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Diagnosis and treatment of chronic bronchitis



A small leukocytosis with a stab shift in the leukocyte formula is possible. With exacerbation of purulent bronchitis, a slight change in the biochemical parameters of inflammation occurs (C-reactive protein, sialic acids, fibronogen, seromucoid, etc. increase). Sputum examination: macroscopic, cytological, biochemical.

With a pronounced exacerbation of sputum, it becomes purulent in nature: predominantly neutrophilic leukocytes appear in it, the level of acid mucopolysaccharides and DNA fibers increase, which increase the viscosity of sputum, the amount of lysozyme decreases, etc. Using bronchoscopy, the endobronchial manifestations of the inflammatory process and stages of the inflammatory process are assessed: catarrhal, purulent, atrophic, hypertrophic, hemorrhagic and severity, but mainly to the level of subsegmental bronchi.

In the phase of exacerbation of chronic bronchitis, therapy is directed to eliminating the inflammatory process, improving bronchial patency, and also restoring impaired general and local immunological reactivity. Antibacterial therapy is prescribed, which is selected taking into account the sensitivity of sputum microflora, is prescribed orally or parenterally, sometimes combined with intratracheal administration. Showing inhalation. They use expectorant, mucolytic drugs, a plentiful drink to restore and improve bronchial patency. Herbal medicine with the use of marshmallow root, leaves of coltsfoot, plantain.
Prescribe proteolytic enzymes (trypsin, chymotrypsin) that reduce the viscosity of sputum. Acetylcysteine ​​has the ability to break the disulfide bonds of mucus proteins and contributes to a strong and rapid liquefaction of sputum. Bronchial drainage improves with the use of mucoregulators that affect the secretion and the production of glycoproteins in bronchial epithelium (bromhexine). In case of insufficiency of bronchial drainage and the existing symptoms of bronchial obstruction, bronchospasmolytic drugs are added to the treatment: aminophylline, anticholinergics (atropine in aerosols), adrenostimulants (ephedrine, salbutamol, berotek). In a hospital, intratracheal lavage with purulent bronchitis must be combined with sanitation bronchoscopy (3-4 sanitation bronchoscopy with a break of 3-7 days). When restoring the drainage function of the bronchi, physiotherapy exercises, chest massage, and physiotherapy are also used. With the development of allergic syndromes, calcium chloride and antihistamines are used; in the absence of effect, a short course of glucocorticoids can be prescribed to relieve the allergic syndrome, but the daily dose should not be more than 30 mg. The danger of activation of infectious agents does not allow the use of glucocorticoids for a long time. Patients with chronic bronchitis complicated by respiratory failure and chronic pulmonary heart are shown to use Veroshpiron (up to 150-200 mg / day).

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Diagnosis and treatment of chronic bronchitis

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    The main symptoms of the disease that cause the patient to see a doctor are increasing shortness of breath, sometimes accompanied by coughing sputum production and wheezing. Shortness of breath - can vary within a very wide range: from a feeling of lack of air during standard physical exertion to severe respiratory failure. Dyspnea usually develops
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