BRONCHITIS

BRONCHITIS is an inflammatory disease of the bronchi. There are acute bronchitis, acute bronchiolitis and chronic bronchitis.

In the development of acute bronchitis the main role belongs to infection, mainly viral, less often viral-bacterial and bacterial. Along with infection, acute bronchitis can cause exposure to chemicals (sulfur dioxide, nitrogen oxides, etc.), unfavorable physical factors (dust, dry, cold and hot air). Predisposing factors are smoking , the presence of focal infection, hypothermia, nasal breathing. Depending on the level of inflammation, tracheobronchitis, bronchitis with lesions of large and medium bronchi and bronchiolitis are distinguished.

Clinical picture. Often acute bronchitis is preceded by rhinitis, laryngitis, tracheitis. The main symptom is the sagging behind the sternum, a dry, painful cough sometimes with a mild separation of mucous sputum. In the future, sputum may become more abundant, acquire a yellowish or greenish color - it is purulent sputum that indicates a bacterial infection. Especially painful cough with discharge of mucous or bloody sputum is observed with toxic-chemical bronchitis. In severe forms, shortness of breath is noted, shortness of breath due to airway obstruction, subfebrile body temperature, weakness, sweating, headache , pain in the lower parts of the chest and upper abdomen associated with muscle overexertion during coughing.

The objective data are meager. Auscultatory determination of hard breathing, prolonged exhalation, dry whistling wheezing (in the case of bronchial obstruction) can be heard, less often wet small bubbling rales . Symptoms of uncomplicated acute bronchitis gradually subsided and disappear by the 5th-7th day of the disease. Cases with bronchial obstruction take a prolonged course and tend to change into chronic bronchitis. In young children and the elderly, acute bronchitis can be complicated by pneumonia. The most severe acute bronchitis with lesions of small bronchi.

Treatment. During the period of fever bed rest is necessary. In uncomplicated forms, a plentiful warm drink with raspberries, honey, lime blossom, mineral waters in a heated form, mustard plasters and cans on the chest is prescribed. Use inhalation of mineral waters, sodium bicarbonate. With dry painful cough appoint libexin , tusuprex. In case of sputum discharge, expectorants (thermopsis, potassium iodide, bromhexine), infusions of herbs (mother-and-stepmother, tri-color violet, elecampane, etc.) are used. To stop bronchospasm, bronchodilators (euphyllin) are indicated. In severe disease and inefficacy of the listed activities, antibiotic therapy is indicated. For this purpose, erythromycin , roxithromycin (rulid), amoxicillin , doxycycline (vibramycin), bactrim, biseptol can be used. With poor fever tolerance, antipyretics (aspirin) are prescribed every 4-6 hours.

Prevention is to eliminate adverse environmental factors, stop smoking, prevent viral infections.

Bronchiolitis occurs with the defeat of bronchioles; Characterized by severe course with the development of respiratory failure; The etiology is usually viral.

Clinical picture. Often bronchiolitis is preceded by symptoms of acute bronchitis or tracheobronchitis. Sometimes the disease develops sharply. Characteristic increase in temperature to 38 - 39 ° C, a painful cough with poor sputum (in the case of development against the background of tracheobronchitis), dyspnea at rest up to 40 breaths per 1 minute or more, shallow breathing with the participation of ancillary musculature. Puffiness and cyanosis of the face, cyanosis of the ears, extremities are noted. The shoulder belt is raised, which gives the impression of a fixed chest in the inhalation position. Percussion sound with a boxed tint, especially in the lower parts, determines the lowering of the lower border of the lungs with the restriction of their mobility. Against the background of a weakened or hard breathing, dry whistling and unvoiced small bubbling rales are heard. There is a tachycardia , there is a tendency to decrease blood pressure. In the blood there may be neutrophilic leukocytosis , an increase in ESR. The course of the disease is severe. The heart-vascular insufficiency joins the respiratory system.

Treatment. The patient is hospitalized. Parenteral administration of broad-spectrum antibiotics in doses prescribed for pneumonia, oxygen therapy, bronchodilators (euphyllin) are shown. Useful mustard plasters, circular cans, rubbing with turpentine ointment, alcohol compresses on the chest. With painful cough apply codeine , libexin , and when the cough becomes productive - expectorants ( mucaltin , acetylcysteine , bromhexine, thermopsis, etc.). With the testimony, it is advisable to manage patients in the intensive care unit or in the intensive care unit.

Chronic bronchitis - diffuse lesion of the bronchial tree, associated with prolonged exposure to nonspecific stimuli; Is accompanied by hypersecretion of mucus and structural changes in the bronchi, manifested by cough and sputum production for 3 months per year for 2 years or more. In the development of chronic bronchitis, an important role is attached to the transferred infection of the respiratory tract, especially the viral, to adverse effects of various factors (smoking, increased dust and gas content), immunodeficiency states. The defeat of the mucous membrane of the bronchial tree leads to the hyperproduction of the viscous secretion, the disorder of the bronchial cleansing function, which contributes to the violation of bronchial patency with the subsequent development of hypoxemia and pulmonary hypertension.

The clinical picture of the disease develops gradually. The main complaints of patients are cough , separation of sputum and dyspnea . The amount of sputum is different - from a scanty discharge to 100-150 ml per day, and depends on the degree of damage, and on the phase of the disease (exacerbation or remission). Sputum can be mucous, mucopurulent or purulent, usually leaves in the morning. Often patients do not attach importance to the separation of sputum, attributing it to smoking. Gradually, patients begin to worry about shortness of breath , first with physical exertion and exposure to cold, and as the disease progresses and at rest. Distal bronchial dyspnea can be the main symptom of the disease. A characteristic sign is a slowing of the forced exhalation: the patient is asked to take a deep breath and exhale as quickly and fully as possible (normally the expiration time does not exceed 4 s). In objective research, a barrel chest, a boxed color with percussion, a weakened or hard breathing with prolonged exhalation, dry whistling or buzzing rales can be detected. In the presence of respiratory failure, cyanosis is noted, with the development of chronic pulmonary heart - heart failure . The disease occurs with exacerbations, alternating with remissions.

Exacerbations are provoked by infection, unfavorable meteorological factors (high humidity, hypothermia). During the period of exacerbations, coughing is increased, sputum is increased, usually purulent, dyspnoea, signs of intoxication (low-grade fever, weakness, sweating), bronchial obstruction: cervical swelling on exhalation, prolonged exhalation, dry wheezes, which are sometimes better audible Lying position or with forced expiration. The course of chronic bronchitis can be complicated by the development of bronchiectasis, focal pneumonia, respiratory failure, chronic pulmonary heart. In blood during exacerbations there may be a moderate increase in ESR.

Diagnosis of chronic bronchitis is established on the basis of the following data: sputum production for at least 3 months in a year, a prolonged course of the disease, alternation of exacerbations and remissions, no indication of tuberculosis and occupational hazard in the anamnesis,

Treatment. Antibacterial therapy is indicated for severe exacerbations of the disease caused by bacterial infection and proceeding with intoxication, purulent sputum, signs of bronchial obstruction. Taking into account the main pathogenic flora (pneumococcus, hemophilic rod), it is advisable to prescribe cefaclor , cefuroxime axetil (zinate), amoxicillin , rooxithromycin , azithromycin , ciprofloxacin , cotrimoxazole. When purulent forms are desirable local administration of antibacterial drugs (inhalation, intratracheal), recommended sanation bronchoscopies with washing solution furatsilina. To liquefy sputum and improve its departure, a generous warm drink, potassium iodide, acetylcysteine , bromhexine , mucaltin, thermopsis (on a tablespoon every 2 to 3 hours) is prescribed. A good effect is given by infusions of herbs (mother-and-stepmother, ledum, tri-color violet, licorice root, etc.) with systematic use, alkaline inhalations, chest massage. In the presence of a bronchospastic component, bronchodilators (euphyllin, inhalation of berotek, beroduala) are used. All patients with chronic bronchitis are shown therapeutic exercise, respiratory gymnastics.

In the prevention of chronic bronchitis the main place is occupied by fighting with smoking, improving the environment, eliminating harmful production factors, preventing respiratory infections.