Chronic bronchitis is an inflammatory process in the bronchi caused by the fact that the airways have been irritated for a long time by some substances or damaged as a result of a viral or bacterial infection.
As a result, a morphological restructuring of the bronchial mucosa occurs, mucus begins to be actively produced, and the cleansing function of the organ is disturbed. Manifestations of this process are persistent cough and sputum production.
Features of diagnosis and the main causes of the disease
Many people confuse chronic bronchitis with chronic obstructive pulmonary disease (COPD). As a result, even pulmonologists often do not have clear criteria for when to diagnose COPD and when chronic bronchitis.
In recent years, WHO has developed certain criteria when even the first signs of chronic bronchitis allow a diagnosis.
So, bronchitis means that inflammation occurs in the wall of the bronchial tree, although it can affect its various layers. This disease is consideredchronic if there is a productive (that is, with sputum) cough for at least three months for two consecutive years.
In this case, chronic bronchitis (CB) can be both primary and secondary. Primary bronchitis is considered as an independent disease, that is, it is in no way connected with other processes in the respiratory organs or with damage to other systems. It is characterized by diffuse bronchial lesions.
Secondary CB is always associated with some kind of disease. Not always these are pathologies of the respiratory system (for example, tuberculosis). Sometimes we are talking about other diseases - for example, congestive heart failure. Secondary bronchitis is usually manifested by local inflammation.
Exogenous causes of HB
It is not enough to know the signs of chronic obstructive bronchitis. It is necessary to understand its causes so that they can be eliminated and the recurrence of the disease can be prevented. And for this you need to understand what the bronchial mucosa is for.
The fact is that it is a protective barrier that prevents the effects of bacteria or other harmful factors of external origin. On the mucous membrane there is a layer of bronchial secretion, which prevents foreign particles and microbes from penetrating further. And the ciliated epithelium allows this mucus, along with harmful elements, to be evacuated.
A person who does not have a violation of the protective function, it is almost impossible to get sick with chronic bronchitis.
Prolonged exposure to irritatingagents:
- tobacco smoking;
- various professional pollutants (dusts and gases in production);
- pollutants contained in the air of megacities and large industrial cities.
Sometimes the disease develops against the background of an atypical bacterial infection. Influenza virus, adenovirus, pneumococcal infection, Haemophilus influenzae are not so much the cause of CB as they provoke its exacerbation.
Endogenous causes of CB
The main internal (endogenous) cause of the disease are various hereditary, congenital or acquired pathologies almost in infancy.
In such cases, computed tomography of the chest organs - CT scan is performed. Signs of chronic bronchitis will be manifested by various developmental disorders of the bronchial tree and bronchiectasis (dilations of individual airways).
At the same time, the doctor often prescribes an additional examination, since primary ciliary insufficiency or Kartagener's syndrome gives a similar picture.
Among the endogenous factors that lead to the development of this disease, there are also various pathologies of the nasopharynx, repeated SARS, impaired local immunity. And, paradoxically, obesity associated with metabolic disorders can also be the cause of pathology.
Classification
Although there is currently no generally accepted classification that would be approved by WHO, the following forms of this disease can be distinguished:
- catarrhal;
- catarrhal-purulent;
- purulent;
- hemorrhagic;
- fibrinous.
The last two forms of CB are rare. These forms differ in the nature of the inflammatory process. Sometimes in the literature you can find another classification, when chronic bronchitis occurs with or without airway obstruction.
Also, depending on the level of damage to the organ, there are two forms:
- proximal CB, in which large bronchi are affected;
- distal CB, in which small bronchi are affected.
Any of these diagnoses can only be made after a full examination. That is, if there are signs of chronic bronchitis in adults without fever, this is not enough for diagnosis. You still need to at least undergo an X-ray examination.
Symptoms
Signs of chronic bronchitis in adults without fever are of interest to many people suffering from frequent coughing. Indeed, the main manifestation of the disease is precisely the latter with sputum production.
However, there are other general symptoms:
- weakness;
- decrease in performance;
- excessive sweating;
- Chronic fatigue or fatigue.
Sometimes a slight increase in body temperature is possible. These signs can sometimes appear only with an exacerbation of the disease. But in some cases, they make themselves felt almost constantly, since they are the result of prolonged intoxication. This happens whenpurulent form of HB. And sometimes weakness and dizziness often appear due to the fact that HB leads to the development of respiratory failure, which causes hypoxia.
With a mild form of chronic bronchitis, it often happens that patients practically do not encounter unpleasant phenomena, exacerbations occur no more than twice a year. Moreover, it usually occurs either in late spring or early autumn, since this time is characterized by temperature fluctuations, and changes in air humidity become especially pronounced.
Efficiency even during such periods remains at a good level, because with a mild form, the cough is unproductive, almost dry, sputum usually leaves in the morning, while washing, and there is no particular deterioration in well-being. But with an unfavorable development of the disease, serious complications can occur.
Cough in chronic bronchitis
At the very beginning of the disease, the cough can be almost dry, but then its character changes. According to its features, one can even assume the form of HB. For example, with catarrhal bronchitis, a small amount of mucous sputum is secreted, mainly in the morning or after physical exertion. At first, the cough practically does not bother the patient, but then it becomes paroxysmal, it becomes barking, there are painful sensations.
In the purulent form of HB, the patient is more concerned about sputum production. In the exacerbation phase, it increases even more, and an intoxication syndrome occurs, accompanied by a strong cough. There may even be pain when swallowing, variouschronic diseases of the nasopharynx. During remission, the cough may become dry again.
Hemoptysis when coughing often indicates that a person has a vulnerable surface of the mucous membrane. But sometimes it is an indicator of a hemorrhagic form of bronchitis or even a more serious pathology.
ChD diagnostic methods
If there are signs of chronic bronchitis in adults, treatment can be started only after diagnosis.
As a rule, if physical symptoms have already appeared, auscultation will help to make the primary diagnosis. When listening, the doctor will note hard breathing, the presence of dry wheezing of a diffuse nature. The timbre of the latter largely depends on which area is affected.
If medium and large bronchi are involved in the process, then wheezing can be described as buzzing, and if small - as whistling. Used in the examination and methods of instrumental diagnostics.
When is X-ray done?
Chest X-ray is done if the doctor suspects CB. However, in this case there are some nuances.
The fact is that in most cases, the signs of chronic bronchitis on x-rays are almost invisible, sometimes there are even no changes in the lungs. But there is a situation when radiography helps to reveal a mesh deformation of the lung pattern, which indicates the development of pneumosclerosis. And with a long course of chronic bronchitis, symptoms of emphysema may appear.
In general, it is not the radiological signs of chronic bronchitis that are important, but the possibilitydistinguish the disease from other pathologies, identify comorbidities (such as tuberculosis or tumors), and diagnose complications, including pneumonia and bronchiectasis.
Bronchoscopy as a diagnostic method
As already noted, CT of the chest organs mainly helps to detect either anomalies in the structure of the organs, or bronchiectasis. Sometimes doctors prescribe an additional bronchoscopy. In general, it can play an important role in the diagnosis of chronic bronchitis, since it performs several tasks at once:
- allows you to confirm or refute the presence of inflammatory processes and even determine the degree of their activity;
- assesses the nature of inflammation, in particular, the hemorrhagic and fibrinous forms of CB mentioned above can only be diagnosed by this method;
- helps detect bronchial tree dysfunction and tracheal dyskinesia;
- reveals organic lesions of an organ, including tumors and structures.
In addition, bronchoscopy is used to obtain the contents of the bronchi for further serological, microbiological and cytological studies.
Basic principles of treatment
If there are signs of chronic bronchitis, exacerbation, treatment becomes an extremely urgent issue. Basically, its goal is to slow down the rate of diffuse damage to this organ, reduce the frequency of exacerbations, lengthen remission periods and improve the patient's quality of life. Also, in the case of adequate therapy, it is possible to achieve an increase in tolerance to moderate physical exertion.
Main directiontherapy - elimination of the exogenous causes described above, that is, a ban on smoking, refraining from passive smoking if possible, changing jobs, if we are talking about professional risks.
As for specific methods of treatment, their choice should be differentiated, depending on the form of the disease, on signs of exacerbation, on the presence of complications.
Therapeutic methods can be divided into two large groups - pathogenetic and etiotropic treatment. The latter is aimed at eliminating the inflammatory process in the bronchi.
Antibiotics in the treatment of CB
If there are signs of chronic bronchitis, treatment may be with antibiotics. They are prescribed after the identification of the causative agent of the disease (for this, sputum analysis is done). Its sensitivity to certain active substances is determined, and taking this into account, an antibiotic is prescribed. As a rule, this is "Amoxicillin", and if there is intolerance to it, then funds from the macrolide group.
The doctor most often prescribes oral medications. For example, dispersible tablets "Flemoxin Solutab" - such a dosage form contributes to the fact that the amoxicillin contained in the preparation begins to be released in the intestine, that is, in the zone where its maximum absorption occurs, which allows achieving high efficiency.
In case of an infectious exacerbation of chronic bronchitis, in the presence of concomitant diseases such as diabetes mellitus or heart failure, so-called protected drugs are prescribedaminopenicillin, specifically amoxicillin/clavulanate (Flemoklav Solutab, which has the benefit of the drug described above).
If such treatment fails, an approach such as parenteral administration of another group of antibiotics - third-generation cephalosporins, which can be administered both intravenously and intramuscularly.
Pathogenetic treatment of CB
The goal of pathogenetic treatment is to improve pulmonary ventilation, normalize bronchial patency. For this, oxygen therapy is carried out, physiotherapy exercises are prescribed.
To relieve bronchospasm and improve patency, bronchodilators, mucolytics and expectorants are used. The former include "Eufillin", anticholinergics (for example, "Ipratropium bromide").
As mucolytics take "Ambroxol" and "Acetylcysteine", sometimes "Bromhexine". The duration of the course of therapy is two weeks.
Herbal preparations like "Thermopsis" and "Muk altin" are considered less effective, but they are sometimes prescribed.
Supportive care and prevention
Supportive therapy mainly uses physiotherapy methods. Chest massage and therapeutic breathing exercises are combined with calcium chloride electrophoresis and hardening of the body.
Moreover, gymnastics is first practiced under controla doctor, but in general it must be done independently, not only during an exacerbation, but also during remission, that is, constantly.
In severe forms, spa treatment is also indicated. Prevention of acute respiratory infections and influenza vaccination play an important role.
