Acute obstructive bronchitis (ICD code 10 - J20)
The content of the article:
- Causes and risk factors
- Symptoms
- Diagnostics
- Treatment of acute obstructive bronchitis
- Forecast and prevention
- Video
Acute obstructive bronchitis is an acute inflammatory disease of the respiratory tract that affects the bronchi of medium and small caliber. It proceeds with a syndrome of bronchial obstruction associated with bronchospasm, edema of the bronchial mucosa and mucus hypersecretion.
Acute obstructive bronchitis (ICD code 10 acute bronchitis - J20) is more often diagnosed in young children.
Acute obstructive bronchitis is manifested by severe coughing, shortness of breath and a deterioration in general well-being
Causes and risk factors
The development of acute obstructive bronchitis in adults and children is caused by infection with the following microorganisms:
- rhinoviruses;
- adenoviruses;
- parainfluenza virus type 3;
- influenza viruses;
- respiratory syncytial viruses;
- viral-bacterial associations.
When conducting bacteriological research in flush waters from the bronchi, chlamydia, mycoplasma, and herpes virus are often isolated.
If you look at the medical histories of people suffering from obstructive bronchitis, you will notice that many of them have a history of weakened immunity, frequent respiratory diseases, and an increased allergic background.
The combination of unfavorable environmental factors and hereditary predisposition provokes the development of an inflammatory process that affects the small and medium bronchi, as well as the tissues surrounding them. This leads to disruption of the movement of the cilia of the cells of the ciliated epithelium. In the future, there is a gradual replacement of ciliated cells with goblet cells. Morphological changes in the bronchial mucosa are accompanied by changes in the composition of bronchial mucus, which leads to the development of mucostasis and obstruction (blockade) of small-caliber bronchi. This, in turn, provokes violations of the ventilation-perfusion ratio.
In bronchial mucus, the content of lysozyme, interferon, lactoferon and other factors of nonspecific local immunity decreases, which normally provide antibacterial and antiviral protection. As a result, pathogenic microorganisms (bacteria, fungi, viruses) begin to actively multiply in the viscous and thick secretion, which supports the activity of inflammation.
In the pathological mechanism of development of bronchial obstruction, activation of cholinergic receptors of the autonomic part of the nervous system is of no small importance, which leads to the emergence of a bronchospastic reaction.
All the processes described above lead to a spasm of the smooth muscles of the bronchi and swelling of their mucous membrane, hypersecretion of mucus.
Symptoms
The disease begins acutely and is characterized by the development of bronchial obstruction and infectious toxicosis, the signs of which are:
- general weakness;
- headache;
- subfebrile temperature (i.e., not exceeding 38 ° C);
- dyspeptic disorders.
In the clinical picture of acute bronchitis with signs of obstruction, the leading role belongs to respiratory disorders. Patients are worried about obsessive cough, which intensifies at night. It can be dry or damp, with mucous expectoration. In adults with hypertension, blood streaks may be present in the sputum.
Shortness of breath occurs and intensifies. During inhalation, the wings of the nose are inflated, and the auxiliary muscles (muscles of the abdominal press, shoulder girdle, neck) take part in the act of breathing.
During auscultation of the lungs, attention is paid to a wheezing elongated exhalation and dry rales that are well audible (often even at a distance).
Diagnostics
Diagnosis of acute bronchitis with obstruction is based on the data of the clinical picture and physical examination of the patient, the results of instrumental and laboratory research methods:
- Auscultation of the lungs. Patients exhibit hard breathing, wheezing dry wheezing. After coughing, the amount and tone of wheezing changes.
- Radiography of the lungs. On the roentgenogram, an increase in the roots of the lungs and bronchial pattern, emphysema of the pulmonary fields are noted.
- Medical and diagnostic bronchoscopy. During the procedure, the doctor examines the mucous membrane of the bronchi, takes sputum for laboratory research and, if necessary, can perform bronchoalveolar lavage.
- Bronchography. This diagnostic procedure is indicated for suspected bronchiectasis.
- Examination of the function of external respiration (FVD). Pneumotachometry, peak flowmetry, spirometry are of the greatest importance in diagnostics. Based on the results obtained, the reversibility and degree of bronchial obstruction, the degree of impaired pulmonary ventilation are determined.
- Laboratory research. The patient undergoes general urine and blood tests, a biochemical blood test (fibrinogen, total protein and protein fractions, glucose, creatinine, aminotransferase, bilirubin are examined). To assess the degree of respiratory failure, the determination of the acid-base state of the blood is shown.
Acute bronchitis with obstruction requires differential diagnosis with a number of other respiratory diseases:
- bronchial asthma;
- bronchiectasis;
- pulmonary embolism (PE);
- lungs' cancer;
- pulmonary tuberculosis.
Treatment of acute obstructive bronchitis
In pediatrics, the diagnosis and treatment of the disease is carried out on the basis of the clinical guidelines "Acute obstructive bronchitis in children." A sick child is prescribed a semi-bed regime. The room should be regularly damp cleaned and ventilated. Food should be easily digestible and served warm. Be sure to drink plenty of warm drink, which helps to liquefy the phlegm and better cough up it.
An important element of the treatment of bronchitis is an abundant drinking regimen.
Drug therapy for obstructive inflammation of the bronchi is carried out only as directed by a doctor and may include:
- antiviral drugs (ribavirin, interferon);
- antispasmodics (drotaverine, papaverine);
- mucolytics (ambroxol, acetylcysteine);
- bronchodilator inhalers (fenoterol hydrobromide, orciprenaline, salbutamol).
Antibiotics are prescribed only when a secondary bacterial infection is attached. The most commonly used cephalosporins, beta-lactams, tetracyclines, fluoroquinolones, macrolides.
In order to improve the discharge of sputum, vibration, percussion or general back massage is performed, and breathing exercises are recommended.
Forecast and prevention
The forecast is favorable. With adequate treatment, the disease ends with recovery within 7–21 days. With high allergization of the body, bronchitis can take on a recurrent or chronic course and, over time, transform into asthmatic, and then into bronchial asthma.
Prevention is based on measures aimed at increasing the general defenses of the body (proper nutrition, playing sports, walking in the fresh air, giving up bad habits).
Video
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
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