Chronic obstructive bronchitis: treatment, signs, varieties
The content of the article:
- The mechanism of development of the disease
- Varieties of the disease
- Causes of the disease
- Chronic obstructive bronchitis symptoms
- Treatment of chronic obstructive bronchitis
- How to prevent the transition from acute to chronic
- Video
Chronic obstructive bronchitis is a long-term (with periods of remission and exacerbations) inflammation of the bronchi of various calibers without the involvement of the own lung tissue in the pathological process, accompanied by impaired bronchial patency. The disease is non-allergic.
The causes of bronchitis can be different: from exposure to aggressive substances to infection with pathogenic microorganisms. The only characteristic feature of the disease will be the presence of bronchial obstruction.
Obstruction, i.e. blockage of the bronchi, the main sign of obstructive bronchitis
The chronic course of the disease is confirmed if the patient complains of a cough accompanied by sputum production for at least three months a year for more than two years in a row. In this case, there is an increase in respiratory failure, shortness of breath.
The mechanism of development of the disease
The main difference between obstructive bronchitis and non-obstructive bronchitis is the violation of the adequate passage of air through the bronchi during breathing.
This is classically explained by three main mechanisms:
- hypercrinia - an increase in the production of bronchial secretions by specialized goblet cells. There is too much mucus in the lumen of the bronchi;
- discrimination - the physical and chemical characteristics of sputum are violated: it becomes thick, viscous, it is difficult to separate from the bronchial walls, it loses its antimicrobial properties;
- mucostasis - dys- and hypercrinia ultimately lead to the development of mucostasis, stagnation of secretions in the lumen of the respiratory tract. This creates the prerequisites for the development of complications in the form of the addition of a bacterial infection.
In addition, additional obstructive mechanisms, reversible and irreversible, play an important role in the history of chronic obstructive bronchitis.
The former include a spasm of the smooth muscles of the bronchi, which significantly narrows their lumen, edema of the inflamed mucous membrane, and blockage of small branches of the bronchial tree with non-detachable mucus.
The process becomes irreversible as it progresses, while the walls of the bronchi are gradually deformed and hardened, the production of surfactant in the lungs decreases, breathing becomes difficult, and emphysema develops.
In adults, the disease is less common than in younger patients. This is due to the anatomical narrowness of the branches of the respiratory tree in a child, a large number of mucus-producing cells, imperfect local immunity, and some other reasons.
Varieties of the disease
The chronic process can proceed in several variations: latent (latent), with rare or frequent exacerbations, or in the form of a continuously recurrent disease.
Depending on the nature of the inflammation, bronchitis can be:
- catarrhal;
- mucopurulent;
- purulent.
Special, rare forms are hemorrhagic and fibrinous.
Depending on the triggering factor of the disease or its causative agent:
- viral;
- bacterial;
- allergic;
- toxic; etc.
Chronic obstructive bronchitis (ICD-10 code - J44), is allocated by the International Classification of Diseases, adopted by the World Health Organization, in a separate category.
When formulating the diagnosis, the form of the disease, the stage (exacerbation or remission), the severity of the process, and the presence of complications are indicated.
Causes of the disease
The immediate causes of the disease are:
- failure of the ciliated epithelium of the bronchi, which ceases to adequately cope with the excretion of mucus;
- increased secretion production;
- failure of the mechanisms of local bronchopulmonary protection.
Moreover, chronic bronchitis does not necessarily transform from acute: it can develop primarily as an independent disease.
The provocateurs in this case are several factors:
- living in an environmentally aggressive environment;
- harsh climatic conditions (high humidity, sharp drops or mainly low ambient temperature);
- industrial contact with potentially hazardous or toxic substances;
- exposure to infectious agents (fungi, bacteria, viruses);
- genetic predisposition (congenital insufficiency of defense mechanisms, bronchial hyperreactivity or anatomical structural features that contribute to mucus stagnation);
- long experience of smoking;
- abuse of alcoholic beverages;
- the presence of some concomitant chronic diseases; and etc.
Currently, it is extremely popular to look for the prerequisites for the development of diseases in the psychological sphere. From the standpoint of psychosomatic medicine in predisposed individuals, the formation and growth of bronchial obstruction is explained by psychological discomfort. It is believed that people with this pathology are “crushed” by a certain territorial conflict or rigid framework in which they are forced to exist. Such a psychological environment "strangles", which is somatically manifested by the presence of respiratory failure.
Chronic obstructive bronchitis symptoms
Dyspnea. Breathing disorder is manifested by difficulty exhaling. Shortness of breath will increase when exposed to unfavorable external factors (gassed air, smell of tobacco smoke, chemicals, etc.) or with a sharp change in climatic conditions.
At the onset of the disease, shortness of breath worries the patient only during periods of exacerbation, further progressing and acquiring an almost permanent character. It is accompanied by a wheezing hard breathing, the appearance of dry wheezing, decreases after coughing up and sputum discharge. It reaches its maximum severity in the morning after waking up.
Dyspnea and coughing for a long time are the main signs of chronic obstructed bronchitis
Cough. With chronic obstruction of the bronchi, the cough is quite exhausting, harsh in nature. Decreases after sputum discharge, increases after exercise, in wet, damp weather. It can manifest itself in the form of peculiar seizures, when the patient cannot effectively cough up his throat for half an hour or more.
Despite popular belief, neither a sore throat or a sore throat, nor a runny nose, nor an increase in body temperature are characteristic signs of obstructive bronchitis.
In addition to coughing and shortness of breath, most often patients complain of unmotivated weakness, rapid fatigue, intolerance to habitual physical exertion, tachycardia, at the time of an exacerbation - an increase in body temperature to subfebrile numbers.
Diagnostics, first of all, is based on the characteristic clinical picture, the length of the disease. From instrumental and laboratory methods of examination, X-ray of the lungs, examination of sputum, respiratory function, and blood gas composition are used.
If it is necessary to clarify the diagnosis and carry out differential diagnostics, bronchoscopy is performed.
Treatment of chronic obstructive bronchitis
The pharmacotherapy scheme of the disease involves the use of several groups of drugs:
- Bronchodilators. This includes drugs from several groups (beta-adrenomimetics, M-anticholinergics, methylxanthines, etc.). Their main effect is the elimination of bronchospasm, expansion of the lumen of the bronchi, due to which the fastest evacuation of mucous secretions is achieved.
- Mucolytics. The drugs in this group thin the thick, viscous mucus, making it easier to drain and eliminating stagnation. Modern agents are better known not as mucolytics, but as mucoregulators. They thin the phlegm without increasing its amount.
- Expectorants of reflex or resorptive action.
Inhalation with a nebulizer allows you to deliver the drug directly to the site of inflammation
With an exacerbation of bronchitis, the addition of a secondary infection, the development of a purulent process, in accordance with clinical guidelines, antibiotic therapy is prescribed. In this case, preference is given to semi-synthetic protected penicillins, cephalosporins of the 2nd or 3rd generation, macrolides / azalides, fluoroquinolones.
If an exacerbation is accompanied by an increase in body temperature, symptomatic treatment with antipyretic drugs is performed, sometimes in combination with antihistamines.
In case of a severe persistent course of the disease or the ineffectiveness of the medications used, inhaled glucocorticosteroids are prescribed, which have a powerful local anti-inflammatory effect.
How to prevent the transition from acute to chronic
To cure bronchitis without allowing the development of complications, including chronicity, you must:
- do not self-medicate, if symptoms of the disease appear, immediately consult a specialist;
- when taking expectorant and mucolytic drugs, observe a special drinking regimen, increasing the daily amount of fluid consumed by about a liter and a half;
- give preference to inhaled forms of drugs, nebulizer therapy;
- when prescribing antibiotic therapy, strictly follow medical recommendations, without independently changing the dosage, the frequency of taking medications or the duration of the course.
Video
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
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