelial cells). They are found in large quantities in the early stages of catarrhal bronchitis, when mucous sputum is just beginning to appear. With the progression of the disease and the addition of a bacterial infection, the number of epithelial cells in the sputum decreases.
• Neutrophils. These cells are responsible for the destruction and digestion of pyogenic bacteria and fragments of bronchial epithelial cells destroyed by the inflammatory process. Especially many neutrophils in sputum are found in purulent bronchitis, however, a small number of them can also be observed in the catarrhal form of the disease (for example, in viral bronchitis).
• bacteria. Can be determined in sputum with purulent bronchitis. It is important to take into account the fact that bacterial cells can enter the sputum from the patient's oral cavity or from the respiratory tract of medical personnel during material sampling (if safety rules are not followed).
• Eosinophils. Cells of the immune system responsible for the development of allergic reactions. A large number of eosinophils in sputum testifies in favor of allergic (asthmatic) bronchitis.
• Erythrocytes. Red blood cells that can enter the sputum when the small vessels of the bronchial wall are damaged (for example, during coughing fits). A large amount of blood in the sputum requires additional research, as it may be a sign of damage to large blood vessels or the development of pulmonary tuberculosis.
• Fibrin. A special protein that is formed by the cells of the immune system as a result of the progression of the inflammatory process.

X-ray for bronchitis

Radiographic signs of bronchitis can be:

• Strengthening of the lung pattern. Under normal conditions, the tissues of the bronchi weakly retain X-rays, so the bronchi are not expressed on the radiograph. With the development of an inflammatory process in the bronchi and swelling of the mucous membrane, their radiopacity increases, as a result of which clear contours of the middle bronchi can be distinguished on the x-ray.
• Enlargement of the roots of the lungs. The radiological image of the roots of the lungs is formed by the large main bronchi and lymph nodes of this area. The expansion of the roots of the lungs can be observed as a result of the migration of bacterial or viral agents into the lymph nodes, which will lead to the activation of immune responses and an increase in the size of the hilar lymph nodes.
• Flattening of the dome of the diaphragm. The diaphragm is a respiratory muscle that separates the thoracic and abdominal cavities. Normally, it has a domed shape and is turned with a bulge upwards (toward the chest). In chronic bronchitis, as a result of blockage of the airways, more air than normal can accumulate in the lungs, as a result of which they will increase in volume and push the dome of the diaphragm down.
• Increasing the transparency of the lung fields. X-rays pass almost completely through air. With bronchitis, as a result of blockage of the respiratory tract with mucous plugs, the ventilation of certain areas of the lungs is disturbed. With an intense breath, a small amount of air can penetrate into the blocked pulmonary alveoli, but it can no longer go outside, which causes the expansion of the alveoli and an increase in pressure in them.
• Expanding the shadow of the heart. As a result of pathological changes in the lung tissue (in particular, due to narrowing of blood vessels and increased pressure in the lungs), blood flow through the pulmonary vessels is disturbed (difficulty), which leads to an increase in blood pressure in the chambers of the heart (in the right ventricle). An increase in the size of the heart (hypertrophy of the heart muscle) is a compensatory mechanism aimed at increasing the pumping function of the heart and maintaining blood flow in the lungs at a normal level.

CT for bronchitis

In chronic bronchitis, CT may reveal:

• thickening of the walls of medium and large bronchi;
• narrowing of the lumen of the bronchi;
• narrowing of the lumen of the blood vessels of the lungs;
• fluid in the bronchi (during an exacerbation);
• compaction of the lung tissue (with the development of complications).

Spirometry

Before the study, the patient is advised to refrain from smoking and heavy physical work for at least 4 to 5 hours, as this may distort the data obtained.

For the study, the patient must be in an upright position. At the doctor's command, the patient takes a deep breath, completely filling the lungs, and then exhales all the air through the mouthpiece of the spirometer, and the exhalation must be carried out with maximum force and speed. The counter apparatus records both the volume of exhaled air and the speed of its passage through the respiratory tract. The procedure is repeated 2-3 times and the average result is taken into account.

During spirometry determine:

• Vital capacity of the lungs (VC). It represents the volume of air that is expelled from the patient's lungs during a maximum exhalation preceded by a maximum inspiration. The vital capacity of a healthy adult male is on average 4-5 liters, and women - 3.5-4 liters (these figures may vary depending on the physique of a person). In chronic bronchitis, small and medium-sized bronchi are blocked by mucous plugs, as a result of which part of the functional lung tissue ceases to be ventilated and VC decreases. The more severe the disease is and the more bronchi are blocked by mucous plugs, the less air the patient will be able to inhale (and exhale) during the study.
• Forced expiratory volume in 1 second (FEV1). This indicator displays the volume of air that the patient can exhale in 1 second with a forced (as fast as possible) exhalation. This volume is directly dependent on the total diameter of the bronchi (the larger it is, the more air can pass through the bronchi per unit time) and in a healthy person it is about 75% of the vital capacity of the lungs. In chronic bronchitis, as a result of the progression of the pathological process, the lumen of the small and medium bronchi narrows, resulting in a decrease in FEV1.

Other instrumental studies

For bronchitis, your doctor may also prescribe:

• Pulse oximetry. This study allows you to evaluate the saturation (saturation) of hemoglobin (a pigment contained in red blood cells and responsible for the transport of respiratory gases) with oxygen. To conduct a study, a special sensor is put on the patient's finger or earlobe, which collects information for several seconds, after which the display shows data on the amount of oxygen in the patient's blood at the moment. Under normal conditions, the blood saturation of a healthy person should be in the range from 95 to 100% (that is, hemoglobin contains the maximum possible amount of oxygen). In chronic bronchitis, the supply of fresh air to the lung tissue is impaired and less oxygen enters the blood, as a result of which the saturation can decrease below 90%.
• Bronchoscopy. The principle of the method is to introduce a special flexible tube (bronchoscope) into the patient's bronchial tree, at the end of which a camera is fixed. This allows you to visually assess the condition of the large bronchi and determine the nature (catarrhal, purulent, atrophic, and so on).

Bronchitis is characterized as a disease with inflammation of the mucous membranes of the bronchi as a result of exposure to certain irritants - infections, physical or chemical factors. The disease is accompanied by cough and increased secretion of bronchial secretions (sputum). In medicine, there are two forms of the disease - acute and chronic bronchitis.

The nature of the onset of the disease, the clinical picture and differential diagnosis of the two forms of the disease

In terms of symptoms, both forms of the disease are similar to each other, but at the same time they are two different diseases with a different nature of origin, different course and severity of symptoms. Before trying to diagnose a particular type of disease, it is necessary to find out the cause of their occurrence, and already on the basis of this, certain conclusions can be drawn on the presence of an acute or chronic form.

Further diagnosis is carried out on the basis of the clinical picture and appropriate therapy is prescribed.

Important. It is difficult to self-diagnose and determine the form of the disease, this should be done by a competent doctor - a pulmonologist or therapist. Successful treatment depends on a correct diagnosis.

acute form

Acute bronchitis is a disease affecting the upper respiratory system caused by inflammation of the bronchial tree, due to exposure to infectious or non-infectious irritants.

Causes of bronchial damage in acute form:

1. Viruses- the main cause of the disease, when they enter the body, they affect the mucous membranes of the bronchi, causing inflammation. Especially frequent outbreaks of diseases occur during influenza epidemics - influenza viruses are the main causative agents of acute bronchitis.
2. bacteria. The defeat of the bronchi by bacteria is less common, usually they are secondary pathogens after viruses, which create optimal conditions for the activation of pathogenic flora in the respiratory tract.
3. Atypical pathogens- microorganisms, a cross between a class of bacteria and viruses. Atypical bronchitis is rare, but has a severe course with complications (joint damage, polyserositis).
4. Non-infectious effects of physical and chemical constituents- work in hazardous industries associated with the inhalation of toxic emissions, smoke and dust, the inhalation of too hot or cold air. All these factors are irritants for the bronchi, causing inflammation.

The impact of one of these causes or with the layering of several on top of each other (for example, a viral disease and exposure to chemical components) causes bronchitis with an acute course, in which the upper respiratory system is first affected - the nasopharynx and tonsils, then the inflammation passes to the trachea, larynx and directly bronchi.

Important. 50% of diseases are caused by viral infections.

Table number 1. Types of causative agents of acute bronchitis:

Clinical picture of the disease:

1. Cough is the central symptom of the disease. At the initial stage of the disease (with the development of the initial inflammatory process), during the first 5 days, it is dry, provoked by inhalation of air or a sharp drop in ambient temperature. Further, a dry cough is replaced by a wet one, in which mucus (sputum) is secreted. Its distinguishing feature is the spontaneous occurrence as sputum accumulates in the bronchi. This is especially noticeable after waking up, in the morning. Sputum is clear or yellowish green.
2. Hyperthermic reaction with temperature rise up to 38°-38.5°C.
3. Violent headache, especially during coughing spells.
4. Pain in the sternum due to overexertion of the muscles of the diaphragm during coughing.
5. General weakness indicates intoxication of the body during a strong inflammatory process.
6. Increased sweating, even with the slightest physical exertion.
7. Shortness of breath is not a characteristic symptom for the acute form of bronchitis, but can occur with a severe course of the disease, when respiratory failure develops.

Chronic

Chronic bronchitis, like the acute form of the disease, is characterized by an inflammatory process in the bronchial tree, but over a long period of time, when a slight but constant irritation leads to damage to the mucous membranes and more and more sputum.

Causes of chronic bronchitis:

1. Work in conditions of hazardous industries and forced inhalation of chemicals and dust. All these components tend to settle on the walls of the bronchi, constantly affecting the body. After a certain period of time, the respiratory system becomes unable to cleanse itself, which leads to chronic inflammation.
2. Smoking- one of the main causes of the disease. Regular inhalation of tobacco smoke with its harmful components causes irritation, leading to a change in the bronchial wall.
3. chronic diseases- sinusitis, laryngitis.
4. Congenital features of the body. For example, the incorrect structure of the bronchial tree (thin lumen) leads to a chronic accumulation of mucus that does not have time to be excreted in time.

Symptoms of the disease:

1. Chronic and acute bronchitis have a common symptom - cough. In the chronic form, it can be both dry and wet with sputum.
2. Sputum. Its color depends on the nature of the disease and can vary from transparent to dark. For example, professional chronic bronchitis of a miner is distinguished by black sputum (due to inhalation of coal dust).
3. Wheezing can occur with a strong filling of the bronchi with mucus.
4. Hemoptysis with a large amount of blood is a rare symptom for this form of the disease and can occur with severe disease and complications. Small streaks of blood that stain the sputum brown are acceptable. This happens as a result of bursting blood vessels when coughing.
5. Cyanosis is manifested by complications that cause respiratory failure. This symptom is characterized by a change in skin color, in places (tips of the ears and nose) or completely of the entire cover.
6. Ascultative breathing - a manifestation of hard wheezing of different timbres - a symptom indicating the transition of a chronic disease to COPD (chronic obstructive pulmonary disease). This disease is characterized by irreversible changes in the structure of the tissues of the respiratory system.

Important. Most chronic bronchitis occurs in nicotine-dependent people. When tobacco smoke is inhaled, formaldehydes, resins, hydrocyanic acid, etc. settle on the walls of the bronchi. All this leads to a decrease in the drainage function of the bronchi, to an increase in the viscosity of mucus and to its stagnation. As a result, inflammation and irreversible changes in tissues occur.

How to distinguish between acute and chronic disease

To diagnose this or that form of bronchitis, differential diagnosis is used - a method of excluding diseases with similar symptoms and not suitable for certain factors and manifestations of symptoms. Acute and chronic bronchitis have a similar clinical picture, but manifest themselves in different ways.

It is not advisable to engage in self-diagnosis, this can complicate treatment and lead to irreversible consequences, but it is reasonable to entrust the examination to a qualified doctor who can easily determine the type of disease and prescribe appropriate therapy.

Table number 2. The difference between the symptoms of acute and chronic bronchitis:

To confirm the diagnosis in a hospital setting, the doctor uses additional diagnostic tools:

• blood analysis;
• radiography is performed to exclude pneumonia and tuberculosis;
• sputum culture;
• in rare cases, analysis for atypical infections.

Treatment of the disease

Therapy with medicines in the treatment of bronchitis should be prescribed by the attending physician.

The use of certain groups of drugs directly depends on the type of disease, its origin and the severity of symptoms, but as a rule it includes:

1. The use of antibiotics for bacterial infection.
2. The use of antiviral drugs for viral infections of the bronchi.
3. Bronchodilators to relieve inflammation.
4. Expectorant medicines that change the consistency of sputum and improve its discharge.
5. Antitussives to relieve coughing fits.
6. Antipyretic if necessary.

Table number 3. Groups of drugs for the treatment of bronchitis:

Important. It is necessary to treat acute bronchitis and chronic bronchitis with the help of medications, but traditional medicine can be used as an addition to therapy. These are mainly medicinal herbs: coltsfoot, knotweed, plantain, St. John's wort, sage, elecampane root.

The video in this article describes the symptoms of acute bronchitis and treatment.

acute bronchitis -- diffuse acute inflammation of the tracheobronchial tree. Refers to common diseases.

Etiology, pathogenesis .
The disease is caused by viruses (influenza viruses, parainfluenza, adenoviruses, respiratory syncytial, measles, whooping cough, etc.), bacteria (staphylococci, streptococci, pneumococci, etc.); physical and chemical factors (dry, cold, hot air, nitrogen oxides, sulfur dioxide, etc.). Chilling, tobacco smoking, alcohol consumption, chronic focal infection in the nasopharyngeal region, impaired nasal breathing, chest deformity predispose to the disease.
The damaging agent penetrates into the trachea and bronchi with inhaled air, hematogenous or lymphogenous route (uremic bronchitis).
Acute inflammation of the bronchial tree may be accompanied by a violation of bronchial patency of the edematous-inflammatory or bronchospastic mechanism.
In severe forms, the inflammatory process captures not only the mucous membrane, but also the deep tissues of the bronchial wall.

Symptoms, course.
Bronchitis of infectious etiology often begins against the background of acute rhinitis, laryngitis.

With mild flow diseases occur soreness behind the sternum, dry, rarely wet cough, feeling of weakness, weakness.
There are no physical signs or severe breathing, dry rales are determined above the lungs. Body temperature is subfebrile or normal. The composition of peripheral blood does not change.
This course is observed more often in lesions trachea and large bronchi.

For moderate flow general malaise, weakness are significantly expressed, a strong dry cough with shortness of breath and shortness of breath, pain in the lower parts of the chest and abdominal wall, associated with muscle strain when coughing, are characteristic. The cough gradually becomes wet, the sputum acquires a mucopurulent or purulent character.
Harsh breathing, dry and moist small bubbling rales are heard above the surface of the lungs.
The body temperature remains subfebrile for several days. There are no pronounced changes in the composition of peripheral blood.

Severe illness usually seen in the predominant lesion bronchioles (see Bronchiolitis).
Acute symptoms of the disease subside by the 4th day and, with a favorable outcome, completely disappear by the 7th day. Acute bronchitis with impaired bronchial patency tends to protracted course and transition to chronic bronchitis.

hard flow acute bronchitis toxic-chemical etiology . The disease begins with a painful cough with the release of mucous or bloody sputum, bronchospasm quickly joins (against the background of an extended exhalation, dry whistling rales are heard) and shortness of breath progresses (up to suffocation), respiratory failure and hypoxemia increase.
X-ray symptoms of acute pulmonary emphysema can be determined. Symptomatic erythrocytosis develops, hematocrit values ​​increase.

Severe course can accept and acute dusty bronchitis. In addition to coughing (at first dry and then wet), marked shortness of breath, cyanosis of the mucous membranes are noted.
A boxed shade of percussion sound, hard breathing, dry wheezing are determined. Slight erythrocytosis is possible.
X-ray increased transparency of the lung fields and a moderate expansion of the roots of the lungs are revealed.

TREATMENT OF ACUTE BRONCHITIS .

Bed rest, plenty of warm drink with honey, raspberries, lime blossom; heated alkaline mineral water;

• Acetylsalicylic acid 0.5 g 3 times a day, ascorbic acid up to 1 g per day, vitamin A 3 mg 3 times a day;mustard plasters, banks on the chest.
• With a pronounced dry cough, appoint Codeine (0.015 g) with Sodium Bicarbonate (0.3 g) 2-3 times a day.
• The drug of choice may be Libeksin 2 tablets 3-4 times a day.
• Of the expectorants are effective Infusion of thermopsis(0.8 g per 200 ml, 1 tablespoon 6-8 times a day); 3% Potassium iodide solution(1 tablespoon 6 times a day) bromhexine 8 mg 3-4 times a day for 7 days, etc.
• Inhalations of expectorants, mucolytics, heated mineral alkaline water, 2% sodium bicarbonate solution, eucalyptus, anise oil using a steam or pocket inhaler are shown. Inhalations are carried out for 5 minutes 3-4 times a day for 3-5 days.
• Bronchospasm stop by appointment Eufillina(0.15 g 3 times a day).
• Showing Antihistamines.
• With the ineffectiveness of symptomatic therapy for 2-3 days, as well as moderate and severe course of the disease, Antibiotics and Sulfonamides in the same doses as in pneumonia.

BRONCHITIS CHRONIC.

Bronchitis chronic --diffuse progressive inflammation of the bronchi, not associated with local or generalized lung damage andmanifested by cough. It is customary to talk about the chronic nature of the process if the cough lasts at least 3 months in 1 year for 2 years in a row. Chronic bronchitis is the most common form of chronic nonspecific lung disease (COPD) and tends to increase.

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

The main pathogenetic mechanisms include hypertrophy and hyperfunction of the bronchial glands with increased secretion of mucus, a relative decrease in serous secretion, a change in the composition of secretion - a significant increase in acid mucopolysaccharides in it, which increases the viscosity of sputum. Prolonged hyperfunction leads to depletion of the mucociliary apparatus of the bronchi, dystrophy and atrophy of the epithelium.
Inflammatory infiltration, superficial in large bronchi, in medium and small bronchi, as well as bronchioles, can be deep with the development of erosions, ulcerations and the formation of meso- and panbronchitis. The remission phase is characterized by a decrease in inflammation in general, a significant decrease in exudation, proliferation of connective tissue and epithelium, especially with ulceration of the mucous membrane. The outcome of the chronic inflammatory process of the bronchi is sclerosis of the bronchial wall, peribronchial sclerosis, atrophy of the glands, muscles, elastic fibers, cartilage. Perhaps stenosis of the lumen of the bronchus or its expansion with the formation of bronchiectasis.

Symptoms, course.
The beginning is gradual. The first symptom is a cough in the morning with mucous sputum. Gradually, the cough begins to occur both at night and during the day, intensifying in cold weather, over the years it becomes constant. The amount of sputum increases, it becomes mucopurulent or purulent. Shortness of breath appears and progresses.

There are 4 forms of chronic bronchitis .

• At P growth, uncomplicated form bronchitis proceeds with the release of mucous sputum without bronchial obstruction.
• At Purulent Bronchitis purulent sputum is constantly or periodically released, but bronchial obstruction is not pronounced.
• Obstructive Chronic Bronchitis characterized by persistent obstructive disorders.
• Purulent-obstructive Bronchitis proceeds with the release of purulent sputum and obstructive ventilation disorders

During an exacerbation with any form of chronic bronchitis, Bronchospasm Syndrome.
Frequent exacerbations are typical, especially during periods of cold damp weather: cough and shortness of breath increase, the amount of sputum increases, malaise, sweat at night, and fatigue appear.
The body temperature is normal or subfebrile, hard breathing and dry wheezing over the entire surface of the lungs can be determined.

The leukocyte formula and ESR often remain normal; a slight leukocytosis with a stab shift in the leukocyte count is possible.
Only with exacerbation of purulent bronchitis, biochemical parameters of inflammation (C-reactive protein, sialic acids, seromucoid, fibrinogen, etc.) change slightly.

In the diagnosis of chronic bronchitis activity comparatively great importance is the study of sputum: macroscopic, cytological, biochemical. In the diagnosis of chronic bronchitis, broncho- and radiography are used. In the early stages of chronic bronchitis, changes in bronchograms are absent in most patients.

TREATMENT OF CHRONIC BRONCHITIS .

In the phase of exacerbation of chronic bronchitis, therapy should be aimed at eliminating the inflammatory process in the bronchi, improving bronchial patency, restoring disturbed general and local immunological reactivity.

• Appoint Antibiotics and Sulfonamides courses sufficient to suppress the activity of the infection.
  Antibiotic selected taking into account the sensitivity of the sputum microflora (bronchial secretion), administered orally or parenterally, sometimes combined with intratracheal administration.
• Showing Inhalation of phytoncides of garlic or onion (garlic and onion juice is prepared before inhalation, mixed with a 0.25% solution of novocaine or isotonic sodium chloride solution in a ratio of 1 part juice to 3 parts solvent).
  Inhalations are carried out 2 times a day; for a course of 20 inhalations.

Apply: Expectorant, Mucolytic and Bronchospasmodic drugs , drinking plenty of water.

• expectorant have an effect potassium iodide, infusion of thermopsis, marshmallow root, coltsfoot leaves, plantain as well as mucolytics and derivatives of cysteine.
  Acetylcysteine ​​(mucomist, mucosolvin, fluimucil, mistabren) has the ability to break the disulfide bonds of mucus proteins and causes a strong and rapid liquefaction of sputum. Apply in the form of an aerosol of a 20% solution of 3-5 ml 2-3 times a day.
• Mucoregulators, affecting both the secretion and the synthesis of glycoproteins in the bronchial epithelium (bromhexine, or bisolvone). Bromhexine (bisolvone) appoint 8 mg (2 tablets) 3-4 times a day for 7 days inside, 4 mg (2 ml) 2-3 times a day subcutaneously or inhalations (2 ml of bromhexine solution is diluted with 2 ml of distilled water) 2 -3 times a day.

• Before inhalation of expectorants in aerosols, apply B roncholytics to warn bronchospasm and enhancing the effect of the means used.
  After inhalation, positional drainage is performed, which is mandatory for viscous sputum and insolvency of the cough (2 times a day, preliminary intake of expectorants and 400-600 ml of warm tea).
• At insufficiency of bronchial drainage and symptoms bronchial obstruction add to therapy:
  Bronchospasmolytics: eufillin rectally (or intravenously) 2-3 times a day, anticholinergics (atropine, platifillin inside, p / c; atrovent in aerosols) adrenostimulators (ephedrine, isadrine, novodrine, euspiran, alupent, terbutaline, salbutamol, berotek). Restoration of the drainage function of the bronchi is also facilitated by physiotherapy exercises, chest massage, and physiotherapy.
• When allergic syndromes appoint calcium chloride inside and in , antihistamines;
  It is possible to conduct a short (until the removal of the allergic syndrome) course glucocorticoids(daily dose should not exceed 30 mg). The risk of infection activation does not allow recommending long-term use of glucocorticoids.
• When a patient develops chronic bronchitis bronchial obstruction syndrome can be assigned:
  Etimizol(0.05-0.1 g 2 times a day orally for 1 month) and Heparin(5000 IU 4 times a day s / c for 3-4 weeks) with a gradual withdrawal of the drug.
• Patients with chronic bronchitis complicated by d respiratory failure and chronic cor pulmonale, shown application Veroshpiron(up to 150-200 mg / day).
• Appoint ascorbic acid in a daily dose of 1 g, B vitamins, nicotinic acid; if necessary - levamisole, aloe, methyluracil.
• When the disease worsens pulmonary and pulmonary heart failure apply oxygen therapy, auxiliary artificial ventilation of the lungs.
  oxygen therapy includes inhalation of 30-40% oxygen mixed with air, she must be intermittent.
  Its elimination by intense and prolonged inhalation of oxygen leads to a decrease in the function of the respiratory center, an increase in alveolar hypoventilation and hypercapnic coma.
• With stable pulmonary hypertension long-term use Long-acting nitrates, calcium ion antagonists (verapamil, fenigidin).
• Cardiac glycosides and saluretics appoint at congestive heart failure.

  Patients need systematic maintenance therapy, which is carried out in a hospital or by a local doctor. The goal of therapy is to combat the progression of pulmonary heart failure, amyloidosis and other possible complications of the disease. Inspection of these patients is carried out at least once a month.
  Diet patients should be high-calorie, fortified.