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CHRONICAL BRONCHITIS

- diffuse inflammatory lesion of the bronchial tree, due to prolonged irritation of the bronchi by various harmful agents, having a progressive course and characterized by impaired mucus formation and drainage function, which is manifested by cough, sputum and shortness of breath

According to the WHO recommendation, bronchitis can be considered chronic if the patient coughs up sputum for three consecutive months, for two years. Chronic bronchitis is divided into primary and secondary. Secondary develops against the background of other diseases — pulmonary (tuberculosis, bronchiectasis, chronic pneumonia, etc.) and extrapulmonary (uremia, congestive heart failure, etc.). Most often, secondary chronic bronchitis is segmental, i.e., is local in nature.



The main clinical manifestations

Patients complain of a cough, which has its own openings, depending on the morphological variant of bronchitis. With catarrhal bronchitis, a cough is accompanied by the release of a small amount of mucous watery sputum, often in the morning. With purulent and mucopurulent bronchitis, patients sometimes see, but rarely feel sputum production. With exacerbation of sputum, it becomes purulent.

With obstructive bronchitis, a cough is unproductive and horsing. Shortness of breath occurs in all patients with chronic bronchitis at various stages of the disease. In typical cases, progresses slowly, shortness of breath usually appears after 20-30 years. A history of hypersensitivity to cooling, an indication of smoking. Men are sick 6 times more often than women. In a number of patients, the disease is associated with occupational hazards or production. Recurrent hemoptysis is an indication of the hemorrhagic form of bronchitis.

Objectively: changes in auscultation data are expressed with obstructive bronchitis; with nonobstructive, they are minimal in the phase of remission and most during exacerbation, when you can listen to wet rales of various calibers. Wet rales disappear after coughing and sputum production. In the future, signs of decompensated pulmonary heart can appear - acrocyanosis, pastes or swelling of the legs and feet, changes in the nails by the type of watch glasses, and terminal phalanges of the hands and feet by the type of drumsticks, swelling of the cervical veins, pulsation in the epigastric region due to the right ventricle, accent II tone in the 2nd intercostal space to the left of the sternum, enlarged liver.

Additional studies have varying degrees of significance in the diagnosis of chronic bronchitis, depending on the stage of the process.



Classification

There is currently no generally accepted classification. It is recommended to highlight the main forms of chronic bronchitis proposed by A. N. Kokosov and V. A. Gerasimov (1984): catarrhal (superficial and purulent) by the nature of the inflammatory process, obstructive and non-obstructive, especially functional characteristics.
N.R. Paleev et al. (1985) in the classification include special, rare forms - hemorrhagic and fibrinous chronic bronchitis. They also propose to divide by the level of bronchial lesions: with a primary lesion of the large bronchi (proximal) and with a primary lesion of the small bronchi (distal).



Diagnostic criteria

Cough, sputum production, shortness of breath, sweating, weakness, fever, fatigue; reduced ability to work appears with an exacerbation of the disease; hard breathing with the development of emphysema can become weakened; dry rales of a diffuse nature, the timbre of which depends on the caliber of the affected bronchi. Whistling wheezing, especially audible on exhalation, is characteristic of lesions of the small bronchi. Wet rales in chronic bronchitis can disappear after a good coughing and sputum production. Signs of bronchial obstruction are expressed. 1) in lengthening the expiratory phase with calm and especially with forced breathing; 2) in wheezing wheezing on exhalation, which is clearly audible with forced breathing and in a prone position; 3) in the symptoms of obstructive emphysema.

Laboratory and instrumental indicators are used to identify the activity of the inflammatory process, clarify the clinical form of the disease, identify complications, differential diagnosis with diseases that have similar clinical symptoms.

In the majority of patients on survey radiographs, changes in the lungs are absent. Mesh deformation of the pulmonary pattern due to the development of pneumosclerosis is sometimes observed. With a long course of the process, signs of emphysema are detected. The "bulging" of the trunk of the pulmonary artery on the left side of the heart shadow, the expansion of the basal arteries with their subsequent conical narrowing and a decrease in the diameter of the peripheral branches is noted with the development of the pulmonary heart. If necessary, the patient undergoes bronchography, bronchoscopy, examines the function of external respiration, blood gases and acid-base state, radiopulmonography, electrocardiography. Clinical and biochemical blood tests are performed to clarify the degree of activity of the process. Examination of sputum and bronchial contents also helps to establish the severity of inflammation.



Diagnosis Examples

1 Chronic catarrhal bronchitis in remission.

2 Chronic purulent bronchitis in the acute phase. complicated by bronchiectasis in the lower lobe of the right lung.
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CHRONICAL BRONCHITIS

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