Bronchitis is the diffusion and inflammatory disease of bronchial tubes affecting a mucous membrane or all thickness of a wall of bronchial tubes. Damage and an inflammation of a bronchial tree can arise as the independent, isolated process (primary bronchitis) or to develop as a complication against the background of the available chronic diseases and the postponed infections (secondary bronchitis). Damage of a mucous epithelium of bronchial tubes breaks development of a secret, physical activity of eyelashes and process of clarification of bronchial tubes. Divide acute and chronic bronchitis, differing on an etiology, pathogenesis and treatment.
Bronchitis – the diffusion and inflammatory disease of bronchial tubes affecting a mucous membrane or all thickness of a wall of bronchial tubes. Damage and an inflammation of a bronchial tree can arise as the independent, isolated process (primary bronchitis) or to develop as a complication against the background of the available chronic diseases and the postponed infections (secondary bronchitis). Damage of a mucous epithelium of bronchial tubes breaks development of a secret, physical activity of eyelashes and process of clarification of bronchial tubes. Divide acute and chronic bronchitis, differing on an etiology, pathogenesis and treatment.
The sharp course of bronchitis is characteristic of many sharp respiratory infections (a SARS, ORZ). Most often viruses of paraflu, respiratory a virus, adenoviruses are the reason of an acute bronchitis, is more rare - a virus of flu, measles, enteroviruses, rhinoviruses, mycoplasmas, hlamidiya and the mixed virus and bacterial infections. The acute bronchitis seldom has the bacterial nature (pneumococci, staphylococcus, streptococci, a hemophilic stick, the causative agent of whooping cough). Inflammatory process at first affects a nasopharynx, almonds, a trachea, gradually extending to the lower airways – bronchial tubes.
The viral infection can provoke reproduction of opportunistic microflora, aggravating catarrhal and infiltrative changes mucous. The top layers of a wall of bronchial tubes are surprised: there is hyperaemia and hypostasis of a mucous membrane, the expressed infiltration of a submucous layer, there are dystrophic changes and rejection of epitelialny cages. At the correct treatment the acute bronchitis has the favorable forecast, the structure and functions of bronchial tubes are completely restored also in 3 – 4 weeks. The acute bronchitis is very often observed at children's age: this fact is explained by a high susceptibility of children to respiratory infections. Regularly repeating bronchitis promotes transition of a disease to a chronic form.
Chronic bronchitis - it is long the proceeding inflammatory disease of bronchial tubes progressing over time and causing structural changes and violation of functions of a bronchial tree. Chronic bronchitis proceeds with the periods of aggravations and remissions, often has the hidden current. Recently growth of incidence of chronic bronchitis in connection with deterioration in ecology (air pollution by harmful impurity), wide circulation of addictions (smoking), the high level of an allergization of the population is observed. At long influence of adverse factors on mucous respiratory tract gradual changes in a structure of a mucous membrane, the increased allocation of a phlegm, violation of drainage ability of bronchial tubes, decrease in local immunity develop. At chronic bronchitis there is a hypertrophy of glands of bronchial tubes, a thickening of a mucous membrane. Progressing of sclerous changes of a wall of bronchial tubes leads to development of bronkhoektaz, the deforming bronchitis. Change of air-conducting ability of bronchial tubes considerably breaks ventilation of lungs.
Classification of bronchitis
Bronchitis classifies by a number of signs:
1. On weight of a current:
- easy degree
- average degree
- heavy degree
2. On a clinical current:
Sharp bronchitis depending on an etiologichesky factor happens:
- infectious origin (virus, bacterial, virus and bacterial)
- noninfectious origin (chemical and physical harmful factors, allergens)
- the mixed origin (combination of an infection and action of physical and chemical factors)
- not specified etiology
On area of inflammatory defeat distinguish:
- bronchitis with primary damage of bronchial tubes of average and small caliber
On the mechanism of emergence allocate primary and secondary sharp bronchitis. On character of inflammatory exudate distinguish bronchitis: catarrhal, purulent, catarrhal and purulent and atrophic.
Depending on character of an inflammation distinguish catarrhal chronic bronchitis and purulent chronic bronchitis. On change of function of external breath allocate obstructive bronchitis and not obstructive form of a disease. On process phases during chronic bronchitis aggravations and remissions alternate.
The major factors promoting development of an acute bronchitis are:
- physical factors (crude, cold air, sharp difference of temperatures, influence of radiation, dust, smoke);
- chemical factors (presence of pollyutant at atmospheric air – carbon oxide, hydrogen sulfide, ammonia, vapors of chlorine, acids and alkalis, tobacco smoke, etc.);
- addictions (smoking, abuse of alcohol);
- stagnant processes in a small circle of blood circulation (cardiovascular pathologies, violation of the mechanism of mukotsiliarny clearance);
- presence of the centers of a chronic infection at an oral cavity and a nose – sinusitis, tonsillitis, adenoidita;
- hereditary factor (allergic predisposition, congenital violations of bronchopulmonary system).
It is established that smoking is the major provocative factor in development of various bronchopulmonary pathologies, including chronic bronchitis. Smokers have chronic bronchitis by 2-5 times more often than non-smoking. The adverse effect of tobacco smoke is observed both at active, and at passive smoking.
Long impact on the person of harmful conditions of production contributes to developing of chronic bronchitis: raise dust – cement, coal, flour, wood; vapors of acids, alkalis, gases; uncomfortable mode of temperature and humidity. Pollution of atmospheric air emissions of the industrial enterprises and transport, products of combustion of fuel makes aggressive impact first of all on respiratory system of the person, causing damage and irritation of bronchial tubes. High concentration of harmful impurity in air of the large cities, especially in windless weather, leads to heavy exacerbations of chronic bronchitis.
Repeatedly postponed SARS, sharp bronchitis and pneumonia, chronic diseases of a nasopharynx, kidneys can cause development of chronic bronchitis further. As a rule, the infection accumulates on already available defeat mucous respiratory organs other damaging factors. The crude and frigid climate promotes development and an exacerbation of chronic diseases, including bronchitis. The important role belongs to heredity which under certain conditions increases risk of developing of chronic bronchitis.
The main clinical symptom of an acute bronchitis – low chest cough – appears usually against the background of already available displays of a sharp respiratory infection or along with them. At the patient weakness, an indisposition, a nose congestion, cold are noted temperature increase (to moderately high). At the beginning of a disease cough dry, from poor, it is difficult the separated phlegm, amplifying at night. Frequent fits of coughing cause painful feelings in muscles of an abdominal tension and a thorax. In 2-3 days the phlegm begins to depart plentifully (mucous, mucopurulent), and cough becomes damp and soft. In lungs dry and damp rattles are listened. In uncomplicated cases of an acute bronchitis of short wind it is not observed, and its emergence demonstrates damage of small bronchial tubes and development of an obstructive syndrome. The condition of the patient is normalized within several days, cough can proceed even several weeks. Long high temperature speaks about accession of a bacterial infection and development of complications.
Chronic bronchitis arises, as a rule, at adults, after repeatedly postponed sharp bronchitis, or at long irritation of bronchial tubes (cigarette smoke, dust, exhaust gases, vapors of chemicals). Symptoms of chronic bronchitis are defined by activity of a disease (an aggravation, remission), character (obstructive, not obstructive), existence of complications.
The main display of chronic bronchitis is a long cough within several months more than 2 years in a row. Cough is usually damp, develops in the morning, is followed by allocation of insignificant quantity of a phlegm. Strengthening of cough is observed during cold, wet weather, and a zatikhaniye - in dry warm season. The general health of patients at the same time almost does not change, cough for smokers becomes the habitual phenomenon. Chronic bronchitis progresses over time, cough amplifies, gains character of attacks, becomes hoarse, unproductive. Appears complaints to a purulent phlegm, indisposition, weakness, fatigue, perspiration at night. Short wind at loadings joins, even insignificant. Patients with predisposition to an allergy have bronchospasm phenomena demonstrating development of an obstructive syndrome, asthmatic manifestations.
Bronchial pneumonia is a frequent complication at an acute bronchitis, develops as a result of decrease in local immunity and stratification of a bacterial infection. Repeatedly postponed sharp bronchitis (3 and more times a year), leads to transition of inflammatory process to a chronic form. Disappearance of provocative factors (refusal of smoking, change of climate, change of the place of work) can save the patient from chronic bronchitis completely. When progressing chronic bronchitis there are repeated acute pneumonias, and at a long current the disease can pass into a chronic obstructive pulmonary disease. Obstructive changes of a bronchial tree are considered as a predastmenny state (asthmatic bronchitis) and increase risk of developing of bronchial asthma. There are complications in the form of emphysema of lungs, pulmonary hypertensia, a bronkhoektatichesky disease, warm and pulmonary insufficiency.
Diagnostics of various forms of bronchitis is based on studying of a clinical picture of a disease and results of researches and laboratory analyses:
- General blood test and urine;
- Immunological and biochemical blood tests;
- X-ray analysis of lungs;
- Spirometry, pikfloumetriya;
- Bronkhoskopiya, bronchography;
- ECG, echocardiography;
- Microbiological analysis of a phlegm.
Treatment of bronchitis
In case of bronchitis with the severe accompanying SARS form treatment in office of pulmonology is shown, at uncomplicated bronchitis treatment – out-patient. Therapy of bronchitis has to be complex: fight against an infection, restoration of passability of bronchial tubes, elimination of harmful provocative factors. It is important to complete a full course of treatment of an acute bronchitis to exclude its transition to a chronic form. In the first days of a disease the bed rest, plentiful drink (norms are 1,5 - 2 times more), a dairy and vegetable diet is shown. For the period of treatment the refusal of smoking is obligatory. It is necessary to increase humidity of air indoors where there is a patient with bronchitis as in dry air cough amplifies.
Therapy of an acute bronchitis can include antiviral medicines: interferon (intranazalno), at flu – remantadin, , at an adenoviral infection – RNA azu. In most cases antibiotics do not apply, except for cases of accession of a bacterial infection, at a long current of an acute bronchitis, at the expressed inflammatory reaction by results of laboratory analyses. For improvement of removal of a phlegm appoint mukolitichesky and expectorant means (Bromhexine, Ambroxol, expectorant grass collecting, inhalations with soda and salt solutions). In treatment of bronchitis apply vibration massage, remedial gymnastics, physical therapy. At dry unproductive painful cough the doctor can appoint administration of drugs, suppressing kashlevy a reflex – , , etc.
Chronic bronchitis demands long-term treatment, both in the period of an aggravation, and during remission. At an exacerbation of bronchitis, at a purulent phlegm the antibiotics (after definition of sensitivity to them the allocated microflora) diluting a phlegm and expectorant medicines are appointed. In case of the allergic nature of chronic bronchitis reception of antihistaminic medicines is necessary. The mode – semi-bed, warm plentiful drink is obligatory (alkaline mineral water, tea with raspberry, honey). Carry sometimes out a medical bronkhoskopiya, with washing of bronchial tubes various medicinal solutions (a bronchial unleavened wheat cake). The respiratory gymnastics and physiotreatment is shown (inhalations, UVCh, an electrophoresis). In house conditions it is possible to use the mustard plasters, medical banks warming compresses. For strengthening of resilience of an organism accept vitamins and immunostimulators. Out of an exacerbation of bronchitis sanatorium treatment is desirable. The walks in the fresh air normalizing respiratory function, a dream and the general state are very useful. If within 2 years exacerbations of the chronic bronchitis sick are not observed remove from dispensary observation at the pulmonologist.
Forecast and prevention
The acute bronchitis in an uncomplicated form lasts about two weeks and comes to an end with an absolute recovery. In case of the accompanying chronic diseases of cardiovascular system the long course of a disease is observed (month and more). The chronic form of bronchitis has a long current, change of the periods of aggravations and remissions.
Preventive measures for the prevention of many bronchopulmonary diseases, including sharp and chronic bronchitis, include: elimination or weakening of impact on respiratory organs of harmful factors (dust content, impurity of air, smoking), timely treatment of chronic infections, prevention of allergic manifestations, increase in immunity, healthy lifestyle.