Chronic bronchitis in adults: treatment. A protracted course of orvi in ​​adults: what to do if the disease is in no hurry to pass

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

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

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

So what to do:

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

• To sleep more

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

• drink more

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

• Maintain hygiene

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

Dangerous Complications

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

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

But most often complications are associated with pathologies like:

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

• Acute otitis media

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

• pneumonia

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

• Acute sinusitis

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

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

lingering pneumonia- an acute onset of an inflammatory process in the lungs, which resolved in 4 weeks or more. Protracted pneumonia, unlike the same disease in a chronic form, has a recovery in the outcome. Acute pneumonia takes a protracted course in approximately 30% of cases.

Pathogenesis

The main role in the pathogenesis is given to disturbances in the system of local bronchopulmonary protection and reactivity of the organism. The function of B- and T-lymphocytes decreases, the complement system is suppressed, the synthesis of IgA in the bronchopulmonary system decreases, the function of alveolar macrophages is impaired, and phagocytosis is inhibited. These factors reduce the protection of the human body from infection, a protracted course of the disease develops. Violation of the glucocorticoid function of the adrenal glands is also important in the pathogenesis.

Diagnostic criteria for protracted pneumonia

The radiograph reveals peribronchial and focal segmental infiltration, which does not disappear for 28 days. Pneumonia lasts from 4 weeks. Bronchoscopy reveals local segmental bronchitis. are saved laboratory manifestations of inflammation:

• ESR exceeds the norm
• leukocytosis
• excess fibrin
• increased levels of sialic acids
• excess seromucoid

There are immunological disorders: the amount of IgA in the blood increases, and the amount of IgM, C4, C3 and C9 components and the total hemolytic activity of complement decreases. The activity of T-lymphocytes (killers and helpers) decreases and the activity of suppressor T-lymphocytes increases, which also indicates immunological disorders.

Recovery must be confirmed clinically (disappearance of pathological symptoms), laboratory and X-ray methods. The recovery time is different in each case. According to Hegglin, recovery occurs within up to 3 months, according to other sources, a person can suffer from prolonged pneumonia for 12 months or longer.

Treatment

When starting therapy for the disease in question, it must be borne in mind that some factors affect the protracted course of pneumonia:

• premature termination of therapy and discharge of a patient with acute pneumonia
• untimely and wrong treatment acute form of the disease
• patient smoking and alcohol abuse
• insufficient volume of rehabilitation measures
• nasal obstruction and frequent relapses nasopharyngeal infection
• expressed
• advanced age of the patient
• superinfection
• concomitant diseases that weaken the body's reactivity (this includes)

The treatment program is the same as in the acute form of the disease. But doctors should still take into account such features of the treatment of prolonged pneumonia:

• it is necessary to detect in time the factors that delay the disease, and eliminate them. This mainly includes sanitation of the nasopharynx, oral cavity, smoking cessation, elimination of other foci of infection, refusal of alcoholic beverages.
• it is recommended to carefully analyze the methodology and the results of the past antibacterial treatment and decide whether to continue it if severe infiltration of lung tissue and symptoms of intoxication persist. But at the same time, antibiotic treatment is prescribed, taking into account the results bacteriological research sputum, which is mandatory for all patients
• special attention should be paid to the restoration of the drainage function of the bronchi. The patient should be prescribed an adequate treatment regimen with expectorants, bronchodilators, and positional drainage. Massage is also used for this. chest, and with symptoms of persistent chronic purulent bronchitis resort to fibrobronchoscopy and fibrobronchoscopy sanitation
• frequently used physiotherapy, massage, acupuncture
• you need to pay attention to the immune system, conduct research, evaluating the factors of nonspecific protection. Taking into account the results obtained, the patient's immunity is corrected.

V. P. Silvestrov in 1986 proposed systemic and local immunity research program, which includes three large groups:

• T-system
• B-system
• Local protective factors

The first group of studies includes:

• assessment of the regulatory link of the T-system (helper activity and suppressor activity)
• determination of the total content of T-lymphocytes
• assessment of the effective link of the T-system (antibody-dependent and natural cytotoxicity)

B-system research includes:

• functional activity of B-lymphocytes
• their total content
• content of immunoglobulins IgG, IgA, IgE, IgM

Local protective factors (the third group of studies according to V.P. Silvestrov) are studied in bronchial secretions. They include the local immune system and alveolar macrophages. The total content of T- and B-lymphocytes, secretory immunoglobulins, the functional ability of alveolar macrophages, etc. are determined.

Not every hospital can provide a patient with the opportunity to undergo a complete immunological examination according to the detailed program described above. But patients with a prolonged form of pneumonia need to be investigated for factors related to immunity, since the vast majority of them have secondary immunodeficiency. This condition needs to be corrected, and for this the results of an immunological study are important.

In the treatment of patients with chronic pneumonia, it is recommended:

• apply methods of stimulation of the adrenal glands (treatment with etimizole, DKV on the area of ​​the adrenal glands)
• actively apply methods of immunocorrective effects: ultraviolet and laser irradiation blood
• the period of dispensary observation for prolonged pneumonia in a patient should be 1 year or longer until the person gets rid of the symptoms of the disease
• as part of complex therapy there should be sanatorium treatment, in the absence of such an opportunity, the rehabilitation program should be used in full in the rehabilitation departments of polyclinics, hospitals or sanatoriums at the place of residence

Glycyram

The drug has a moderate anti-inflammatory effect, has a stimulating effect on the adrenal cortex. The expectorant effect of the drug is weakly expressed. It is often used to treat mild forms bronchial asthma, with inflammation of the skin and children's skin diseases. The dose of the drug for treatment lingering doctor determines individually.

The instructions indicate that adults should take the drug in the amount of 1-2 tablets (0.05-0.1 g) half an hour before meals, 2-4 times a day. AT severe cases reception from 3 to 6 times a day for 0.1 g. Children take glyceram in granular form. The drug can be prescribed to children in tablet form (0/4-1/2-1 tablet per dose, depending on age). The duration of treatment with glycyram is strictly individual and should be determined by your doctor. The course can be either 3-4 days or 3-4 months. Contraindications to taking glyceram are violations of the liver and kidneys, as well as organic lesions hearts.

In this article, you will learn about what is lingering pneumonia in the child, its symptoms and causes, how prolonged pneumonia is treated, and what preventive measures you can take to protect the child from this disease.

Causes of protracted pneumonia

Protracted pneumonia (pneumonia protracta) is a disease in which clinical and radiological changes in the lungs persist for up to 6 weeks. and more, can last up to 6 - 8 months. and end in recovery.

Protracted pneumonia is currently considered as independent disease, which occupies an intermediate position between acute and chronic forms of the disease. The disease may be the cause of chronic inflammation lungs.

The problem of this disease is of particular importance for children. early age, because it is registered among them 6.5 times more often than in other age groups.

Protracted course of pneumonia

The causes of chronic pneumonia in a child are numerous and not well understood. Of particular importance is a particularly virulent microflora - the so-called bronchopathogenic pathogens that have a tropism for lung tissue and development purulent inflammation(influenza stick, staphylococci). At the same time, individual strains of microbes in association with other pathogens can change their properties, become insensitive to antibiotics, and acquire the ability to increase their growth. Particularly severe damage bronchopulmonary system cause viruses in combination with gram-negative and coccal flora. Pneumonia caused by pneumocystis, mycoplasmas acquires a tendency to a protracted course. In addition, conditions are created for enhanced growth fungal flora, which can sustain inflammatory changes in the lungs for a long time. Finally, under the influence of antibacterial drugs, the appearance of L-forms of bacteria is possible, which partially or completely lose their membrane along with the antigenic determinant, adapting to long-term persistence in the body. AT certain conditions they revert to their previous state with restoration of virulence. This may explain the recurrence of the disease even in the absence of obvious reinfection.

The cause of prolonged pneumonia in a child may be a severe and complicated course of acute pneumonia, especially with the localization of the process in the middle lobe, where drainage and ventilation are difficult due to anatomical features.

An important role is played by the premorbid background and accompanying illnesses, rickets, malnutrition, exudative diathesis, intracranial birth trauma, prematurity. Acidosis with "blooming" rickets helps to reduce the tone of the vessels of the lungs, their plethora and congestion, which leads to swelling of the interstitium of the lungs, thickening of the interalveolar septa, and a decrease in the airiness of the lungs. All this is aggravated by general muscular hypotension, especially of the respiratory muscles and diaphragm. Reducing the excursion of the chest, uneven ventilation of the lungs, the occurrence of micro- and macroatelectasis lead to a protracted course of pneumonia.

At exudative diathesis matter:

• increased vascular permeability and cell membranes;
• tendency to rapid formation of edema and hypersecretion;
• impaired immune response and reduced resistance to infectious agents.

The timely resolution of pneumonia in such children is hindered by the presence of foci of infection in the nasopharynx, which serve as a persistent source of microbial contamination of the bronchopulmonary system and a focus of child sensitization.

Protracted pneumonia in premature babies

It is expressed by morphological immaturity and functional weakness. respiratory center and respiratory organs (in newborns with intracranial birth trauma and damage to the central nervous system). Superficial, arrhythmic breathing, intermittent prolonged apnea, bouts of asphyxia, and an insufficient amount of surfactant lead to uneven ventilation of the lungs, the appearance of hypopneumatosis, primary and secondary atelectasis. In addition, the inflammatory process in the lungs is complicated by multiple hemorrhages, indicating a violation of vascular permeability, apparently associated with hypoxia.

The pathogenesis of protracted pneumonia

It also leads to hereditary diseases such as cystic fibrosis, oti-antitrypsin deficiency, immunodeficiency states, and birth defects development respiratory system(cysts, hypoplasia, sequestration of the lung, stenosis, deformation and atresia of the trachea and bronchi, etc.), and impaired drainage function and stagnation of the infected secretion.

An important place in pathogenesis belongs to a change in the adaptive capabilities and immunobiological reactions of the child's body as a result of the influence of a virulent infection, hypoxemia, toxemia, and also due to ongoing antibiotic therapy. These changes are confirmed by a decrease in complement titer, indicators of phagocytic activity of leukocytes, a decrease in the level of properdin, lysozyme, etc., an imbalance of T- and B-lymphocytes. Against this background, the processes of microbial allergy and autoallergy that develop as a result of prolonged microbial sensitization and inflammation are of great importance.

All pulmonary inflammatory diseases are usually accompanied by the production of antimicrobial antibodies and non-specific antipulmonary autoantibodies that bind to pulmonary antigen. The titer of antipulmonary antibodies increases more significantly with a long course compared with an acute one. These autoantibodies can cause non-specific tissue damage (immune inflammation). A sensitized organism is able to respond to the impact of even a nonspecific stimulus with a paraallergic reaction, which manifests itself in the clinic with a relapse of the disease.

Symptoms of protracted pneumonia

According to the prevalence of the inflammatory process, prolonged pneumonia can be both focal and segmental, localized in one or more lobes of the lungs, on one or both sides.

In most cases, there is a slight disturbance general condition. A number of patients may experience pallor, increased fatigue at normal or subfebrile body temperature. Heat rarely observed. One of the most persistent symptoms is a cough. It can be both dry and wet, frequent or rare.

Due to weakness cough reflex and respiratory muscles, small children cough up sputum poorly and often swallow it. Often, due to the insufficient effectiveness of coughing, hoarse, bubbling breathing, shortness of breath of a mixed nature appear. The latter is slight or moderate and is more pronounced in infants. Changes in the lungs are accompanied by a predominantly boxed tone of percussion sound due to emphysema, sometimes with separate areas of its shortening, auscultatory-hard breathing and scattered dry or wet rales of various sizes, usually on inhalation and exhalation. Less commonly, weakened breathing is heard over the area of ​​the affected lung, there may also be small bubbling rales and even crepitus as residual effects of long-lasting local changes with an overall positive dynamics of the process.

Signs of prolonged pneumonia in a child

Extrapulmonary signs include pulse lability with a tendency to tachycardia with a slight physical activity and even at rest. Protracted pneumonia in a number of babies occurs with respiratory arrhythmia and the appearance systolic murmur of a functional nature, the liver also moderately increases in size. The general muscular hypotension. Dystrophy may develop. These changes are most often associated with metabolic disorders in organs and with hypoxia varying degrees and gradually disappear as the child recovers.

Changes in peripheral blood parameters are usually unstable, not detected in all patients and are most often represented by moderate leukocytosis with a mild neutrophilic shift, sometimes transient eosinophilia; ESR, as a rule, is not more than 15 - 20 mm/h. Some patients tend to develop hypochromic anemia.

Prolonged pneumonia studies

1. An x-ray examination reveals areas of increased bronchovascular pattern from the side of the affected lung, often with signs of peribronchial and perivascular infiltration of the lung tissue. Infiltrative shadows are heterogeneous and are focal or segmental in nature. Often there is a reaction lung root. Most often, the inflammatory process is localized in the middle and lower lobes right lung, in the lower lobe and reed segments left lung. In 10 - 25% of patients with X-ray examination, atelectasis of the lung tissue is diagnosed.
2. Endoscopy bronchial tree reveals inflammatory changes in the bronchial mucosa in the area of ​​the affected segments of the lung, which are often widespread.

For young children, swelling and hyperemia of the bronchial mucosa and hyperproduction of secretions are most characteristic. Such changes lead to a significant narrowing of the bronchial lumen, obturation of their secretion and the occurrence of atelectasis and areas of hypopneumatosis. In this case, the excreted secret is muco-serous, purulent or muco-purulent. Pus in the bronchial secret indirectly indicates the presence of bronchopathogenic flora in it and more active inflammation.

A long-term pathological process can lead to bronchial deformation of an inflammatory and dystonic nature, which disappears as the child recovers.

How does chronic pneumonia progress in a child?

The course can be torpid with very slow positive dynamics or undulating with short-term periods of a decrease in pulmonary changes and a subsequent increase in clinical and radiological manifestations of the disease.

Diagnosis of protracted pneumonia in children

Of great importance are data on the timing of the onset of prolonged pneumonia in a child, the nature and duration, as well as the effectiveness of the therapy. From clinical symptoms it is important to establish the presence of persistent cough and physical changes in the lungs in the form of local or scattered wheezing, which indicates current process. An additional (but not always detectable) sign is the shortening of percussion sound in the area of ​​the inflammatory focus.

1. The most valuable information comes from the results of the multi-axis x-ray examination. They allow you to identify the presence of pulmonary and peribronchial infiltration, to establish the most reliable localization and prevalence of the process, and the presence of atelectasis, hypopneumatization of certain areas of the lung, an increase lymph nodes etc.
2. The activity of the inflammatory process can be indirectly indicated by changes in peripheral blood parameters, as well as visual inspection bronchial tree using tracheobronchoscopy. This method can also be used to determine the nature of endobronchitis (catarrhal, purulent) and to determine the dominant pathogen and its sensitivity to antibacterial drugs. With the localization of the focus of inflammation in the middle lobe, sometimes you have to resort to bronchography.

When establishing the diagnosis of "prolonged pneumonia", it is necessary to indicate the localization and prevalence of the process. Reliable diagnosis can be set only after a long, within 6 - 8 months, monitoring the dynamics pathological process, reflecting the reduction or elimination of changes in the lungs, and after the exclusion of a number of diseases, often masked by prolonged pneumonia.

Differential diagnosis should be made with:

• chronic pneumonia,
• pneumopathy caused by damage to the nasopharynx and bronchi,
• as well as with primary diffuse pneumofibrosis and cystic fibrosis.

Treatment of protracted pneumonia in children

For treatment, it is necessary to eliminate the factors that determine the long course. It should be borne in mind that a long-term inflammatory process and previous treatment often change the properties of the pathogen and the reactivity of the macroorganism. In this regard, for antibiotic therapy, there must be certain indications: subfebrile temperature or rises to febrile, sputum purulent nature changes in peripheral blood (leukocytosis, neutrophilia, increase in ESR), i.e., clinical signs of the activity of the inflammatory process. Preference is given to antibiotics a wide range actions, mainly with a bactericidal effect. The duration of their use depends on the dynamics of the inflammatory process in the lungs, which is assessed according to the results of clinical and radiological studies and is confirmed by laboratory data.

Treatment of chronic pneumonia with medicines

In addition to antibiotics, prolonged pneumonia in a child can be cured using mucolytic agents (mucaltin orally, acetylcysteine, mucosolvin, trypsin, chymopsin in electroaerosols, 10-12 procedures per course) and expectorants, and methods that help remove thinned secretions from the respiratory tract ( massotherapy, vibration massage, breathing exercises, postural or positional drainage). For the same purpose, steam and heat-moist inhalations are used. Increased viscosity sputum requires an appointment plentiful drink. In the presence of symptoms of bronchial obstruction, it is necessary to prescribe bronchospasmolytic drugs (eufillin, ephedrine, etc.) in the form of electroaerosols or for oral administration.

A quick and persistent absorbable and anti-inflammatory effect is achieved with the help of physiotherapy treatment aimed at improving lymph and blood circulation, increasing tissue metabolism, restoring the mechanisms of regulation of bronchial and lung function:

• UHF on the chest - 8 - 10 sessions for 5 - 7 minutes,
• microwave therapy - 5 - 8 procedures,
• inductothermy with eddy current electrodes (EVT) - 7 - 10 procedures for 5 - 7 - 12 minutes,
• electrophoresis with calcium, magnesium, copper, dionine, ascorbic acid - 10 procedures per course,
• fractional ultraviolet irradiation on the back, thermal treatments(applications of paraffin, ozocerite) - 10 - 12 sessions per course.

How to treat prolonged pneumonia in a child?

Hyposensitizing therapy is widely used to restore changes in the body's reactivity. antihistamines, to normalize metabolic processes, reducing vascular permeability and stimulating regeneration processes - vitamin therapy (vitamins C, B, A and E). In addition to this, it is necessary biogenic stimulants(aloe extract, apilac) and drugs that act on non-specific defense mechanisms(pentoxyl, methyluracil, etc.)

With insufficient effectiveness for 2-3 months of complex therapy, examination and treatment of the child in a specialized pulmonological hospital is indicated. Here, along with the above methods of treatment, such methods of influence as bronchoscopic lavage of the respiratory tract are used, i.e. bronchial lavage, followed by aspiration of bronchial secretions and the introduction of antibiotics and antiseptics directly into the focus of inflammation. Endobronchial route of administration of antibiotics is a highly effective treatment for long-term bronchitis. Indications for its use are persistent purulent or catarrhal-purulent changes in the bronchi. Therapeutic bronchoscopy is carried out in a course of 3-4 procedures with an interval between them of 4-5 days. The antibiotic during bronchoscopy is administered once after the preliminary toilet of the bronchi in the maximum allowable daily dosage.

An important condition The fact that prolonged pneumonia in a child will be cured is the observance of the principle of continuity between medical institutions (hospital - sanatorium - clinic).

The sanatorium shows the implementation of rehabilitation measures. Among them, the organization of a medical and protective regimen is of great importance. rational nutrition. Physiotherapy exercises are obligatory, as well as the use of tempering hydrotherapy procedures.

Prevention of protracted pneumonia

Primary prevention is early diagnosis and rational treatment acute pneumonia, careful clinical and radiographic monitoring of its course and outcome, and active dispensary monitoring of children who have had a severe or complicated destructive acute pneumonia within 3 - 6 months, with timely correction residual effects diseases.

To measures to prevent the formation chronic form diseases should be attributed complex treatment lingering pneumonia aimed at eliminating inflammatory changes in the lungs with complete restoration of ventilation capacity and normalization of the patient's immune reactivity, as well as the organization of dispensary observation in the clinic for convalescents. It must last at least 1 - 1/2 years from preventive examinations every 3 - 4 months. The absence of clinical radiological signs disease during the observation period allows us to talk about the recovery of the child and his removal from the dispensary register.

Treatment prognosis. It is determined primarily by the possibility of eliminating the etiotropic factor. At rational therapy recovery occurs in 3-4 months. from the onset of the disease. The process can be reversible and with a longer duration of the disease (up to 6-8 months). Persistence of radiographic changes long time in the absence of clinical symptoms, it should be alarming, tk. may indicate the formation of a chronic form of the disease. The specified terms, as if defining the framework of prolonged pneumonia, are conditional, because. in a number of patients, irreversible changes in the lungs and the formation chronic pneumonia begin much earlier, even at the very beginning of the disease. This is especially true for severe destructive acute forms diseases.

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

Factors contributing to the protracted course of pneumonia

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

Features of the clinical picture of prolonged pneumonia

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

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

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

Diagnosis of the disease

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

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

Treatment

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

To restore the drainage function of the bronchi, according to indications, expectorants and bronchodilators, chest massage, positional drainage, sanitation of the bronchi with the help of fibrobronchoscopy are used. Physiotherapy, breathing exercises, physiotherapy, acupuncture, various methods immunocorrection.

Possible complications and prognosis

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

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Counters

currents

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

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

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

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

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

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

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

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

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

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

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