Obstructive bronchitis
The content of the article:
- Causes and risk factors
- Forms
- Stages
- Obstructive bronchitis symptoms
- Features of the course of the disease in children
- Diagnostics
- Obstructive bronchitis treatment
- Possible complications and consequences
- Forecast
- Prevention
Obstructive bronchitis is a diffuse inflammation of the bronchial mucosa of various etiologies, which is accompanied by impaired airway patency due to bronchospasm, i.e. narrowing of the lumen of the bronchioles and the formation of a large amount of poorly separated exudate.
With obstructive bronchitis, a large amount of poorly separated mucus is formed
Hyperemia of the inner covers of the bronchopulmonary tract impedes the movement of the cilia of the ciliated epithelium, causing metaplasia of ciliated cells. Dead epithelial cells are replaced by goblet cells that produce mucus, as a result of which the amount of sputum increases sharply, the discharge of which is hampered by bronchospastic reactions from the autonomic nervous system.
At the same time, the composition of bronchial mucus changes: an increase in the viscosity of the secretion is accompanied by a decrease in the concentration of nonspecific immune factors - interferon, lysozyme and lactoferin. Thus, the products of inflammatory reactions become a breeding ground for representatives of pathogenic and opportunistic microflora. The progressive inflammatory process entails a persistent violation of ventilation and the development of respiratory failure.
Causes and risk factors
Obstructive bronchitis can be of both infectious and non-infectious origin. The most common causative agents of the disease are viruses - rhinovirus and adenovirus, as well as viruses of herpes, influenza and parainfluenza type III. Against the background of a strong suppression of the immune system, a bacterial component can be added to the viral infection. Quite often, obstructive bronchitis develops against the background of a chronic focus of infection in the nasopharynx.
Non-infectious obstructive bronchitis occurs as a result of persistent irritation of the mucous membranes in the airways. Allergens - pollen of plants, particles of animal epithelium, house dust, bed mites, etc. can have an irritating effect. Neoplasms in the trachea and bronchi usually act as mechanical stimuli. Also, the occurrence of the disease is facilitated by traumatic injuries and burns of the mucous membranes of respiratory substances, as well as the damaging effect of toxic substances such as ammonia, ozone, chlorine, acid fumes, sulfur dioxide, suspended fine particles of copper, cadmium, silicon, etc.
Frequent inhalation of toxic substances and fine dust particles in conditions of hazardous production is considered one of the main predisposing factors for the development of chronic obstructive bronchitis in representatives of a number of professions. The risk group includes miners, metallurgists, printing workers, railway workers, builders, plasterers, workers in the chemical industry and agriculture, as well as residents of ecologically unfavorable regions.
Work in hazardous work is one of the main predisposing factors for the development of obstructive bronchitis
Smoking and alcohol abuse also contribute to the development of bronchial obstruction. In pulmonology, there is the concept of "smoker's bronchitis", used in relation to patients with more than 10 years of smoking experience, complaining of shortness of breath and a severe hacking cough in the morning. The likelihood of this disease with active and passive smoking is approximately the same.
An inadequate approach to the treatment of acute obstructive bronchitis creates the preconditions for the transition of the disease to a chronic form. Exacerbations of chronic bronchitis are provoked by a number of external and internal factors:
- viral, bacterial and fungal infections;
- exposure to allergens, dust and pesticides;
- heavy physical activity;
- arrhythmia;
- uncontrolled diabetes mellitus;
- long-term use of certain medications.
Finally, a significant role in the pathogenesis of acute and chronic obstructive bronchitis is played by a hereditary predisposition - congenital hyperreactivity of the mucous membranes and genetically determined enzyme deficiency, in particular, the deficiency of some antiproteases.
Forms
Based on the reversibility of bronchial obstruction, in pulmonary practice, it is customary to distinguish between acute and chronic forms of obstructive bronchitis. In young children, acute obstructive bronchitis is more common; the chronic form is more typical for adult patients. In chronic bronchial obstruction, irreversible changes in the bronchopulmonary tissue are noted up to a violation of the ventilation-perfusion balance and the development of chronic obstructive pulmonary disease (COPD).
Stages
The initial stage of acute obstructive bronchitis is manifested by catarrhal inflammation of the upper respiratory tract. Further, the clinical picture of the disease unfolds as the inflammatory process spreads to the peribronchial tissue, bronchioles and bronchi of small and medium caliber. The disease lasts from 7-10 days to 2-3 weeks.
Depending on the effectiveness of therapeutic measures, two options for the development of events are possible - stopping the inflammatory process or the transition of the disease to a chronic form. In case of recurrence of three or more episodes per year, a diagnosis of recurrent obstructive bronchitis is made; the chronic form is diagnosed if symptoms persist for two years.
The progressive development of chronic obstructive bronchitis is characterized by a gradual decrease in the volume of forced inspiration in one second (FE-1), expressed as a percentage of the standard value.
- Stage I: OVF-1 from 50% and above. The disease does not significantly impair the quality of life.
- Stage II: FE-1 decreases to 35–49%, signs of respiratory failure appear. Systematic observation of a pulmonologist is shown.
- Stage III: OVF-1 is less than 34%. Pathological changes in the bronchopulmonary tissue become irreversible, a pronounced decompensation of respiratory failure occurs. The quality of life is improved by supportive care in an outpatient and day hospital setting. During the period of exacerbations, hospitalization may be required. When signs of peribronchial fibrosis and emphysema appear, the transition of chronic obstructive bronchitis to COPD can be assumed.
Obstructive bronchitis symptoms
Acute and chronic forms of bronchial obstruction manifest themselves differently. The initial symptoms of acute obstructive bronchitis coincide with the manifestations of catarrh of the upper respiratory tract:
- dry, hacking cough, worse at night;
- difficult sputum separation;
- feeling of tightness in the chest;
- heavy wheezing;
- subfebrile temperature;
- sweating.
With the rest of obstructive bronchitis, the patient is worried about dry hacking cough, especially at night
In some cases, the symptoms of obstructive bronchitis resemble ARVI. In addition to coughing, headaches, dyspeptic disorders, myalgia and arthralgia, general depression, apathy and fatigue are observed.
With chronic bronchial obstruction, the cough does not stop even during remission. After prolonged attacks, accompanied by profuse sweating and a feeling of suffocation, a small amount of mucus is expelled. With the course of the disease against the background of persistent arterial hypertension, streaks of blood may appear in the sputum.
During exacerbations, the cough increases, purulent exudate is found in the sputum. At the same time, shortness of breath is observed, which initially manifests itself during physical and emotional stress, and in severe and neglected cases, even at rest.
With progressive obstructive bronchitis, the period of inspiration is lengthened, due to which breathing is accompanied by wheezing and whistling on exhalation. In the expansion of the chest, not only the respiratory muscles take part, but also the muscles of the back, neck, shoulders and press; swelling of the veins in the neck, swelling of the wings of the nose at the time of inhalation and the sinking of the compliant parts of the chest - the jugular fossa, intercostal spaces, supraclavicular and subclavian regions are clearly visible.
Chronic obstructive bronchitis is characterized by asthma attacks, whistling and wheezing when breathing.
As the body's compensatory resources are exhausted, signs of respiratory and heart failure appear - cyanosis of the nails and skin in the area of the nasolabial triangle, on the tip of the nose and on the earlobes. In some patients, the lower extremities swell, the heart rate and blood pressure increase, and the nail plates acquire a specific "watch-glass" shape. Patients are worried about the loss of strength, increased fatigue and decreased performance; signs of intoxication are often present.
Features of the course of the disease in children
In children of preschool and primary school age, the acute form of obstructive bronchitis predominates, which is easily cured with adequate and timely initiated therapy. The treatment of obstructive bronchitis in children prone to colds and allergic reactions requires special attention, since there is a possibility of developing allergic bronchitis and bronchial asthma against the background of frequent relapses.
Diagnostics
Acute obstructive bronchitis is usually diagnosed based on clinical findings and physical examination. On auscultation, humid wheezing is heard in the lungs, the frequency and tone of which change when coughing. To accurately assess the degree of bronchial damage, identify concomitant diseases and exclude local and disseminated lung lesions in tuberculosis, pneumonia and oncopathology, an X-ray of the lungs may be required.
In chronic obstructive bronchitis, hard breathing appears, accompanied by a whistling noise during forced expiration, the mobility of the pulmonary edges decreases, and with percussion over the lungs, a box sound is noted. A characteristic sign of developed pulmonary heart failure is a pronounced accent of the second tone of the pulmonary artery on auscultation. However, if chronic obstructive bronchitis is suspected, physical methods are not sufficient. Additionally, endoscopic and functional studies are prescribed, which make it possible to judge the depth and degree of reversibility of pathological processes:
- spirometry - measurement of volumetric parameters of respiration with inhalation tests;
- pneumotachometry - determination of the volume and speed of air flows during calm and forced breathing;
- peak flowmetry - determination of the peak forced expiratory flow rate;
- bronchoscopy with biopsy sampling;
- bronchography.
Examination methods for the diagnosis of obstructive bronchitis
The laboratory research package includes:
- general blood and urine tests;
- blood chemistry;
- immunological tests;
- determination of blood gas composition;
- microbiological and bacteriological studies of sputum and lavage fluid.
In doubtful cases of exacerbation of chronic obstructive bronchitis, it is necessary to differentiate from pneumonia, tuberculosis, bronchial asthma, bronchiectal disease, pulmonary embolism and lung cancer.
Obstructive bronchitis treatment
The treatment of acute obstructive bronchitis is based on a comprehensive therapeutic regimen using a wide range of individually selected drugs. The acute form of the disease is usually triggered by a viral infection. For this reason, antibiotics are prescribed only for bacterial complications; the need for their use is determined by the attending physician. If the disease is triggered by an allergic reaction, antihistamines are used.
Symptomatic treatment of obstructive bronchitis involves the elimination of bronchospasm and the relief of sputum waste. To eliminate bronchospasm, anticholinergic drugs, beta-blockers and theophyllines are prescribed, used parenterally, in inhalation form or using a nebulizer. Parallel administration of mucolytics promotes liquefaction of exudate and rapid evacuation of sputum. In case of severe shortness of breath, inhaled bronchodilators are used.
To relax the pectoral muscles and to restore the respiratory function as soon as possible, percussion massage, as well as breathing exercises according to Buteyko or Strelnikova are recommended. A steady therapeutic effect is given by training on the Frolov breathing trainer.
In obstructive bronchitis, breathing exercises according to Buteyko or Strelnikova are useful
In order to prevent intoxication and dehydration, the patient needs a plentiful warm drink - alkaline mineral water, dried fruit decoction, fruit juices, berry fruit drinks, weak tea.
In the chronic form of the disease, symptomatic treatment predominates. Etiotropic therapy is used only during exacerbations. In the absence of a beneficial effect, corticosteroids may be prescribed. The patient's active participation in the therapeutic process is assumed: it is required to revise the lifestyle, diet and diet, daily routine, and give up bad habits.
In the most severe cases, acute and chronic obstructive bronchitis is treated in a hospital. Indications for hospitalization:
- intractable bacterial complications;
- rapidly growing intoxication;
- feverish conditions;
- confused consciousness;
- acute respiratory and heart failure;
- debilitating cough accompanied by vomiting;
- accession of pneumonia.
Possible complications and consequences
In the absence of qualified medical care in acute obstructive bronchitis, the likelihood of an asthmatic and bacterial component is high. In children prone to allergies, complications such as asthmatic bronchitis and bronchial asthma are more common; for adults, the development of bacterial pneumonia and the transition of bronchial obstruction to a chronic form are typical.
In children, bronchial asthma becomes a common complication of obstructive bronchitis.
The most likely complications of chronic obstructive bronchitis are emphysema, chronic obstructive pulmonary disease (COPD) and pulmonary heart failure - the so-called. Pulmonary heart. Acute infectious processes, pulmonary embolism or spontaneous pneumothorax can cause acute respiratory failure, requiring immediate hospitalization of the patient. In some patients, frequent attacks of breathlessness provoke panic attacks.
Forecast
With timely implementation of adequate therapy, the prognosis of acute bronchial obstruction is favorable, the disease responds well to treatment. In chronic obstructive bronchitis, the prognosis is more cautious, however, a properly selected therapy regimen can slow the progression of pathology and prevent complications. With a large number of concomitant diseases and in old age, the effectiveness of treatment decreases.
Prevention
The primary prevention of obstructive bronchitis is reduced to a healthy lifestyle. It is advisable to quit smoking and drinking alcohol, eat rationally, devote time to hardening and regular walks in the fresh air. It is necessary to timely and adequately treat acute respiratory infections, and in case of respiratory disorders of an allergic nature, undergo a course of desensitizing therapy.
Of great importance for the prevention of obstructive diseases of the respiratory system are living conditions, the ecological situation in the region and the organization of labor protection at enterprises. It is necessary to ventilate the premises every day and carry out wet cleaning at least two to three times a week. If the atmosphere is heavily polluted, air humidifiers can be used. To prevent exacerbations of chronic obstructive bronchitis caused by the irritating effect of pesticides, a change of place of residence or profession may be required.
YouTube video related to the article:
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
