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Chronical bronchitis



Chronic bronchitis is a progressive diffuse inflammation of the bronchi that is not associated with local or generalized lung damage, manifests itself as a cough. About chronic bronchitis can be said if the cough lasts for 3 months in the 1st year - 2 years in a row.

Etiology. The disease is associated with prolonged irritation of the bronchi with various harmful factors (inhalation of air polluted by dust, smoke, carbon monoxide, sulfur dioxide, nitrogen oxides and other chemical compounds) and recurrent respiratory infection (respiratory viruses, Pfeiffer's rod, pneumococci) occurs with cystic fibrosis. Predisposing factors are chronic inflammatory, suppuration in the lungs, chronic foci of infection and chronic diseases localized in the upper respiratory tract, decreased reactivity of the organism, hereditary factors.

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

Clinical manifestations. The onset of the disease is gradual. The first and main symptom is a cough in the morning with the departure of mucous sputum, gradually a cough begins to occur at any time of the day, increases in cold weather and with time becomes permanent. Increased sputum, sputum becomes mucopurulent or purulent. Appears shortness of breath. With purulent bronchitis, purulent sputum may periodically be released, but bronchial obstruction is little pronounced. Obstructive chronic bronchitis is manifested by persistent obstructive disorders. Purulent-obstructive bronchitis is characterized by the release of purulent sputum and obstructive ventilation disorders. Frequent exacerbations during periods of cold wet weather: cough, shortness of breath, sputum increases, malaise, fatigue. Body temperature is normal or subfebrile, hard breathing and dry wheezing can be determined over the entire pulmonary surface.

Diagnostics. A small leukocytosis with a stab-shift shift in the leukocyte formula is possible. With exacerbation of purulent bronchitis, there is an insignificant change in the biochemical indices of inflammation (C-reactive protein, sialic acids, fibronogen, seromucoid, etc.) increase. Sputum examination: macroscopic, cytological, biochemical. In severe exacerbation, sputum becomes purulent: a large number of neutrophilic leukocytes, an increased content of acid mucopolysaccharides and DNA fibers, a sputum character, predominantly neutrophilic leukocytes, an increase in the level of acid mucopolysaccharides and DNA fibers, which increase the viscosity of phlegm, decrease the amount of lysozyme, etc. Bronchoscopy, with the help of which the endobronchial manifestation of the inflammatory process is evaluated, the stages of development of the inflammatory process: catarrhal, purulent, atrophic, gi peritrophic, hemorrhagic and its severity, but mainly to the level of subsegmental bronchi.

Differential diagnosis is carried out with chronic pneumonia, bronchial asthma, tuberculosis.
Unlike chronic pneumonia, chronic bronchitis always develops with a gradual onset, with widespread bronchial obstruction and often emphysema, respiratory failure and pulmonary hypertension with the development of a chronic pulmonary heart. When X-ray examination, the changes are also diffuse: peribronchial sclerosis, increased transparency of the pulmonary fields due to emphysema, expansion of the branches of the pulmonary artery. From bronchial asthma, chronic bronchitis is characterized by the absence of asthma attacks, with pulmonary tuberculosis associated with the presence or absence of symptoms of tuberculous intoxication, mycobacterium tuberculosis in sputum, the results of radiographic and bronchoscopic examination, tuberculin samples.

Treatment. In the phase of exacerbation of chronic bronchitis, therapy is directed at eliminating the inflammatory process, improving the patency of the bronchi, and restoring the impaired general and local immunological reactivity. Assign antibiotibacterial therapy, which is selected to take into account the sensitivity of the microflora of phlegm, appointed orally, or parenterally, sometimes combined with intratracheal administration. Showing inhalation. Applied expectorant, mucolytic and bronchospasmolytic drugs, abundant drink to restore and improve bronchial patency. Phytotherapy with the use of Altaic root, leaves of mother-and-stepmother, plantain. Assign proteolytic enzymes (trypsin, chymotrypsin), which reduce the viscosity of phlegm, but are currently used rarely. Acetylcysteine ​​has the ability to rupture the disulfide bonds of mucus proteins and promotes strong and rapid liquefaction of sputum. Bronchial drainage improves with the use of mucoregulators that affect the secret and the production of glycoproteins in the bronchial epithelium (bromhexine). With insufficient bronchial drainage and the existing symptoms of bronchial obstruction, bronchospasmolytic agents are added to the treatment: euphyllin, holinoblockers (atropine in aerosols), adrenostimulants (ephedrine, salbutamol, berotek). In a hospital, intra-tracheal lavage with purulent bronchitis should be combined with sanation bronchoscopy (3-4 sanation bronchoscopy with a break of 3-7 days). When restoring the drainage function of the bronchi, they also use physical therapy, chest massage, physiotherapy. 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 long-term glucocorticoids. In patients with chronic bronchitis, complicated by respiratory failure and chronic pulmonary heart, the use of veroshpiron (up to 150-200 mg / day) is indicated.

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

Anti-relapse and maintenance therapy is prescribed during the acute exacerbation phase, it is performed in local and climatic sanatoriums, this therapy is prescribed during clinical examination.

It is recommended to allocate 3 groups of dispensary patients.

1st group. It includes patients with pulmonary heart, with severe respiratory insufficiency and other complications, with disability. Patients are assigned maintenance therapy, which is carried out in a hospital or a district doctor. These patients are examined at least once a month.

2nd group. It includes patients with frequent exacerbations of chronic bronchitis, as well as moderate impairment of respiratory function. Such patients are examined by a pulmonologist 3-4 times a year, anti-relapse therapy is prescribed in the fall and in the spring, as well as in acute respiratory diseases. An effective method of drug administration is the inhalation route, according to indications it is necessary to sanitize the bronchial tree using intracerebral lavage, sanative bronchoscopy. With active infection, antibacterial drugs are prescribed.

3rd group. It includes patients in whom anti-relapse therapy has led to the process's calming down and the absence of relapses for 2 years. Such patients are shown preventive therapy, which includes means aimed at improving bronchial drainage and increasing its reactivity.
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Chronical bronchitis

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  5. Chronical bronchitis
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