Classification of acute bronchitis. Acute bronchitis. Definition. Causes. Clinic, diagnostics. Treatment Acute and chronic bronchitis diagnosis clinic treatment

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

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

1) physical: hypothermia, dust inhalation

2) chemical: inhalation of vapors of acids and alkalis

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

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

The pathogenesis of acute bronchitis:

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

Classification of acute bronchitis:

1) primary and secondary acute bronchitis

2) according to the level of damage:

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

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

c) bronchiolitis

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

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

Clinic and diagnosis of acute bronchitis.

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

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

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

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

Treatment of acute bronchitis.

1. Home mode, drinking plenty of water

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

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

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

5. Symptomatic treatment (NSAIDs, etc.).

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

Allocate HB:

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

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

Etiology of chronic bronchitis:

1) smoking:

Nicotine, tobacco polycyclic aromatic hydrocarbons (benzpyrene, cresol) are strong carcinogens

Violation of the function of the ciliated epithelium of the bronchi, mucociliary transport

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

Tobacco smoke leads to metaplasia of the ciliated epithelium and Clara cells, forming cancer cell precursors

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

- ACE activity of alveolar macrophages --> AT II synthesis --> pulmonary hypertension

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

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

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

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

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

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

7)genetic factors and hereditary predisposition

The pathogenesis of chronic bronchitis.

1. Violation of the function of the system of local bronchopulmonary protection and immune systems

a. dysfunction of mucociliary transport (ciliated epithelium)

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

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

d. violation of the ratio of proteases and their inhibitors (a 1 -antitrypsin and a 2 -macroglobulin)

e. decreased function of alveolar macrophages

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

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

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

Clinical picture of chronic bronchitis.

Subjectively:

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

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

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

Objectively:

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

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

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

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

Clinical and diagnostic signs of exacerbation of CB:

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

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

Subfebrile body temperature

Tachycardia at normal temperature

Increased cough, increase in the amount and "purulence" of sputum

The appearance of biochemical signs of inflammation

Shift in the leukocyte formula to the left and an increase in ESR to moderate numbers

Diagnosis of chronic bronchitis.

1. Laboratory data:

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

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

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

2. Instrumental research:

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

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

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

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

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

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

Complications of HB.

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

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

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

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

2. During an exacerbation:

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

b) pathogenetic treatment aimed at improving pulmonary ventilation, restoring bronchial patency:

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

Therapeutic bronchoscopy with bronchial sanitation

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

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

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

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

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

Bronchitis refers to diseases of the respiratory system, is a diffuse inflammation of the mucous membrane of the trachea and bronchi. The clinic of bronchitis may differ depending on the form of the pathological process, as well as the severity of its course.

According to the international classification, bronchitis is divided into acute and chronic. The first is characterized by an acute course, increased sputum production, dry cough, worse at night. After a few days, the cough becomes wet, sputum begins to move away. Acute bronchitis usually lasts 2-4 weeks.

In accordance with the guidelines of the World Health Organization, the signs of bronchitis, which allows it to be classified as chronic, is a cough with intense bronchial secretion, lasting more than 3 months for 2 years in a row.

In a chronic process, the lesion spreads to the bronchial tree, the protective functions of the bronchi are disturbed, there is difficulty breathing, abundant formation of viscous sputum in the lungs, and a prolonged cough. The urge to cough with expectoration is especially intense in the morning.

Reasons for the development of bronchitis

Various forms of bronchitis differ significantly from each other in terms of causes, pathogenesis and clinical manifestations.

The etiology of acute bronchitis is the basis for the classification, according to which diseases are divided into the following types:

infectious (bacterial, viral, viral-bacterial, rarely fungal infection);
stay in adverse harmful conditions;
unspecified;
mixed etiology.

More than half of all cases of the disease are caused by viral pathogens. The causative agents of the viral form of the disease in most cases are rhino-, adenoviruses, influenza, parainfluenza, respiratory-interstitial.

Of the bacteria, the disease is more often caused by pneumococci, streptococci, Haemophilus influenzae and Pseudomonas aeruginosa, Moraxella catarrhalis, Klebsiella. Pseudomonas aeruginosa and Klebsiella are more often detected in immunocompromised patients who abuse alcohol. In smokers, the disease is more often caused by Moraxella or Haemophilus influenzae. Exacerbation of the chronic form of the disease is often provoked by Pseudomonas aeruginosa and staphylococci.

Mixed etiology of bronchitis is very common. The primary pathogen enters the body, reduces the protective functions of the immune system. This creates favorable conditions for the attachment of a secondary infection.

The main causes of chronic bronchitis, in addition to bacteria and viruses, are the impact on the bronchi of harmful physical, chemical factors (irritation of the bronchial mucosa with coal, cement, quartz dust, sulfur vapor, hydrogen sulfide, bromine, chlorine, ammonia), prolonged contact with allergens. In rare cases, the development of pathology is due to genetic disorders. The relationship between the incidence rate and climatic factors has been established, the rise is observed in the cold damp period.

Atypical forms of bronchitis are caused by pathogens that occupy an intermediate niche between viruses and bacteria. These include:

legionella;
mycoplasmas;
chlamydia.

Atypical diseases are characterized by uncharacteristic symptoms with the development of polyserositis, damage to the joints and internal organs.

Features of the pathogenesis of inflammation of the bronchi

The pathogenesis of bronchitis consists of neuro-reflex and infectious stages of the development of the disease. Under the influence of provoking factors, trophic disorders are noted in the walls of the bronchi. Infectious disease begins with the adhesion of the infecting pathogen to the epithelial cells of the mucous membrane of the airways of the lungs. At the same time, local protective mechanisms are violated, such as air filtration, moisturizing, cleansing, the activity of the phagocytic function of alveolar macrophages and neutrophils decreases.

The penetration of pathogens into the lung tissue is also facilitated by a disruption in the functioning of the immune system, an increase in the body's sensitivity to allergens or toxic substances formed during the vital activity of pathogens of the inflammatory process. With constant smoking or contact with harmful conditions, the purification of the lungs from small irritants slows down.

With further progression of the disease, obstruction of the tracheobronchial tree develops, redness, swelling of the mucosa is noted, and increased desquamation of the integumentary epithelium begins. As a result, an exudate of a mucous or mucopurulent nature is produced. Sometimes there may be a complete blockage of the lumen of the bronchioles, bronchi.

In severe cases, yellowish or greenish purulent sputum is formed. With hemorrhages from the blood vessels of the mucous membrane, the exudate acquires a hemorrhagic form with brown lumps (rusty sputum).

A mild degree of the disease is characterized by damage to only the upper layers of the mucous membrane, in severe cases, all layers of the bronchial wall undergo morphological changes. With a favorable outcome, the consequences of the inflammatory process disappear in 2-3 weeks. In the case of panbronchitis, the restoration of deep layers of the mucosa lasts about 3-4 weeks. If pathological changes become irreversible, the acute phase of the disease acquires a chronic course.

The conditions for the transition of pathology into a chronic form are:

decrease in the body's defenses to diseases, exposure to allergens, hypothermia;
viral respiratory diseases;
foci of infectious processes in the organs of the respiratory system;
allergic diseases;
heart failure with congestion in the lungs;
deterioration of drainage function due to failures in motor skills and disorders of the ciliated epithelium;
the presence of a tracheostomy;
socially unfavorable living conditions;
violations of the functioning of the neurohumoral system of regulation;
smoking, alcoholism.

The most significant in this type of pathology is the functioning of the nervous system.

Set of manifestations of bronchitis

The symptomatology of bronchitis, depending on the form of the disease, has significant differences, therefore, in order to correctly assess the patient's condition, as well as prescribe the appropriate treatment, it is necessary to identify the distinctive features of the pathology in time.

The clinical picture of the acute form of bronchitis

The clinic of acute bronchitis in the initial stage is manifested by signs of acute respiratory infections, runny nose, general weakness, headache, slight fever, redness, sore throat). Simultaneously with these symptoms, a dry, painful cough occurs.

Patients complain of a sore feeling in the chest. After a few days, the cough acquires a wet character, becomes softer, mucous exudate begins to move away (catarrhal form of the disease). If infection with a bacterial agent joins the viral pathology, sputum acquires a mucopurulent character. Purulent sputum in acute bronchitis is extremely rare. With severe coughing fits, the exudate may be streaked with blood.

If inflammation of the bronchioles develops against the background of bronchitis, symptoms of respiratory failure, such as shortness of breath, blue skin, may be observed. Rapid breathing may indicate the development of bronchial obstruction syndrome.

When tapping the chest, percussion sound and trembling of the voice usually do not change. Harsh breathing is heard. In the initial stage of the course of the disease, dry rales are noted, when sputum begins to depart, they become wet.

In the blood there is a moderate increase in the number of leukocytes with a predominance of neutrophils. The erythrocyte sedimentation rate may increase slightly. There is a high probability of the appearance of C-reactive protein, an increased level of sialic acids, alpha 2-globulins.

The type of pathogen is determined by bacterioscopy of lung exudate or sputum culture. For the timely detection of blockage of the bronchi or bronchioles, peak flowmetry or spirometry is performed.

In acute bronchitis, the pathology of the structure of the lungs is usually not observed on an x-ray.

In acute bronchitis, recovery occurs in 10-14 days. In immunocompromised patients, the disease is protracted and can last more than a month. In children, there are more pronounced signs of bronchitis, but the tolerance of the disease in pediatric patients is easier than in adults.

Symptoms of chronic bronchitis

Chronic non-obstructive or obstructive bronchitis manifests itself in different ways, based on the duration of the disease, the likelihood of heart failure or emphysema. The chronic form of the disease has the same varieties as the acute form.

In chronic bronchitis, the following clinical manifestations of the disease are noted:

increased secretion and secretion of purulent sputum;
whistling during inspiration;
difficult breathing process, hard breathing when listening;
strong painful cough;
more often dry rales, wet with a large amount of viscous sputum;
heat;
sweating;
muscle tremor;
change in the frequency and duration of sleep;
severe headaches at night;
attention disorders;
heart palpitations, increased blood pressure;
convulsions.

The main sign of chronic bronchitis is a strong paroxysmal barking cough, especially in the morning, with copious secretion of thick sputum. After a few days with such a cough comes soreness of the chest.

The nature of the secreted sputum, its consistency, color, differ depending on the following types of chronic bronchitis:

catarrhal;
catarrhal-purulent;
purulent;
fibrinous;
hemorrhagic (hemoptysis).

With the progression of bronchitis, the patient begins to be disturbed by shortness of breath even without physical exertion. Outwardly, this is manifested by cyanosis of the skin. The chest takes the form of a barrel, the ribs rise to a horizontal position, the pits above the collarbones begin to bulge.

In a separate form, hemorrhagic bronchitis is isolated. The disease is non-obstructive in nature, the course is long-term, a distinctive feature is hemoptysis, due to an increase in the permeability of the vascular wall. Pathology is quite rare, in order to establish a diagnosis, it is necessary to exclude other factors for the formation of mucous secretions of the lungs with an admixture of blood. To do this, during bronchoscopy, the thickness of the walls of the blood vessels of the mucosa is determined.

The fibrinous form of bronchitis is very rare. A distinctive feature of this pathology is the presence of fibrin deposits, Kurshman spirals, Charcot-Leiden crystals. The clinic is manifested by coughing, with expectoration of casts in the form of a bronchial tree.

Bronchitis is a common disease. With adequate therapy, it has a favorable prognosis. Nevertheless, with self-medication, there is a high probability of developing serious complications or the transition of the disease to a chronic form. Therefore, at the first symptoms characteristic of bronchial inflammation, it is necessary to consult a doctor.

Bronchitis - inflammation of the bronchial mucosa without signs of damage to the lung tissue - is one of the most common acute respiratory diseases.

Elena Lapteva, Head of the Department of Pulmonology and Phthisiology BelMAPO, Dr. med. Sciences, Associate Professor;

Irina Kovalenko, Associate Professor of the Department of Pulmonology and Phthisiology of BelMAPO, candidate of medical sciences Sciences.

Bronchitis - inflammation of the bronchial mucosa without signs of damage to the lung tissue - is one of the most common acute respiratory diseases. It occurs, as a rule, against the background of SARS, which in 20% of patients acts as an independent cause of the disease. However, in 80% of patients, the main role in the etiology of the disease belongs to viral-bacterial associations. Among viral pathogens, the most common influenza, parainfluenza, adenoviruses, respiratory syncytial, adeno-, corona- and rhinoviruses. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, opportunistic microflora and their associations are leading among bacterial pathogens.

All SARS are characterized by signs of intoxication (fever, headache, weakness, myalgia, etc.) with symptoms of respiratory tract damage. Intoxication is usually not as pronounced as with the flu. The clinical picture is dominated by catarrhal syndrome: in adenovirus diseases - pharyngitis and conjunctivitis (pain or sore throat, pain in the eyes, lacrimation, cough, often productive), laryngitis (hoarseness, dry cough), with respiratory syncytial infection - frequent obsessive cough for a long time, obstructive syndrome.

Acute bronchitis is characterized by diffuse lesions of the bronchi of different calibers, which causes certain clinical symptoms. The course can be acute (up to 3 weeks) and protracted (more than 3 weeks). In cases of repeated (2–3 or more within a year) episodes, we can talk about recurrent bronchitis or (if there are signs of obstructive ventilation insufficiency) about recurrent acute obstructive bronchitis.

Infectious factors are of decisive importance in the formation of the recurrent course of the disease. When exposed to viruses on immature tissue structures, it is possible to attach bacterial inflammation that damages the ciliated epithelium and impairs the self-cleaning function of the bronchi. The reproduction of microorganisms contributes to the progression of inflammation, both due to independent damage to the structure of the bronchus, and due to the activation of lysosomal cell enzymes. The consequence of this is mucociliary disorders, leading to the development of panbronchitis, peribronchitis and contributing to the formation of deforming bronchitis when fibrosis occurs.

Protracted and recurrent course of bronchitis can provoke intracellular pathogens such as chlamydia, mycoplasmas (can also cause severe variants of its course).

Mycoplasma infection is manifested by pharyngitis, general malaise, weakness, sweating and is accompanied by a prolonged (up to 4–6 weeks) paroxysmal cough. Respiratory chlamydia is characterized by pharyngitis, laryngitis, and bronchitis. Patients most often complain of hoarseness, sore throat, subfebrile body temperature, persistent unproductive cough with discharge of a small amount of mucous sputum.

Risk Factors for Bronchitis

Hypothermia, influenza and other respiratory viral diseases, smoking (including passive), alcoholism, congestion in the lungs with heart failure, viral and allergic diseases, immunodeficiency states, epidemic situation (contact with the patient), autumn-winter period, the presence of a tracheostomy, elderly or childhood, reflux esophagitis, chronic sinusitis, exposure to physical (cold and hot air) and chemical (inhalation of sulfur vapor, hydrogen sulfide, chlorine, bromine, ammonia) factors.

Diagnostic criteria

The diagnosis of "acute bronchitis" is made when a cough occurs that lasts no more than 3 weeks, regardless of the presence of sputum, in the absence of signs of pneumonia and chronic lung diseases, which can also cause coughing. The diagnosis is determined by the exclusion of other diseases characterized by cough, and is based on the clinical picture. The main clinical manifestations: symptoms of intoxication (malaise, chills, low-grade fever, chest pain, muscle pain), cough - first dry, then productive with mucous sputum, shortness of breath, which may be due to obstructive syndrome or underlying pathology of the lungs or heart. Auscultation reveals scattered dry or moist rales in the lungs.

Viral etiology of the disease is accompanied by fever with chills, pharyngitis, conjunctivitis, rhinitis, headache, aching joints and muscles, cough. In the general analysis of blood, leukocytosis, an increase in ESR can be detected. In the general analysis of urine, slight proteinuria is possible, but more often there are no pathological changes.

Principles of treatment of bronchitis

Bronchosanation therapy;
anti-inflammatory therapy;
detoxification therapy;
antibiotic therapy (according to indications);
restorative therapy.

Currently, there is no doubt that treatment should be carried out taking into account the etiology of the disease and the presence of bronchial obstruction, in the genesis of which inflammatory edema and hypersecretion of viscous mucus predominate. Therefore, pathogenetic and symptomatic methods of therapy are anti-inflammatory, bronchodilator and mucolytic drugs. However, treatment should first of all be aimed at eliminating the cause of the disease - an infectious agent. The most difficult, both in terms of diagnosis and therapy at the present stage, is the treatment of recurrent broncho-obstructive diseases associated with atypical pathogens of respiratory infections (Mycoplasma pneumoniae, Chlamydia pneumonia, etc.), which is associated with the ability of these pathogens to persistence and adverse immunotropic effects.

Due to irrational pharmacotherapy, bronchitis can turn into a protracted form, which leads to a decrease in the working capacity and quality of life of patients, an increase in the economic costs associated with treatment.

Rationally selected etiological therapy will reduce the risk of developing severe forms of the course of the disease and its chronicity.

Drug therapy

Expectorants that irritate the stomach receptors

Means based on medicinal plants: istod, ivy, plantain, thyme, licorice, marshmallow, thermopsis, guaifenesin, etc.

These drugs have a moderate irritant effect on the receptors of the gastric mucosa and reflexively increase the secretion of the bronchi and bronchial glands. Promote the movement of mucus from the lower to the upper respiratory tract. The effect of some drugs (thermopsis, istoda, etc.) is associated with a stimulating effect on the vomiting and respiratory centers.

Expectorants with resorptive action

Carriers of sulfhydryl groups: acetylcysteine, carbocysteine.
Vasicin derivatives: synthetic analogues of the Adhatoda vasica alkaloid: bromhexine, ambroxol.

After oral administration, these drugs are absorbed, enter the bloodstream, are delivered to the bronchi, are secreted by the respiratory mucosa, stimulate the secretion of bronchial glands, thin and facilitate sputum separation, and increase bronchial motility.

Centrally acting non-opioid antitussives

Butamirate - depresses the receptors of the respiratory tract, acts on the central nervous system, does not depress the respiratory center (sinekod, codelak, stoptussin).
Glaucine is a yellow alkaloid from the poppy family. Selectively inhibits the cough center (glaucine, glauvent).
Oxeladin - suppresses the cough center and does not suppress the respiratory center. Does not cause drowsiness (paxeladin, tusuprex).
Pentoxyverine - suppresses the cough reflex, reduces the stimulation of the cough center (sedotussin).
Ledin is a derivative of the essential oil of wild rosemary shoots, 8-hydroxyaromadendran. Antitussive action is achieved by inhibiting the central cough reflex (ledin).
Dextromethorphan - inhibiting the respiratory tract receptors, does not inhibit the respiratory center, partially acts on the central nervous system (tussin plus).

Combined drugs of mucolytic and bronchodilator action in the form of syrups

Recently, combined drugs have appeared, the meaning of which is the complex effect on the symptoms of the disease that caused the cough. There are many combinations in which antitussives, expectorants, mucolytics occur in a variety of combinations, while due to the combined effect, the results of treatment are significantly superior to those in monotherapy.

The variety of means for treating cough is due, on the one hand, to the need to solve various therapeutic problems depending on the nature of the cough, the stage of the infectious process and the combination of certain pathological factors underlying it, and on the other hand, the lack of effectiveness of the therapy.

Joset, coughnol, ascoril - combined with salbutamol. Baladeks combined with theophylline, clenbuterol.

In the pathogenetic therapy of bronchitis, an inhibitor of anti-inflammatory mediators has appeared, including fenspiride, which has bronchodilator and anti-inflammatory activity. The drug reduces the manifestations of bronchospasm, reduces the production of a number of biologically active substances involved in the development of inflammation and contributing to an increase in bronchial tone, including cytokines, arachidonic acid derivatives, and free radicals. Fenspiride also inhibits the formation of histamine - its antispasmodic and antitussive effects are associated with this.

In symptomatic and pathogenetic therapy in the acute period with obstructive syndrome, it is advisable to choose inhaled bronchodilators and inhaled glucocorticosteroids.

The use of the scheme "bronchodilator + mucolytic + inhaled glucocorticosteroid" in comparison with the scheme "bronchodilator + mucolytic" and with the use of one bronchodilator in the symptomatic treatment of recurrent obstructive bronchitis is the most optimal from a pharmacoeconomic point of view. The likelihood of positive clinical effects of using this scheme is very high.

Nebulizer therapy

Currently, nebulizers are widely used for inhalation therapy in pulmonology. The operation of the devices is based on the principle of spraying liquid medicines into an aerosol mist using compressed air or ultrasound. There are two types of nebulizers: jet, using a jet of gas (air or oxygen), and ultrasonic, using the energy of a piezocrystal vibration. Jet nebulizers are more popular.

In lung diseases, the inhalation route of administration of drugs is the most logical, since the drug is delivered by the shortest route, acts faster at a lower dose, and with a lower risk of developing side effects of a systemic nature compared to drugs that are administered orally or parenterally.

The use of nebulizers allows you to:

improve the flow of the drug into the lungs without increasing the dose;
achieve significant drug savings;
use treatment regardless of age and severity of the disease.

Nebulizer therapy provides the largest percentage of drug delivery to the distal parts of the respiratory tract (compared to any other delivery devices), regardless of the patient's inhalation strength, is the most suitable for stopping an asthma attack (or cough) of any severity, as well as for basic stepwise therapy with transfer of the patient when the condition stabilizes to the use of drugs using other delivery devices.

Bronchodilators

Fenoterol (Berotek). The drug helps to expand the bronchi and facilitate the passage of air flow through the respiratory tract narrowed by inflammation. For inhalation, 1–2 ml of the drug is used, the effect persists for 3 hours. It is used symptomatically depending on the severity of bronchospasm. During an exacerbation, on average, it is used up to 4 times a day. Berotek inhalation through a nebulizer has significant advantages over a metered-dose aerosol can: the drug acts directly in the smallest bronchioles, and does not settle in the oropharynx, is not absorbed into the blood and does not cause a lot of side effects (increased blood pressure, arrhythmias, tremor). When using a spray can, it is necessary to hold your breath for a few seconds after the administration of the drug, which is not always possible during a severe attack, as well as in children. This is not necessary when using a nebulizer.
Salbutamol. It is used for the appearance of bronchospasm. Produced in special nebulas of 2.5 ml. For inhalation, one nebula is used, the therapeutic effect lasts for 4-6 hours. The number of inhalations depends on the severity of the underlying disease.
Ipratropium bromide (Atrovent). Inhaled 2-4 ml, the effect persists for 5-6 hours. The bronchodilating properties of the drug are somewhat weaker than those of Berotek, but it is practically devoid of side effects, and is more often prescribed to patients with cardiovascular diseases.
Combined bronchodilator berodual (fenoterol + atrovent). 2–4 ml of solution are inhaled, the number of procedures depends on the patient's condition.

Drugs affecting sputum rheology

Lazolvan. The solution intended for inhalation is available in 100 ml vials. Effectively liquefies viscous, difficult-to-separate sputum, as a result of which it becomes liquid and the patient can easily cough it up. 3 ml of the drug is inhaled 4 times a day.
Fluimucil (acetylcysteine). It is used as an expectorant, 3 ml several times a day.
Slightly alkaline mineral waters: "Borjomi", "Narzan", physiological solution at a dose of 3 ml 4 times a day.

Antibacterial and antiseptic agents

Should be used only if there is a clinic of bacterial damage to the bronchi.

Fluimucil-antibiotic IT. A two-component preparation containing the antibiotic thiamphenicol and acetylcysteine, which effectively dilutes sputum. It is prescribed for purulent bronchitis. The dry powder is dissolved in 5 ml of 0.9% sodium chloride and divided into 2 doses.
Dioxidin, Miramistin. Broad spectrum antiseptics. Used for purulent processes at a dose of 4 ml 2 times a day.
Furacilin. Antiseptic. Use a ready-made 0.02% solution of 4 ml 2 times a day.

Inhaled corticosteroids

Dexamethasone, budesonide, pulmicort. Nebules of 2 ml in various dosages. They are used for broncho-obstructive syndrome. The dose and multiplicity depend on the severity of the course of the disease and are selected by the doctor.

Lidocaine

In cases of obsessive dry cough, inhalation of lidocaine through a nebulizer can be used as a symptomatic remedy. The drug, having local anesthetic properties, reduces the sensitivity of cough receptors and effectively suppresses the cough reflex. The most common indications for lidocaine inhalation are viral tracheitis, laryngitis and even lung cancer. You can inhale a 2% solution, produced in ampoules, 2 ml 2 times a day. With the simultaneous appointment of several drugs, the order should be observed. The first is a bronchodilator, after 10-15 minutes - an expectorant, after sputum is discharged - an anti-inflammatory or disinfectant.

Antibiotic therapy

Treatment of prolonged and recurrent bronchitis of bacterial etiology should be aimed at eliminating the cause of the disease, eradicating the infectious agent. The leading role belongs to antibiotic therapy. Adequate antibiotic therapy can not only stop the symptoms of acute inflammation, but also lead to the eradication of the pathogen, reduce the frequency of relapses, increase the interval between exacerbations, which ultimately improves the quality of life of patients.

Indications for appointment:

temperature above 38 ° C, not decreasing for longer than 3 days, fever during treatment;
discharge of purulent sputum;
prolonged course (2-3 weeks without improvement);
serious condition: high fever, weakness, signs of intoxication;
increase in ESR up to 20 mm/hour, stab shift, changes in the blood formula.

The choice of antibiotic was carried out empirically, taking into account the likely etiology and sensitivity of the alleged pathogen to antimicrobial drugs (see table).

Restorative therapy for recurrent bronchitis

In recent years, among immunomodulatory drugs, bacterial lysates of pathogens of respiratory infections are of particular interest in pulmonology. These drugs have a dual purpose: specific (vaccinating) and nonspecific (immunomodulatory).

It should be noted that specific active immunization against the most common pathogens of respiratory diseases favorably differs from nonspecific immunostimulation in its purposefulness and efficiency. This is also due to the fact that, unfortunately, the most highly effective method of preventing infectious diseases - vaccination - today has rather limited possibilities in pulmonology. There are vaccinations against pneumococcus, Haemophilus influenzae, etc., and new vaccines against the influenza virus and staphylococcus aureus appear every year. However, there are no vaccines against most respiratory pathogens, let alone the absence of polio vaccines with antigens of the main respiratory pathogens. In addition, respiratory pathogens are characterized by rapid variability, and specific immunity against them is short-lived.

Therefore, the so-called vaccine-like drugs are of great importance, the action of which is aimed at creating specific immunity against a specific pathogen of respiratory tract infections. In this regard, in recent years, immunocorrectors of bacterial origin, primarily bacterial lysates, which cause the formation of a selective immune response against specific pathogens, have been widely used for the treatment and prevention of respiratory infections. Drugs can also be prescribed for prophylactic purposes in the acute period of respiratory infections (more effectively in combination with appropriate etiotropic therapy).

The main representatives of bacterial lysates are broncho-munal (capsules), IRS-19 (nasal spray), ribomunil (tablets). The drugs initiate a specific immune response to the bacterial antigens present in these drugs. The use of oral lysates causes the contact of antigens of the most significant pathogens of respiratory infections with macrophages located in the mucous membranes of the gastrointestinal tract, followed by their presentation to lymphocytes in the lymphoid tissue. As a result, committed clones of B-lymphocytes appear, producing specific antibodies to the antigens of pathogens contained in bacterial lysates, and secretory IgA for the development of effective local mucosal immune defense against the main pathogens of respiratory diseases. Since bacterial immunomodulating preparations are intended to stimulate the body's specific defense against the pathogenic effects of those microorganisms whose antigenic substrates are included in its composition, this vaccine-like action is accompanied by the induction of a specific response of both local and general immunity. They are able to increase the overall resistance of the body, which has a positive effect on the preventive effect in case of respiratory infections.

Criteria for transfer to the inpatient stage of treatment. Transfer to the inpatient stage of treatment is advisable to carry out with the development of complications: pneumonia, obstructive syndrome, increasing intoxication, fever, signs of respiratory failure. Thus, the treatment of bronchitis should be comprehensive, taking into account the etiology of the disease, its severity and nature of the course.

Table. Etiotropic prescription of antibiotics

Microflora	Antibiotics
Pneumococcus	macrolides (clarithromycin).
Streptococcus	Amoxicillin, including with clavulanic acid; cephalosporins of the 1st-2nd generation; macrolides (clarithromycin).
Staphylococcus aureus	Amoxicillin, including with clavulanic acid; cephalosporins of the 1st-2nd generation; macrolides (clarithromycin); fluoroquinolones; vancomycin (with resistance to methicillin).
Haemophilus influenzae	Amoxicillin, including with clavulanic acid; cephalosporins of the 1st-2nd generation; macrolides (clarithromycin).
legionella	macrolides (clarithromycin); fluoroquinolones.
Mycoplasma Chlamydia	macrolides (clarithromycin).

Note.
The low efficacy of protected penicillins and cephalosporins in the treatment of bronchitis in the absence of concomitant diseases may indicate an atypical nature of the disease.

case from practice

In practice, 3 types of erroneous use of antibacterial agents most often occur: late (after 4 hours from the moment of diagnosis) appointment in patients, for example, with pneumonia; inadequate initial therapy for non-severe diseases, including reserve antibiotics; unjustified appointment to patients with a viral infection (most often). The latter is demonstrated by the clinical case below.

Patient G., born in 1984, came to the clinic with complaints of malaise, fever above 38 °C, unproductive cough, pain and sore throat, runny nose. Objective examination: skin and visible mucous membranes of normal color, increased sweating, temperature 37.8 °C. During auscultation in the lungs, hard breathing is heard, single dry whistling rales, heart sounds are rhythmic, clear, somewhat muffled.

Research results. Complete blood count: leukocytes - 7.4x10 9 , lymphocytes - 41%, eosinophils - 4%, ESR - 19 mm/h; urinalysis without pathological changes; radiography - increased lung pattern, focal and infiltrative shadows were not detected.

Diagnosis: acute bronchitis.
The patient was prescribed: amoxicillin 0.5 g 3 times a day, lazolvan 0.03 g 3 times a day.
Sick leave issued.

After 3 days, the patient re-applied to the clinic to extend the sick leave. He reported that the temperature had dropped to 37.3-37.0 ° C, but complained of a paroxysmal unproductive cough that appeared, periodic shortness of breath that occurs in the early morning hours. On auscultation of the lungs, dry whistling rales are heard mainly in the lower sections of both lungs. A referral for a spirogram was issued, a moderate obstruction of the distal bronchi was revealed, which is reversible during a bronchodilator test with salbutamol.

Diagnosis: acute bronchitis with symptoms of bronchospasm.
The patient was discontinued amoxicillin, prescribed berodual (1 puff 3 times a day) while taking lazolvan at the same dose, Tylol hot (symptomatically), phencarol (0.025 g 2 times a day), gargling. Extended sick leave.

After 4 days, the patient visited the clinic with complaints of slight malaise and a rare non-productive cough. On auscultation of the lungs, rales were not audible, hard breathing persisted. When conducting spirometry revealed mild obstruction at the level of the distal bronchi, reversible. It is recommended to continue taking berodual 1 breath 2 times a day. Control spirogram - in 10 days. Sick leave closed.

This case demonstrates a typical, unfortunately, mistake in prescribing initial therapy in this category of patients - the use of antibacterial agents in cases of viral infection, which is the most common cause of acute bronchitis. Despite the correct diagnosis in this case, such a therapeutic tactic aggravated the phenomena of bronchial hyperreactivity in the predisposed patient, which were detected already at the first request for medical help in the form of dry wheezing. Probably, the increased reactivity of the bronchi was provoked by a viral infection and "supported" by the antibiotic. However, during the follow-up visit, the doctor correctly assessed the situation and made appropriate adjustments to the treatment regimen.

In the future, this patient needs to be examined to exclude bronchial asthma.

In accordance with the guidelines of the World Health Organization, the signs of bronchitis, which allows it to be classified as chronic, is a cough with intense bronchial secretion, lasting more than 3 months for 2 years in a row.

Reasons for the development of bronchitis

Various forms of bronchitis differ significantly from each other in terms of causes, pathogenesis and clinical manifestations.

The etiology of acute bronchitis is the basis for the classification, according to which diseases are divided into the following types:

infectious (bacterial, viral, viral-bacterial, rarely fungal infection);
stay in adverse harmful conditions;
unspecified;
mixed etiology.

Atypical forms of bronchitis are caused by pathogens that occupy an intermediate niche between viruses and bacteria. These include:

Atypical diseases are characterized by uncharacteristic symptoms with the development of polyserositis, damage to the joints and internal organs.

Features of the pathogenesis of inflammation of the bronchi

In severe cases, yellowish or greenish purulent sputum is formed. With hemorrhages from the blood vessels of the mucous membrane, the exudate acquires a hemorrhagic form with brown lumps (rusty sputum).

The conditions for the transition of pathology into a chronic form are:

decrease in the body's defenses to diseases, exposure to allergens, hypothermia;
viral respiratory diseases;
foci of infectious processes in the organs of the respiratory system;
allergic diseases;
heart failure with congestion in the lungs;
deterioration of drainage function due to failures in motor skills and disorders of the ciliated epithelium;
the presence of a tracheostomy;
socially unfavorable living conditions;
violations of the functioning of the neurohumoral system of regulation;
smoking, alcoholism.

The most significant in this type of pathology is the functioning of the nervous system.

Set of manifestations of bronchitis

The clinical picture of the acute form of bronchitis

If inflammation of the bronchioles develops against the background of bronchitis, symptoms of respiratory failure, such as shortness of breath, blue skin, may be observed. Rapid breathing may indicate the development of bronchial obstruction syndrome.

The type of pathogen is determined by bacterioscopy of lung exudate or sputum culture. For the timely detection of blockage of the bronchi or bronchioles, peak flowmetry or spirometry is performed.

In acute bronchitis, the pathology of the structure of the lungs is usually not observed on an x-ray.

Symptoms of chronic bronchitis

In chronic bronchitis, the following clinical manifestations of the disease are noted:

increased secretion and secretion of purulent sputum;
whistling during inspiration;
difficult breathing process, hard breathing when listening;
strong painful cough;
more often dry rales, wet with a large amount of viscous sputum;
heat;
sweating;
muscle tremor;
change in the frequency and duration of sleep;
severe headaches at night;
attention disorders;
heart palpitations, increased blood pressure;
convulsions.

The nature of the secreted sputum, its consistency, color, differ depending on the following types of chronic bronchitis:

catarrhal;
catarrhal-purulent;
purulent;
fibrinous;
hemorrhagic (hemoptysis).

The fibrinous form of bronchitis is very rare. A distinctive feature of this pathology is the presence of fibrin deposits, Kurshman spirals, Charcot-Leiden crystals. The clinic is manifested by coughing, with expectoration of casts in the form of a bronchial tree.

LECTURE No. 19 Diseases of the respiratory system. Acute bronchitis. Clinic, diagnosis, treatment, prevention. Chronical bronchitis. Clinic, diagnosis, treatment, prevention

Respiratory diseases. Acute bronchitis. Clinic, diagnosis, treatment, prevention. Chronical bronchitis. Clinic, diagnosis, treatment, prevention

1. Acute bronchitis

Acute bronchitis is an acute diffuse inflammation of the tracheobronchial tree. Classification:

1) acute bronchitis (simple);

3) acute bronchiolitis;

5) recurrent bronchitis;

7) chronic bronchitis;

2. Chronic bronchitis

Chronic bronchitis clinic principles of treatment

1) acute bronchitis (simple);

2) acute obstructive bronchitis;

3) acute bronchiolitis;

4) acute bronchiolitis obliterans;

5) recurrent bronchitis;

6) recurrent obstructive bronchitis;

7) chronic bronchitis;

8) chronic bronchitis with obliteration. Etiology. The disease is caused by viral infections (influenza viruses, parainfluenza, adenoviruses, respiratory syncytial, measles, whooping cough, etc.) and bacterial infections (staphylococci, streptococci, pneumococci, etc.); physical and chemical factors (cold, dry, hot air, nitrogen oxides, sulfur dioxide, etc.). Chilling, chronic focal infection of the nasopharyngeal region and impaired nasal breathing, deformity of the chest predispose to the disease.

Pathogenesis. The damaging agent enters the trachea and bronchi with inhaled air by hematogenous and lymphogenous routes. Acute inflammation of the bronchial tree is accompanied by a violation of bronchial patency of the edematous-inflammatory or bronchospastic mechanism. Characterized by hyperemia, swelling of the mucous membrane; on the wall of the bronchus and in its lumen is a mucous, mucopurulent or purulent secret; degenerative disorders of the ciliated epithelium develop. In severe forms of acute bronchitis, inflammation is localized not only on the mucous membrane, but also in the deep tissues of the bronchial wall.

Clinical signs. Clinical manifestations of bronchitis of infectious etiology begin with rhinitis, nasopharyngitis, moderate intoxication, fever, weakness, feeling of weakness, soreness behind the sternum, dry, turning into a wet cough. There are no auscultatory signs or hard breathing is determined over the lungs, dry rales are heard. There are no changes in peripheral blood. This course is observed more often with damage to the trachea and bronchi. With a moderate course of bronchitis, general malaise, weakness are significantly expressed, a strong dry cough appears with difficulty breathing, shortness of breath, pain in the chest and in the abdominal wall, which is associated with muscle strain when coughing. Cough gradually becomes wet, sputum acquires a mucopurulent or purulent character. In the lungs during auscultation, hard breathing, dry and moist small bubbling rales are heard. Body temperature is subfebrile. There are no pronounced changes in peripheral blood. A severe course of the disease is observed with a predominant lesion of the bronchioles. Acute clinical manifestations of the disease begin to subside by the 4th day and, with a favorable outcome, almost completely disappear by the 7th day of the disease. Acute bronchitis with a violation of bronchial patency has a tendency to a protracted course and the transition to chronic bronchitis. Acute bronchitis of toxic-chemical etiology is severe. The disease begins with a painful cough, which is accompanied by the release of mucous or bloody sputum, bronchospasm quickly joins (against the background of an extended expiration during auscultation, dry wheezing can be heard), shortness of breath progresses (up to suffocation), symptoms of respiratory failure and hypoxemia increase. A chest x-ray can identify symptoms of acute pulmonary emphysema.

Diagnosis: based on clinical and laboratory data.

Treatment. Bed rest, plenty of warm drink with raspberries, honey, lime blossom. Assign antiviral and antibacterial therapy, vitamin therapy: ascorbic acid up to 1 g per day, vitamin A 3 mg 3 times a day. You can use cans on the chest, mustard plasters. With a strong dry cough - antitussive drugs: codeine, libexin, etc. With a wet cough - mucolytic drugs: bromhexine, ambrobene, etc. Inhalation of expectorants, mucolytics, heated mineral alkaline water, eucalyptus, anise oil using a steam inhaler is indicated. inhalations - 5 minutes 3-4 times a day for 3-5 days. Bronchospasm can be stopped with the appointment of aminophylline (0.25 g 3 times a day). Showing antihistamines, Prevention. Elimination of the etiological factor of acute bronchitis (hypothermia, chronic and focal infection in the respiratory tract, etc.).

2. Chronic bronchitis

Chronic bronchitis is a progressive diffuse inflammation of the bronchi, not associated with local or generalized lung damage, manifested by cough. You can talk about chronic bronchitis if the cough continues for 3 months in the 1st year - 2 years in a row.

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

Pathogenesis. The main pathogenetic mechanism is hypertrophy and hyperfunction of the bronchial glands with increased secretion of mucus, with a decrease in serous secretion and a change in the composition of secretion, as well as an increase in acid mucopolysaccharides in it, which increases the viscosity of sputum. Under these conditions, the ciliated epithelium does not improve the emptying of the bronchial tree, usually the entire layer of secretion is renewed normally (partial purification of the bronchi is possible only with coughing). Prolonged hyperfunction is characterized by depletion of the mucociliary apparatus of the bronchi, the development of dystrophy and atrophy of the epithelium. In case of violation of the drainage function of the bronchi, a bronchogenic infection occurs, the activity and relapses of which depend on the local immunity of the bronchi and the occurrence of secondary immunological deficiency. With the development of bronchial obstruction due to hyperplasia of the epithelium of the mucous glands, edema and inflammatory compaction of the bronchial wall, bronchial obstruction, excess viscous bronchial secretion, bronchospasm are observed. With obstruction of the small bronchi, overstretching of the alveoli on exhalation and a violation of the elastic structures of the alveolar walls and the appearance of hypoventilated or non-ventilated zones develop, and therefore the blood passing through them is not oxygenated and arterial hypoxemia develops. In response to alveolar hypoxia, a spasm of the pulmonary arterioles and an increase in total pulmonary and pulmonary arteriolar resistance develop; Pericapillary pulmonary hypertension develops. Chronic hypoxemia leads to an increase in blood viscosity, which is accompanied by metabolic acidosis, which further increases vasoconstriction in the pulmonary circulation. Inflammatory infiltration in large bronchi is superficial, and in medium and small bronchi, bronchioles - deep with the development of erosion and the formation of meso- and panbronchitis. The remission phase is manifested by a decrease in inflammation and a large decrease in exudation, proliferation of connective tissue and epithelium, especially with ulceration of the mucous membrane.

Clinical manifestations. The onset of the disease is gradual. The first and main symptom is a cough in the morning with sputum discharge, gradually the cough begins to occur at any time of the day, intensifies in cold weather and becomes constant over the years. The amount of sputum increases, the sputum becomes mucopurulent or purulent. Shortness of breath appears. With purulent bronchitis, purulent sputum may occasionally be released, but bronchial obstruction is not very pronounced. Obstructive chronic bronchitis is manifested by persistent obstructive disorders. Purulent-obstructive bronchitis is characterized by the release of purulent sputum and obstructive ventilation disorders. Frequent exacerbations during periods of cold damp weather: coughing increases, shortness of breath, the amount of sputum increases, malaise appears, fatigue. The body temperature is normal or subfebrile, hard breathing and dry rales over the entire lung surface can be determined.

Diagnostics. A slight leukocytosis with a stab-nuclear shift in the leukocyte formula is possible. With an exacerbation of purulent bronchitis, a slight change in the biochemical parameters of inflammation occurs (C-reactive protein, sialic acids, fibrogen, seromucoid, etc. increase). Sputum examination: macroscopic, cytological, biochemical. With a pronounced exacerbation, sputum acquires a purulent character: a large number of neutrophilic leukocytes, an increased content of acid mucopolysaccharides and DNA fibers, the nature of sputum, mainly neutrophilic leukocytes, an increase in the level of acid mucopolysaccharides and DNA fibers, which increase the viscosity of sputum, a decrease in the amount of lysozyme, etc. Bronchoscopy, which evaluates the endobronchial manifestations of the inflammatory process, the stages of development of the inflammatory process: catarrhal, purulent, atrophic, hypertrophic, hemorrhagic and its severity, but mainly to the level of subsegmental bronchi.

Differential diagnosis is carried out with chronic pneumonia, bronchial asthma, tuberculosis. Unlike chronic pneumonia, chronic bronchitis always develops with a gradual onset, with widespread bronchial obstruction and often emphysema, respiratory failure and pulmonary hypertension with the development of chronic cor pulmonale. In X-ray examination, the changes are also diffuse in nature: peribronchial sclerosis, increased transparency of the lung fields due to emphysema, expansion of the branches of the pulmonary artery. Chronic bronchitis differs from bronchial asthma in the absence of asthma attacks, with pulmonary tuberculosis it is associated with the presence or absence of symptoms of tuberculosis intoxication, Mycobacterium tuberculosis in sputum, the results of X-ray and bronchoscopic examination, tuberculin tests.

Treatment. In the phase of exacerbation of chronic bronchitis, therapy is aimed at eliminating the inflammatory process, improving bronchial patency, as well as restoring disturbed general and local immunological reactivity. Antibiotic bacterial therapy is prescribed, which is selected taking into account the sensitivity of the sputum microflora, administered orally or parenterally, sometimes combined with intratracheal administration. Showing inhalation. Apply expectorant, mucolytic and bronchospasmolytic drugs, drink plenty of water to restore and improve bronchial patency. Phytotherapy using marshmallow root, coltsfoot leaves, plantain. Assign proteolytic enzymes (trypsin, chymotrypsin), which reduce the viscosity of sputum, but are now rarely used. Acetylcysteine has the ability to break the disulfide bonds of mucus proteins and contributes to a strong and rapid liquefaction of sputum. Bronchial drainage improves with the use of mucoregulators that affect the secretion and production of glycoproteins in the bronchial epithelium (bromhexine). In case of insufficiency of bronchial drainage and the existing symptoms of bronchial obstruction, bronchospasmolytic agents are added to the treatment: eufillin, anticholinergics (atropine in aerosols), adrenostimulants (ephedrine, salbutamol, berotek). In a hospital setting, intratracheal lavage in case of purulent bronchitis must be combined with sanitation bronchoscopy (3–4 sanitation bronchoscopy with a break of 3–7 days). When restoring the drainage function of the bronchi, physiotherapy exercises, chest massage, and physiotherapy are also used. With the development of allergic syndromes, calcium chloride and antihistamines are used; if there is no effect, a short course of glucocorticoids can be prescribed to relieve the allergic syndrome, but the daily dose should not be more than 30 mg. The danger of activation of infectious agents does not allow the use of glucocorticoids for a long time. In patients with chronic bronchitis, complicated respiratory failure and chronic cor pulmonale, the use of veroshpiron (up to 150-200 mg / day) is indicated.

The food of patients should be high-calorie, fortified. Apply ascorbic acid 1 g per day, nicotinic acid, B vitamins; if necessary, aloe, methyluracil. With the development of complications of such a disease as pulmonary and pulmonary heart failure, oxygen therapy, auxiliary artificial ventilation of the lungs are used.

Anti-relapse and maintenance therapy is prescribed in the phase of exacerbation subsidence, carried out in local and climatic sanatoriums, this therapy is prescribed during medical examination. It is recommended to allocate 3 groups of dispensary patients.

1st group. It includes patients with cor pulmonale, with severe respiratory failure and other complications, with disability. Patients are prescribed maintenance therapy, which is carried out in a hospital or by a local doctor. Inspection of these patients is carried out at least once a month.

2nd group. It includes patients with frequent exacerbations of chronic bronchitis, as well as moderate respiratory dysfunction. Inspection of such patients is carried out by a pulmonologist 3-4 times a year, anti-relapse therapy is prescribed in autumn and spring, as well as in case of acute respiratory diseases. An effective method of administering drugs is the inhalation route; according to indications, it is necessary to sanitize the bronchial tree using intratracheal lavage, sanitation bronchoscopy. In case of active infection, antibiotics are prescribed.

3rd group. It includes patients in whom anti-relapse therapy led to a cessation of the process and the absence of relapses for 2 years. Such patients are shown preventive therapy, which includes funds aimed at improving bronchial drainage and increasing its reactivity.

Arising as a result of the development of the inflammatory process in the bronchi. The main mechanism for the appearance of pathology is the entry of pathogenic microorganisms and bacteria into the human body. From this article you will learn about the etiology, pathogenesis, clinic of bronchitis, the treatment and diagnosis of which should be carried out under the supervision of a specialist. What is an ailment?

Bronchitis Clinic

Clinical manifestations of bronchitis directly depend on the form and stage of development of the disease. The symptomatology of the acute form of bronchitis has a number of significant differences from the clinical picture and symptoms of bronchitis in its chronic form. So, the main manifestations of acute bronchitis include the following phenomena:

in the acute initial stage, a dry cough is noted, which is often accompanied by painful sensations behind the sternum, the voice becomes hoarse, swallowing is painful;
symptoms of general intoxication are expressed: fever, weakness, headache, fever;
along with this, symptoms of the primary disease (ARVI, influenza, upper respiratory tract infections) are noted.

For the clinic of chronic bronchitis, the following symptoms are characteristic:

coughing fits are present continuously for three months for two years;
when coughing, sputum is separated (the consistency of sputum depends on the degree of damage to the bronchi: from mucous and light to mucopurulent and opaque);
at advanced stages, shortness of breath appears and breathing becomes difficult as a result of obstructive processes in the bronchi and lungs.

Etiology of bronchitis

The main cause of the clinic of obstructive bronchitis is infection of the upper respiratory tract. Basically, the development of bronchitis is promoted by viral colds (rhinoviruses, SARS, adenoviruses, influenza), as well as bacterial infections (for example, streptococcus or chlamydia). It should be noted that the development of bronchitis in colds often occurs in the body, weakened by smoking, poor lifestyle, as well as the presence of a number of diseases in history.

The clinic of acute bronchitis in children and adults means that various external influences can also provoke the disease: inhalation of harmful chemicals, dustiness of the room, regular hypothermia. Chronic bronchitis, as a rule, is the result of untimely treatment of acute bronchitis. Among the main etiological reasons, one should also dwell on the following:

environmental problems (air pollution with hazardous emissions);
smoking;
harmful working conditions (for example, work in a chemical industry);
severe cold climate tolerance.

The pathogenesis of acute and chronic bronchitis

With the progressive development of bronchitis, the walls of the bronchi, in which atrophic processes begin, are first exposed to pathological effects. This, in turn, leads to a weakening of the protective functions of the bronchi, which causes a decrease in the function of the immune system. When an infection enters the respiratory tract, an inflammatory process develops in the body in its acute form. If appropriate drug therapy is not carried out, then the further development of the pathological process leads to edema and hyperemia of the mucous membranes, the appearance of mucopurulent exudate. With full treatment, it is possible to get rid of bronchitis in two to three weeks, it will take about a month to restore bronchial function, but if atrophic processes have led to irreversible changes, then bronchitis becomes chronic.

Causes

With bronchitis, the walls of the bronchi are damaged, which can occur due to a number of reasons such as:

Infection with viral infections - acute bronchitis is caused in 90% of cases by viruses. In adults, the disease is usually caused by myxoviruses (influenza, parainfluenza).
Infection with bacterial infections - in 5-10% of cases, bacteria (streptococci, hemophilus and chlamydia) become the cause of bronchitis, bacterial infections often become secondary infections as a result of viral damage.
Weakened immunity and beriberi.
Hypothermia.
Living in places with high humidity, polluted air and poor ecology.
Active and passive smoking - when cigarette smoke is inhaled, various chemicals settle on the lungs, which leads to irritation of the walls.
Inhalation of toxic and harmful gases and toxins that damage the walls of the lungs and bronchi (ammonia, hydrochloric acid, sulfur dioxide, etc.).
A consequence of other chronic or acute diseases - with improper or incomplete treatment, bacteria can enter the lungs and begin to spread there.
Wrong nutrition.
Due to an allergic reaction.

Symptoms

The manifestation of acute bronchitis begins with a cold. Severe fatigue, weakness, perspiration and cough. In the midst of the disease, the cough is dry, sputum soon joins. Allocations can be both mucous and have a purulent character. Bronchitis may be accompanied by fever. A form of chronic bronchitis is diagnosed after a few months of the disease. A wet and painful cough with sputum torments a person every day. Contact with irritants may increase the cough reflex. A long process leads to difficulty breathing and the development of emphysema.

What are the symptoms of infectious bronchitis? At the beginning of the disease, a dry cough, a feeling of weakness, an increase in body temperature are disturbing; when a dry cough changes to a wet one, discomfort in the chest area joins.

How does allergic bronchitis manifest itself? Contact with the pathogen gives discomfort and the appearance of a cough. Sputum in allergic bronchitis always has a mucous secret. There is no increase in body temperature. Symptoms of bronchitis disappear when the irritant is removed.

With toxic bronchitis, a strong cough is disturbing, causing difficulty in breathing, shortness of breath or suffocation.

Diagnosis of bronchitis

The easiest disease, if we consider the issue of diagnosis, is bronchitis. Currently, there are many objective and modern methods for diagnosing the clinic of bronchitis in children and adults:

Conversation with a doctor. In most cases, the diagnosis of "bronchitis" is made on the basis of a patient interview and the identification of complaints related to the respiratory system. During the interview, the doctor also finds out the approximate onset of the disease and possible causes.
Inspection. The doctor checks for breath sounds in the chest with a phonendoscope. Auscultation also reveals the presence of dry and moist rales. For differential diagnosis and exclusion of pneumonia and pleurisy, it is possible to use the percussion method. In chronic bronchitis, the percussion sound changes due to changes in the lung tissue.
clinical analyses. A blood and sputum examination is performed to substantiate the diagnosis. With bronchitis, blood counts in the general analysis will vary depending on the pathogen. The bacterial flora will lead to an increase in ESR, as well as the number of leukocytes and neutrophils. With viral bronchitis, there is a decrease in the number of leukocytes and an increase in lymphocytes.
Chest x-ray in two projections - a method for diagnosing diseases
Spirography. A modern method for detecting a decrease in the functions of the respiratory tract. In bronchitis, due to the inflammatory component, there is an obstacle to inhalation and exhalation, which will undoubtedly affect the decrease in the total volume of the lungs.

Bronchitis treatment

The clinic and treatment of acute bronchitis consists in following the doctor's recommendations:

Bed rest and complete physical and mental peace of the patient are prescribed.
It is necessary to provide the patient with a sufficient amount of drink.
Application of the necessary physiotherapeutic methods of treatment.
Taking necessary medications.
It should also be noted that depending on the causes contributing to the development of diseases, the methods of treating the disease also differ.

Antiviral

So, in etiology, such antiviral types of drugs are prescribed:

"Viferon". This is a preparation containing combined human interferon. This substance belongs to medicines of a wide spectrum of action, is available in the form of ointments and suppositories of various dosages. The course of therapy is from five to ten days. Possible side effects include an allergic reaction.
"Laferobion". This drug can be used both for the prevention and treatment of diseases caused by pathogens of various viruses. Produced in the form of a solution. The course of therapy should not exceed ten days.

Antibacterial

As a rule, the following groups of drugs are selected for the treatment of bronchitis of bacterial origin:

Aminopenicillins.
Cephalosporins.
Macrolides.
Fluoroquinolones.

Prebiotics

It is also necessary to prescribe the necessary prebiotics to prevent the development of intestinal dysbacteriosis in a patient. All of these substances must be used in a complex for the treatment of the disease. Also, all patients with bronchitis, regardless of etiology, are prescribed physiotherapeutic methods of exposure. This method of treatment is one of the oldest in medical practice, its use allows to achieve an effective result in treating the disease in a safe way for health.

Physiotherapy

In the treatment of the disease, the following physiotherapeutic methods of treatment are used:

Inhalation. This way of influencing makes it possible to use it in the treatment of pregnant women and children with bronchitis. For the procedure, a special device-inhaler is used. This method of exposure can effectively eliminate such clinical manifestations of the disease as the presence of sputum, cough, pathogens. Also, the undoubted advantage of this method is the possibility of home use.
massage techniques. For the treatment of bronchitis, the masseur conducts dynamic tapping and stroking with his fingertips. Mandatory in the procedure is the use of essential oils. Manipulations are carried out only on the human thoracic spine. The duration of the procedure is from five to ten minutes daily, the course of treatment is five days.
Inductothermy. The basis of this method is the effect of heat rays on a person. Under the influence of electromagnetic waves, there is an increase in blood circulation in the tissues affected by inflammation. The duration of the manipulation is twenty minutes. Depending on the severity of the condition, the course of the procedure can vary from six to twelve manipulations.
Electrophoresis. This technology is used to thin the secretion released from the bronchi. The procedure is performed using a special apparatus that allows the substance to penetrate into the deep layers of the epidermis, which contributes to the expansion of the bronchi and the restoration of damaged mucous membranes of the organ.
Halotherapy. This method consists in artificially creating a climate similar to that which exists in salt caves. Used to improve lung ventilation.
Heat treatment. For this procedure, special paraffin pads are used, which are preheated and then applied to the patient's chest, which helps to reduce spasms during coughing fits. The duration of this manipulation is ten minutes.

Best Herbs

Also, for the treatment of the disease, you can use medicinal herbs and breast fees. Preparation of herbal infusions from licorice root and thyme helps to accelerate the removal of secretions from the bronchi. From coughing fits, the collection of herbs such as coltsfoot, elecampane root, anise will help.

Classification of acute bronchitis. Acute bronchitis. Definition. Causes. Clinic, diagnostics. Treatment Acute and chronic bronchitis diagnosis clinic treatment

Reasons for the development of bronchitis

Features of the pathogenesis of inflammation of the bronchi

Set of manifestations of bronchitis

The clinical picture of the acute form of bronchitis

Symptoms of chronic bronchitis

Reasons for the development of bronchitis

Features of the pathogenesis of inflammation of the bronchi

Set of manifestations of bronchitis

The clinical picture of the acute form of bronchitis

Symptoms of chronic bronchitis

LECTURE No. 19 Diseases of the respiratory system. Acute bronchitis. Clinic, diagnosis, treatment, prevention. Chronical bronchitis. Clinic, diagnosis, treatment, prevention

Chronic bronchitis clinic principles of treatment

Bronchitis Clinic

Etiology of bronchitis

The pathogenesis of acute and chronic bronchitis

Causes

Symptoms

Diagnosis of bronchitis

Bronchitis treatment

Antiviral

Antibacterial

Prebiotics

Physiotherapy

Best Herbs

Classification of acute bronchitis

Features of performance and recovery after circular facelift surgery (rhytidectomy)