Chronic Bronchitis - Causes, Symptoms, Diagnosis and Treatment
Chronic bronchitis - Progressive diffuse inflammation in the bronchial tubes leading to the morphological rearrangement of the bronchial wall and peribronchial tissue. Exacerbations of chronic bronchitis occur several times a year and proceed with increased cough, purulent sputum, shortness of breath, bronchial obstruction, low-grade fever. A survey of chronic bronchitis includes radiography lungs, bronchoscopy, microscopic and bacteriological analysis of sputum, ERF, and others. In the treatment of chronic bronchitis combined medical therapy (antibiotics, mucolytics, bronchodilators, immunomodulators), sanation bronchoscopy, oxygen therapy, physiotherapy (inhalations, massages, breathing gymnastics, iontophoresis, etc.).
Chronic bronchitis
Pulmonology say in the event that over the past two years marked exacerbation of the disease lasting at least 3 months, accompanied by productive cough with sputum. When during a long-term chronic bronchitis greatly increases the likelihood of diseases such as COPD, pulmonary fibrosis, pulmonary emphysema, pulmonary heart, bronchial asthma, bronchiectasis, lung cancer. In chronic bronchitis, inflammation of the bronchi is diffuse and eventually leads to structural changes in the walls of the bronchus with development around peribronhita.
atrophic.
acute bronchitis.
Exacerbation of chronic bronchitis, typically occurs when attaching a secondary component of infectious (viral, bacterial, fungal, parasitic). To the development of chronic bronchitis predisposed persons suffering from chronic inflammation of the upper respiratory tract - tracheitis, pharyngitis, laryngitis, tonsillitis, sinusitis, rhinitis. Non-infectious factors causing exacerbation of chronic bronchitis, may be an arrhythmia, chronic heart failure, pulmonary embolism, gastroesophageal reflux disease, a1-antitrypsin deficiency, and others.
Coronary heart disease, diabetes, vascular encephalopathy, and others.
The criteria for the severity of acute exacerbations of chronic bronchitis are the severity of obstructive component of the respiratory insufficiency, decompensation of comorbidity.
When catarrhal uncomplicated chronic bronchitis exacerbations occur up to 4 times a year, bronchial obstruction is not expressed (FEV1> 50% of normal). More frequent exacerbations occur with obstructive chronic bronchitis; they manifest an increase in the amount of sputum, and changes in its nature, significant violations of bronchial obstruction (FEV1 purulent bronchitis occurs with regular sputum production, decreased FEV1
lung radiography X-ray picture of chronic bronchitis is characterized by a mesh deformation and increased pulmonary pattern, a third of patients - signs of emphysema. Radiodiagnosis avoids pneumonia, tuberculosis, and lung cancer.
Microscopic examination of sputum reveals its increased viscosity, greyish or yellowish-green color, mucopurulent or purulent, a large number of neutrophils. Bacteriological culture of sputum allows identify microbial pathogens (Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, Pseudomonas spp., Enterobacteriaceae, etc.). If you have difficulty sputum collection is shown holding a bronchoalveolar lavage and bacteriological examination of water washing of the bronchi.
The degree of activity and the nature of inflammation in chronic bronchitis specified during diagnostic bronchoscopy. With bronhografii estimated architectonic bronchial tree, excluded the presence of bronchiectasis.
Severity of violations of the external breathing function is determined during spirometry. Spirogram in patients with chronic bronchitis shows a decline ZHЁL varying degrees, increase the MOU; bronchial obstruction - and the decline in FZHЁL MVL. When pneumotachograph marked reduction in the maximum expiratory flow volume.
From laboratory tests in chronic bronchitis conducted a general analysis of urine and blood; total protein, protein fractions, fibrin, sialic acids, CRP, immunoglobulin et al. indices. In severe respiratory failure are investigated CBS and blood gases.
pulmonologist. In this respect the basic principles of treatment of acute bronchitis. It is important to avoid contact with toxic factors (tobacco smoke, harmful substances, and so on. D.).
Pharmacotherapy of chronic bronchitis includes the appointment of antimicrobial, mucolytic, bronchodilatory, immunomodulatory drugs. For the antibiotic therapy used penicillins, macrolides, cephalosporins, fluoroquinolones, tetracyclines inside, parenterally or endobronchial. When trudnootdelyaemoy viscous sputum apply mucolytic and expectorant (ambroxol, acetylcysteine, etc.). With a view to the relief of bronchospasm in chronic bronchitis showing bronchodilators (aminophylline, teopek, salbutamol). Mandatory reception immunoregulatory agents (levamisole, metiluratsila and so on. D.).
In severe chronic bronchitis treatment can be carried out (sanation) bronchoscopy, bronchoalveolar lavage. To restore the drainage function of bronchi methods used adjuvant therapy: alkaline and medicinal inhalation, postural drainage, chest compressions (vibration, percussion), breathing exercises, physiotherapy (UHF and electrophoresis on the chest, diathermy), speleotherapy. Outside exacerbation is recommended to stay in sanatoriums of the southern coast.
In chronic bronchitis, complicated by pulmonary heart disease, shows oxygen therapy, cardiac glycosides, diuretics, anticoagulants.
pulmonary hypertension.
Preventive work on the prevention of chronic bronchitis is to promote smoking cessation, eliminating adverse chemical and physical factors, treatment of comorbidities, increase immunity, timely and complete treatment of acute bronchitis.