Chronic obstructive bronchitis diagnosis. Obstructive bronchitis

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is a diffuse progressive inflammatory process in the bronchi, leading to morphological restructuring of the bronchial wall and peribronchial tissue. Exacerbations chronic bronchitis occur several times a year and occur with increased cough, purulent sputum, shortness of breath, bronchial obstruction, and low-grade fever. Examination for chronic bronchitis includes radiography of the lungs, bronchoscopy, microscopic and bacteriological analysis of sputum, respiratory function, etc. The treatment of chronic bronchitis combines drug therapy (antibiotics, mucolytics, bronchodilators, immunomodulators), sanitary bronchoscopy, oxygen therapy, physiotherapy (inhalation, massage, respiratory gymnastics, medicinal electrophoresis, etc.).

ICD-10

J41 J42

General information

The incidence of chronic bronchitis among adults is 3-10%. Chronic bronchitis develops 2-3 times more often in men aged 40 years. In modern pulmonology, we speak of chronic bronchitis if, over the course of two years, there are exacerbations of the disease lasting at least 3 months, which are accompanied by a productive cough with sputum production. With a long-term course of chronic bronchitis, the likelihood of diseases such as COPD, pneumosclerosis, emphysema, cor pulmonale, bronchial asthma, bronchiectasis, and lung cancer increases significantly. In chronic bronchitis, inflammatory damage to the bronchi is diffuse and over time leads to structural changes in the bronchial wall with the development of peribronchitis around it.

Causes

Among the reasons causing the development of chronic bronchitis, the leading role belongs to prolonged inhalation of pollutants - various chemical impurities contained in the air (tobacco smoke, dust, exhaust gases, toxic fumes, etc.). Toxic agents have an irritating effect on the mucous membrane, causing restructuring of the bronchial secretory apparatus, hypersecretion of mucus, inflammatory and sclerotic changes in the bronchial wall. Quite often, untimely or incompletely cured acute bronchitis transforms into chronic bronchitis.

The mechanism of development of chronic bronchitis is based on damage to various parts of the local bronchopulmonary defense system: mucociliary clearance, local cellular and humoral immunity (the drainage function of the bronchi is impaired; the activity of a1-antitrypsin decreases; the production of interferon, lysozyme, IgA, pulmonary surfactant decreases; the phagocytic activity of alveolar macrophages is inhibited and neutrophils).

This leads to the development of the classic pathological triad: hypercrinia (hyperfunction of the bronchial glands with the formation of a large amount of mucus), discrinia (increased sputum viscosity due to changes in its rheological and physicochemical properties), mucostasis (stagnation of thick viscous sputum in the bronchi). These disorders contribute to the colonization of the bronchial mucosa by infectious agents and further damage to the bronchial wall.

The endoscopic picture of chronic bronchitis in the acute phase is characterized by hyperemia of the bronchial mucosa, the presence of mucopurulent or purulent secretion in the lumen of the bronchial tree, in the later stages - atrophy of the mucous membrane, sclerotic changes in the deep layers of the bronchial wall.

Against the background of inflammatory edema and infiltration, hypotonic dyskinesia of large and collapse of small bronchi, hyperplastic changes in the bronchial wall, bronchial obstruction is easily associated, which maintains respiratory hypoxia and contributes to the increase in respiratory failure in chronic bronchitis.

Classification

The clinical and functional classification of chronic bronchitis identifies the following forms of the disease:

According to the nature of the changes: catarrhal (simple), purulent, hemorrhagic, fibrinous, atrophic.
By level of damage: proximal (with predominant inflammation of large bronchi) and distal (with predominant inflammation of small bronchi).
According to the presence of a bronchospastic component: non-obstructive and obstructive bronchitis.
According to the clinical course: latent chronic bronchitis; with frequent exacerbations; with rare exacerbations; continuously relapsing.
According to the phase of the process: remission and exacerbation.
According to the presence of complications: chronic bronchitis, complicated by pulmonary emphysema, hemoptysis, respiratory failure of varying degrees, chronic cor pulmonale (compensated or decompensated).

Symptoms of chronic bronchitis

Chronic non-obstructive bronchitis is characterized by a cough with mucopurulent sputum. The amount of coughed up bronchial secretions outside of an exacerbation reaches 100-150 ml per day. During the exacerbation phase of chronic bronchitis, the cough intensifies, the sputum becomes purulent in nature, and its quantity increases; low-grade fever, sweating, and weakness occur.

With the development of bronchial obstruction, the main clinical manifestations include expiratory shortness of breath, swelling of the neck veins during exhalation, wheezing, and a whooping cough-like unproductive cough. The long-term course of chronic bronchitis leads to thickening of the terminal phalanges and nails of the fingers (“ Drumsticks" and "watch glasses").

The severity of respiratory failure in chronic bronchitis can vary from minor shortness of breath to severe ventilation disorders requiring intensive care and mechanical ventilation. Against the background of an exacerbation of chronic bronchitis, decompensation of concomitant diseases may be observed: coronary artery disease, diabetes mellitus, dyscirculatory encephalopathy, etc. The severity of an exacerbation of chronic bronchitis is determined by the severity of the obstructive component, respiratory failure, and decompensation of concomitant pathology.

In catarrhal uncomplicated chronic bronchitis, exacerbations occur up to 4 times a year, bronchial obstruction is not pronounced (FEV1 > 50% of normal). More frequent exacerbations occur with obstructive chronic bronchitis; they are manifested by an increase in the amount of sputum and a change in its character, significant impairment of bronchial obstruction (FEV1, purulent bronchitis occurs with constant sputum production, a decrease in FEV1

Diagnostics

In the diagnosis of chronic bronchitis, it is essential to clarify the history of the disease and life (complaints, smoking history, professional and household hazards). Auscultatory signs of chronic bronchitis include hard breathing, prolonged exhalation, dry rales (wheezing, buzzing), moist rales of various sizes. With the development of pulmonary emphysema, a boxy percussion sound is detected.

Verification of the diagnosis is facilitated by chest radiography. The X-ray picture of chronic bronchitis is characterized by reticular deformation and increased pulmonary pattern; in a third of patients there are signs of pulmonary emphysema. Radiation diagnostics can exclude pneumonia, tuberculosis and lung cancer.

Microscopic examination of sputum reveals its increased viscosity, grayish or yellowish-green color, mucopurulent or purulent character, and a large number of neutrophilic leukocytes. Bacteriological culture of sputum makes it possible to identify microbial pathogens (Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, Pseudomonas spp., Enterobacteriaceae, etc.). If it is difficult to collect sputum, bronchoalveolar lavage and bacteriological examination of bronchial lavage waters are indicated.

The degree of activity and nature of inflammation in chronic bronchitis is clarified during diagnostic bronchoscopy. Using bronchography, the architectonics of the bronchial tree is assessed and the presence of bronchiectasis is excluded.

The severity of respiratory dysfunction is determined by spirometry. The spirogram in patients with chronic bronchitis demonstrates a decrease in VC of varying degrees, an increase in MOD; with bronchial obstruction – a decrease in FVC and MVL indicators. Pneumotachography shows a decrease in the maximum volumetric expiratory flow rate.

Laboratory tests for chronic bronchitis include a general analysis of urine and blood; determination of total protein, protein fractions, fibrin, sialic acids, CRP, immunoglobulins and other indicators. In case of severe respiratory failure, CBS and blood gas composition are examined.

Treatment of chronic bronchitis

Exacerbation of chronic bronchitis is treated inpatiently, under the supervision of a pulmonologist. In this case, the basic principles of treatment of acute bronchitis are observed. It is important to avoid contact with toxic factors (tobacco smoke, harmful substances, etc.).

Pharmacotherapy of chronic bronchitis includes the prescription of antimicrobial, mucolytic, bronchodilator, and immunomodulatory drugs. For antibacterial therapy, penicillins, macrolides, cephalosporins, fluoroquinolones, tetracyclines are used orally, parenterally or endobronchially. For difficult to separate viscous sputum, mucolytic and expectorant agents (ambroxol, acetylcysteine, etc.) are used. In order to relieve bronchospasm in chronic bronchitis, bronchodilators (aminophylline, theophylline, salbutamol) are indicated. It is mandatory to take immunoregulatory agents (levamisole, methyluracil, etc.).

In case of severe chronic bronchitis, therapeutic (sanitation) bronchoscopy and bronchoalveolar lavage can be performed. To restore the drainage function of the bronchi, auxiliary therapy methods are used: alkaline and pulmonary hypertension. Preventative work to prevent chronic bronchitis is to promote smoking cessation, eliminate unfavorable chemical and physical factors, treatment of concomitant pathologies, increasing immunity, timely and complete treatment of acute bronchitis.

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Currently, about 600 million people in the world suffer from chronic obstructive pulmonary disease (COPD). Mortality from COPD is constantly increasing, and according to World Health Organization (WHO) forecasts, by 2020 COPD will be the fifth leading cause of death. The main cause of COPD is smoking. In Russia, 70% of men and 30% of women smoke. (COPD statistics // Official website of the Russian Respiratory Society, 2004).

According to WHO, the mortality rate for COPD in the Russian Federation is 16.2 per 100,000 population, which is comparable to most European countries: in Germany 12.5, in Italy 13.7, in the UK 23.1

COPD in Russia ranks first (55%) in the structure of respiratory diseases, significantly ahead of bronchial asthma (19%) and pneumonia (14%). According to official data from the Ministry of Health and social development In the Russian Federation in 2003, 2.4 million patients with COPD were registered in the country. Taking into account the latest data from epidemiological studies, the number of patients with COPD in Russia may exceed 11 million people

The large international PLATINO study, conducted in 5 Latin American countries, demonstrated a prevalence of COPD ranging from 7.8% (men 11%, women 5.6%) in Mexico to 19.7% (men 27.1%, women 14). .5%) in Uruguay In Russia, among the unorganized population in the Ryazan region, obstructive disorders of the external respiratory function were detected in 14% of those examined. In the Irkutsk region, the prevalence of COPD among the rural population was 6.6% (among men - 14.6%, among women - 1 .8%), among the urban population 3.1% (among men - 4.7% and among women - 1.6%) In Samara, the prevalence of COPD was 14.49% (among men - 18.72%, among women - 11.21%). However, at present in Russia, taking into account the vast territory and various climatic-geographical and demographic features, modern epidemiological studies on COPD have been clearly insufficient.

To reduce mortality from COPD, WHO experts recommend the GOLD treatment program (Global Initiative on COPD 2005, 2007), an important component of which is pulmonary rehabilitation.

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

Chronic obstructive bronchitis is divided into primary and secondary:

Primary chronic obstructive bronchitis occurs independently and is not associated with bronchopulmonary diseases or systemic diseases in which there is damage to the bronchial tree. The development of primary chronic bronchitis is associated with external irritating and damaging factors. Often occurring and inadequately treated, acute bronchitis can also lead to the development of chronic bronchitis over time.

Secondary chronic bronchitis occurs against the background of other bronchopulmonary diseases (for example, pulmonary tuberculosis or extrapulmonary diseases (for example, chronic heart failure).

According to the nature of sputum, chronic bronchitis is divided into:

1. catarrhal,

2. catarrhal-purulent

3. purulent.

Etiology

The disease is associated with prolonged irritation of the bronchi by various harmful factors (smoking, inhalation of air contaminated with dust, smoke, carbon monoxide, sulfur dioxide, nitrogen oxides and other chemical compounds) and recurrent respiratory infection ( the main role belongs to respiratory viruses, Pfeiffer's bacillus, pneumococci), less commonly occurs in cystic fibrosis, alpha (one)-antitrypsin deficiency.

Predisposing factors:

chronic inflammatory and suppurative processes in the lungs,

chronic foci of infection in the upper respiratory tract,

decreased body reactivity,

hereditary factors.

Pathogenesis

The main pathogenetic mechanisms include hypertrophy and hyperfunction of the bronchial glands with increased mucus secretion, a relative decrease in serous secretion, a change in the composition of the secretion - a significant increase in acidic mucopolysaccharides in it, which increases the viscosity of sputum. Under these conditions, the ciliated epithelium does not ensure emptying of the bronchial tree and the normal renewal of the entire layer of secretion (emptying of the bronchi occurs only when coughing). Long-term hyperfunction leads to depletion of the mucociliary apparatus of the bronchi, dystrophy and atrophy of the epithelium. Violation of the drainage function of the bronchi contributes to the occurrence of bronchogenic infection, the activity and recurrence of which largely depend on the local immunity of the bronchi and the development of secondary immunological insufficiency.

bronchitis chronic obstructive treatment

Clinical picture

The main subjective manifestations of chronic bronchitis are cough with sputum, general weakness, sweating (with exacerbation of the disease and purulent nature of bronchitis).

At the onset of the disease, coughing bothers patients, usually in the morning immediately or shortly after waking up, and the amount of sputum produced is small. This is due to the daily rhythm of the functioning of the ciliated epithelium. Its activity is most pronounced in the morning and low at night. In addition, the patient’s morning physical activity and increased tone of the sympathetic nervous system play an important role in the appearance of cough. The cough usually intensifies in the cold and damp seasons, and in warm and dry weather, patients feel much better, the cough bothers them less often and may even stop completely.

At the beginning of the disease, cough bothers patients only during the period of exacerbation; during the period of remission it is almost not expressed. As chronic bronchitis progresses, the cough becomes more regular, almost constant and bothers you not only in the morning, but also during the day, as well as at night. Cough at night in a horizontal position of the patient is associated with the flow of sputum from the small bronchi.

Cough is caused by irritation of the vagus nerve receptors in the cough reflex zones (larynx, vocal cords, tracheal bifurcation, area of division of large bronchi). There are no cough receptors in the small bronchi, so with predominantly distal bronchitis, cough may be absent and the main complaint of patients is shortness of breath.

During the period of exacerbation of chronic bronchitis, the sensitivity of cough receptors increases significantly, which leads to a sharp increase in coughing; it becomes annoying, painful, and sometimes “barking.” During the day, bronchial patency improves, and the cough becomes less pronounced and less frequent.

Coughing attacks in chronic bronchitis can be provoked by cold, frosty air; returning in cold weather from the street to a warm room; tobacco smoke; exhaust gases; the presence of various irritating substances in the air and other factors. In the late stage of the disease, the cough reflex may fade, coughing little bothers patients, and bronchial drainage is sharply disrupted.

Sputum production is the most important symptom of chronic bronchitis. The sputum can be mucous, purulent, mucopurulent, sometimes streaked with blood. In the early stages of the disease, sputum is usually mucous and light-colored. However, in patients who work for a long time in a dusty atmosphere, the sputum may become gray or black (for example, the “black” sputum of miners). As chronic bronchitis progresses, the sputum becomes mucopurulent or purulent in nature, this is especially noticeable during the period of exacerbation of the disease. Purulent sputum is more viscous and is separated with great difficulty. With exacerbation of chronic bronchitis, the amount of sputum increases, but in damp weather and after drinking alcohol it may decrease.

There are cases of chronic bronchitis that occurs without sputum production (“dry bronchial catarrh”). In 10 - 17% of cases with chronic bronchitis, hemoptysis is possible. It may be caused by damage to the blood vessels of the bronchial mucosa during a hacking cough (this is especially typical for atrophic bronchitis). The appearance of hemoptysis requires careful differential diagnosis with pulmonary tuberculosis, lung cancer, and bronchiectasis.

The general condition of patients in the initial stages of chronic bronchitis is satisfactory. It is significantly impaired as the disease progresses and bronchial obstruction, emphysema and the appearance of respiratory failure develop.

As a rule, no significant changes are detected when studying other organs and systems in patients with chronic non-obstructive bronchitis. With severe purulent bronchitis, the development of myocardial dystrophy is possible, which is manifested by muffled heart sounds, low-intensity systolic murmur in the area of the apex of the heart.

Complications of chronic obstructive bronchitis

All complications of chronic obstructive bronchitis can be divided into two groups:

Directly caused by infection:

pneumonia (infection of lung tissue);

bronchiectasis (dilation of the bronchi or their sections);

bronchospastic (non-allergic) component;

asthmatic (allergic) component.

Caused by the development of bronchitis:

hemoptysis,

pulmonary emphysema (destruction of interalveolar septa);

pneumosclerosis (overgrowth of connective tissue in the lung);

pulmonary failure,

pulmonary heart (compensated and decompensated with the development of right ventricular heart failure).

The most severe complication of obstructive bronchitis is acute respiratory failure with rapidly progressing gas exchange disorders and the development of acute respiratory disorders and metabolism.

Diagnosis of chronic obstructive bronchitis

The following can be considered diagnostic criteria for chronic obstructive bronchitis:

Persistent cough with sputum production for at least 3 months for 2 consecutive years or more (WHO criteria). If the duration of a productive cough does not meet WHO criteria, and the cough recurs repeatedly, the following situations must be considered:

Smoker's cough;

Cough as a result of irritation of the respiratory tract by industrial hazards (gases, vapors, fumes, etc.);

Cough due to pathology of the nasopharynx;

Prolonged or recurrent course of acute bronchitis;

Respiratory discomfort and cough due to contact with volatile irritants;

A combination of these factors.

A typical auscultatory picture is rough, hard breathing with prolonged exhalation, scattered dry and moist rales.

Inflammatory changes in the bronchi according to bronchoscopy (the method is used primarily for differential diagnosis).

Exclusion of other diseases manifested by long-term productive cough, i.e. bronchiectasis, chronic lung abscess, tuberculosis, pneumoconiosis, congenital pathology of the bronchopulmonary system, diseases of the cardiovascular system that occur with stagnation of blood in the lungs.

Disturbances of bronchial obstruction during the study of external respiration function.

To diagnose chronic bronchitis, the following studies are carried out:

Laboratory

CBC (complete blood count) - slight neutrophilic leukocytosis and a moderate increase in ESR are possible.

Sputum analysis is a macroscopic examination. Sputum can be mucous (white or transparent) or purulent (yellow or yellow-green), a large number of neutrophilic leukocytes are found, bronchial epithelial cells, macrophages, and bacterial cells are often found. Bacteriological examination of sputum reveals various types of infectious pathogens and their sensitivity to antibacterial agents. The most reliable are the results of bacteriological examination of sputum obtained during bronchoscopy (aspirates and washings from the bronchi).

BAC (biochemical blood test). Based on the determination of biochemical indicators of the activity of the inflammatory process, its severity is judged.

Instrumental

Bronchoscopy.

Bronchography. Bronchoscopy and bronchography are not mandatory research methods for chronic bronchitis; they are usually used for differential diagnosis with other bronchopulmonary diseases (tuberculosis, bronchocarcinoma, congenital anomalies, bronchiectasis, etc.).

Fluoroscopy and radiography of the lungs.

Study of external respiration function.

Study of blood gas composition.

Treatment and prognosis of chronic obstructive bronchitis

The goal of treatment is to reduce the rate of progression of diffuse bronchial damage, reduce the frequency of exacerbations, prolong remission, increase tolerance to physical activity and improve quality of life.

The main direction of treatment and prevention of progression of Chronic obstructive bronchitis (COPD) is the elimination of exposure to harmful impurities in the inhaled air (smoking ban, elimination of exposure to passive smoking, rational employment). The treatment of chronic obstructive bronchitis itself should be differentiated and depend on the form of the disease and certain complications.

Treatment of chronic obstructive bronchitis consists of a set of measures that differ slightly in periods of exacerbation and remission of the disease.

There are two main areas of treatment during an exacerbation: etiotropic and pathogenetic.

Etiotropic treatment during an exacerbation is aimed at eliminating the inflammatory process in the bronchi and includes therapy with antibiotics, antiseptics, phytoncides, etc. Antibiotics are prescribed taking into account the sensitivity of the flora isolated from sputum or bronchial contents. If sensitivity cannot be determined, then treatment should begin with semi-synthetic and protected penicillins and macrolides. Preference is given to oral antibacterial agents. Ampicillin orally 0.5 g 4 times a day, or amoxicillin orally 0.5 g 3 times a day, or amoxiclav 0.625 g 3 times a day, or clarithromycin 0.5 g 2 times a day, or azithromycin according to 0.5 g 1 time per day. Treatment is carried out for 7-10 days.

In cases of purulent bronchitis, preference is given to fluoroquinolones (since they penetrate best into sputum) and III-IV generation cephalosporins: levofloxacin orally 0.5 g once a day, or moxifloxacin orally 0.4 g once a day, or Cefaclor orally 0.5 g 3 times a day. If such treatment is insufficiently effective, they switch to parenteral administration: cefepime intramuscularly and intravenously, 2 g 2 times a day, or cefatoxime intramuscularly or intravenously, 2 g 3 times a day.

For simple (catarrhal) chronic bronchitis, anti-inflammatory therapy is carried out with fenspiride (erespal). The drug is prescribed orally at a dose of 80 mg 2 times a day for 2-3 weeks.

Pathogenetic treatment is aimed at improving pulmonary ventilation and restoring bronchial patency.

Improvement (restoration) of impaired pulmonary ventilation, in addition to eliminating the inflammatory process in the bronchi, is facilitated by oxygen therapy and exercise therapy.

The main thing in the treatment of chronic bronchitis is the restoration of bronchial patency, which is achieved by improving their drainage and eliminating bronchospasm.

In the treatment of chronic bronchitis, it is important to use mucolytic and expectorant drugs: ambroxol orally 30 mg 3 times a day, acetylcysteine orally 200 mg 3-4 times a day, carbocysteine 750 mg 3 times a day, bromhexine orally 8-16 mg 3 times a day. Therapy is carried out for 2 weeks. Herbal preparations (thermopsis, ipecac, mucaltin) are used as alternative medicines. In the case of purulent sputum, preference is given to a combination of N-acetylcysteine (fluimucil) with an antibiotic.

The previously practiced use of proteolytic enzymes as mucolytics is unacceptable. Therapeutic bronchoscopy is successfully used. The use of low-frequency ultrasound bronchoscopic sanitation is promising.

To eliminate bronchospasm, bronchodilators are used. Anticholinergic drugs are used (ipratropium bromide - Atrovent, domestic drug - Troventol); a combination of Atvent and fenoterol (Berodual) and methylxanthines (aminophylline and its derivatives). The most preferable and safest route for administering drugs is inhalation. Long-acting aminophylline preparations (teopek, theotard, theobiolong, etc.), which are prescribed orally only 2 times a day, are also effective.

As additional therapy the following is prescribed:

medications that suppress the cough reflex: for an unproductive cough - libexin, tusuprex, bromhexine, for a hacking cough - codeine, dionine, stoptussin;

medicines that increase the body's resistance: vitamins A, C, group B, biogenic stimulants.

Currently, in the treatment of chronic bronchitis (especially prolonged exacerbations, often recurrent and purulent forms), immunocorrective drugs are increasingly used: T-activin or thymalin (100 mg subcutaneously for 3 days); Bacterial immunocorrectors are successfully used internally: ribomunil (ribosomal-proteoglycan complex of the four most common pathogens), bronchomunal (lyophilized lysate of eight major pathogens), bronchovacone.

Physiotherapeutic treatment is prescribed: diathermy, calcium chloride electrophoresis, quartz on the chest area, chest massage and breathing exercises.

Outside the period of exacerbation of mild bronchitis, foci of infection are eliminated (tonsillectomy, etc.); begin to harden the body. Exercise therapy (breathing exercises) classes are carried out constantly.

With moderate and severe bronchitis, along with anti-relapse and sanatorium-resort treatment (Southern coast of Crimea, dry steppe strip), many patients are forced to constantly receive supportive drug treatment. In moderate cases of chronic bronchitis, constant breathing exercises are required.

Maintenance therapy is aimed at improving bronchial patency, reducing pulmonary hypertension and combating right ventricular failure. The same drugs are prescribed as during an exacerbation, only in smaller doses, in courses.

Prognosis of chronic obstructive bronchitis

The prognosis for complete recovery is unfavorable. The least favorable prognosis is for obstructive chronic bronchitis and chronic bronchitis with predominant damage to the distal bronchi, which quickly leads to the development of pulmonary failure and the formation of cor pulmonale. The most favorable prognosis is for superficial (catarrhal) chronic bronchitis without obstruction.

Prevention of chronic obstructive bronchitis

Prevention of chronic obstructive bronchitis includes a whole range of measures both to prevent the development of chronic bronchitis and to prevent its progression.

In this regard, it is customary to distinguish between primary and secondary prevention of chronic bronchitis.

Primary prevention of chronic obstructive bronchitis

Primary prevention is a set of measures aimed at preventing the development of the disease by eliminating the causes of the development of chronic obstructive bronchitis. Primary prevention measures include, first of all, the fight against smoking, measures to protect the environment, as well as protecting workers at work from the influence of harmful production factors.

In addition, measures for the primary prevention of chronic bronchitis include timely and correct treatment of acute bronchitis to prevent its transition to chronic, as well as sanitation of chronic foci of infection, especially in the nasopharynx.

Secondary prevention of chronic obstructive bronchitis

In fact, measures for secondary prevention are similar to those for primary prevention, but are aimed at preventing the progression of the disease, and not at preventing it from occurring.

In addition to all of the above, an important measure of secondary prevention of chronic obstructive bronchitis is the timely treatment of exacerbations of chronic bronchitis in cases where they occur, as well as sanitization of the nasopharynx and other foci of chronic infection.

Prevalence of risk factors

The results of a survey aimed at identifying tobacco smoking showed that among people over 18 years of age, 30% were active smokers, 10.4% were former smokers, 51.4% were not associated with smoking, 8.2% reported passive smoking. Among men with COPD, 92% had ever smoked (average smoking history was 37.9 + 2.3 pack-years); 50% of women with COPD had a history of passive smoking. The smoking index increased with age. The average smoking index in smokers with COPD is significantly higher than in smokers without COPD. The prevalence of COPD increased with increasing smoking index (Table)

Average smoking index in smokers with COPD and smokers without COPD by age group

Smoking index in smokers with COPD	Smoking index in smokers without COPD	Prevalence of COPD in smokers (n=182)

21,5+ 0,5	19,7+ 1,2
38,2+ 3,4	27,9+ 1,4
40,8+ 5,7	28,3+ 1,5
39,8+ 3,6	29,5+ 3,1
37,9+ 2,3	22,3+ 0,8

Mortality, disability, hospitalization, mortality in COPD

When analyzing epidemiological indicators in the city of Berezovsky in 2007, there was an increase in mortality from COPD by 1.4 times compared to 2005. Mortality rates in 2007 exceeded the average for the Russian Federation by 1.9 times. The mortality rate among women tripled in 2007 compared to 2005. The mortality rate among men was 2.6 times higher than among women (Fig. 1).

Rice. 1 Dynamics of mortality rates in 2005 -2007. in Berezovsky

Primary disability in 2007 increased 2.5 times compared to 2005. The number of hospitalizations in a 24-hour hospital did not change for three years, but mortality during this period increased 4.6 times.

Thus, during the epidemiological study conducted in 2005-2007. an increase in disability, mortality and mortality from COPD was revealed in the city of Berezovsky with a low level of morbidity in terms of appeal. This negative trend can be explained by late diagnosis, low quality treatment and prevention of COPD. An analysis of 100 outpatient records of patients with COPD in 2007 showed a discrepancy between the treatment prescribed by doctors in Berezovsky and GOLD recommendations: only 23% of medical prescriptions corresponded to the stage of COPD; no rehabilitation measures were carried out. To reduce mortality, disability, and health care costs associated with COPD, WHO experts recommend the GOLD treatment program, an important component of which is pulmonary rehabilitation.

Cost-effectiveness of PLR in patients with COPD in a day hospital clinic

The economic effectiveness of pulmonary rehabilitation was determined by the cost/effectiveness method and by the dynamics of direct costs for the management of patients with COPD during one year before and during the one-year period of implementation of PLR in the main group, as well as in the comparison group without the use of pulmonary rehabilitation.

In the main group using PLR, costs decreased: for planned visits by 34.3%, for unplanned visits by 58.5%, for hospitalization in a 24-hour hospital by 58.3%, for hospitalization in a day hospital by 89.3%, by EMS calls by 64.3%. At the same time, the cost of pharmacotherapy increased by 16.9%.

In general, in the group with PLR, direct costs per patient per year decreased by 1165.38: from 15100.85 to 13935.47 rubles. (table).

Structure and dynamics of direct costs (rub.) per patient per year in the main group (n=40) using pulmonary rehabilitation

Indicators	Costs before PLR	Costs as a result of PLR	Growth RUR	Growth %
Scheduled visits
Unscheduled visits


EMS calls
Costs for 5 visits to a doctor for PLR
Pharmacotherapy
For 1 patient per year

In the comparison group without the use of PLR, costs decreased: for unplanned doctor visits by 12.9%, for hospitalization in a day hospital by 72.8%, for emergency calls by 16.1%. At the same time, costs increased: for routine doctor visits by 12.6%, for hospitalization in a 24-hour hospital by 4.6%, for pharmacotherapy by 37.6%.

In general, in the comparison group, direct costs per patient per year increased by 2107.03 rubles: from 15011.1 to 17118.13 rubles. (Table 10).

Structure and dynamics of direct costs (rub.) per patient per year in the comparison group (n=30)

Indicators	Costs 2007	Costs 2008	Growth (rub.)	Growth (%)
Scheduled visits
Unscheduled visits
Hospitalization in a 24-hour hospital
Hospitalization in a day hospital
EMS calls
Pharmacotherapy
For 1 patient per year

Thus, the introduction of PLR in patients with COPD is accompanied by a decrease in direct costs per 1 patient per year in the main group from 15,100.85 to 13,935.47 rubles. by 1165.38 rub. When extrapolating RUB 1,165.38. For 336 patients with COPD who are registered at the clinic, it is possible to obtain prevented economic damage in the amount of 391,567.68 rubles. When comparing direct costs in the main group (13,935.47 rubles) with the comparison group, where direct costs are 17,118.13 rubles, the financial savings per patient per year will be 3,182.66 rubles. (18.6%). When extrapolating RUB 3,182.66. for 336 patients with COPD who are registered at the clinic, an economic effect in the amount of 1,069,373.76 rubles can be obtained.

The cost-effectiveness analysis was carried out using the formula:

where DC is direct costs; Ef - efficiency.

The following indicators were used as units of treatment effectiveness: the proportion of patients (%) who experienced an improvement in quality of life according to the SGRQ questionnaire; the proportion of patients (%) who experienced a decrease in the BODE index; proportion of patients (%) in whom the number of exacerbations decreased.

Frequency of positive treatment outcome (%) by efficiency units

Cost-effectiveness ratio (RUB /% of patients with a positive effect of therapy)

Thus, as a result of this study, in a typical industrial city of Omsk, a high level of prevalence of a prognostically unfavorable disease was determined - COPD - 8.2%; significant underdiagnosis was revealed; the most significant risk factors for COPD were identified - smoking, male gender, age over 50 years, occupational hazards; an increase in disability, mortality and mortality was revealed with low quality of treatment and prevention of COPD. Managing patients according to GOLD recommendations improves clinical and functional indicators in patients with COPD, reduces mortality, increases life expectancy, reduces direct costs per unit of effectiveness, and with the introduction of pulmonary rehabilitation in the day hospital of a clinic in 336 patients with COPD, it can provide an economic effect in the amount of 1,069,373, 76 rub. in year

conclusions

1. In a typical industrial city of Omsk, a high prevalence of COPD was determined - 8.2%, which is 13.4 r. exceeds the morbidity data for appeal (0.61%). The prevalence of COPD among men is 2 times. more than women; COPD of moderate severity predominates - 5.1%. Mortality rates from COPD exceed the Russian average by 1.9 rubles. The mortality rate for men is higher than for women by 2.6 times.

2. Smoking, male gender, occupational hazards, age over 50 years, passive smoking in women, smoking index of 20 or more pack-years are risk factors for COPD. Occupational exposures are more common in men with COPD, regardless of whether they smoke or not. The prevalence of COPD increases with smoking and age.

3. Adapted to the conditions of the day hospital of the clinic, the GOLD pulmonary rehabilitation program for patients with COPD provides a significant clinical and functional effect, expressed in reducing the severity of shortness of breath, increasing exercise tolerance and quality of life, reducing the BODE index, the number and duration of exacerbations of COPD.

4. With the implementation of GOLD recommendations for the management of patients with COPD in the city of Berezovsky, a trend towards a decrease in mortality from COPD in 2008-2009 was determined. in comparison with 2005-2007: mortality decreased by 1.2 times, and in COPD patients of working age, mortality and mortality decreased to 0. At the same time, the average life expectancy of COPD patients increased by an average of 2.8 years.

5. The introduction of a pulmonary rehabilitation program for patients with COPD in the day hospital of the clinic provides economic advantages: direct costs per patient per year are reduced from 15,100.85 rubles. up to 13935.47 rub. and become smaller than in the comparison group by 18.6%; costs per unit of efficiency are reduced by 1.8 rubles for quality of life, by 1.7 rubles for the BODE index, and by 1.4 rubles for the number of exacerbations. Subject to the implementation of a pulmonary rehabilitation program for 336 outpatient COPD patients, the economic effect could amount to 1,069,373.76 rubles. in year.

WITHlist of used literature

1. Alexandrova N.I. Modern understanding of chronic bronchitis and obstructive pulmonary disease, their diagnosis and prevention. // Respiratory diseases./ Ed. Kokosova A.N. Series "World of Medicine". - St. Petersburg: Lan Publishing House, 1999. - P. 116-126.

2. Berbentsova E.P. // Manual on pulmonology. Immunology, clinical picture, diagnosis and treatment of inflammatory viral and bacterial diseases of the upper respiratory tract, bronchi, and lungs. M.: Editorial office of the journal “Uspekhi Fizicheskikh Nauk”, 1998. - 624 p.

3. Kokosov A.N., Gerasin V.A. // Chronical bronchitis. L., "Medicine", L. o. 1984.-S. 90-119.

4. Paleev N.R., Ilchenko V.A. Chronical bronchitis. // Respiratory diseases. / Ed. N.R. Paleeva. M., 1990. - P. 110-180.

5. Smoleva E.V. // Nursing in therapy with a course of primary medical care / ed. Ph.D. B.V. Kabarukhina / publishing house "Phoenix", 2005. - p. 100-105.

6. Fennelly K.P., Stuhlbarg M.S. Chronic bronchitis // Pulmonology. 1994.-№2.-S. 6-13.

7. http://www.dom-zdorovia.ru

8. http://pulmonology.eurodoctor.ru

9. http://med-zabolevaniya.ru

10. http://health.rin.ru

11. http://bronhit.info

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Bronchitis clinic

The clinical manifestations of bronchitis directly depend on the form and stage of development of the disease. The symptoms of acute bronchitis have 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:

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

The clinical picture of chronic bronchitis is characterized by the following symptoms:

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

Etiology of bronchitis

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

The clinic of acute bronchitis in children and adults indicates that the disease can also be triggered by various external influences: inhalation of harmful chemicals, dusty premises, regular hypothermia. Chronic bronchitis, as a rule, is a consequence of untimely treatment of acute bronchitis. Among the main etiological reasons, the following should also be considered:

ecological problems(air pollution with emissions harmful to health);
smoking;
hazardous working conditions (for example, work in chemical production);
severe tolerance to cold climates.

Pathogenesis of acute and chronic bronchitis

With the progressive development of bronchitis, the walls of the bronchi are primarily affected by pathological effects, in which atrophic processes begin. 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 acute inflammatory process develops in the body. If appropriate drug therapy is not carried out, then the further development of the pathological process leads to swelling and hyperemia of the mucous membranes, and 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; if atrophic processes lead to irreversible changes, then bronchitis becomes chronic.

Causes

With bronchitis, the walls of the bronchi are damaged, which can happen 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, the cause of bronchitis is bacteria (streptococci, hemophilia and chlamydia); bacterial infections often become secondary infections as a result of infection by a virus.
Weakened immunity and vitamin deficiency.
Hypothermia.
Living in places with high humidity, polluted air and poor ecology.
Active and passive smoking - when you inhale cigarette smoke, various chemicals deposit 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 - if treatment is incorrect or not completed, bacteria can enter the lungs and begin to spread there.
Poor nutrition.
Due to an allergic reaction.

Symptoms

The manifestation of acute bronchitis begins with a cold. Severe fatigue, weakness, tickling and cough. At the height of the disease, the cough is dry, soon followed by sputum. The discharge can be either mucous or purulent in nature. Bronchitis may be accompanied by fever. A form of chronic bronchitis is diagnosed after several months of illness. A wet and painful cough with phlegm torments a person every day. When in contact with irritants, the cough reflex may be strengthened. A long process leads to difficulty breathing and the development of emphysema.

What symptoms are accompanied by 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 occurs.

How does allergic bronchitis manifest? Contact with the pathogen causes discomfort and coughing. Sputum in allergic bronchitis always has a mucous secretion. There is no increase in body temperature. Symptoms of bronchitis disappear when the irritant is eliminated.

With toxic bronchitis, a severe cough causes difficulty breathing, shortness of breath or suffocation.

Diagnosis of bronchitis

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

Conversation with a doctor. In most cases, the diagnosis of bronchitis is made based on interviewing the patient and identifying complaints related to the respiratory system. During the interview, the doctor also finds out the approximate onset of the disease and possible reasons.
Inspection. The doctor checks for breath sounds in the chest using a phonendoscope. Auscultation 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, percussion sound changes due to changes in lung tissue.
Clinical tests. A blood and sputum test is performed to confirm the diagnosis. With bronchitis, blood counts in the general analysis will vary depending on the pathogen. 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 identifying decreased respiratory tract function. With bronchitis, due to the inflammatory component, there is an obstacle to inhalation and exhalation, which will undoubtedly affect a decrease in the total volume of the lungs.

Treatment of bronchitis

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

Bed rest and complete physical and mental rest of the patient are prescribed.
It is necessary to provide the patient with enough fluids.
Application of necessary physiotherapeutic treatment methods.
Taking necessary medications.
It should also be noted that depending on the reasons contributing to the development of the disease, the methods of treating the disease differ.

Antiviral

So, in etiology the following types of antiviral drugs are prescribed:

"Viferon". This is a drug containing combined human interferon. This substance is a broad-spectrum medicine, available in the form of ointments and suppositories of various dosages. The course of therapy ranges from five to ten days. Possible side effects may include an allergic reaction.
"Laferobion". This drug can be used both for the prevention and treatment of diseases caused by pathogens of various viruses. Available 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

The necessary prebiotics are also prescribed to prevent the development of intestinal dysbiosis in the patient. All of the listed substances must be used in combination to treat the disease. Also, all patients with bronchitis, regardless of etiology, are prescribed physiotherapeutic methods. This treatment method is one of the oldest in medical practice; its use allows you to achieve an effective result in influencing the disease in a safe way for health.

Physiotherapy

The following physiotherapeutic methods of treatment are used in the treatment of the disease:

Inhalation. This method of action allows it to be used in the treatment of pregnant women and children with bronchitis. A special inhaler device is used to carry out the procedure. This method of exposure can effectively eliminate such clinical manifestations of the disease as the presence of sputum, cough, and pathogens. Also, the undoubted advantage of this method is the possibility of home use.
Massage techniques. To treat bronchitis, the massage therapist performs dynamic tapping and stroking with his fingertips. The use of essential oils is mandatory during the procedure. 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, blood circulation increases 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 liquefy secretions 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 helps to expand the bronchi and restore damaged mucous membranes of the organ.
Halotherapy. This method consists of artificially creating a climate similar to that existing in salt caves. Used to improve lung ventilation.
Heat therapy. For this procedure, special paraffin pads are used, which are preheated and then applied to the patient’s chest, which helps reduce spasms during coughing attacks. The duration of this manipulation is ten minutes.

The best herbs

You can also use it to treat illness medicinal herbs And breast training. Preparing herbal infusions from licorice root and thyme helps accelerate the removal of secretions from the bronchi. Collecting herbs such as coltsfoot, elecampane root, and anise will help against coughing attacks.

The content of the article

Chronical bronchitis- permanent or recurrent diffuse damage to the bronchial mucosa with subsequent involvement of the deeper layers of their wall in the process, accompanied by hypersecretion of mucus, disruption of the cleansing and protective functions of the bronchi, manifested by constant or periodic cough with sputum and shortness of breath, not associated with other bronchopulmonary processes and pathology other organs and systems.
According to the epidemiological criteria of the World Health Organization, bronchitis is considered chronic if a cough with sputum production continues for three months or more per year and for at least two years in a row.
According to the All-Union Research Institute of Pulmonology (VNIIP) of the Ministry of Health, in the general group of patients with chronic nonspecific lung diseases, chronic bronchitis is 68.5%. Men get sick more often (the ratio between men and women is 7:1), and those who perform manual labor associated with frequent cooling and changes in temperature conditions.

Classification of chronic bronchitis

Chronic bronchitis, according to the VNIIP Ministry of Health classification, refers to chronic diseases with predominant damage to the bronchial tree of a diffuse nature.
The following types of chronic bronchitis are divided: simple, uncomplicated, occurring with the release of mucous sputum but without disturbances in ventilation; purulent, manifested by the release of purulent sputum constantly or in the acute phase; obstructive, accompanied by persistent obstructive ventilation disorders; purulent-obstructive, in which purulent inflammation is combined with obstructive ventilation disorders. The question of the advisability of identifying allergic bronchitis as an independent nosological form is debated. In the domestic literature, especially related to pediatrics, the terms “asthmatic bronchitis”, “allergic bronchitis”, “asthmatoid bronchitis” are found. Foreign researchers, although they do not distinguish asthmatic bronchitis (synonyms: asthmatoid bronchitis, pseudoasthma, capillary bronchitis) as a separate nosological unit, often use this term in pediatric practice. Allergic bronchitis is described in the domestic literature, which is characterized by the characteristics of obstructive syndrome (predominance of bronchospasm), a peculiar endoscopic picture (vasomotor reaction of the bronchial mucosa), and characteristics of the bronchial contents (a large number of eosinophils), which is not typical for other forms of bronchitis. Currently, in domestic medicine it is considered appropriate to designate this form of bronchitis (as well as other forms of chronic bronchitis, obstructive and non-obstructive, when combined with extrapulmonary manifestations of allergy and bronchospastic syndrome) as pre-asthma.

Etiology of chronic bronchitis

The etiology of chronic bronchitis has not been definitively established; it includes many factors. Toxic-chemical is considered the main cause of chronic bronchitis. influences: smoking and inhalation of toxic substances, air pollution, irritating effects of industrial dust, vapors, gases. Infection plays an important role in the progression of chronic bronchitis, but its significance as a direct and underlying cause remains controversial. The most common opinion is about the secondary nature of the chronic infectious-inflammatory process that develops in the altered bronchial mucosa. In the etiology of the inflammatory process, the leading role of pneumococcus (Streptococcus pneumonie) and Haemophilus influenzae (Haemophylis influenze) is generally recognized. Activation of the inflammatory process is caused mainly by pneumococcus. In some cases, chronic bronchitis is a consequence of untreated acute bronchitis of an infectious (most often viral) nature - a secondary chronic process. It is possible that chronic bronchitis in adults is associated with chronic respiratory diseases of childhood, which may be the beginning of chronic bronchitis, which proceeds latently and progresses in adulthood. Most foreign scientists deny the existence of chronic bronchitis in childhood and adolescence. Further study of this issue is needed.

Pathogenesis of chronic bronchitis

In chronic bronchitis, the secretory, cleansing and protective functions of the bronchi are disrupted, the amount of mucus increases (hyperfunction of the secretory glands), its composition and rheological properties change. a transport defect occurs (mucociliary insufficiency) due to degeneration of specialized ciliated epithelial cells. The main mechanism for removing tracheobronchial secretions is coughing. Stagnation of mucus contributes to secondary infection and the development of a chronic infectious-inflammatory process, which is aggravated by a change in the ratio between the proteolytic activity of bronchial secretions and the level of serum protease inhibitors. In chronic bronchitis, both an increase in the amount of ai-antitrypsin in the serum and its deficiency occur along with an increase in elastase activity of bronchial secretions.
The protective function of the lungs is ensured by the interaction of systemic immunity and local immunity. Changes in local immunity are characterized by: a decrease in the number and functional activity of alveolar macrophages; oppression phagocytic activity neutrophils and monocytes; deficiency and functional failure of T lymphocytes; the predominance of bacterial antigens in the bronchial contents compared to antibacterial antibodies; a decrease in the concentrations of secretory immunoglobulin A in the bronchial contents and immunoglobulin A in the blood serum; a decrease in the number of plasma cells secreting immunoglobulin A in the bronchial mucosa in severe forms of chronic bronchitis.
With long-term chronic bronchitis, the content of immunoglobulin G increases in the contents of the bronchi, which, with a deficiency of secretory immunoglobulin A, can be compensatory in nature, however, the long-term predominance of antibodies related to immunoglobulin Q can increase inflammation in the bronchi, activating the complement system. In the contents of the bronchi during chronic bronchitis (without concomitant allergic manifestations), the concentration of immunoglobulin E is significantly increased, which indicates its predominantly local synthesis and can be considered as a protective reaction against the background of a decrease in the level of secretory immunoglobulin A, however, there is a significant imbalance in the levels of immunoglobulin A and immunoglobulin E may cause a relapse of the disease.
Changes in systemic immunity are characterized by skin anergy to antigens that induce delayed-type hypersensitivity, a decrease in the number and activity of T lymphocytes, phagocytic activity of neutrophils, monocytes and antibody-dependent cellular cytotoxicity, a decrease in the level of natural killer lymphocytes, inhibition of the function of T-suppressors, long-term circulation of immune complexes in high concentrations , detection of antinuclear antibodies to rheumatoid factor. disimmunoglobulinemic syndrome.
Antibacterial antibodies in the serum relate mainly to immunoglobulin M and immunoglobulin G, in the contents of the bronchi - to immunoglobulin A, immunoglobulin E and immunoglobulin G. The high level of antibacterial antibodies related to immunoglobulins E in the contents of the bronchi indicates their possible protective role. It is believed that the significance of allergic reactions in chronic bronchitis is small, but there is an opinion that immediate-type allergic reactions take part in the pathogenesis of B. x with transient bronchial obstruction syndrome
Violations of local and systemic immunity have the nature of secondary immunological failure, depend on the stage of the process and are most pronounced in purulent chronic bronchitis. However, this is contradicted by a significant decrease in many parameters of systemic and local immunity at the stage of remission of chronic bronchitis.
The connection between smoking and toxic chemicals. influences, infection and violations of local protection are presented as follows. The adverse effects of smoking and pollutants lead to defects in local defense, which contributes to secondary infection and the development of the inflammatory process, which is constantly supported by the ongoing invasion of microorganisms. Increasing damage to the mucosa leads to a progressive breakdown of defense mechanisms.
Although allergic reactions are not expected to play a significant role in the pathogenesis of chronic bronchitis, consideration of its etiology, pathogenesis, and treatment is important for theoretical and practical allergology, since in a third of patients with bronchial asthma, chronic bronchitis precedes its development, being the basis for the formation of infectious-allergic asthma. Exacerbation of concomitant bronchitis with bronchial infectious-allergic asthma is one of the main reasons for its recurrent course, prolonged asthmatic status, and chronic pulmonary emphysema.

Pathomorphology of chronic bronchitis

According to the level of damage, proximal and distal chronic bronchitis is distinguished. Most often with B x. there is widespread uneven damage to large, small bronchi and bronchioles; the bronchial wall thickens due to gland hyperplasia, vasodilation, and edema; cellular infiltration is weak or moderate (lymphocytes). Usually a catarrhal process occurs, less often - an atrophic one. Changes in the distal sections occur like simple distal bronchitis and bronchiolitis. The lumen of the bronchioles increases, there are no accumulations of leukocytes in the bronchial wall.

Chronic bronchitis clinic

Chronic bronchitis is characterized by a gradual onset. Long time(10-12 years) the disease does not affect the patient’s well-being and performance. Beginning B x. patients are often associated with colds, acute respiratory diseases, influenza, and acute pneumonia with a prolonged course. However, according to the anamnesis, cough in the morning due to smoking (“smoker’s cough”, pre-bronchitis) precedes obvious symptoms of chronic bronchitis. There is no shortness of breath or signs of active inflammation in the lungs at first. Gradually, the cough becomes more frequent, especially in cold weather, becomes constant, sometimes decreasing in the warm season. The amount of sputum increases, its character changes (mucopurulent, purulent). Shortness of breath occurs, first with exertion, then at rest. The health of patients worsens, especially in damp, cold weather. Of the physical data, the most important for diagnosis are: hard breathing (in 80% of patients): scattered dry wheezing (in 75%); limited mobility of the pulmonary edge during breathing (54%); tympanic shade of percussion tone; cyanosis of visible mucous membranes. The clinical picture of chronic bronchitis depends on the level of bronchial damage, the phase of its course, the presence and degree of bronchial obstruction, as well as complications. With predominant damage to the large bronchi (proximal bronchitis), a cough with mucous sputum is noted, auscultatory changes in the lungs are either absent, or are manifested by rough, hard breathing with a large number of different dry rales of a relatively low timbre; bronchial obstruction ket. The process in the medium-sized bronchi is characterized by a cough with mucopurulent sputum, dry wheezing in the lungs, and the absence of bronchial obstruction. With predominant damage to the small bronchi (distal bronchitis), the following are observed: high-pitched dry wheezing and bronchial obstruction, the clinical signs of which are shortness of breath during physical activity. load and leaving a warm room in the cold; paroxysmal painful cough with the release of a small amount of viscous sputum; dry wheezing during exhalation and prolongation of the expiratory phase, especially forced expiration. Bronchial obstruction is always prognostically unfavorable, since its progression leads to pulmonary hypertension and hemodynamic disorders of the systemic circulation. Usually the process begins with proximal bronchitis, then in almost two thirds of patients distal bronchitis joins it.
Based on the nature of the inflammatory process, catarrhal and purulent chronic bronchitis are distinguished. In case of catarrhal chronic bronchitis, a cough with mucous or mucopurulent sputum is noted, there are no symptoms of intoxication, exacerbations and remissions are clearly expressed, the activity of the inflammatory process is established only by biochemistry. indicators. With purulent chronic bronchitis, a cough with purulent sputum is detected, permanent symptoms of intoxication, remission are not expressed, and the activity of the inflammatory process is of degree II, III.
According to clinical and functional data, obstructive and non-obstructive chronic bronchitis is distinguished. Shortness of breath is characteristic of obstructive chronic bronchitis. Non-obstructive shortness of breath is not accompanied, and there are no ventilation disturbances for many years (“functionally stable bronchitis”). The transitional state between these forms is conventionally designated as “functionally unstable bronchitis.” In patients with such bronchitis, repeated functional studies show lability of external respiration parameters, their improvement under the influence of treatment, and transient obstructive disorders during the period of exacerbation.
Exacerbation of chronic bronchitis is manifested by increased cough, increased amount of sputum, general symptoms (fatigue, weakness); body temperature rarely rises, usually to low-grade fever; Chills and sweating are often observed, especially at night. Almost a third of patients experience neuropsychic disorders of varying degrees: neurasthenic-like reactions, asthenodepressive syndrome, irritability, autonomic disorders (weakness, sweating, tremor, dizziness).
Chronic bronchitis is known with initial damage to the small bronchi, when the disease (distal bronchitis) begins with shortness of breath (5-25% of cases). This raises the possibility of primary heart disease. There are no “cough” receptors in the small bronchi, so the lesion is characterized only by shortness of breath. Further spread of inflammation to the large bronchi causes coughing, sputum production, and the disease acquires more typical features.
Complications of chronic bronchitis are pulmonary emphysema, cor pulmonale, pulmonary and pulmonary-heart failure. Chronic bronchitis progresses slowly. From the onset of the disease to the development of severe respiratory failure, an average of 25-30 years pass. Most often, its course is recurrent, with almost asymptomatic intervals. Seasonality of exacerbations is noted (spring, autumn). There are several stages of chronic bronchitis: pre-bronchitis; simple non-obstructive bronchitis with predominant damage to large and medium-sized bronchi; obstructive bronchitis with widespread damage to the small bronchi; secondary emphysema; chronic compensated cor pulmonale; decompensated cor pulmonale. Deviations from this scheme are possible: initial damage to the small bronchi with severe obstructive syndrome, the formation of cor pulmonale without emphysema.

Diagnosis of chronic bronchitis

Diagnosis of chronic bronchitis is based on clinical, radiological, laboratory, bronchoscopic and functional data.
Radiologically, chronic bronchitis is characterized by increased transparency and reticular deformation of the pulmonary pattern, most pronounced in the middle and lower sections and caused by sclerosis of the interacinar, interlobular, intersegmental septa. The differentiation of the roots of the lungs may also be lost, and the basal pattern may change. A third of patients show signs of emphysema. In the later stages, a quarter of patients develop anatomical defects of the bronchi, detected by bronchography.
The function of external respiration in the early stages of chronic bronchitis is not changed. Obstructive syndrome is characterized by a decrease in FEV1 from 74 to 35% of the proper value, Tiffno test indicators - from 59 to 40%, a decrease in MVL, VC and dynamic compliance, an increase in TVC and respiratory rate. When studying the dynamics of ventilation disorders, preference is given to speed indicators (FEV1). In the first stages of chronic bronchitis, the minimum dynamics of FEV is determined no earlier than after 8 years. The average annual decrease in FEV1 in patients with chronic bronchitis is 46-88 ml (this value determines the prognosis of the disease). FEV often falls abruptly. The predominance of proximal obstruction is characterized by an increase in TBL without an increase in TBL, peripheral - a significant increase in TBL and TBL; Generalized obstruction is characterized by a decrease in FEV], an increase in bronchial resistance, and the formation of pulmonary emphysema. The functional component of obstruction is detected using pneumotachometer before and after the administration of bronchodilators.
Data from peripheral blood tests and ESR change little: moderate leukocytosis, increased levels of histamine and acetylcholine (more in obstructive chronic bronchitis) in the blood serum may be observed. A third of patients with obstructive chronic bronchitis experience a decrease in antitryptic activity of the blood; in asthmatic chronic bronchitis, the level of acid phosphatase in the blood serum is increased. In the case of the development of chronic pulmonary heart disease, the androgen content, fibrinolytic activity of the blood, and heparin concentration decrease.
For the purpose of timely diagnosis of an active inflammatory process, a complex of laboratory tests is used: biochemical. tests, examination of sputum and bronchial contents.
From biochem. The most informative indicators of inflammatory activity are the level of sialic acids, haptoglobin and protein fractions in serum, and the content of plasma fibrinogen. An increase in the concentration of sialic acids above 100 arb. units and protein in the range of 9-11 mg/l in sputum corresponds to the activity of inflammation and the level of sialic acids in the serum. In chronic bronchitis, the concentration of pathogenic microorganisms increases and is 102-109 in 1 ml; at the stage of exacerbation, pneumococcus is predominantly isolated (and in 50% of patients it is also detected at the stage of remission - a latent course of inflammation); the pH, viscosity of sputum and the content of acidic mucopolysaccharides in it increase; the level of lactoferin, lysozyme, secretory YG A and protease activity decrease; ai-antitrypsin activity increases. Cytological analysis of sputum in patients with chronic bronchitis reveals: accumulations of neutrophils, single macrophages at the stage of severe exacerbation; neutrophils, macrophages, bronchial epithelial cells - in moderate stages; predominance of bronchial epithelial cells, single leukocytes, macrophages at the stage of mild exacerbation. In the bronchial contents (lavage fluid obtained during fibrobronchoscopy) of patients with chronic bronchitis, the level of phosphatidylcholine and lysophosphatides is reduced, and the free fraction of cholesterol is increased, the ratio of serum and secretory immunoglobulin A is shifted towards the predominance of serum, the concentration of lysozyme is reduced. In the lavage fluid of patients with purulent chronic bronchitis, neutrophils predominate (75-90%), the number of eosinophils and lymphocytes is insignificant and does not change significantly during treatment, while in healthy individuals such fluid contains only alveolar macrophages (80-85% In non-smokers, 90- 95 - in smokers) and lymphocytes. In allergic chronic bronchitis, eosinophils (up to 40%) and macrophages predominate in the lavage fluid. In the catarrhal form of chronic bronchitis, the cytology of the lavage fluid depends on the nature of the secretion.

Differential diagnosis of chronic bronchitis

Obstructive chronic bronchitis must be distinguished from bronchial infectious-allergic asthma, obstructive chronic bronchitis with pre-asthma, chronic pneumonia, bronchiectasis, and lung cancer. Among the large contingent of patients with chronic bronchitis, there are certain groups that require a particularly thorough examination: patients with recurrent purulent bronchitis; patients with a combination of sinusitis, otitis media and recurrent bronchitis; patients with chronic bronchitis with intestinal malabsorption syndrome. When differentially diagnosing these conditions, it is necessary to keep in mind immunodeficiency diseases (antibody deficiencies). Although in in this case Recurrent infections (otitis, sinusitis, persistent bronchitis) in childhood are typical; symptoms may first appear only at a young age. Serum protease inhibitor deficiency should also be considered.

Treatment of chronic bronchitis

One of the principles is treatment as early as possible. Types and methods of therapy are determined by the form of chronic bronchitis and the presence of complications. At the acute stage, complex therapy is carried out: anti-inflammatory, desensitizing, improving bronchial patency, secretolytic. Anti-inflammatory and antibacterial agents include long-acting sulfonamides, chemotherapy drugs - bactrim, biseptol, poteseptil, and antibiotics. The appropriate choice of antibiotics is facilitated by microbiological examination of sputum. Against the background of antibacterial therapy (prescribing a second antibiotic after a long course of the first), an exacerbation of the disease may occur, which is often the result of the activation of another pathogen that is resistant to the drug used. Penicillin group drugs activate the growth of Escherichia coli, broad-spectrum antibiotics - Proteus, Pseudomonas aeruginosa, levomycin - pneumococcus (with a large amount of Haemophilus influenzae). The latter is especially important, since the etiology of chronic bronchitis is most often associated with pneumococcus and Haemophilus influenzae, which have an antagonistic relationship. Exacerbation is accompanied by thinning of sputum and an increase in the number of microbes in it. Thickening of sputum is an indirect sign of successful antibacterial treatment, however, in this case, coughing, shortness of breath may increase and there will be a need for bronchodilators and secretolytic drugs.
Due to pronounced immunological disorders, the treatment of chronic bronchitis uses drugs that affect the immune system, immunocorrective therapy (diucifon, decaris, prodigiosan, sodium nucleinate), which is under study and should be based on a comprehensive assessment of systemic and local immunity. During the period of exacerbation, γ-globulin preparations are used, in particular antistaphylococcal γ-globulin (5 ml twice a week, four-six injections), in case of prolonged course, staphylococcal toxoid (0.05-0.1 ml subcutaneously, followed by an increase of 0.1 -0.2 ml within 1.5-2 ml). A positive effect of the transfer factor on the course of the disease was noted. The effectiveness of prodigiosan has been shown (a polysaccharide complex from the culture of Bacillus prodigiosae stimulates mainly B lymphocytes, phagocytosis, and increases resistance to viruses), which is recommended for impaired antibody production. In case of dysfunction of phagocytosis, drugs with a phagocytosis-stimulating effect (methyluracil, pentoxyl) are advisable; in case of insufficiency of the T-system, decaris is used.
Of great importance in the complex treatment of chronic bronchitis are methods of endobronchial sanitation, various types of therapeutic bronchoscopy, in addition to lavage, which rarely gives good results. In case of severe breathing disorders, one of the rational and effective ways treatment is considered to be auxiliary artificial ventilation in combination with drug therapy and oxygen aerosol therapy, carried out in a specialized department.
In the presence of insufficient antitryptic activity of serum, proteolytic enzymes are not recommended. With the development of chronic pulmonary heart disease with a concomitant decrease in the level of androgens and fibrinolytic activity of the blood, anabolic steroids, heparin and drugs that lower pressure in the pulmonary artery are used.
Therapeutic and preventive measures include: eliminating the harmful effects of irritating factors and smoking; suppression of the activity of the infectious-inflammatory process; improving pulmonary ventilation and bronchial drainage with expectorants; eliminating hypoxemia; sanitization of foci of infection; restoration of nasal breathing; physiotherapy courses two to three times a year; hardening procedures; Exercise therapy - “respiratory”, “drainage”.

7. Antibiotics are prescribed only when a secondary bacterial infection occurs. What the following symptoms may indicate:

Increase in body temperature above 39 degrees.

A child, with full treatment, suddenly becomes lethargic, inactive, and loses appetite

Severe weakness, headaches, nausea, vomiting

In the general blood test, the ESR was accelerated and the leukocyte count was increased.

Reviews

When I was 13 years old, I was first diagnosed with acute bronchitis, then they said it was obstructive. Every day I get IVs and breathe through an inhaler 5 times a day.

I usually buy antibiotics and some kind of mucolytic, for example, ambroxol - syrup ambrobene. Well, besides, it is important for me that the medicine has a taste, because a sick child sometimes refuses to take pills, but the syrup willingly drinks because it tastes good.

Basically, we treat only this way.

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Chronic obstructive bronchitis is a disease of the bronchi and lungs, characterized by a partially irreversible restriction of air flow in the bronchopulmonary system, which is constantly progressing. The main symptoms of this pathology in the lungs are shortness of breath and cough with viscous sputum.

Chronic obstructive bronchitis is common throughout the globe and occurs on average in 250–330 people in the population.

The lowest incidence of reported cases is less than 110 and includes countries such as Canada, Alaska, southwestern South America, France, Germany, Bulgaria, the Arabian Peninsula, Asian Russia and Japan.

The average distribution of the disease is the USA, Argentina, Uruguay, Brazil, Great Britain, Norway, Poland, Czech Republic, Slovakia, and African countries, where the incidence of cases is 110–550 per population.

The highest incidence of chronic obstructive bronchitis occurs in the countries of Europe (Ukraine, Belarus, Russia), Asia (China, Mongolia, Tibet, Nepal, India, Indonesia, Iran, Iraq), Australia, Oceania and amounts to 550–1350 or more population.

Middle-aged and elderly people are more often affected; in men, chronic obstructive bronchitis occurs 3–4 times more often than in women.

The prognosis for work capacity and life is unfavorable. As the pathological process progresses in the lungs, efficiency is gradually lost. Adequate, timely treatment only stops the course of the disease for a short time. Death occurs from complications (cor pulmonale, emphysema, etc.).

Causes of the disease

Chronic obstructive bronchitis in adults occurs due to many negative influences on the lungs, both from the environment and directly from the body, and therefore the causes of the disease are conventionally divided into two groups:

External factors:

Smoking is the main cause of the disease, accounting for 80–90% of cases;
Professional factors – work in enterprises that are characterized by high dust levels. The most harmful components of dust that negatively affect the lungs of an adult are cadmium and silicon.

High-risk professions:

mining industry;
builders;
miners;
metallurgists;
pulp and paper industry workers;
railway workers;
pharmaceutical industry workers.

Frequent ARVI (acute respiratory viral infections);
Adenoviral infection;
Chronic vitamin C deficiency;
Previously suffered mononucleosis.

Internal factors:

Hereditary predisposition, the basis of which is a deficiency of alpha1-antitrypsin - a substance that blocks enzymes that break down protein in the bronchial tree and thereby prevent the destruction of lung tissue;
Prematurity - the lungs fully develop only by 38–39 weeks of pregnancy (9 months);
HIV infection (human immunodeficiency virus);
Bronchial asthma, which is accompanied by an increase in the level of immunoglobulin E;
Bronchial hyperreactivity is a persistent increase in the formation of mucus in the bronchial tree.

Classification of the disease

Severity depending on symptoms:

0 degree – no severity – shortness of breath occurs with intense stress on the body;
1st degree – mild severity – shortness of breath occurs when climbing or while walking relatively quickly;
2nd degree - moderate severity - shortness of breath forces patients to move at a slower speed compared to healthy people same age group;
3rd degree – severe – shortness of breath requires patients to stop during normal walking every 100 m;
Grade 4 – very severe – shortness of breath occurs when eating, changing clothes or turning in bed. Such patients do not leave the room.

Stages of the disease depending on the study of external respiration function using spirometry - measurement of volume and speed parameters of breathing. (This method will be described in detail in the section " Modern methods examinations", i.e. diagnosis of the disease).

Stage I – mild.

Tiffno index is less than 70%;
FEV 1 greater than 80%;
Absence of the main symptoms of the disease - sputum, shortness of breath and cough.

Stage II – middle.

Tiffno index is less than 70%;
FEV 1 is less than 80%;
The presence or absence of the main symptoms of the disease - sputum, shortness of breath and cough.

Stage III – severe.

Tiffno index is less than 70%;
FEV 1 is less than 50%;

Stage IV is extremely severe.

Tiffno index is less than 70%;
FEV 1 is less than 30%;
Chronic respiratory failure;
The presence of the main symptoms of the disease is sputum, shortness of breath and cough.

Symptoms of the disease

Chronic obstructive bronchitis occurs with a constant alternation of 2 phases of the disease - exacerbation and remission, and symptoms vary depending on the phase.

Signs during an exacerbation:

slight increase in body temperature;
general weakness;
headache;
dizziness;
nausea;
aches, chills, increased sweating;
decreased ability to work;
shortness of breath with minimal physical exertion;
cough with the release of viscous sputum of a purulent nature (yellow).

Symptoms during remission:

shortness of breath with increased exertion;
cough, mainly in the morning, sputum is serous (transparent or white).

Concomitant symptoms of damage to other organs from oxygen starvation resulting from damage to the bronchopulmonary system:

Signs of damage to the cardiovascular system - increased blood pressure, increased heart rate, pain in the heart, palpitations, blueness of the nose, lips, fingertips;
Signs of damage to the urinary system - pain in the lumbar region, swelling of the lower extremities;
Signs of damage to the central nervous system - impaired consciousness, shallow breathing, decreased memory and attention, blurred vision, hallucinations;
Signs of damage to the digestive system are yellowness of the skin, lack of appetite, bloating, and abdominal pain.

Modern examination methods

Adult patients with a disease such as chronic obstructive bronchitis are observed at their place of residence or work by a general practitioner. When visiting a clinic for diagnosis and treatment, they can be observed by local therapists, family doctors or pulmonologists. At inpatient treatment should be located in specialized pulmonology departments.

Algorithm for examining such patients:

Diagnostic survey and collection of complaints;
Diagnostic examination of the patient, including percussion (tapping) and auscultation (listening) of the chest.

During percussion, a boxy sound appears, which means increased airiness of the lungs.

On auscultation, harsh breathing and dry, whistling or buzzing rales are observed.

Diagnostic laboratory examination:

A general blood test, which will be characterized by an increase in leukocytes, a shift in the leukocyte formula to the left and an increase in ESR (erythrocyte sedimentation rate);
A general urine test, in which an increase in squamous epithelial cells and leukocytes in the field of view will be observed, as well as the possible appearance of mucus and traces of protein;
General sputum analysis, which will be characterized by the presence of a large number of neutrophils and leukocytes.

Diagnostic instrumental examination:

Spirometry is one of the most common methods for studying respiratory function. Based on this method, a classification of the disease by severity has been developed;

The patient is asked to breathe into a tube connected to a computer program that immediately displays a graph of inhalation and exhalation. During the examination, the doctor gives commands to patients, which involve changing the speed and depth of breathing.

The main indicators that can be determined using spirometry:

VC (vital capacity of the lungs) is the total amount of air inhaled and exhaled from the lungs during quiet deep breathing;
FVC (forced vital capacity) is the total amount of air inhaled and exhaled from the lungs during deep, rapid breathing;
FEV 1 (forced expiratory volume in 1 second) - the volume of air during a sharp exhalation after a calm, deep inhalation;
Tiffno index – the ratio of FEV 1 to vital capacity. This parameter is a diagnostic criterion for determining the severity of the disease;
POS (peak volumetric velocity) – maximum speed air flow, achieved by sharp exhalation after a deep inhalation.

X-ray of the chest cavity, which is characterized by the presence of dilated bronchi and increased airiness of the lung tissue.

Main types of treatment

For a disease such as chronic obstructive bronchitis, treatment is prescribed only by qualified specialists in a hospital or outpatient setting. Therapy should be combined, i.e. Drug treatment must necessarily be supplemented by physiotherapeutic treatment, which includes aromatherapy, inhalations, massages, warming and exercise therapy (therapeutic gymnastics).

Drug treatment

The main goals of treatment are to prevent frequent exacerbations of chronic obstructive bronchitis, relieve symptoms of the disease, improve the body's tolerance to physical activity and reduce mortality.

Bronchodilators are drugs that dilate the bronchi:

M-cholinergic blockers (ipratropium bromide) - Atrovent, Ipravent have a bronchodilator effect by blocking m-cholinergic receptors in the smooth muscles of the bronchi. The drug is prescribed to adults in the form of an aerosol of 40 mcg (2 puffs) 4–6 times a day;
Short-acting beta2-agonists (salbutamol) - Salbuvent, Volmas, Ventolin - have a bronchodilator effect by stimulating beta2-adrenergic receptors, which are located in the bronchial wall. For adults, the drug is prescribed by inhalation at 2–4 mg (1–2 puffs) up to 6 times a day;
Long-acting beta2-agonists (formoterol) - Atimos, Foradil have a pronounced bronchodilator effect. Prescribed for adults: 2 breaths 2 times a day (morning and evening).

Glucocorticosteroids (hormonal drugs):

Prednisolone (Medopred, Prednisol) – has anti-inflammatory, antiallergic and anti-edematous effects. The drugs are prescribed to adults in the form of tablets of 5–10 mg 1 time per day – in the morning;
Dexamethasone (Dexasone, Dexamed) – has a pronounced anti-inflammatory and anti-edematous effect. The drug is prescribed to adults as injections of 4 ml–1 ml 1–2 times a day.

Combination drugs containing long-acting beta2-agonists and glucocorticosteroids:

Seretide (salmeterol - a long-acting beta2-agonist and fluticasone - a glucocorticosteroid) is prescribed to adults 2 puffs 2 times a day. The dosage of the drug is selected according to the severity of chronic obstructive bronchitis.

Antibacterial drugs act on chronic foci of infection in the bronchi due to the accumulation of copious amounts of sputum, which serves as a breeding ground for them. These drugs are prescribed only during the period of exacerbation of the disease.

2nd generation cephalosporins (cefuroxime, cefamandole);
3rd generation cephalosporins (cefotaxime, ceftriaxone);
2nd generation fluoroquinolones (ciprofloxacin, ofloxacin);
Respiratory fluoroquinolones (levofloxacin);
Aminoglycosides (amikacin).

Mucolytic drugs are drugs that stimulate the discharge of sputum from the bronchial tree:

Bromhexine (Solvin, Bronchostop) has antitussive, mucolytic and expectorant effects. Prescribed in tablets of 8–16 mg 3–4 times a day;
Ambroxol (Abrol, Ambrotard) stimulates the liquefaction of sputum by reducing viscosity, which contributes to its better excretion. Prescribed 30 mg (1 tablet) 3 times a day;
Acetylcysteine (ACC) has antitussive and mucolytic effects. Prescribed 200–400 mg 2–3 times a day or 800 mg 1 time a day.

Physiotherapeutic treatment

Inhalations;
Back massage;
Warming up the chest with dry heat;
Therapeutic gymnastics with an individual set of exercises;
Aromatherapy is one of the most effective additional methods of treating chronic obstructive bronchitis, the essence of which consists of prolonged inhalation of essential oils heated in a water bath.

The following are used for aromatherapy: essential oils How:

Obstructive bronchitis

Obstructive bronchitis is a diffuse inflammation of the bronchi of small and medium caliber, occurring with a sharp bronchial spasm and progressive impairment of pulmonary ventilation. Obstructive bronchitis is manifested by cough with sputum, expiratory shortness of breath, wheezing, and respiratory failure. Diagnosis of obstructive bronchitis is based on auscultatory, radiological data, and the results of a study of external respiration function. Therapy for obstructive bronchitis includes the prescription of antispasmodics, bronchodilators, mucolytics, antibiotics, inhaled corticosteroid drugs, breathing exercises, and massage.

Obstructive bronchitis

Bronchitis (simple acute, recurrent, chronic, obstructive) constitutes a large group of inflammatory diseases of the bronchi, varying in etiology, mechanisms of occurrence and clinical course. In pulmonology, obstructive bronchitis includes cases of acute and chronic inflammation of the bronchi, occurring with the syndrome of bronchial obstruction, which occurs against the background of swelling of the mucous membrane, hypersecretion of mucus and bronchospasm. Acute obstructive bronchitis often develops in young children, chronic obstructive bronchitis in adults.

Chronic obstructive bronchitis, along with other diseases that occur with progressive obstruction of the respiratory tract (emphysema, bronchial asthma), is usually referred to as chronic obstructive pulmonary disease (COPD). In the UK and US, COPD also includes cystic fibrosis, bronchiolitis obliterans and bronchiectasis.

Causes of obstructive bronchitis

Acute obstructive bronchitis is etiologically associated with respiratory syncytial viruses, influenza viruses, parainfluenza virus type 3, adenoviruses and rhinoviruses, and viral-bacterial associations. When studying bronchial washings in patients with recurrent obstructive bronchitis, DNA of persistent infectious pathogens - herpesvirus, mycoplasma, chlamydia - is often isolated. Acute obstructive bronchitis mainly occurs in young children. The most susceptible to the development of acute obstructive bronchitis are children who often suffer from acute respiratory viral infections, have a weakened immune system and an increased allergic background, and a genetic predisposition.

The main factors contributing to the development of chronic obstructive bronchitis are smoking (passive and active), occupational risks (contact with silicon, cadmium), air pollution (mainly sulfur dioxide), deficiency of antiproteases (alpha1-antitrypsin), etc. To the group Those at risk for the development of chronic obstructive bronchitis include miners, construction workers, metallurgical and agricultural workers, railway workers, office employees associated with printing on laser printers, etc. Chronic obstructive bronchitis most often affects men.

Pathogenesis of obstructive bronchitis

The summation of genetic predisposition and environmental factors leads to the development of an inflammatory process, which involves small and medium-sized bronchi and peribronchial tissue. This causes disruption of the movement of the cilia of the ciliated epithelium, and then its metaplasia, loss of ciliated cells and an increase in the number of goblet cells. Following the morphological transformation of the mucosa, a change in the composition of the bronchial secretion occurs with the development of mucostasis and blockade of small bronchi, which leads to disruption of the ventilation-perfusion balance.

In the bronchial secretions, the content of nonspecific factors of local immunity that provide antiviral and antimicrobial protection decreases: lactoferin, interferon and lysozyme. Thick and viscous bronchial secretions with reduced bactericidal properties are a good breeding ground for various pathogens (viruses, bacteria, fungi). In the pathogenesis of bronchial obstruction, a significant role is played by the activation of cholinergic factors of the autonomic nervous system, causing the development of bronchospastic reactions.

The complex of these mechanisms leads to swelling of the bronchial mucosa, hypersecretion of mucus and spasm of smooth muscles, i.e. the development of obstructive bronchitis. In case of irreversibility of the bronchial obstruction component, one should think about COPD - the addition of emphysema and peribronchial fibrosis.

Symptoms of acute obstructive bronchitis

As a rule, acute obstructive bronchitis develops in children during the first 3 years of life. The disease has an acute onset and occurs with symptoms of infectious toxicosis and bronchial obstruction.

Infectious-toxic manifestations are characterized by low-grade body temperature, headache, dyspeptic disorders, and weakness. The leading clinical manifestations of obstructive bronchitis are respiratory disorders. Children are bothered by a dry or wet obsessive cough that does not bring relief and worsens at night, and shortness of breath. Note the flaring of the wings of the nose during inhalation, the participation of auxiliary muscles in the act of breathing (neck muscles, shoulder girdle, abdominal muscles), the retraction of compliant areas of the chest during breathing (intercostal spaces, jugular fossa, supra- and subclavian region). For obstructive bronchitis, a prolonged wheezing exhalation and dry (“musical”) wheezing, heard at a distance, are typical.

The duration of acute obstructive bronchitis is from 7-10 days to 2-3 weeks. In case of repetition of episodes of acute obstructive bronchitis three or more times a year, they speak of recurrent obstructive bronchitis; If symptoms persist for two years, a diagnosis of chronic obstructive bronchitis is made.

Symptoms of chronic obstructive bronchitis

The basis of the clinical picture of chronic obstructive bronchitis is cough and shortness of breath. When coughing, a small amount of mucous sputum is usually released; during periods of exacerbation, the amount of sputum increases, and its character becomes mucopurulent or purulent. The cough is constant and is accompanied by wheezing. Against the background of arterial hypertension, episodes of hemoptysis may occur.

Expiratory shortness of breath in chronic obstructive bronchitis usually occurs later, but in some cases the disease can debut immediately with shortness of breath. The severity of shortness of breath varies widely: from sensations of lack of air during exertion to severe respiratory failure. The degree of shortness of breath depends on the severity of obstructive bronchitis, the presence of exacerbation, and concomitant pathology.

Exacerbation of chronic obstructive bronchitis can be provoked by respiratory infection, exogenous damaging factors, physical activity, spontaneous pneumothorax, arrhythmia, the use of certain medications, decompensation diabetes mellitus and other factors. At the same time, signs of respiratory failure increase, low-grade fever, sweating, fatigue, and myalgia appear.

The objective status of chronic obstructive bronchitis is characterized by prolonged exhalation, the participation of additional muscles in breathing, distant wheezing, swelling of the neck veins, and changes in the shape of the nails (“hour glass”). As hypoxia increases, cyanosis appears.

The severity of chronic obstructive bronchitis, according to methodological recommendations Russian society pulmonologists, is assessed by FEV1 (forced expiratory volume in 1 second).

Stage I of chronic obstructive bronchitis is characterized by an FEV1 value exceeding 50% of the normative value. At this stage, the disease has little impact on the quality of life. Patients do not need constant medical monitoring by a pulmonologist.
Stage II of chronic obstructive bronchitis is diagnosed when FEV1 decreases to 35-49% of the normative value. In this case, the disease significantly affects the quality of life; patients require systematic monitoring by a pulmonologist.
Stage III of chronic obstructive bronchitis corresponds to an FEV1 indicator of less than 34% of the expected value. In this case, there is a sharp decrease in stress tolerance; inpatient and outpatient treatment is required in pulmonology departments and offices.

Complications of chronic obstructive bronchitis are emphysema, cor pulmonale, amyloidosis, and respiratory failure. To make a diagnosis of chronic obstructive bronchitis, other causes of shortness of breath and cough must be excluded, primarily tuberculosis and lung cancer.

Diagnosis of obstructive bronchitis

The examination program for persons with obstructive bronchitis includes physical, laboratory, radiological, functional, and endoscopic examinations. The nature of physical findings depends on the form and stage of obstructive bronchitis. As the disease progresses, vocal tremors weaken, a boxy percussion sound appears over the lungs, and the mobility of the pulmonary edges decreases; Auscultation reveals hard breathing, wheezing during forced exhalation, and during exacerbation - moist rales. The tone or amount of wheezing changes after coughing.

X-ray of the lungs allows you to exclude local and disseminated lung lesions and detect concomitant diseases. Usually, after 2-3 years of obstructive bronchitis, an increase in the bronchial pattern, deformation of the roots of the lungs, and pulmonary emphysema are detected. Therapeutic and diagnostic bronchoscopy for obstructive bronchitis allows you to examine the bronchial mucosa, collect sputum and perform bronchoalveolar lavage. To exclude bronchiectasis, bronchography may be necessary.

A necessary criterion for diagnosing obstructive bronchitis is a study of external respiration function. The most important data are spirometry (including inhalation tests), peak flowmetry, and pneumotachometry. Based on the data obtained, the presence, degree and reversibility of bronchial obstruction, impaired pulmonary ventilation, and the stage of chronic obstructive bronchitis are determined.

The complex of laboratory diagnostics examines general blood and urine tests, biochemical blood parameters (total protein and protein fractions, fibrinogen, sialic acids, bilirubin, aminotransferases, glucose, creatinine, etc.). Immunological tests determine the subpopulation functional ability of T-lymphocytes, immunoglobulins, and CEC. Determination of CBS and blood gas composition makes it possible to objectively assess the degree of respiratory failure in obstructive bronchitis.

Microscopic and bacteriological examination of sputum and lavage fluid is carried out, and in order to exclude pulmonary tuberculosis, sputum analysis is carried out using PCR and AFB. Exacerbation of chronic obstructive bronchitis should be differentiated from bronchiectasis, bronchial asthma, pneumonia, tuberculosis and lung cancer, pulmonary embolism.

Treatment of obstructive bronchitis

For acute obstructive bronchitis, rest, drinking plenty of fluids, air humidification, alkaline and medicinal inhalations are prescribed. Etiotropic antiviral therapy (interferon, ribavirin, etc.) is prescribed. For severe bronchial obstruction, antispasmodic (papaverine, drotaverine) and mucolytic (acetylcysteine, ambroxol) agents, bronchodilator inhalers (salbutamol, orciprenaline, fenoterol hydrobromide) are used. To facilitate the discharge of sputum, percussion massage of the chest, vibration massage, massage of the back muscles, and breathing exercises are performed. Antibacterial therapy is prescribed only when a secondary microbial infection occurs.

The goal of treatment of chronic obstructive bronchitis is to slow the progression of the disease, reduce the frequency and duration of exacerbations, and improve the quality of life. The basis of pharmacotherapy for chronic obstructive bronchitis is basic and symptomatic therapy. Quitting smoking is a mandatory requirement.

Basic therapy includes the use of bronchodilators: anticholinergics (ipratropium bromide), b2-agonists (fenoterol, salbutamol), xanthines (theophylline). If there is no effect from the treatment of chronic obstructive bronchitis, corticosteroid drugs are used. To improve bronchial patency, mucolytic drugs (ambroxol, acetylcysteine, bromhexine) are used. Drugs can be administered orally, in the form of aerosol inhalation, nebulizer therapy, or parenterally.

When the bacterial component accumulates during periods of exacerbation of chronic obstructive bronchitis, macrolides, fluoroquinolones, tetracyclines, b-lactams, cephalosporins are prescribed for a course of 7-14 days. In case of hypercapnia and hypoxemia, oxygen therapy is a mandatory component of the treatment of obstructive bronchitis.

Forecast and prevention of obstructive bronchitis

Acute obstructive bronchitis responds well to treatment. In children with an allergic predisposition, obstructive bronchitis can recur, leading to the development of asthmatic bronchitis or bronchial asthma. The transition of obstructive bronchitis to a chronic form is prognostically less favorable.

Adequate therapy helps delay the progression of obstructive syndrome and respiratory failure. Unfavorable factors that aggravate the prognosis are the elderly age of patients, concomitant pathology, frequent exacerbations, continued smoking, poor response to therapy, and the formation of cor pulmonale.

Primary prevention measures for obstructive bronchitis include maintaining a healthy lifestyle, increasing overall resistance to infections, and improving working conditions and the environment. The principles of secondary prevention of obstructive bronchitis involve the prevention and adequate treatment of exacerbations to slow the progression of the disease.

Obstructive bronchitis - treatment in Moscow

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Obstructive bronchitis - symptoms, treatment

Obstructive bronchitis is an inflammatory disease of the bronchi that obstructs the airways. There are acute and chronic forms of the disease. Acute obstructive bronchitis most often occurs in childhood. The main causes of the disease in this case are viral infections (influenza, parainfluenza, adenoviruses, rhinoviruses, respiratory syncytial virus). The chronic form of the disease usually develops in adults.

There are many factors that increase the risk of developing chronic obstructive bronchitis:

smoking;
hereditary genetic pathology, in which patients have a deficiency of α1-antitrypsin;
unfavorable environmental conditions (air pollution, high humidity);
occupational hazards (working with silicon, cadmium, cement, in coal mines, metallurgy, etc.).

Symptoms of obstructive bronchitis

Signs of the acute form of the disease almost always develop against the background of acute respiratory viral infection. Patients experience increased body temperature, weakness, and chills. The main symptom of bronchitis is a cough; at the beginning of the disease it is dry and persistent, and then becomes wet, and a large amount of sputum is released. Shortness of breath, which occurs in severe cases, is caused by the accumulation of secretions in the bronchi, as well as swelling of their mucous membrane. Sometimes, from a distance, when the patient breathes, wheezing, the so-called wheezing exhalation, can be heard.

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

The first visit to the doctor is usually associated with the appearance of shortness of breath and cough, which is sometimes accompanied by sputum production. These symptoms are most pronounced in the morning. Since the disease progresses slowly, in most cases shortness of breath, which initially occurs only during physical exertion, appears on average 7–10 years later than cough.

Exacerbations of chronic obstructive bronchitis are usually associated with acute respiratory diseases, so coughing with purulent sputum and increased shortness of breath are often not regarded as signs of this particular disease. Over time, exacerbations of the disease begin to occur more often, and periods of remission are significantly reduced.

As bronchitis progresses, “wheezing” breathing joins the cough, and shortness of breath can vary from a feeling of lack of air with habitual physical activity to severe respiratory failure.

Treatment of acute obstructive bronchitis

In the acute form of obstructive bronchitis, therapy is aimed at treating the underlying disease, as well as eliminating bronchial obstruction. In children, to clear the airways, it is recommended to suction out accumulated mucus and secretions with a rubber balloon or an electric suction. Vibration massage and postural (positional) drainage help improve mucus discharge.

Distraction therapy - hot foot baths - will help alleviate the patient's condition somewhat, and if you are feeling well, you are allowed to take a shared bath. Warm (not hot) drinking plenty of fluids and expectorant mixtures (infusions based on marshmallow root, ipecac, thermopsis) help thin the mucus and facilitate its release. To relieve swelling of the bronchial mucosa and thin the sputum, aerosol inhalations are recommended.

If a bacterial infection occurs and the sputum becomes purulent, the doctor may prescribe broad-spectrum antibiotics. It should be noted that in order to prevent infectious complications, antibacterial drugs should never be used. To strengthen the body's defenses, vitamin therapy is prescribed (Biomax, Vitrum, Complivit, ascorbic acid).

Treatment of chronic obstructive bronchitis

Therapeutic tactics for the chronic form of the disease differ significantly from those for acute bronchitis. Only a doctor can select a treatment regimen for a patient, taking into account the stage of the disease, the patient’s age and the presence of concomitant diseases.

First of all, it is necessary to eliminate the factor that caused the development of the disease. This is an important and mandatory stage of treatment, without which achieving a positive treatment result is impossible.
Bronchodilator therapy is necessary for patients suffering from chronic obstructive bronchitis, since obstruction of the airways, in this case, is the main link in the pathogenesis of the disease. Drugs that have a bronchodilator effect include m-anticholinergics (Atrovent, Spiriva), β2-agonists (Salbutamol, Fenoterol) and methylxanthines (Eufillin).
Mucolytics (Ambrobene, Bromhexine) help liquefy and, therefore, facilitate the discharge of sputum from the bronchi. Herbal remedies can also be used as expectorants.
Antibacterial therapy is prescribed only if pus appears in the sputum.

To prevent exacerbations of the disease during periods of remission, patients are recommended to perform procedures aimed at strengthening the immune system (hardening, physical exercise, proper nutrition, periodic courses of vitamin therapy).

Which doctor should I contact?

If initial symptoms of bronchial inflammation (cough) appear, you can consult a pediatrician or therapist and undergo an initial examination, which should include an assessment of external respiratory function and a test with bronchodilators. Subsequently, patients with bronchial obstruction are treated by a pulmonologist.

Sections

Chronic obstructive bronchitis diagnosis. Obstructive bronchitis

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General information

Causes

Classification

Symptoms of chronic bronchitis

Diagnostics

Treatment of chronic bronchitis

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JMedic.ru

Causes of the disease

Classification of the disease

Symptoms of the disease

Modern examination methods

Main types of treatment

Drug treatment

Physiotherapeutic treatment

Obstructive bronchitis

Obstructive bronchitis

Causes of obstructive bronchitis

Pathogenesis of obstructive bronchitis

Symptoms of acute obstructive bronchitis

Symptoms of chronic obstructive bronchitis

Diagnosis of obstructive bronchitis

Treatment of obstructive bronchitis

Forecast and prevention of obstructive bronchitis

Obstructive bronchitis - treatment in Moscow

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Respiratory diseases

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Obstructive bronchitis - symptoms, treatment

Symptoms of obstructive bronchitis

Treatment of acute obstructive bronchitis

Treatment of chronic obstructive bronchitis

Which doctor should I contact?