Atrophic bronchitis is the morphological kind of chronic bronchitis which is characterized by restructuring of an integumentary epithelium and thinning of a mucous membrane of bronchial tubes. The clinic of atrophic bronchitis includes dry cough (long, recidivous or constant), discomfort and pain at deep breath, short wind, blood spitting episodes. Diagnostics is based on data of an endoscopic research and morphology of bronkhobioptat; also the X-ray analysis of lungs, the spirography, the analysis of a phlegm and washing waters of bronchial tubes is carried out. Therapeutic actions at an aggravation of symptomatology can include medical bronkhoskopiya, inhalations, physical therapy.
Atrophic bronchitis - the structurally functional reorganization of a mucous membrane of bronchial tubes presented dystrophic - sclerous processes. Chronic bronchitis possesses a dominant position (60-65%) in structure of nonspecific diseases of easy (HNZL). From the point of view of endoscopic and cytomorphological changes distinguish the following forms of chronic bronchitis: catarrhal, purulent, hypertrophic, atrophic, hemorrhagic, fibrinozno-ulcer. Atrophic bronchitis turned into a serious social and medical problem of industrialized countries in recent years that is connected with anthropogenous transformations of the environment and, first of all, pollution of the atmosphere. At the same time, questions of an etiopatogenez, manifestations and therapy of atrophic bronchitis remain the least studied in pulmonology.
It is conventional that mucous bronchial tubes such factors of the external environment as dust content and pollution of atmospheric air, nicotine addiction, professional harm lead to structural changes (contact with dust, gases, chemicals, a pneumoconiosis and so forth). Among the endogenous reasons it should be noted hereditary and constitutional features and hormonal dysfunction. Endogenous mechanisms, according to researchers, explain the fact that atrophic bronchitis is quite often combined with similar damage of mucous membranes of an oral cavity and GIT (an atrophic gingivit, atrophic gastritis).
In a bronchial tree can lead local inflammatory diseases to emergence and progressing of atrophic processes: chronic not obstructive and obstructive bronchitis, bronkhoektatichesky disease, chronic pneumonia, repeated SARS, etc. Approximately hypersensibility to dust, pollen, household and other aerogenic allergens is found in a third of patients with atrophic bronchitis.
Taking into account morfo-and pathogenesis of sclerous process in a mucous membrane of bronchial tubes distinguish a primary and dystrophic and primary and inflammatory form of atrophic bronchitis. The primary and dystrophic bronchopathy develops against the background of lack of the pulmonary anamnesis, as a result of regenerator and plastic insufficiency. This state is characterized by reduction or the termination of synthesis of cellular proteins under the influence of damaging endo-and exogenous factors that leads to dystrophic changes in cages and impossibility of performance of the functions by them. The primary and inflammatory form of atrophic bronchitis arises at patients with the long previous current of HNZL. At the same time restructuring of a wall of bronchial tubes develops gradually (from catarrhal, to catarrhal and sclerous and then to sclerous changes), and the level of metabolic reactions of a bronchial epithelium remains high.
At atrophic bronchitis there is a thinning of an integumentary epithelium of bronchial tubes due to reduction of number of scyphoid cages, transformations of a cylindrical epithelium in flat, reductions of the resnitchaty device, replacement of bronchial glands with fibrous fabric. The reduction of the vascular course, a sclerosis of a muscular layer of bronchial tubes is noted; at a primary and inflammatory form - vospalitelnokletochny infiltration of a mucous membrane. Against the background of atrophic bronchitis in bronchial tubes there can be centers of a planocellular metaplaziya and a dysplasia forming a basis for development of bronkhogenny lung cancer.
Symptoms of atrophic bronchitis
Patients with a primary and dystrophic form of atrophic bronchitis note communication of emergence of symptoms with a viral infection, psychoemotional loadings, contact with production pollyutant, smoking renewal, etc. The complaint to dry irritativny cough which can remain a long time is most typical, have recidivous or constant character. Pristupoobrazny developing or strengthening of cough can provoke a conversation, cold air, meal, emotional pressure that reflects change of sensitivity of a mucous membrane of bronchial tubes to action of ordinary nonspecific factors. A part of patients with atrophic bronchitis notes discomfortable feelings and even thorax pain at a deep breath, single or repeated episodes of a blood spitting.
In case of primary and inflammatory atrophic bronchitis the symptomatology appears in connection with an aggravation of the main bronchopulmonary process. In a sharp stage the hyperthermia, damp cough, short wind is observed. Out of an aggravation of symptoms can not be; sometimes small cough, usually remains in the mornings. This form has the progressing current and, as a rule, leads to development of chronic respiratory insufficiency, a diffusion pneumosclerosis, emphysema of lungs and pulmonary hypertensia.
Standard diagnostics (fizikalny, radiological, laboratory) at atrophic bronchitis has to be surely added with performing endoscopy and a research of bronkhobioptat. Objective data are not specific: the auskultativny picture differs in a variety – from vesicular breath before dry or damp rattles, at emphysematous changes over lungs the box sound is perkutorno defined. The X-ray analysis of lungs often does not reveal aberrations; in certain cases symptoms of the deforming bronchitis and diffusion emphysema are found. By results of spirometry ventilating violations can be determined by the restrictive, obstructive or mixed type.
It is possible to confirm the diagnosis of atrophic bronchitis only after carrying out a bronkhoskopiya with a biopsy. Endoscopic thinning and pallor of a mucous membrane of bronchial tubes, its small skladchatost, strengthening of the vascular drawing, easy bleeding at contact, a zapustevaniye and a gaping of mouths of bronchial glands is visualized. At a morphological research of a bioptat of bronchial tubes symptoms of dystrophy of an epithelium, sharp decrease in height of epitelialny layer, a planocellular metaplaziya of an integumentary epithelium are defined. The analysis of a bronkhoalveolyarny secret at atrophic bronchitis is characterized by decrease in quantity of neytrofilny granulocytes and macrophages, and also low level of pro-inflammatory and antioxidant activity of the liquid received during a bronkhoalveolyarny unleavened wheat cake.
Treatment of atrophic bronchitis
Therapy of a primary and dystrophic form of atrophic bronchitis begins with identification and elimination of risk factor (the termination of contact with production vrednost, elimination of allergen, correction of hormonal dysfunction and so forth). Medicamentous therapy includes purpose of polyvitamins, bronchodilators, antihistaminic and haemo rheological means. At primary and inflammatory atrophic bronchitis sanatsionny bronkhoskopiya with antiseptics, antibacterial therapy are carried out to the periods of an exacerbation of the main disease. In addition to pharmacotherapy medicinal, oil inhalations, a speleoterapiya, physiotherapeutic procedures (laser therapy, ultra-violet radiation, UVCh-therapy, ultrasonic therapy) are appointed.
For prevention of a primary and dystrophic form of atrophic bronchitis it is recommended to minimize, and whenever possible - to exclude influence of the adverse factors irritating bronchial tubes (smoking, inhalation of harmful substances, recurrent infections). Timely sanitation of the centers of an infection of airways and regular dispensary observation of the specialist pulmonologist will allow not to allow transition of chronic bronchitis to an atrophic stage.