the main
about the project
Medicine news
To the authors
Licensed books on medicine
<< Ahead

Chronical bronchitis



Chronic bronchitis is a progressive diffuse inflammation of the bronchi that is not associated with a local or generalized lung lesion, and is manifested by coughing. About chronic bronchitis, you can talk 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 by various harmful factors (inhalation of air contaminated with dust, smoke, carbon monoxide, sulfur dioxide, nitrogen oxides and other compounds of chemical nature) and recurrent respiratory infection (a large role belongs to respiratory viruses, Pfeiffer rod, pneumococcus), less often occurs when cystic fibrosis. Predisposing factors - chronic inflammatory, suppurative processes in the lungs, chronic foci of infection and chronic diseases localized in the upper respiratory tract, decreased reactivity of the body, hereditary factors.

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

Clinical manifestations. The onset of the disease is gradual. The first and main symptom is a cough in the morning with the discharge of mucous sputum, gradually the cough begins to occur at any time of the day, increases in cold weather and becomes permanent over the years. The amount of sputum increases, the sputum becomes mucopurulent or purulent. Dyspnea appears. In purulent bronchitis, purulent sputum can periodically be released, but bronchial obstruction is not very pronounced. Obstructive chronic bronchitis is manifested 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 increases, shortness of breath, sputum increases, malaise, fatigue. Body temperature is normal or subfebrile, hard breathing and dry rales over the entire lung surface can be determined.

Diagnostics. Possible small leukocytosis with a stab shift in leukocyte formula. When exacerbation of purulent bronchitis, there is a slight change in the biochemical parameters of inflammation (increased C-reactive protein, sialic acids, fibronogen, seromukoid, etc.). Sputum examination: macroscopic, cytological, biochemical. With a pronounced exacerbation of sputum becomes purulent: a large number of neutrophilic leukocytes, elevated levels of acidic mucopolysaccharides and DNA fibers, sputum character, mainly neutrophilic leukocytes, increased levels of acidic mucopolysaccharides and DNA fibers, which increase the viscosity of sputum, reduced lysozyme, etc. Bronchoscopy, with the help of which the endobronchial manifestations of the inflammatory process are evaluated, the stages of development of the inflammatory process: catarrhal, purulent, atrophic, gi pertrophic, hemorrhagic and its severity, but mainly to the level of subsegmental bronchi.

The differential diagnosis is carried out with chronic pneumonia, bronchial asthma, and tuberculosis.
In contrast to chronic pneumonia, chronic bronchitis always develops from a gradual onset, with widespread bronchial obstruction and often emphysema, respiratory failure and pulmonary hypertension with the development of chronic pulmonary heart disease. In X-ray studies, the changes are also diffuse: peribronchial sclerosis, increased transparency of the pulmonary fields due to emphysema, expansion of the branches of the pulmonary artery. Chronic bronchitis differs from bronchial asthma in the absence of suffocation attacks, it is associated with pulmonary tuberculosis by the presence or absence of symptoms of tuberculous intoxication, mycobacterium tuberculosis in sputum, the results of x-ray and bronchoscopic examination, tuberculin tests.

Treatment. In the phase of exacerbation of chronic bronchitis, therapy is directed to the elimination of the inflammatory process, improvement of the bronchial patency, as well as restoration of impaired general and local immunological reactivity. Antibiotics are prescribed, which are selected taking into account the sensitivity of sputum microflora, administered orally or parenterally, sometimes combined with intratracheal administration. Showing inhalation. Apply expectorant, mucolytic and bronchospasmolytic drugs, drink plenty of fluids to restore and improve bronchial patency. Herbal medicine with the use of Altea root, leaves, mother and stepmother, plantain. Prescribed proteolytic enzymes (trypsin, chymotrypsin), which reduce the viscosity of sputum, but are now rarely used. Acetylcysteine ​​has the ability to break the disulfide bonds of mucus proteins and contributes to the strong and rapid dilution of sputum. Bronchial drainage improves with the use of mucoregulators, which affect the secret and the production of glycoproteins in the bronchial epithelium (bromhexin). In case of insufficiency of bronchial drainage and existing symptoms of bronchial obstruction, bronchospasmolytic agents are added to the treatment: aminophylline, holinoblokatory (atropine in aerosols), adrenostimulants (ephedrine, salbutamol, berotok). In a hospital setting intratracheal washing with purulent bronchitis must be combined with a rehabilitation bronchoscopy (3-4 sanation bronchoscopy with a break of 3-7 days). When restoring the drainage function of the bronchi, therapeutic physical training, chest massage, and physiotherapy are also used. With the development of allergic syndromes, calcium chloride and antihistamines are used; in the absence of effect, you can prescribe a short course of glucocorticoids 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 Verohspiron is shown (up to 150–200 mg / day).

Food of patients should be high-calorie, fortified. Applied ascorbic acid 1 g per day, nicotinic acid, B vitamins; if necessary aloe, methyluracil. With the development of complications of the disease such as pulmonary and pulmonary heart disease, use oxygen therapy, auxiliary artificial respiration.

Anti-relapse and supportive therapy is prescribed in the phase of exacerbation, it is carried out in local and climatic sanatoriums, this therapy is prescribed during medical examination.

Recommend to allocate 3 groups of dispensary patients.

1st group. It includes patients with a pulmonary heart, with a pronounced respiratory failure and other complications, with disability. Patients are prescribed supportive therapy, which is carried out in a hospital or general practitioner. Examination of these patients is carried out at least 1 time per month.

2 nd group. It includes patients with frequent exacerbations of chronic bronchitis, as well as moderate violations of the function of the respiratory organs. Examination of such patients is carried out by a pulmonologist 3-4 times a year, anti-relapse therapy is prescribed in the fall and spring, as well as in acute respiratory diseases. An effective method of administering drugs is the inhalation route; according to indications, it is necessary to carry out a reorganization of the bronchial tree, using intratracheal washes, and reorganization bronchoscopy. With active infection, prescribe antibacterial drugs.

3rd group. It includes patients in whom anti-relapse therapy has led to a decline in the process and the absence of relapses for over 2 years. Such patients are shown prophylactic therapy, which includes means aimed at improving bronchial drainage and increasing its reactivity.
<< Ahead
= Go to tutorial content =

Chronical bronchitis

  1. CHRONICAL BRONCHITIS. CHRONIC PULMONARY HEART.
    In recent years, due to the deteriorating environmental situation, the prevalence of smoking, changes in the reactivity of the human body, there has been a significant increase in the incidence of chronic nonspecific lung diseases (COPD). The term COPD was adopted in 1958 in London at a symposium convened by the pharmaceutical concern Ciba. He combined such diffuse diseases
  2. Chronical bronchitis
    Chronic bronchitis is a chronic disease characterized by diffuse inflammatory lesions of the respiratory tract with excessive secretion of mucus in the bronchial tree and sclerotic changes in the deeper layers of the bronchial wall, manifested by productive cough, persistent rattles of different caliber in the lungs (for 3 months), if there are exacerbations at least two times a
  3. Chronical bronchitis
    Chronic bronchitis is a disease that is common among smokers and residents of megalopolises affected by smog (a mixture of fog, smoke and soot). The diagnosis of chronic bronchitis is made when a persistent cough with sputum lasts for at least 3 months in 2 years. With simple chronic bronchitis, cough with sputum is noted without signs of airflow obstruction.
  4. CHRONICAL BRONCHITIS
    - diffuse inflammatory lesion of the bronchial tree, caused by prolonged irritation of the bronchi by various harmful agents, which has a progressive course and is characterized by impaired mucus formation and draining function, which manifests as cough, sputum and shortness of breath. According to the WHO recommendation, bronchitis can be considered chronic if the patient coughs up sputum on
  5. Chronical bronchitis
    Chronic bronchitis - a progressive, diffuse inflammation of the bronchi, not associated with local or generalized lung disease, is manifested by coughing. You can talk about chronic bronchitis if the cough lasts for 3 months in 1 year for 2 years in a row. The disease is associated with prolonged irritation of the bronchi by various harmful factors (smoking, inhalation of air contaminated with dust,
  6. CHRONICAL BRONCHITIS
    On the patency of the bronchi: obstructive and non-obstructive. By lesion level: proximal - up to 5 - 6 bronchus generation. Purulent and catarrhal. Obstructive bronchitis. If distal, then the main symptom is associated with an air trap (when breathing in, air enters the alveoli, during exhalation the bronchi are shortened, take the form of a corrugated tube and the air does not pass back, the volume increases
  7. Chronic bronchitis in children
    Protocol code: 04-042 Profile: pediatric Stage: inpatient Purpose of the stage: 1. clarification of the diagnosis and elimination of the inflammatory process in the bronchi; 2. relief of symptoms of respiratory failure, general intoxication; 3. restoration of FEV1. Duration: 11 days. ICD codes: J40 Bronchitis, not specified as acute or chronic. J41.0. Simple chronic bronchitis. J41.1. Muco-purulent
  8. Chronical bronchitis
    CHRONIC BRONCHITIS (HB) is a diffuse inflammatory lesion of the bronchial tree, caused by prolonged irritation of the airways by volatile pollutants and / or (rarely) by viral-bacterial agents, accompanied by hypersecretion of mucus, impaired bronchial cleansing function, which manifests itself as a permanent or periodically occurring cough and sputum production.
  9. Chronic bronchitis and emphysema
    Chronic bronchitis is a disease characterized by chronic or recurrent excessive secretion of mucus in the bronchi, leading to the appearance of productive cough with annual exacerbations of up to 3 months or more in recent years. Pulmonary emphysema is a disease caused by an increase in the airspace of the terminal bronchioles as a result of destructive changes in their walls. There are
  10. CHRONIC BRONCHITIS AND LUNG EMPHYSIS
    Chronic bronchitis is a disease characterized by chronic or recurrent excessive secretion of mucus in the bronchi, leading to the appearance of productive cough with annual exacerbations of up to 3 months or more in recent years. Pulmonary emphysema is a disease caused by an increase in the airspace of the terminal bronchioles as a result of destructive changes in their walls. There are
  11. Chronical bronchitis.
    The criterion for the diagnosis of chronic bronchitis is a productive cough for most days of three consecutive months for at least two consecutive years. In the etiology of chronic bronchitis, smoking, air pollution, occupational contact with dust, recurrent pulmonary infections, and hereditary factors play a role. Hypertrophied bronchial gland secretion and edema
  12. Chronic bronchitis (code J 41, J 44)
    Definition Chronic bronchitis is a diffuse, progressive non-allergic inflammatory lesion of the bronchial tree, associated with prolonged irritation of the airways by harmful agents, usually characterized by restructuring of the mucosal secretory apparatus, as well as sclerotic changes in the deeper layers of the bronchial wall and peribronchial tissue,
  13. 50. CHRONIC BRONCHITIS.
    bronchi and bronchioles. Etiology and pathogenesis. Infection. HB can develop on the basis of acute bronchitis or pneumonia. An important role in its development has long-term irritation of the bronchial mucosa with chemicals, dust, and smoking. At the onset of the disease, the mucosa is full-blooded, sometimes hypertrophied, the mucous glands in a state of hyperplasia. Further, the inflammation spreads to
  14. CHRONIC OBSTRUCTIVE LUNG DISEASES / CHRONIC BRONCHITIS AND LUNG EMPHYSIS /
    Chronic obstructive pulmonary disease is a pathological condition characterized by the formation of chronic obstruction of the airways due to chronic bronchitis (CB) and / or pulmonary emphysema / EL /. Chronic obstructive pulmonary diseases are widespread. It is estimated that HB affects about 14–20% of the male and about 3–8% of the female adult population, but only
  15. CHRONIC BRONCHITIS, LUNG EMPHYSIS AND BRONCHO-OBSTRUCTIVE SYNDROME
    Roland G. Ingram, Jr. (Roland H. Ingram, Sr.) Chronic bronchitis and pulmonary emphysema are two relatively independent diseases, often occurring simultaneously and causing the development of chronic bronchial obstruction. The diagnosis of chronic bronchitis is established on the basis of anamnesis, the presence of broncho-obstructive syndrome, confirmed in the course of functional studies
  16. Abstract. Chronic obstructive bronchitis, 2009
    Content Introduction 1. The clinical picture of chronic bronchitis 2. Diagnosis of COB 3. Prevention and treatment of chronic obstructive bronchitis Conclusion
Medical portal "MedguideBook" © 2014-2016
info@medicine-guidebook.com