As a child, parents often told us: do not drink cold - you will catch a cold, do not walk around with your hat - you will get pneumonia, do not get your feet wet - your throat will hurt. But we didn't listen and got sick. Either out of stubbornness, or for the sake of research interest, they tested their body for strength. So what causes bronchitis and what is it?
Acute bronchitis
Bronchitis is an inflammatory disease of the lower respiratory tract, with the symptoms of which people around the world go to hospital most often. The causes of bronchitis can be very diverse: bacteria, viruses or protozoa.
In this case, no damage to the lung tissue occurs, and the inflammatory process is localized exclusively in the bronchial tree.
The following types of bronchitis are distinguished:
- acute, when the volume of bronchial secretion increases and a reflex cough appears; - chronic, when the mucous membrane changes at the cellular level, which leads to hypersecretion and impaired ventilation.
Etiology
As mentioned above, the causes of bronchitis can be the mostvarious. From the bacterial spectrum, the most common pathogens are streptococci, mycoplasmas, chlamydia, and anaerobic flora. Viral etiology is represented by influenza, parainfluenza and rhinovirus.
Slightly less common are bronchitis caused by chemical or toxic effects on the body. But in this case, the addition of a secondary infection is inevitable. According to the International Classification of Diseases of the tenth revision, there are acute bronchitis caused by established pathogens and unspecified acute bronchitis.
According to the duration of the disease, they are distinguished:
- acute (up to three weeks); - protracted course (more than a month).
Acute bronchitis can occur with or without bronchospasm. By localization, one can distinguish between tracheobronchitis, when inflammatory changes are concentrated in the upper part of the bronchial tree, and bronchiolitis (the pathological process affects small bronchioles and alveoli). Purulent, catarrhal and necrotic bronchitis are distinguished by the nature of the exudate.
Pathophysiology
How does bronchitis develop? Symptoms and treatment in adults directly depend on the mechanism of the onset of the disease, since therapy is aimed precisely at the links of the pathological process.
Etiological factors somehow damage the cells of the bronchial mucosa and cause their necrosis. These "gaps" in the defense create conditions for the penetration of the pathogen. If the virus initially colonized the epithelium, then after two or three days some bacterium will join it, asusually pneumococcus.
Inflammatory tissue reactions (swelling, redness, increased local temperature and impaired function) cause impaired blood flow in the capillary bed, compression of nerve endings and the formation of blood clots.
If the dynamics of the process is positive and the treatment is prescribed on time, then after the disappearance of inflammation, the mucosa is restored within a few months. But in a small percentage of patients, this does not happen. Then the disease becomes chronic. If the changes affected only the mucous membrane, then this will not affect a person's life too much. But damage to all layers of the bronchus can cause hemorrhages in the lung tissue, as well as staining of sputum with blood.
Clinic
Causes of obstructive bronchitis, such as bacteria or viruses, cause characteristic clinical manifestations. In the prodromal period, there is an increase in body temperature to febrile numbers, weakness, drowsiness, loss of appetite, headaches, sweating, heart palpitations.
Patients describe their sensations as soreness or soreness in the throat and behind the sternum, which are aggravated by the inhalation of cold air. In addition, they are disturbed by a dry, barking cough that does not bring relief. After two to three days, patients develop thick sputum of mucus or pus. Coughing may be accompanied by pain in the lower chest. This is due to overexertion of the pectoral muscles.
During a general examination, attention is drawn to the excessive moisture of the skin, its redness against the background of cyanosis of the lips. Muscles with each breath are drawn into the intercostalintervals, the auxiliary muscles are used for breathing.
On average, uncomplicated bronchitis lasts about two weeks and ends with full recovery.
Diagnosis
The causes of bronchitis are easy to identify if you correctly use diagnostic tools. After a visual examination, it is necessary to carry out physical methods of examination, such as palpation, percussion and auscultation. Feeling and percussion in this case will not show anything unusual, but through the phonendoscope you can hear hard breathing, accompanied by scattered wheezing. When sputum appears, the rales become moist coarse bubbling.
In the general blood test, an increase in the number of leukocytes and an increase in the erythrocyte sedimentation rate (ESR) will be observed. In the analysis of urine, as a rule, there are no changes, but at the height of the fever, protein may appear. A biochemical blood test allows you to see the appearance of C-reactive protein and an increase in the alpha fraction of proteins. Fibrin, leukocytes, desquamated bronchial epithelium and erythrocytes are found in sputum. In addition, in the laboratory, bronchial contents are cultured for the presence of bacteria and viruses.
There will be no specific changes on the radiograph, except perhaps only an increase in the lung pattern. A spirogram will assess the presence and degree of obstruction.
Treatment
The causes of bronchitis determine the choice of treatment tactics in each case. Depending on the severity of the pathological process, acute bronchitis can be treatedboth outpatient and inpatient, under round-the-clock medical supervision.
Therapy should include an antiviral or antibacterial component, as well as drugs that dilate the bronchi. In addition, it is necessary to eliminate the factors that will contribute to the progression of the infection. The course of treatment must be completed to the end, regardless of whether the symptoms of the disease persist or not.
Currently, doctors actively include physiotherapy, massage, and gymnastics in therapy. This helps to better evacuate secretions from the bronchi, and also allows you to change the way drugs are introduced into the body.
Chronic bronchitis
The main reason for the development of bronchitis is damage to the epithelium of the mucous membrane of the lower respiratory tract. You can talk about chronic bronchitis four weeks after the onset of the disease, provided that the clinical picture and pathomorphological changes in the lungs are preserved.
This condition is characterized by a diffuse lesion of the bronchial wall, which is associated with a long-term inflammatory process leading to tissue sclerosis. The secretory apparatus of the bronchi undergoes a number of changes and adjusts to increased mucus production.
Classification
There are several clinical classifications of chronic bronchitis. The following clinical forms of the disease are distinguished:
- simple (or catarrhal);
- purulent non-obstructive;
- simple form with impaired ventilation;
- purulent obstructive; - special, for example, fibrous orhemorrhagic.
According to the level of damage, bronchitis of large and small bronchi is divided. The presence of an asthmatic symptom complex and its severity are taken into account. By the nature of the course, like other inflammatory diseases, bronchitis is latent, having rare exacerbations, and constantly recurring.
Complications after chronic bronchitis are:
- emphysema;
- hemoptysis;
- formation of respiratory failure;- chronic cor pulmonale.
Reasons
Chronic course is usually preceded by acute bronchitis. The causes of this process can be concentrated both inside the body and outside it. First of all, it is necessary to take into account the readiness of immunity. If it is too strong or too weak, it can cause lingering inflammation and tissue damage. In addition, reduced immunity will attract more and more colonies of bacteria and viruses, so the disease will occur again and again.
In addition, prolonged, over the years, irritation of the bronchial mucosa with too dry and cold air, smoking, dust, carbon monoxide and other chemicals found in some industries can adversely affect the course of the disease.
There is evidence that some genetic diseases can also contribute to chronic inflammation in the lungs.
Pathogenesis
The causes of bronchitis are directly related tothe mechanism of disease formation. First of all, local bronchopulmonary protection decreases, namely: slowing down of the villi of the ciliated epithelium, a decrease in the amount of surfactant, lysozyme, interferons and immunoglobulins A, various groups of T-cells and alveolar macrophages.
Secondly, a pathogenetic triad develops in the bronchi:
- hyperfunction of the mucous glands of the bronchi (hypercrinia);
- increased sputum viscosity (discrinia);- secretion stagnation in the bronchi (mucostasis).
And thirdly, the development of sensitization to the pathogen and cross-reaction with the cells of one's own body. These three items ensure that inflammation persists for more than four weeks.
Symptoms
The disease is manifested by a strong cough with sputum up to one hundred and fifty milliliters per day, usually in the morning. In moments of exacerbation of inflammatory reactions, there may be temperature rises, sweating, weakness.
With the progression of respiratory and heart failure, thickening of the phalanges of the fingers (“drumsticks”) and thickening of the nail plates (“watch glasses”) develop. Pain in bronchitis occurs only if the pleura is involved in the inflammatory process or during a prolonged coughing fit, the auxiliary muscles are too tense.
Laboratory and instrumental studies
The diagnosis of "bronchitis" is made on the basis of laboratory and instrumental studies. In the general blood test, there is an increase in leukocytes, a shift in the leukocyte formulato the left, an increase in the erythrocyte sedimentation rate. Biochemically, the amount of sialic acids, seromucoids, alpha and gamma globulins in the blood is increased, C-reactive protein appears. Sputum mucous or purulent, may be streaked with blood. It contains epithelial cells, erythrocytes and neutrophils.
For morphological confirmation of the diagnosis, bronchoscopy is performed. On the radiograph, an increase in the pulmonary pattern and its mesh deformation, as well as signs of emphysema, are visible. Spirometry helps to orient the doctor about the presence or absence of signs of bronchial obstruction.
Treatment
What to do after the diagnosis of "chronic bronchitis"? Symptoms and treatment in adults do not differ much from those in the acute form. Usually, the doctor prescribes several combinations of drugs in the hope of influencing the etiological factor of the inflammatory response. If this fails, then it is necessary to stabilize the patient's condition. For this, the following groups of drugs are used:
- antibiotics;
- expectorants;
- bronchodilators;
- antihistamines; - inhalations and physiotherapy procedures.
