Chronic pneumonia – a local nonspecific inflammation of pulmonary fabric which morphological features the karnifikation, a pneumosclerosis and the deforming bronchitis are. Is an outcome of not completely resolved acute pneumonia. It is clinically shown by a periodic recurrence of inflammatory process (rise in temperature, perspiration, weakness, cough with a mucopurulent phlegm). Chronic pneumonia is diagnosed taking into account radiological and laboratory signs, results of a bronkhoskopiya and the spirography. During the periods of an aggravation antimicrobic therapy, bronchodilators, mukoregulyator is appointed; bronchoscopic sanitation, massage, FTL is carried out. At frequent aggravations the lung resection is shown.
Chronic pneumonia - the permanent structural changes in a lung which are characterized by a local pneumosclerosis and deformation of bronchial tubes, followed by a periodic recurrence of an inflammation. According to the All-Russian Research Institute of pulmonology, transition of an acute pneumonia to a chronic form is observed at 3-4% of adults and at 0,6-1% of patients of children's age. In structure of HNZL 10-12% of cases fall to the share of chronic pneumonia. For the last decades thanks to improvement of protocols of therapy of the lake of pneumonia, introduction to clinical practice of new effective antibiotics the number of cases of chronic pneumonia was significantly reduced.
The concept "chronic pneumonia" arose in 1810 for designation of various not tubercular chronic processes in lungs. Since then the concept of chronic pneumonia was repeatedly discussed and revised by therapists and pulmonologists of the whole world. Today chronic pneumonia as nosological unit, did not find reflection in MKB-10 and does not admit most of foreign clinical physicians. Nevertheless, in domestic pulmonology there was a clear idea of chronic pneumonia as about the HNZL special form, and this term is widely used in medical literature and practice.
Reasons of chronic pneumonia
Chronic pneumonia develops in the outcome of acute or long pneumonia at their incomplete permission, especially at preservation in a lung of sites of hypoventilation or an atelektaz. Synchronization of a pulmonary inflammation can be promoted by inadequate and untimely treatment of sharp process, an early extract, and also factors of decrease in reactivity of an organism (advanced age, hypovitaminoses, alcoholism, smoking and so forth). It is proved that chronic pneumonia develops at patients with the accompanying chronic bronchitis more often. At children importance defects of leaving, a hypotrophy, ekssudativny diathesis, the postponed primary tuberculosis, in due time not taken foreign matters of bronchial tubes, chronic infections of a nasopharynx (adenoidit play, tonsillitis, sinusitis, etc.).
The bacterial landscape sowed at a microbiological research of a phlegm or washouts from bronchial tubes is presented by various flora (pathogenic staphylococcus, a pneumococcus, a hemolytic streptococcus, a hemophilic stick of Pfeyffer, a sinegnoyny stick, Candida mushrooms, etc.). In most cases the mixed kokkovy flora acts as etioagenta (staphylococcus in association with other microbes). At 15% of patients with chronic pneumonia the etiologichesky role of mycoplasmas is proved. Exacerbations of chronic pneumonia are most often provoked by a SARS (paraflu, the RS-infection, an adenoviral infection), at children also children's infections (measles, whooping cough, chicken pox).
The morphological basis of chronic pneumonia is made by irreversible changes of pulmonary fabric (a pneumosclerosis and/or a karnifikation) and bronchial tubes (the deforming bronchitis). These changes lead to violation of respiratory function mainly on restrictive type. Hyper secretion of slime in combination with inefficient drainage ability of bronchial tubes, and also violation of aeration of alveoluses in a zone of a pneumosclerosis is led to the fact that the affected area of a lung becomes the most vulnerable to different adverse effects. It finds expression in emergence of repeated local aggravations of bronchopulmonary process.
Classification of chronic pneumonia
Lack of uniform views of essence of a chronic pnevyomoniya was led to existence of a set of classifications, however not one of them is not standard. "Minsk" (1964) and "Tbilisi" (1972) of classification are of historical interest now and are not used in daily practice.
Depending on the prevailing patomorfologichesky changes chronic pneumonia can be divided on karnifitsiruyushchy (the karnifikation - overgrowing of alveoluses connecting fabric prevails) and interstitsialny (the interstitsialny pneumosclerosis prevails). To these forms there corresponds the kliniko-radiological picture.
On prevalence of changes distinguish focal, segmentary (polysegmentary) and share chronic pneumonia. Taking into account activity of inflammatory process allocate phases remission (compensations), a slow inflammation (subcompensation) and an aggravation (decompensation).
Symptoms of chronic pneumonia
Criteria of transition of an acute pneumonia in chronic lack of positive radiological dynamics during the period from 3 months to 1 year and longer, despite long and intensive therapy, and also a numerous recurrence of an inflammation in the same site of a lung is considered.
During the remission periods the symptomatology poor or is absent. The general satisfactory condition, unproductive cough is possible in the morning. At an exacerbation of chronic pneumonia the subfebrilny or febrilny temperature, perspiration, weakness appears. Cough amplifies and becomes constant, the phlegm gains mucopurulent or purulent character. Breast pains in a projection of the pathological center can be noted, occasionally there is a blood spitting.
Weight of aggravations can significantly differ: from rather easy forms to heavy, proceeding with the phenomena of warm and pulmonary insufficiency. In the latter case at patients intoxication, short wind at rest, with a large number of a phlegm is expressed. The aggravation reminds a heavy foryoma of krupozny pneumonia.
At insufficiently full or too short treatment the aggravation does not turn into remission, and is replaced by a slow inflammation. In this phase easy fatigue, periodic cough dry or with a phlegm, short wind remains at physical effort. Temperature can be normal or subfebrilny. Only after the additional, carefully carried out therapy slow process is replaced by remission. The most important of complications of chronic pneumonia exerting impact on its the subsequent currents are emphysema of lungs, a diffusion pneumosclerosis, bronkhoektaza, asthmatic bronchitis.
Diagnosis of chronic pneumonia
Obligatory methods of the confirming diagnostics include carrying out radiological (a X-ray analysis of lungs, a bronchography), endoscopic (bronkhoskopiya), functional (spirometry), laboratory inspection (OAK, blood biochemistry, microscopic and bacteriological the analysis of a phlegm).
The X-ray analysis of lungs in 2 projections has crucial importance in verification of chronic pneumonia. On roentgenograms the following signs can come to light: reduction of volume of a share of a lung, deformation and a tyazhistost of the pulmonary drawing, focal shadows (at a karnifikation), peribronkhialny infiltration, pleural changes, etc. In an aggravation phase against the background of a pneumosclerosis fresh infiltrative shadows are found. These bronchographies indicate the deforming bronchitis (roughness of contours and unevenness of distribution of contrast is defined).
At bronkhologichesky inspection can come to light catarrhal (out of an aggravation) or purulent (at an aggravation) the bronchitis which was more expressed in the corresponding segment or a share. At uncomplicated forms of chronic pneumonia indicators of FVD can insignificantly change. At associated diseases (obstructive bronchitis, emphysema) FZhYoL and ZhYoL, Tiffno's index and other values decreases.
Changes generally and biochemical blood tests are more characteristic of a phase of an exacerbation of chronic pneumonia. During this period there is an increase in SOE, with shift to the left, increase in fibrinogen, alpha and gamma globulins, a seromukoid, a gaptoglobin. At microscopy of a phlegm a large number of neutrophils is found; allows to define character of pathogenic microflora.
Careful differential diagnostics should be carried out with lung cancer, chronic bronchitis, BEB, chronic abscess of a lung, tuberculosis of lungs. For this purpose additional inspection (a X-ray tomography, KT of lungs, a transbronchial or transthoracic biopsy of a lung, tuberkulinovy tests, a torakoskopiya) can be required.
Treatment of chronic pneumonia
The principles of therapy in the period of an exacerbation of chronic pneumonia completely correspond to rules of treatment of an acute pneumonia. Antibacterial medicines are selected taking into account sensitivity of activators, at the same time two antibiotics of different groups (penicillin, tsefalosporina of the II-III generation, macroleads) quite often are at the same time used. Antibiotic therapy is combined with infusional, vitamin, immunocorrective therapy, intravenous administration of chloride calcium, reception bronkho-and mukolitichesky medicines.
Much attention is paid to carrying out endotrakhealny and endobronchial sanitation (washing of a bronchial tree by solution of a hydrocarbonate of sodium and introduction of antibiotics). During subsiding of an aggravation inhalations, respiratory gymnastics, massage of a thorax, physiotherapeutic procedure (SMV, an induktotermiya, a medicinal electrophoresis, UVCh, UFOK, VLOK, balneotherapy) are added. At the frequent and heavy aggravations caused by complications of chronic pneumonia the issue of a resection of the site of a lung is resolved.
In a remission phase the patient has to be observed at the pulmonologist and the local therapist at the place of residence. For the prevention of exacerbations of chronic pneumonia the smoking termination, rational employment, treatment of a nazofaringealny infection, improvement in sanatoria dispensaries is recommended. At correctly organized treatment and observation the forecast of chronic pneumonia rather favorable. At impossibility of achievement of full compensation of inflammatory process by the patient the III-II group of disability is appropriated. The forecast worsens in connection with development of the accompanying complications and warm and pulmonary insufficiency.