Acute bronchitis – the form of a diffusion inflammation of a bronchial tree which is characterized by the increased bronchial secretion and violation of passability of bronchial tubes. The sharp beginning, respiratory symptoms (cold, irritation in a throat, pristupoobrazny cough with a phlegm, breast pain, short wind, a bronchospasm) and intoxication symptoms (rise in temperature, a headache, weakness) is characteristic of an acute bronchitis. Data of fizikalny survey, a X-ray analysis of lungs, laboratory researches, functional tests, the ECG, a bronkhoskopiya help with diagnostics of an acute bronchitis. Treatment of an acute bronchitis complex conservative; includes antiviral, antibacterial, febrifugal, antihistaminic, mukolitichesky, expectorant and spazmolitichesky medicines, NPVS, glucocorticoids, physical therapy.
Acute bronchitis - a widespread disease of respiratory organs; can develop as independent process when the inflammation is limited to bronchial tubes (primary bronchitis), or to complicate other available pathology (secondary bronchitis). On the level of damage of the lower airways sharp bronchitis divides on: trakheobronkhita, bronchitis with primary damage of bronchial tubes of average caliber, a bronkhiolita. Almost all sharp bronchitis belongs to inflammatory processes of diffusion character; more rare they are segmentary (usually as a component of other sharp local inflammatory process).
On character of inflammatory exudate allocate catarrhal, mucous, purulent sharp bronchitis. The majority of sharp bronchitis has kataralyyony character, purulent forms of a disease meet seldom, as a rule, at a combination of a viral and streptococcal infection.
At an acute bronchitis inflammatory process can affect only a mucous membrane of bronchial tubes, in case of a heavy current - to strike deeper fabrics: submucous and muscular layers. Pathological changes of a bronchial wall at an acute bronchitis are characterized by hypostasis and hyperaemia of the mucous membrane expressed by infiltration of a submucous layer with a hypertrophy of mucous and proteinaceous glands, increase in quantity of scyphoid cages, a degeneration and decrease in barrier function of a ciliary epithelium. On the internal surface of bronchial tubes serous, mucous or mucopurulent exudate is noted. The increased secretion of slime at an acute bronchitis leads to violation of passability of small bronchial tubes and bronchioles.
Reasons of an acute bronchitis
Depending on an etiologichesky factor allocate sharp bronchitis of the infectious, noninfectious, mixed and unknown genesis. The leading mechanism of development of an acute bronchitis is the infection: viruses (a SARS, flu and paraflu, measles, a rubella) act as activators, is more rare – bacteria (a pneumococcus, staphylococcus, mycoplasmas, hlamidiya, representatives of tifoparatifozny group). Infectious agents can get into bronchial tubes air, hematogenic and limfogenny in the ways.
A significant role in an etiology of an acute bronchitis is played respiratory by a viral infection which in most cases is followed by defeat of a bronchial tree. Primary sharp bacterial bronchitis meets infrequently, usually there is a stratification of a secondary bacterial infection on virus owing to activation of opportunistic microflora of the top airways.
Physical and chemical factors (dust, smoke, cold or hot dry air, chlorine, ammonia, hydrogen sulfide, vapors of acids and alkalis) become the reason of noninfectious sharp bronchitis. Besides, the acute bronchitis can develop at a combination of an infection and action of physical and chemical irritants. Sharp allergic bronchitis arises, as a rule, at the patients who are genetically predisposed to allergic reactions.
The factors reducing the general and local resistance of an organism and promoting emergence of an acute bronchitis are frequent overcoolings, harmful working conditions, smoking and alcoholism, the centers of a chronic infection in a nasopharynx and violation of nasal breath, developments of stagnation in a small circle of blood circulation, the postponed serious illness, irrational food. The acute bronchitis is more often observed at children's and advanced age.
Inflammatory process at an acute bronchitis of a virus etiology begins usually in the top airways: a nasopharynx, almonds, gradually extending to a throat, a trachea, and further to bronchial tubes. Activation of opportunistic microflora burdens catarrhal and infiltrative changes of a mucous membrane of bronchial tubes, causing a long current or complications of an acute bronchitis.
Symptoms of an acute bronchitis
Features of a clinical picture of an acute bronchitis depend on a causal factor, character, prevalence and degree of expressiveness of pathological changes, level of defeat of a bronchial tree, weight of a course of inflammatory process.
The sharp beginning with signs of damage of the top and lower airways, intoxication is characteristic of a disease. The acute bronchitis of an infectious etiology is preceded by SARS symptoms - a nose congestion, cold, irritation and a sore throat, a voice osiplost. Development of the general intoxication at an acute bronchitis is shown by a fever, temperature increase of a body to subfebrilny values, weakness, bystry fatigue, a headache, perspiration, pain in muscles of a back and extremities. At an easy current of an acute bronchitis of temperature reaction can not be. The acute bronchitis caused by causative agents of measles of a rubella and whooping cough is followed by the symptoms characteristic of the main disease.
The leading symptom of an acute bronchitis is dry painful cough which develops from the very beginning and keeps throughout all disease. Cough – pristupoobrazny, rough and sonorous, sometimes "barking", strengthening feeling of a sadneniye and burning behind a breast. Owing to an overstrain of pectoral muscles and spastic reduction of a diaphragm at hoarse cough pains in the lower department of a thorax and a belly wall develop. Cough is followed by office at first of a poor and viscous phlegm, then character of a phlegm gradually changes: it becomes less viscous and easier departs, can have mucopurulent character.
The heavy and long current of an acute bronchitis is observed upon transition of inflammatory process from bronchial tubes to bronchioles when sharp narrowing or even closing of a bronkhiolyarny gleam leads to development of a heavy obstructive syndrome, violation of gas exchange and blood circulation. At accession to an acute bronchitis of a bronkhiolit the condition of the patient suddenly worsens: fever, pallor of skin, cyanosis, sharp short wind (40 and more dykhaniye in min.), painful cough with a poor mucous phlegm, at first excitement and concern, then giperkapniya symptoms (slackness, drowsiness) and cardiovascular insufficiency is noted (decrease HELL and tachycardia).
Connection of a disease with allergen influence, the expressed obstructive syndrome with pristupoobrazny cough, allocation of a light vitreous phlegm is characteristic of acute allergic bronchitis. Development of the acute bronchitis caused by inhalation of toxic gases is followed by constraint in a breast, larinogospazmy, suffocation and painful cough.
Diagnostics of an acute bronchitis
The diagnosis of an acute bronchitis is made by the therapist or the pulmonologist on the basis of clinical manifestations, and also these laboratory and tool researches. At inspection of the patient it is necessary to consider that the acute bronchitis can be display of various infectious diseases (measles, whooping cough, etc.).
Auskultativny data at an acute bronchitis are characterized by rigid breath on obstructive type, scattered dry rattles. At accumulation in bronchial tubes of a liquid secret the damp melkopuzyrchaty rattles disappearing after a vigorous expectoration of a phlegm can be listened. At a sharp allergic bronyokhit lack of a mucopurulent and purulent phlegm, tendency to allergicheyosky reactions in the anamnesis is observed.
For the purpose of diagnostics of an acute bronchitis make the general, biochemical and immunological blood tests, the general analysis of urine, a X-ray analysis of lungs, a bronkhoskopiya, a research of function of external breath (spirometry, a pikfloumetriya), the ECG and EHOKG, crops of a phlegm on microflora. Functional parameters of external breath at an acute bronchitis show violation of pulmonary ventilation on obstructive type. Changes of a picture of blood include neytrofilny , acceleration of SOE; and in case of allergic genesis of a disease – increase in quantity of eosinophils.
The radiological research in case of an acute bronchitis of a virus etiology reveals a moderate rasshiyoreniye and an illegibility of the drawing of roots of lungs, at a zayotyazhny current helps to find accession of complications (a bronkhiolit, pneumonia). Differential diagnostics of an acute bronchitis is carried out with bronchial pneumonia, miliarny tuberculosis of lungs.
Treatment of an acute bronchitis
In most cases treatment of an acute bronchitis is carried out in out-patient conditions, only at the heavy course of a disease (for example, with the expressed obstructive syndrome or complicated by pneumonia) hospitalization in office of pulmonology is necessary.
At the acute bronchitis which is followed by fever or subfebrilitety the bed rest, with observance of a diet and plentiful drink (the warmed-up alkaline mineral waters, grass infusions), the ban on smoking is shown. The room where there is a patient with an acute bronchitis, has to be aired often and well with maintenance of high humidity of air. At thorax pains it is necessary to use the warming compresses, mustard plasters, banks on area of a breast, interscapular area, mustard foot bathtubs.
In treatment of an acute bronchitis against the background of a SARS apply antiviral therapy (interferon, remantadin), febrifugal, soothing medicines, NPVS. Antibiotics or sulfanylamides are appointed only at a secondary bacterial infection, at a long current of an acute bronchitis, at pronounced inflammatory reaction.
In case of dry painful cough at an acute bronchitis in the first days of a disease accept codeine, , , suppressing kashlevy a reflex. At increase in the allocated phlegm for its fluidifying and improvement of drainage function mukolitichesky and expectorant means are shown: infusion of a grass of a termopsis, , Bromhexine, Ambroxol, steam alkaline inhalations. Reception of vitamins, immunomodulators is recommended. At obstruction for removal of a bronchospasm use adrenolitik (ephedrine), spazmolitik (, a papaverine), according to indications - steroid hormones (Prednisolonum). If necessary carry out intensive therapy of sharp heart and respiratory failure.
At an acute bronchitis widely apply physiotherapeutic methods (Ural federal district, an induktotermiya of interscapular area, a diathermy of a thorax, UVCh), LFK, vibration massage. In therapy of acute allergic bronchitis use antihistaminic medicines (, , ), sodium, , in hard cases glucocorticoids are shown.
The uncomplicated acute bronchitis, as a rule, within 2 – 3 weeks comes to an end with clinical recovery, at the same time restoration of functional indicators (function of external breath and bronchial passability) happens within a month. At a long current of an acute bronchitis clinical recovery occurs more slowly, approximately in 1 - 1,5 month from the beginning of a disease.
Complications of an acute bronchitis
Treat complications of an acute bronchitis obliterating bronkhiolit, bronchial pneumonia, asthmatic bronchitis, in case of a heavy current at the elderly and weakened patients is possible sharp respiratory and heart failure. Regularly repeating sharp bronchitis promotes transition of a disease to a chronic form when which progressing development of HOBL, bronchial asthma, emphysema of lungs is possible.
Forecast and prevention of an acute bronchitis
At acute catarrhal bronchitis the forecast favorable, the disease comes to an end, as a rule, with a complete recovery of structure of a mucous membrane of bronchial tubes and absolute recovery. In case of acute purulent bronchitis or development of a bronkhiolit, the forecast worsens in connection with a residual fibrous thickening of a bronchial wall and narrowing of a gleam of bronchial tubes. Violation of drainage function and deformation of a bronchial tree at an acute bronchitis promote the long course of a disease and its synchronization.
Prevention of an acute bronchitis has to consist in elimination of a possible cause of illness (respect for sanitary and hygienic norms on production, elimination of dust content and a gas contamination, refusal of smoking and abuse of alcohol, timely treatment of chronic infections and respiratory diseases, the prevention of a SARS, overcoolings), increase in resilience of an organism.