Chronic bronchitis – the diffusion progressing inflammatory process in bronchial tubes leading to morphological reorganization of a bronchial wall and peribronkhialny fabric. Exacerbations of chronic bronchitis arise several times a year and proceed with strengthening of cough, allocation of a purulent phlegm, short wind, bronchial obstruction, subfebrilitety. Inspection at chronic bronchitis includes carrying out a X-ray analysis of lungs, bronkhoskopiya, the microscopic and bacteriological analysis of a phlegm, FVD, etc. In treatment of chronic bronchitis combine medicamentous therapy (antibiotics, mucolytics, bronchial spasmolytics, immunomodulators), sanatsionny bronkhoskopiya, oxygenotherapy, physical therapy (inhalations, massage, respiratory gymnastics, a medicinal electrophoresis, etc.).
Incidence of chronic bronchitis among adult population makes 3-10%. Chronic bronchitis 2-3 times more often develops at men at the age of 40 years. In pulmonology speak about chronic bronchitis in case for two years exacerbations of a disease lasting not less than 3 months which are followed by productive cough with allocation of a phlegm are noted. At the long-term course of chronic bronchitis the probability of such diseases as HOBL, a pneumosclerosis, emphysema of lungs, pulmonary heart, bronchial asthma, a bronkhoektatichesky disease, lung cancer significantly increases. At chronic bronchitis inflammatory damage of bronchial tubes has diffusion character and over time leads to structural changes of a wall of a bronchial tube with development of a peribronkhit around it.
Classification of chronic bronchitis
Kliniko-funktsionalnaya classification of chronic bronchitis allocates the following forms of a disease:
- On the nature of changes: catarrhal (idle time), purulent, hemorrhagic, fibrinozny, atrophic.
- On defeat level: proximal (with a primary inflammation of large bronchial tubes) and distalny (with a primary inflammation of small bronchial tubes).
- On existence of a bronkhospastichesky component: not obstructive and obstructive bronchitis.
- On a clinical current: chronic bronchitis of a latent current; with frequent aggravations; with rare aggravations; continuously recidivous.
- On a process phase: remission and aggravation.
- On existence of complications: the chronic bronchitis complicated by emphysema of lungs, a blood spitting, respiratory insufficiency of various degree, the chronic pulmonary heart (compensated or dekompensirovanny).
Reasons of chronic bronchitis
Among the reasons causing development of chronic bronchitis, the leading role belongs to long inhalation of polyutant – various chemical impurity which are contained in air (tobacco smoke, dust, exhaust gases, toxic vapors, etc.). Toxic agents make the irritating impact on mucous, causing reorganization of the sekretorny device of bronchial tubes, slime hyper secretion, inflammatory and sclerous changes of a bronchial wall. Quite often to chronic bronchitis it is transformed out of time or not up to the end cured acute bronchitis.
The exacerbation of chronic bronchitis, as a rule, arises at accession of a secondary infectious component (virus, bacterial, fungal, parasitic). The persons suffering from chronic inflammations of the top airways - tracheitises, pharyngitises, laryngitis, tonsillitis, sinusitis, rhinitises are predisposed to development of chronic bronchitis. Arrhythmias, chronic heart failure, TELA, a gastroezofagealny reflux disease, deficiency of a1-anti-trypsin, etc. can be the noninfectious factors causing an exacerbation of chronic bronchitis.
Pathogenesis of chronic bronchitis
Damage of various links of system of local bronkhopulmonalny protection is the cornerstone of the mechanism of development of chronic bronchitis: mukotsiliarny clearance, local cellular and humoral immunity (drainage function of bronchial tubes is broken; decreases aktivnostya1-anti-trypsin; production of interferon, a lizotsim, IgA, pulmonary surfactant decreases; fagotsitarny activity of alveolar macrophages and neutrophils is oppressed).
It leads to development of a classical pathological triad: giperkriniya (hyperfunctions of bronchial glands with formation of a large amount of slime), diskriniya (to increase in viscosity of a phlegm in view of change of its rheological and physical and chemical properties), to a mukostaz (to stagnation of a dense viscous phlegm in bronchial tubes). These violations promote colonization mucous bronchial tubes infectious agents and to further damage of a bronchial wall.
The endoscopic picture of chronic bronchitis in a phase of an aggravation is characterized by hyperaemia mucous bronchial tubes, existence of a mucopurulent or purulent secret in a gleam of a bronchial tree, at late stages - an atrophy of a mucous membrane, sclerous changes in deep layers of a bronchial wall.
Against the background of inflammatory hypostasis and infiltration, hypotonic dyskinesia large and a collapse of small bronchial tubes, hyper plastic changes of a bronchial wall bronchial obstruction which supports a respiratory hypoxia and promotes increase of respiratory insufficiency at chronic bronchitis easily joins.
Symptoms of chronic bronchitis
Chronic not obstructive bronchitis is characterized by cough with allocation of a phlegm of mucopurulent character. The quantity of the coughed-up bronchial secret out of an aggravation reaches 100-150 ml a day. In a phase of an exacerbation of chronic bronchitis cough amplifies, the phlegm gains purulent character, its quantity increases; join subfebrilitt, perspiration, weakness.
At development of bronchial obstruction expiratory short wind, swelling of veins of a neck on an exhalation, the whistling rattles, koklyushepodobny unproductive cough is added to the main clinical manifestations. The long-term course of chronic bronchitis leads to a thickening of trailer phalanxes and nails of fingers of hands ("drum sticks" and "hour glasses").
Expressiveness of respiratory insufficiency at chronic bronchitis can vary from insignificant short wind before the heavy ventilating violations demanding performing intensive therapy and IVL. Against the background of an exacerbation of chronic bronchitis the decompensation of associated diseases can be noted: IBS, diabetes, distsirkulyatorny encephalopathy, etc.
As criteria of weight of an exacerbation of chronic bronchitis serve expressiveness of an obstructive component, respiratory insufficiency, a decompensation of the accompanying pathology.
At catarrhal uncomplicated chronic bronchitis of an aggravation there are about 4 once a year, bronchial obstruction is not expressed (OFV1> 50% of norm). More frequent aggravations arise at obstructive chronic bronchitis; they are shown by increase in quantity of a phlegm and change of its character, considerable violations of bronchial passability (OFV1 purulent bronchitis proceeds with constant allocation of a phlegm, decrease in OFV1
Diagnosis of chronic bronchitis
In diagnosis of chronic bronchitis essential value has clarification of the anamnesis of a disease and life (complaints, an experience of smoking, professional and household vrednost). Rigid breath, the extended exhalation, the dry rattles (whistling, buzzing), damp mixed rattles are Auskultativny signs of chronic bronchitis. At development of emphysema of lungs the box perkutorny sound is defined.
Verification of the diagnosis is promoted by carrying out a X-ray analysis of lungs. The radiological picture at chronic bronchitis is characterized by mesh deformation and strengthening of the pulmonary drawing, at a third of patients – symptoms of emphysema of lungs. Radiodiagnosis allows to exclude pneumonia, tuberculosis and lung cancer.
The microscopic research of a phlegm reveals its increased viscosity, grayish or yellowish-green color, mucopurulent or purulent character, a large number of neytrofilny leukocytes. Bacteriological crops of a phlegm allow to define microbic activators (Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, Pseudomonas spp., Enterobacteriaceae, etc.). At difficulties of collecting a phlegm carrying out a bronkhoalveolyarny unleavened wheat cake and a bacteriological research of washing waters of bronchial tubes is shown.
Degree of activity and character of an inflammation at chronic bronchitis is specified in the course of a diagnostic bronkhoskopiya. By means of a bronchography the very tectonics of a bronchial tree is estimated, existence of bronkhoektaz is excluded.
Expressiveness of malfunction of external breath is defined when carrying out spirometry. Spirogramma at patients with chronic bronchitis shows decrease in ZhYoL of various degree, increase in FASHION; at bronchial obstruction – decrease in indicators of FZhYoL and MVL. At a pnevmotakhografiya decrease in the maximum volume speed of an exhalation is noted.
From laboratory tests at chronic bronchitis are carried out the general analysis of urine and blood; definition of the general protein, proteinaceous fractions, fibrin, sialovy acids, SRB, immunoglobulins, etc. indicators. At the expressed respiratory insufficiency are investigated BRAIDS and gas composition of blood.
Treatment of chronic bronchitis
The exacerbation of chronic bronchitis is treated permanently, under control of the pulmonologist. At the same time the basic principles of treatment of an acute bronchitis are observed. It is important to exclude contact with toxic factors (tobacco smoke, harmful substances etc.).
The pharmacotherapy of chronic bronchitis includes purpose of antimicrobic, mukolitichesky, bronkhodilatiruyushchy, immunomodulatory medicines. For performing antibacterial therapy penicillin, macroleads, tsefalosporina, ftorkhinolona, tetratsiklina inside, parenterally or endobronkhialno are used. At the hardly separated viscous phlegm mukolitichesky and expectorant means are applied (Ambroxol, , etc.). For the purpose of knocking over of a bronchospasm at chronic bronchitis bronchial spasmolytics are shown (, , ). Reception of the immunoregulating means is obligatory (a levamizola, methyluracil etc.).
At heavy chronic bronchitis medical (sanatsionny) bronkhoskopiya, a bronkhoalveolyarny unleavened wheat cake can be carried out. For restoration of drainage function of bronchial tubes methods of auxiliary therapy are used: alkaline and medicinal inhalations, a posturalny drainage, massage of a thorax (vibration, perkutorny), respiratory gymnastics, physical therapy (UVCh and an electrophoresis on a thorax, a diathermy), a speleoterapiya. Out of an aggravation stay in sanatoria of the Southern coast of the Crimea is recommended.
Forecast and prevention of chronic bronchitis
Timely complex treatment of chronic bronchitis allows to increase remission period duration, to reduce the frequency and weight of aggravations, however does not give permanent treatment. The forecast of chronic bronchitis is burdened at accession of bronchial obstruction, respiratory insufficiency and pulmonary hypertensia.
Scheduled maintenance on the prevention of chronic bronchitis consists in promotion of refusal of smoking, elimination of adverse chemical and physical factors, treatment of the accompanying pathology, increase in immunity, timely and full treatment of an acute bronchitis.