What is obstructive bronchitis. Chronic obstructive bronchitis in adults: etiology, pathogenesis, symptoms. Chronic obstructive bronchitis

Obstructive bronchitis is a lung disease associated with obstruction. When applied to the bronchi, they say - bronchial obstruction. The name comes from the Latin obstructio, which means "obstruction". In medicine, there are synonyms for translation - blockage or obstruction.

In the course of the development of obstructive bronchitis, in violation of the patency of the bronchial tree, respiratory failure occurs. Characteristically, along with inflammation, damage to the bronchial mucosa occurs. Tissues swell, narrowing the lumen of the bronchi almost twice, spasm the walls of the bronchi. All these manifestations significantly complicate the ventilation of the lungs and sputum discharge.

In the structure of general morbidity in terms of the prevalence of respiratory diseases, they remain unchanged leaders. The leading place among them belongs to diseases of the respiratory tract, which include bronchitis.

Attention. Often bronchitis is a manifestation of an acute respiratory viral infection (ARVI). These are acute conditions that can be cured. Sometimes the disease acquires a protracted course and becomes chronic. Chronic obstructive bronchitis leads to severe consequences up to permanent disability.

For reference. is an inflammatory disease of an infectious or non-infectious nature that diffusely affects the bronchial tree. Obstructive bronchitis is one of the types of this pathology.

There are several forms of bronchitis:

• Simple bronchitis is a common manifestation of SARS. Cough with a cold most often occurs precisely because of simple bronchitis.
• Bronchiolitis is an inflammation of the smallest branches of the bronchi - bronchioles. This is an intermediate stage between bronchitis and pneumonia, and often occurs in children.
• Obstructive bronchitis is an inflammation of the bronchial tree, which is accompanied by obstruction.

Obstruction is the reduction or disappearance of the lumen of the bronchi, as a result of which the breathing process is difficult. When the lumen of the bronchial tree is blocked, it is difficult for the patient to exhale, because one of the manifestations of obstructive inflammation of the bronchi is expiratory dyspnea.

Obstructive bronchitis is usually divided into acute and chronic. They speak of an acute process when the symptoms of the disease last no more than three weeks and recur three times a year. This pathology is more common in children and less common in adults. The transition of the disease to a chronic form indicates the irreversibility of the process.

Acute obstructive bronchitis occurs when there is increased secretion of mucus, swelling of the bronchial mucosa and bronchospasm. All these processes are reversible, because such a pathological process passes without a trace. Chronic obstructive bronchitis occurs when the structure of the bronchial wall changes, it becomes less elastic and turns the distensible bronchi into narrow tubes.

Attention. Now there is no such diagnosis as chronic obstructive bronchitis in ICD 10. It was replaced by the term chronic obstructive pulmonary disease (COPD) - a collective concept that combines several nosologies.

This is due to the common pathogenesis and clinical manifestations of all diseases included here. COPD includes not only chronic bronchitis, but also other pathologies of the respiratory system, as well as a number of diseases of the heart and blood vessels, leading to shortness of breath.

Etiology of obstructive inflammation

Acute bronchitis usually has a viral etiology. It is called:

• respiratory syncytial viruses,
• parainfluenza,
• adenoviruses,
• some types of enteroviruses.

For reference. Sometimes bacterial flora joins the viral flora, then they talk about purulent obstructive bronchitis.

This pathology is extremely rare in adults. The fact is that the bronchial tree of adults is quite wide. Inflammatory changes in it are not enough to lead to obstruction. In children, the bronchi are small and narrow, so the overlap of the lumen occurs quickly.

The exact etiological nature of chronic obstructive bronchitis is unknown. There are a number of risk factors that can lead to the occurrence of this disease. Among them, smoking occupies a leading position.

Attention. In the vast majority of cases, COPD in people under 40 years of age occurs precisely because of smoking. In addition, a separate risk factor is passive smoking in children. People who inhale cigarette smoke as adults are more likely to develop chronic obstructive bronchitis as adults.

In addition to smoking, occupational hazards occupy an important place among the risk factors. First of all, the increased dustiness of the workplace. COPD is common in miners, metallurgists, and construction workers. Dust containing a large amount of silicon is especially dangerous.

Residents of large cities are more prone to chronic obstructive bronchitis, which is associated with polluted environment and high dust content in the air.

For reference. Irreversible pulmonary obstruction may be the outcome of bronchial asthma. A distinctive feature of the latter is the reversibility of bronchospasm. With an uncontrolled course of bronchial asthma, obstruction becomes irreversible and COPD develops.

At the moment, there is an assumption about another predisposing factor - hereditary. The fact that the predisposition to chronic bronchitis is genetically transmitted is evidenced by the frequent occurrence of the disease in close relatives.

Disease pathogenesis

Bronchial obstruction can be a reversible or irreversible process. The first is characteristic of acute obstructive bronchitis.
In a chronic course, the ability to reverse the development of the process is lost, the obstruction becomes permanent.

The pathogenesis of reversible obstruction is:

• Inflammatory edema of the mucous membrane of the bronchial tree. The etiological factor damages the mucosa, causing an inflammatory reaction in it. One of the components of this reaction is a pronounced mucosal edema, which reduces the lumen of the bronchi.
• Hypersecretion. The epithelial cells of the bronchial mucosa always secrete a small amount of substances that moisten the surface and prevent dangerous substances from entering the lungs. When the mucosa is damaged, the secretory activity of cells increases. In addition, the permeability of the bronchial vessels increases, which leads to the exudation of fluid into the lumen of the bronchial tree.
• Hyperreactivity. Due to the inflammatory process, a large number of mediators act on the bronchi, which lead to spasm of the bronchial tree and narrowing of its lumen.

The pathogenetic links of irreversible obstruction are as follows:

• epithelial metaplasia. Normally, the bronchial mucosa is covered with a cylindrical ciliated epithelium, which is able to produce mucus and cleanse the bronchial tree from particles entering it. With prolonged exposure to risk factors, the epithelium becomes flat. It is not able to protect the bronchi, as a result of which a cascade of further changes is launched.
• Changes in the connective tissue of the bronchial wall. Normally, the bronchi contain a large number of elastic fibers that are able to stretch and return to their original position during breathing. In chronic bronchitis, these fibers are replaced by collagen fibers, which are not capable of stretching and turn the bronchi into thin tubes.

For reference. In chronic obstructive bronchitis during the period of remission in a patient, the lumen of the bronchial tree remains narrowed, as a result of which some of the complaints remain. During the period of exacerbation, the bacterial flora joins, as a result of which inflammation occurs again. Chronic bronchitis always proceeds with exacerbations and remissions.

Ultimately, there are complications such as emphysema, bronchiectasis, hypertension in the pulmonary circulation, cor pulmonale.

Acute obstructive bronchitis - symptoms

This pathology is more common in young children. Two syndromes come to the fore - intoxication and respiratory.

Intoxication causes:

• refusal to eat,
• significant loss of appetite
• weakness,
• fatigue,
• increase in body temperature.

For reference. With obstructive bronchitis, even in young children, the fever rarely exceeds 38 degrees.

Respiratory syndrome includes two manifestations: cough and frequent shallow breathing difficulties. Cough at the beginning of the disease is dry, hacking, later, scanty, viscous, transparent sputum may appear. If there is a lot of sputum, and it acquires a greenish tint, then there is a bacterial infection in the pathological focus.

Shortness of breath is expiratory in nature, it is more difficult for the patient to exhale than to inhale. At the same time, breathing noticeably quickens. On exhalation, you can hear distant wheezing - noises that are heard without a phonendoscope when approaching the patient.

For reference. Respiratory failure is accompanied by cyanosis. Initially, cyanosis spreads to the nasolabial triangle and toes and hands, and then to the whole body. Total cyanosis indicates severe respiratory failure. These patients have difficulty breathing. From the outside, it seems that the arms and face are involved in breathing - when breathing, the shoulders seem to rise, and the nose expands.

In the acute course of the disease, all symptoms gradually disappear within three weeks.

Chronic obstructive bronchitis - symptoms

Obstructive bronchitis in adults flows in waves, the patient's condition either improves or worsens. During the upgrade the following manifestations are present:

• Cough. He appears first among all manifestations. Cough occurs most often in the morning when the body position changes from horizontal to vertical; with the progression of the disease, the cough torments the patient throughout the day.
• Sputum. Doesn't appear right away. Initially, the cough is dry, and then a meager amount of very viscous sputum, which is difficult to separate, appears. Productive cough becomes, as a rule, in the morning. While the patient is sleeping, sputum stagnates in the bronchi, and when the position changes to a vertical one, it irritates the bronchi and a productive cough occurs. There is no sputum during the day.
• Dyspnea. This is a typical symptom of obstructive bronchitis, but it does not appear immediately. Chronic bronchitis progresses for a very long time, while shortness of breath occurs years after the onset of the disease. It is expiratory in nature. It is difficult for the patient to exhale, because of which breathing becomes more shallow and frequent. First, shortness of breath occurs during exercise, and then at rest.
• Forced posture. This symptom is the latest and occurs along with severe respiratory failure. In order to ensure adequate gas exchange, the patient has to use all the auxiliary respiratory muscles, and for this it is necessary to fix the shoulder girdle. That is why such patients often sit or stand, resting their hands on a hard surface.

During the period of exacerbations, the bacterial flora joins the already existing pathology.

Attention. In patients with chronic bronchitis, the airways cannot defend themselves against infection, so exacerbations often occur.

During the period of exacerbation, sputum becomes abundant in patients, it liquefies, acquires a green tint. The cough has a wet character and worries the patient all day. This intensifies the manifestations of respiratory failure. High fever is not a characteristic symptom of bronchitis, but some patients have a fever.

Diagnostic methods

Bronchitis does not always require special confirmation. In the acute course of the disease, the diagnosis is made on the basis of clinical symptoms. Often this disease does not require confirmation, diagnostic methods are uninformative. Chronic bronchitis requires more reliable confirmation.

A patient with suspected acute inflammation of the respiratory tract is prescribed an X-ray of the lungs and a complete blood count to rule out pneumonia.

For reference. On the radiograph with bronchitis, the pattern of the bronchial tree is enhanced, in some patients there are emphysematous areas of enlightenment in the lungs. If infiltration is visible in the lungs, then the patient has pneumonia. In the general analysis of blood with bronchitis, leukocytosis with lymphocytosis is more common, with pneumonia - with neutrophilia.

These data are non-specific, may occur in other pathologies of the respiratory system. The most informative bronchoscopy is a method that allows you to see the bronchial tree from the inside, assess the condition of the bronchial mucosa. Bronchoscopy is rarely used because the method is invasive and causes discomfort to the patient.

In chronic obstructive bronchitis, it is necessary not only to confirm the presence of obstruction, but also to exclude other pathology. To confirm chronic bronchitis, radiography and a clinical blood test are used.

For reference. Changes characteristic of bronchial obstruction are detected more often than in the acute course of the disease. The main method of confirming the diagnosis is spirometry.

Spirometry is a study of the function of the respiratory system. The patient is asked to take a deep breath and exhale, and then breathe at a normal pace into a special device. A computer program evaluates its results and prints them out.

During spirometry, two parameters (FVC and FEV1) are determined and their ratio is calculated. FVC is the amount of air that a person can exhale after a full breath. This parameter shows how much lung tissue is able to stretch (the volume of inhaled air depends on this, which affects the enrichment of blood with oxygen).

FEV1 is a measure of the rate at which air passes through the bronchi. With obstruction, that is, with blockage of the bronchi, the speed, of course, decreases.

To assess the type of violation, an indicator called the Tiffno Index was derived. This is the ratio of FEV1 to FVC.

In chronic obstructive bronchitis, there is a decrease in forced expiratory volume in the first second (FEV1) less than 80% of the norm. The Tiffno index decreases (the norm is 0.7).

Attention. The same changes are characteristic of bronchial asthma, therefore, a mandatory study is a test with salbutamol.

The patient is given spirometry, then the drug is given and spirometry is performed again. In the event that the indicators increased by 15% or more, we can talk about reversible bronchial obstruction. This confirms bronchial asthma. If the indicators increased slightly, remained unchanged or worsened, obstructive bronchitis is confirmed.

Spirometry allows not only to confirm the diagnosis, but also to determine the stage of the disease.

Obstructive bronchitis - treatment in adults and children

Acute inflammation of the bronchi is etiotropically treated with interferons, adding symptomatic therapy to them. The latter consists in the appointment of mucolytic drugs (bromhexine, ACC). With severe obstruction, short-acting bronchodilators (ipratropium, salbutamol) are also prescribed.

If the patient has chronic obstructive bronchitis, treatment is prescribed according to the schemes. During the period of remission, such patients are prescribed mucolytics in the morning to thin the sputum and discharge it. With severe obstruction, bronchodilators (salmeterol, pentoxifylline) are indicated. During an exacerbation, if the sputum becomes purulent, antibacterial drugs are added. If severe inflammation joins, inhaled glucocorticosteroids are administered.

Attention. Respiratory failure of the third degree is an indication for the appointment of oxygen therapy.

Of great importance in the treatment of the disease is a change in habits, smoking cessation, moderate physical activity, relaxation in seaside resorts, humidification of the air in the house.

Forecast and prevention

Acute obstructive bronchitis has a good prognosis. With proper treatment, the disease goes away without a trace. Children can get sick with this form of bronchitis quite often, but get rid of all its manifestations in adulthood.

Prevention of acute inflammation of the respiratory tract is a non-specific increase in immunity:

• proper nutrition,
• daily regime,
• walks in the open air,
• timely treatment of viral diseases.

Attention. Chronic obstructive bronchitis has a poor prognosis. The obstruction is irreversible, it cannot be reduced, but the progression of the disease can be prevented.

Primary prevention includes cessation of active smoking, compliance with the rules of personal protection in the workplace, strengthening the immune system. Secondary prevention of chronic obstructive bronchitis is the correct treatment of the disease and compliance with the doctor's recommendations. COPD often becomes the cause of the patient's disability.

Chronic obstructive bronchitis is the undisputed leader in the list of the most common respiratory diseases. Often aggravated, it can lead to the development of pulmonary insufficiency and disability, therefore, at the first suspicion of an ailment, it is important to contact a pulmonologist without delay.

What is obstructive bronchitis?

The word "obstruction" is translated from Latin as "obstruction", which quite accurately reflects the essence of the pathological process: due to the narrowing or blocking of the airway lumen, air hardly seeps into the lungs. And the term means inflammation of the small respiratory tubes - the bronchi. So it turns out that "obstructive bronchitis" is a violation of the patency of the bronchi, which leads to the accumulation of mucus in them and difficulty breathing. A chronic disease is called if it lasts at least 3 months a year for 2 or more years.

Currently, the concept of "chronic obstructive bronchitis" is increasingly replaced by another, more generalized - chronic obstructive pulmonary disease (abbreviated as COPD). Such a diagnosis more accurately describes the nature of the lesion, because in reality inflammation affects not only the bronchi. Very quickly, it spreads to all elements of the lung tissue - blood vessels, pleura and respiratory muscles.

Causes of the disease

The European Respiratory Community has determined that 90% of cases of obstructive bronchitis are related to smoking. The fact is that cigarette smoke causes burns to the mucous membranes of the respiratory tract. The resins and formaldehydes contained in tobacco complete the attack on irritated shells, which provoke their destruction. The disease can occur with both active and passive smoking.

An important role in the development of bronchitis is played by inhalation of other harmful substances that hover in the atmosphere: industrial emissions, exhaust gases. That is why residents of large cities and workers in chemical industries are often among the victims of a chronic illness.

More rare causes of the disease include severe congenital deficiency of α1-antitrypsin, an enzyme produced by liver cells. One of the functions of this compound is to protect lung tissues from the action of aggressive factors.

In addition, the following can contribute to the development of the disease:

• frequent ,
• alcohol abuse,
• elderly age,
• low immunity,
• hereditary predisposition to bronchitis,
• neurological disorders.

Chronic bronchitis is exacerbated by infection of weakened mucous membranes with viruses, pneumococci or mycoplasmas.

Stages of development

The development of the disease begins with irritation of the bronchial mucosa. In response to it, special substances are produced in the walls of the respiratory tubes - inflammatory mediators. They cause swelling of the membranes and increase the secretion of mucus.

At the same time, the formation of protective factors (interferon, immunoglobulin) that prevent the reproduction of microbes on the mucous membranes is reduced. The surface of the respiratory tract is colonized by all kinds of pathogenic bacteria.

With prolonged inflammation, scar tissue grows around the bronchi, which squeezes them even more and prevents normal breathing. During this period, a person has dry wheezing and whistling sounds on exhalation.

The outcome of the inflammatory process is the "sticking" of the smallest branches of the bronchi - bronchioles, as a result of which the supply of oxygen to the air sacs of the lungs (alveoli) is disturbed. This is how respiratory failure develops. This is the last stage of obstructive bronchitis, in which it is no longer possible to restore the destroyed bronchi.

Symptoms

The main symptom of chronic bronchitis is cough. At first, he worries patients only during periods of exacerbations that occur in the cold season. During attacks, a small amount of sputum is separated. Against the background of the disease, the temperature may slightly increase (up to 37.5–37.8 degrees).

Over time, patients begin to complain of a daily hacking morning cough. For some, attacks are repeated in the daytime. Annoying odors, cold drinks, frosty air become their provocateurs.

Sometimes bronchospasm is accompanied by hemoptysis. Blood appears due to rupture of capillaries with strong straining.

How to treat obstructive bronchitis and what is it?

Over time, inflammation in the bronchial wall progresses, bronchospasm and shortness of breath increase, obstructive syndrome and chronic impairment of pulmonary ventilation develop.

What it is?

Obstructive bronchitis is the occurrence of reflex spasms that prevent mucus from coming out. Obstruction may be intermittent, especially in the chronic form. The peculiarity of such bronchitis is that it is able to proceed latently.

Reasons for development

The disease in most cases becomes complicated by the continuation of respiratory viral infections, the influence of factors of external trouble: smoking, unfavorable environmental conditions, harmful production, poor living conditions.

Environmental factors:

1. The presence of chemical irritants in the air at work or at home - inorganic and organic dust, acid fumes, ozone, chlorine, ammonia, silicon, cadmium, sulfur dioxide, etc. (see the impact of household chemicals on health).
2. Prolonged exposure of the bronchial mucosa to physical irritants in the external environment - allergens, such as the pollen of some plants, house dust, animal hair, etc.

Socio-economic factors:

1. alcohol abuse;
2. Unfavorable living conditions;
3. Smoking, passive smoking (see video of what cigarettes are made of);
4. Elderly age.

Medical factors:

1. Tumors of the trachea and bronchi;
2. Airway hyperreactivity;
3. genetic predisposition;
4. Tendency to allergic reactions;
5. Injuries and burns;
6. poisoning;
7. Infectious and inflammatory diseases of the respiratory system and impaired nasal breathing, foci of infection in the upper respiratory tract - bronchitis, pneumonia;
8. Recurrent viral infections and diseases of the nasopharynx.

Chronic obstructive bronchitis

This is a progressive obstruction of the bronchi in response to various stimuli. Violation of bronchial patency is conventionally divided into: reversible and irreversible.

Signs with which patients usually go to the doctor:

1. Violent cough, with scanty mucus in the morning
2. Dyspnea, initially only on exertion
3. Wheezing, labored breathing
4. Sputum can acquire a purulent character during the period of accession of other infections and viruses and is regarded as a recurrence of obstructive bronchitis.

Over time, with an irreversible chronic process, the disease progresses, and the intervals between relapses become shorter.

Symptoms

The clinical picture of obstructive bronchitis is formed by the following symptoms:

• Cough - in the early stages, dry, without sputum, "whistling", mainly in the morning, and also at night, when the person is in a horizontal position. The symptom intensifies in the cold season. Over time, when coughing, sputum, clots appear, in older people there may be traces of blood in the separated secret;
• Difficulty breathing, or shortness of breath (after 7-10 years after the onset of cough) - first appears during physical exertion, then during the rest period;
• With exacerbation - fever, sweating, fatigue, headaches, muscle pain;
• Acrocyanosis - cyanosis of the lips, tip of the nose, fingers;
• Syndrome of "watch glasses", "Hippocratic nail" - deformation of the nail plates, when they become like watch glasses;
• The symptom of "drum sticks" is a characteristic change in the phalanges of the fingers;
• Emphysematous chest - the shoulder blades fit snugly against the chest, the epigastric angle is deployed, its value exceeds 90 °, "short neck", increased intercostal spaces.

It is important to remember that obstructive bronchitis does not make itself felt immediately. Symptoms usually appear when the disease is already in full swing in the body. As a rule, most patients seek help late, after the age of 40 years.

Diagnostics

The diagnosis is usually made on the basis of the patient's complaints, accompanying clinical history, lung auscultation, and heart rate.

The task of differential diagnosis is to exclude the development of such severe pathologies as pulmonary tuberculosis, pneumonia, a tumor of the lung tissue, developing heart failure due to a decrease in cardiac ejection fraction. If the patient has a decrease in cardiac output fraction, a strong incessant cough appears, a suspicion of alveolar edema (pulmonary edema) appears, then the actions of doctors should be lightning fast.

Obstructive bronchitis is characterized by the following:

• listening to percussion sound over the lungs;
• loss of mobility of the lung edge;
• hard breathing;
• on inspiration, wheezing is auscultated;
• the appearance of moist rales with an exacerbation of the disease.

If the patient is a smoker, then the doctor needs to find out the total experience of a bad habit, calculate the index of the smoker. When classifying obstructive bronchitis at the developmental stage, the indicator of forced expiratory volume in 1 min (in the abbreviation FEV) is used in relation to the vital capacity of the lungs (in the abbr. VC). The following stages are distinguished:

1. Stage I. FEV = 50% of the norm. At this stage, the patient almost does not know discomfort, and dispensary control in this situation is not needed.
2. Stage II. OFI \u003d 34-40% of the norm. The patient is advised to visit a pulmonologist due to a pronounced deterioration in the quality of life.
3. Stage III. FEV<33% от нормы. Этот этап заболевания предполагает стационарное либо амбулаторное лечение.

To exclude pneumonia, pulmonary tuberculosis, dilatation of the cardiac sections, a chest x-ray procedure is performed. As additional research methods, laboratory test data (blood, urine, scraping of mucus or sputum) is required. Accurate diagnosis will allow you to quickly identify the underlying disease, stop the symptoms of obstructive bronchitis, and exclude its recurrence in the future.

Complications

When an obstruction develops, the required amount of air stops flowing into the lungs. Inhalations become heavy, the diaphragm does not fully open. Also, we breathe in more than we breathe out.

Some part remains in the lungs and provokes pulmonary emphysema. In severe and chronic forms, pulmonary insufficiency may appear, and this is the reason for mortality. Untreated bronchitis almost always ends in pneumonia, which is much more problematic to treat.

How to treat obstructive bronchitis?

First of all, in the treatment of obstructive bronchitis in adults, it is important to minimize, if possible, completely eliminate contact with irritating factors that may be a prerequisite for the progression of the process in the bronchi and its exacerbations.

It is necessary to give up smoking and other bad habits, stop contact with allergens, which in some cases may require quite radical steps: a change of job or place of residence.

The next step should be treatment at home with effective modern means.

Medical treatment

With obstructive bronchitis, which is caused by a viral infection, antiviral drugs are prescribed:

1. Rimantadine (Algirem, Orvirem) has an intense antiviral effect by blocking healthy body cells from viral penetration. The drug is prescribed 100 mg (1 tablet) 1-3 times a day for 3-4 days. Allergic reactions are rare.
2. Inosine pranobex (Isoprinosine, Groprinosine) have antiviral (stimulate the death of viral cells) and immunomodulatory (strengthen the immune system) effect. The drugs are prescribed 1-2 tablets 3-4 times a day. The course of treatment is 7-10 days, but can be extended by 1 month according to indications. The drug is well tolerated and usually does not cause allergic reactions.

With obstructive bronchitis caused by a bacterial infection, antibacterial drugs are prescribed, with the help of which the disease can be cured after 5-10 days:

1. Macrolides (Clarithromycin, Rovamycin) have a bactericidal effect. Assigned to 500 mg 1 time per day. The course of treatment is 5-7 days. The drug does not cause allergic manifestations;
2. Protected penicillins (Augmentin, Flemoxin-solutab) have bacteriostatic (reduce the growth and division of bacterial cells) and bactericidal (promote the death of bacteria) action. The drug is prescribed in tablets of 625 mg 3 times a day or 1000 mg 2 times a day for 7-14 days. With caution, this group of drugs is given to patients with frequent allergic reactions;
3. In extremely severe cases of the development of the disease, the drugs of choice are respiratory fluoroquinolones - levofloxacin (Loxof, Leflok) 500 mg 1 time per day or 500–1000 mg in a 100.0 ml vial intravenously 1 time per day. This drug may cause acute allergic reactions.

If a cough occurs - mucolytic drugs:

1. Ambroxol (Lazolvan, Abrol) has an expectorant effect and stimulates the movement of ciliated epithelium in the bronchi, which contributes to better sputum excretion. It is prescribed 30 mg (1 tablet) 3 times a day or 75 ml (1 tablet) 1 time per day. The course of treatment is 10 days. The drug does not provoke allergic effects;
2. Acetylcysteine ​​​​(ACC) reduces the viscosity of sputum and thereby stimulates its better discharge. Assigned to 400 - 800 mg 1 - 2 times a day for 10 days. Allergic reactions in the form of a skin rash;
3. Local anti-inflammatory drugs - Erespal, Inspiron eliminate mucus hyperproduction and reduce swelling of the mucous and submucosal layers of the bronchial tree. Assigned to 1 tablet 2 times a day. The course of treatment is 10 days. Special instructions: causes an increase in heart rate and interruptions in the work of the heart. Allergic reactions are rare.

At elevated body temperature, non-steroidal anti-inflammatory drugs are used - Nimesulide, Ibuprofen - have antipyretic, decongestant and analgesic effects. Assigned to 200 mg 1-2 times a day.

If shortness of breath occurs, the treatment of obstructive bronchitis is supplemented with bronchodilators in aerosols (Salmeterol, Berodual, Ventolin, Salbutamol), which have a bronchodilatory effect and contribute to a better discharge of sputum from the bronchi. 2 breaths are prescribed 3-6 times a day.

Inhalations

With exacerbation of obstructive chronic bronchitis, it is noted:

• increased shortness of breath with a change in the frequency of respiratory movements, the depth of inspiration;
• change in the nature of cough, sputum;
• tightness in the chest.

When these symptoms appear, indicating an exacerbation, bronchodilators of all three groups are prescribed in inhalations. You can read about the properties of these drugs in the article Bronchodilator drugs.

The main cause of obstruction in adults is bronchospasm. To eliminate it, they resort to drugs of short and long action. The drugs of choice for chronic obstructive bronchitis are Atrovent, Troventol, oxytorpium bromide. The effect of their use appears after 30 minutes, lasts up to 6 hours, 3-4 doses are made per day.

With the ineffectiveness of therapy additionally prescribed:

• adrenostimulants - Ventolin, Brikanil, Berotek in inhalations, Clenbuterol Sopharma tablets, Clenbuterol syrup;
• theophylline tablets - Teopek, Teotard.

In acute conditions, inhalations of combined preparations are prescribed that combine the action of a hormonal agent with a bronchodilator. Read more about inhalations for bronchitis in our article Inhalations for bronchitis with a nebulizer.

Physiotherapy

The patient's condition will improve physiotherapy. One of its means is massage (percussion, vibration, back muscles). Such manipulations help to relax the bronchi, eliminate secretions from the respiratory tract. Apply modulated currents, electrophoresis. The state of health is stabilized after sanatorium treatment in the southern resorts of Krasnodar and Primorsky Krai.

Nutrition and diet

The diet during an exacerbation of the disease is aimed at eliminating the edema of the bronchial tree, stimulating the immune system, and replenishing protein reserves. Food should be high-calorie, at least 3000 calories / day with a predominance of proteins.

Healthy foods:

• fruits with vitamin C: orange, lemon, raspberry, grapefruit;
• dairy products: cheese, milk, cottage cheese;
• foods containing magnesium: nuts, bananas, sesame seeds, pumpkin seeds, rye bread, buckwheat, olives, tomatoes;
• products with omega-3 acids: fish oil, cod liver;
• vitamins A and E: green peas, beans, spinach, peach, avocado, carrots.

At the time of treatment of relapse, it is necessary to reduce the consumption of sugar and salt, limit the intake of allergenic foods (tea, chocolate, coffee, cocoa). Spicy, spicy, smoked foods contribute to the development of bronchospasm, so they should also be excluded from the diet or eaten in small quantities.

Prevention

Prevention of obstructive bronchitis also involves:

• refusal of addiction - smoking;
• dust reduction at home by carrying out wet cleaning. You can replace pillows filled with feathers with hypoallergenic fillers. You can also remove carpets and soft toys, which are the first accumulators of dust particles;
• adherence to a hypoallergenic diet, during which all foods that can increase coughing attacks are excluded;
• taking vitamins of groups B and C to maintain immunity. For this purpose, you can use herbal teas, which also contribute to the removal of mucus from the bronchi;
• during the period of pollination of plants, you can organize a stay in a comfortable microclimate, where any allergens are excluded.

Patients with obstructive asthmatic bronchitis first of all need to carry out hardening procedures, perform therapeutic respiratory complexes.

Obstructive bronchitis is a diffuse inflammation of the bronchi of small and medium caliber, occurring with a sharp bronchial spasm and a progressive impairment of pulmonary ventilation.

Next, we will look at what kind of disease it is, what are the first signs in adults, what is prescribed as a diagnosis for detecting an obstructive form of bronchitis, and what methods of treatment and prevention are most effective.

What is obstructive bronchitis?

Obstructive bronchitis is an inflammatory disease of the bronchial tree, which is characterized by the occurrence of an unproductive cough with sputum, shortness of breath and, in some cases, broncho-obstructive syndrome, which is similar in its etiology to bronchial asthma.

The word "obstruction" is translated from Latin as "obstruction", which quite accurately reflects the essence of the pathological process: due to the narrowing or blocking of the airway lumen, air hardly seeps into the lungs. And the term "" means inflammation of the small respiratory tubes - the bronchi. Obstructive bronchitis is a violation of the patency of the bronchi, which leads to the accumulation of mucus in them and difficulty breathing.

The disease is characterized by the fact that not only inflammation develops in the bronchi, but damage to the mucous membrane also occurs, which causes:

• spasm of the bronchial walls;
• tissue swelling;
• accumulation of mucus in the bronchi.

Also, obstructive bronchitis in adults causes a significant thickening of the walls of blood vessels, which leads to a narrowing of the bronchial lumen. In this case, the patient feels difficulty in breathing, difficulty with normal ventilation of the lungs, lack of rapid discharge of sputum from the lungs.

Forms of development

There are 2 forms of the disease:

Acute obstructive bronchitis

It is typical for children under the age of four, but sometimes occurs in adults (in this case it is called primary obstructive bronchitis). In order to develop broncho-obstructive syndrome in adults, it is necessary that one or several predisposing factors join the inflammatory process in the airways. For example, an obstructive syndrome can develop against the background of:

• banal bronchitis or with improper treatment of the disease,
• contact with an allergen
• exposure to polluted air.

Chronic obstructive form

The chronic form of the disease is characterized by a long absence of symptoms of obstructive bronchitis. The disease proceeds with periods of remission and exacerbations, most often caused by hypothermia and acute respiratory infections. Clinical symptoms occur during periods of exacerbation of the disease and depend on its stage and the level of damage to the bronchial tree.

Chronic obstructive bronchitis, along with other diseases that occur with progressive airway obstruction (bronchial asthma), is commonly referred to as chronic obstructive pulmonary disease (COPD).

The reasons

Causes of obstructive bronchitis in adults:

• Chronic forms of diseases of the nasopharynx.
• Bad ecology.
• Smoking.
• Harmful working conditions. A person with air inhales particles of substances that contribute to the development of the disease.
• Heredity. If someone in the family suffers from obstructive bronchitis, then the pathology can develop in relatives.

Chronic obstructive bronchitis is an ailment that most often begins to progress in people who smoke for a long time, working in production with various chemicals. substances and so on.

It is also worth highlighting the internal factors that contribute to the development of obstructive bronchitis in adults and children:

• second blood group;
• hereditary deficiency of immunoglobulin A;
• alpha1 antitrypsin deficiency.

stages

The progressive development of chronic obstructive bronchitis is characterized by a gradual decrease in the volume of forced inspiration in one second (EF-1), expressed as a percentage of the standard value.

Symptoms of obstructive bronchitis in adults

Doctors say that even at the initial stage, obstructive bronchitis in adults can be suspected. Symptoms and treatment of pathology are best discussed with a doctor. After all, making a diagnosis on your own, and even more so choosing a therapy, can be very dangerous.

Of course, the main complaint of the patient with obstructive bronchitis is a strong, long, cutting and unpleasant cough. However, this does not mean that the victim develops exactly bronchitis. Therefore, it is important for any person to know all the symptoms of the disease in order to catch on in time and visit a doctor.

It is worth noting that acute obstructive bronchitis affects mainly children under five years of age, while in adults, symptoms appear only when the acute course turns into. But sometimes primary acute obstructive bronchitis can begin to progress. As a rule, this happens in the background.

Symptoms:

• temperature rise;
• dry cough. It usually develops in attacks, intensifying in the morning or at night;
• the frequency of respiratory movements per minute increases up to 18 times. In a child, this figure will be slightly higher;
• during exhalation, wheezing wheezing is noted, which is audible even at a distance.

Note: if the patient, when symptoms of acute obstructive bronchitis appear, does not begin to carry out therapeutic measures, then he may experience shortness of breath. This is due to the accumulation of a large amount of sputum in the bronchi. In addition to shortness of breath, in the severe course of the acute form of the disease in question, wheezing during breathing, a whistling air outlet can be noted.

If chronic obstructive bronchitis is observed in adults, the symptoms of the pathology are as follows:

• persistent cough, worse in the morning;
• body temperature is mostly normal;
• developing shortness of breath, which can be treated only at an early stage.

Over time, patients begin to complain of a daily hacking morning cough. For some, attacks are repeated in the daytime. Annoying odors, cold drinks, frosty air become their provocateurs.

Sometimes bronchospasm is accompanied by hemoptysis. Blood appears due to rupture of capillaries with strong straining.

In the later stages, the disease is much like asthma. Patients have difficulty breathing. Exhale with wheezing and whistling. The duration of their exhalation increases.

The period of remission of the disease is characterized by slight sweating, moderate shortness of breath and the presence of a wet cough only in the morning, after waking up.

There is a special form of the disease - often recurrent obstructive bronchitis, which is characterized by almost constant periods of exacerbation with the presence of short remissions. This form of the disease most often leads to complications.

Diagnostics

The diagnosis of acute obstructive bronchitis is usually made on the basis of a pronounced clinical picture and the results of a physical examination. During auscultation, moist rales are heard in the lungs, the frequency and tone of which change with coughing.

The laboratory research package includes:

• general blood and urine tests;
• blood chemistry;
• immunological tests;
• determination of the gas composition of the blood;
• microbiological and bacteriological studies of sputum and lavage fluid.

In doubtful cases of exacerbation of chronic obstructive bronchitis should be differentiated from pneumonia, tuberculosis, bronchial asthma, bronchiectasis, pulmonary embolism, and.

Instrumental examination:

Spirometry is an examination of the volume and speed indicators of inhalation and exhalation using a device - a spirograph. The main criteria for assessing the severity of the disease are indicators such as:

• VC - vital capacity of the lungs;
• FEV1 - forced expiratory volume in 1 second;
• Tiffno index - the ratio of VC to FEV1;
• POS - peak space velocity.

X-ray of the chest (thoracic organs), on which you can see dilated bronchi and a uniform increase in the airiness of the lung fields.

Treatment

When diagnosed with obstructive bronchitis, the symptoms identified and the prescribed treatment allow you to quickly put a person on his feet, but it requires a long and thorough treatment that will help prevent another attack, as well as restore bronchi with blockage from sputum.

In acute obstructive bronchitis is prescribed:

1. rest, drink plenty of water, humidify the air, alkaline and medicinal inhalations.
2. Etiotropic antiviral therapy is prescribed (interferon, ribavirin, etc.).
3. With severe broncho-obstruction, spasmolytic (papaverine, drotaverine) and mucolytic (acetylcysteine, ambroxol) agents, bronchodilator inhalers (salbutamol, orciprenaline, fenoterol hydrobromide) are used.
4. To facilitate the discharge of sputum, percussion massage of the chest, vibration massage, massage of the back muscles, and breathing exercises are performed.
5. Antibacterial therapy is prescribed only when a secondary microbial infection is attached.

The patient needs emergency care if there is a danger of complete blockage of the airways - in this case, the longer a person delays, the sooner he will need help. What to do if the condition worsens?

The patient should consult a doctor who will prescribe treatment in a hospital, namely:

• dropper;
• taking mucolytics (Sinekod);
• antibiotics (if the pathology is contagious, since bacteria and viruses are transmitted instantly).

How to treat chronic obstructive bronchitis in adults?

Therapeutic tactics in the chronic form of the disease is significantly different from that in acute bronchitis. Only a doctor can choose a treatment regimen for a patient, taking into account the stage of the disease, the age of the patient and the presence of concomitant diseases.

The general principles of therapy for the disease under consideration are as follows:

1. It is necessary to eliminate the factor that led to the exacerbation of chronic obstructive bronchitis - to cure an acute respiratory viral infection, tonsillitis.
2. The doctor should prescribe drugs with a bronchodilatory effect, for example: Salbutamol, Eufillin, Atrovent and others.
3. To thin the sputum and ensure its rapid withdrawal, the patient should take mucolytic drugs - for example, Bromhexine or Ambrobene.

To prevent exacerbations of the disease during periods of remission, patients are recommended to perform procedures aimed at strengthening immunity:

• hardening,
• physical exercises,
• proper nutrition,
• periodic courses of vitamin therapy.

How to treat obstructive bronchitis if home treatment does not help? Most likely, the doctor will recommend treatment in a hospital. In addition to the ineffectiveness of outpatient treatment, indications for inpatient treatment are as follows:

• acute, sudden onset respiratory failure;
• pneumonia;
• development of heart failure;
• the need for bronchoscopy.

Prevention

With obstructive bronchitis in adults, prevention is of great importance.

1. Primary prevention involves quitting smoking.
2. It is also recommended to change working conditions, place of residence to more favorable ones.
3. You need to eat right. There should be enough vitamins and nutrients in food - this activates the body's defenses.
4. It is worth thinking about hardening.
5. Fresh air is important - daily walks are a must.

Measures of secondary prevention imply a timely visit to the doctor if the condition worsens, passing examinations. The period of well-being lasts longer if the prescriptions of doctors are strictly followed.

At the first signs of obstructive bronchitis, be sure to visit a pulmonologist. Only a doctor can make an accurate diagnosis and prescribe the right treatment.

This is all about obstructive bronchitis in children and adults: what kind of disease is it, what are its causes, signs and symptoms, and treatment features. Be healthy and take care of yourself!

Obstructive bronchitis is an inflammatory disease of the bronchial tree, which is characterized by the occurrence of an unproductive cough with sputum, shortness of breath and, in some cases, broncho-obstructive syndrome, which is similar in its etiology to bronchial asthma.

The figure shows a bronchus in obstructive bronchitis.

The disease is common throughout the world, but is more common in regions with a humid and cold climate, where the average annual temperature does not rise above 15–17 0 C. This temperature, in combination with high humidity, promotes the reproduction of viral agents and pathological microorganisms, which, getting upper respiratory tract, provoke the development of the pathological process.

The prognosis for the disease is uncertain.

When a diagnosis such as acute obstructive bronchitis is established, recovery occurs within 7–14 days.

When establishing a diagnosis such as chronic obstructive bronchitis, the prognosis is unfavorable because the disease is constantly progressing and is accompanied by a gradual increase in respiratory failure, which negatively affects the entire body.

What can cause a pathological process in the bronchial tree?

The structure of the bronchial tree is shown on the left in the figure.

A disease such as obstructive bronchitis can be caused by many reasons, among which the most significant are:

• Bacteria:

1. Pneumococci;
2. Staphylococci;
3. Streptococci;
4. Pseudomonas aeruginosa;
5. Legionella.

• Viruses:

1. Flu;
2. Rhinoviruses;
3. Adenoviruses;
4. Herpes;
5. Cytomegalovirus.

• The simplest microorganisms:

1. Chlamydia;
2. Proteus;
3. Mycoplasmas.

The infection is transmitted by airborne droplets after contact with a sick person or a carrier of the infection.

With obstructive bronchitis, the etiology of which is a bacterial infection, a person is contagious 3-5 days after the onset of the disease.

With obstructive bronchitis, the cause of which is a viral infection, the patient is contagious 1-2 days after the onset of the disease.

In obstructive bronchitis caused by a protozoal infection, an affected person is contagious for 4 to 6 days after onset.

Predisposing factors to the development of pathology:

• reduced immunity due to chronic diseases of internal organs, after operations, frequent viral infections, etc.;
• persons with impaired functioning of the thermoregulation center (when the body temperature is constantly higher than normal);
• persons diagnosed with HIV (human immunodeficiency virus) or AIDS (acquired immunodeficiency syndrome);
• smoking;
• alcoholism;
• addiction;
• living in dusty and gassed areas or regions;
• labor that is associated with the mining, metallurgical, woodworking, pulp and paper or chemical industries.

The pathogenesis of obstruction in bronchitis (the mechanism of origin, development of the disease and its individual symptoms).

The pathogenesis is based on the summation of predisposing factors and causes of obstructive bronchitis, which lead to the development of an inflammatory process, which gradually involves bronchi of medium and small caliber. There are 4 components of pathogenesis:

1. Violation of the movement of cilia of the ciliated epithelium of the bronchial mucosa, which helps to cleanse the bronchial tree.
2. Replacement of the ciliated epithelium with goblet cells, which begin to produce a large amount of mucus.
3. A decrease in the secretion of the bronchi due to its amount of content of immune cells that fight infection that has entered the bronchi with inhalation.
4. Spasm of the smooth muscles of the bronchi.

Classification

On the left is a normal bronchus, on the right is an inflamed bronchus.

Establishing a diagnosis such as obstructive bronchitis involves determining the severity and stage of the process.

The severity of obstructive bronchitis, which is directly proportional to shortness of breath:

Grade 1 - shortness of breath begins to bother the patient with a long rise or with a fairly fast walk.

Grade 2 - shortness of breath begins to force the patient to move at a lower speed, in relation to healthy people.

Grade 3 - shortness of breath forces the patient to stop when walking slowly every 80–100 m.

Grade 4 - shortness of breath occurs when talking, eating, turning in bed.

The stages of the disease, which are determined depending on the results of spirometry (measurement of speed and volume indicators of breathing) and the main symptoms of the disease:

Main symptoms

Obstructive bronchitis in adults occurs with alternating periods of exacerbation and remission.

The period of exacerbation of the disease (during this period, a sick person is contagious to others):

• Broncho-obstructive syndrome, which is manifested by obstruction of the bronchi:

• Symptoms of damage to other internal organs and systems directly related to bronchial obstruction:

1. Headache;
2. Dizziness;
3. Nausea;
4. Vomit;
5. Violation of consciousness;
6. Chills;
7. Increased heart rate;
8. Increase in blood pressure figures.

The period of remission of the disease is characterized by slight sweating, moderate shortness of breath and the presence of a wet cough only in the morning, after waking up.

There is a special form of the disease - often recurrent obstructive bronchitis, which is characterized by almost constant periods of exacerbation with the presence of short remissions. This form of the disease most often leads to complications.

Diagnostics

Establishing the diagnosis of obstructive bronchitis in doctors usually does not cause difficulties. You can seek primary care from a general practitioner, pulmonologist or family doctor.

A preliminary diagnosis is made on the basis of the collected symptoms of the patient, his complaints and examination, which includes percussion of the chest with the identification of a characteristic box sound and auscultation of the lungs, during which weakened breathing and many dry wheezing are heard.

Auscultation of the lungs

The final diagnosis is made after the delivery of laboratory tests and the passage of an instrumental examination, taking into account the identification of changes characteristic of obstructive bronchitis in them:

• Laboratory examination:

• Instrumental examination:

Spirometry is an examination of the volume and speed indicators of inhalation and exhalation using a device - a spirograph. The main criteria for assessing the severity of the disease are indicators such as:

• VC - vital capacity of the lungs;
• FEV1 - forced expiratory volume in 1 second;
• Tiffno index - the ratio of VC to FEV1;
• POS - peak space velocity.

X-ray of the chest (thoracic organs), on which you can see dilated bronchi and a uniform increase in the airiness of the lung fields.
The differential diagnosis of obstructive bronchitis should be carried out after the main examination with a disease such as bronchial asthma. Since an asthma attack is very similar to obstructive bronchitis.

Differential diagnosis is carried out according to the following criteria:

Methods of modern therapy

• Antibacterial drugs:

1. Macrolides (Azithromycin, Erythromycin, Rovamycin, Clarithromycin) have a pronounced antibacterial and bacteriostatic (inhibit the processes of division and growth of a bacterial cell) action. This drug can also be used for infection with protozoa. It is prescribed 500 mg 1-2 times a day. The course of treatment is 3-7 days.
2. 2nd generation cephalosporins (Norfloxacin, Ciprofloxacin, Cefuroxime) have bacteriostatic and antiprotozoal (effective against protozoan microorganisms) action. Taking the drug can give allergic complications in predisposed individuals. It is prescribed after meals, 1 tablet (200 mg) 2 times a day. The course of treatment is 7-14 days.

During treatment, it is necessary to observe bed rest, walking is strictly prohibited. Doses of drugs, frequency of administration and duration of administration are decided individually by your doctor.

Effects

1. Often recurrent obstructive bronchitis.
2. Respiratory failure.
3. Emphysema of the lungs.
4. Frequent complications associated with the cardiovascular system: cor pulmonale, tricuspid valve insufficiency, pulmonary hypertension, circulatory failure.

Disease prevention

1. Exclude communication with contagious people, especially in the autumn-winter period.
2. Refusal of bad habits and, first of all, smoking.
3. With an increase in body temperature and the appearance of symptoms of damage to the respiratory system and ENT organs, you should immediately consult a doctor and begin treatment.
4. Being outdoors, walking in the forest, walking along the coast.
5. Leisure.
6. Balanced diet.

Video: Bronchitis, bronchitis in children, acute bronchitis in children