When massively affected the bronchial tree, the reconstructed mucous secretory apparatus and sclerotic changes occur in the walls of the bronchi, talk about chronic bronchitis.
The disease is constantly progressing, and treatment is aimed at reducing exacerbations. In chronic bronchitis marked cough and sputum for three months in a row. The disease is the most "popular" among all the pathologies of bronchopulmonary system. According to statistics, chronic bronchitis most males suffer after 40 years.
Kinds
By the nature of sputum are the following types of chronic bronchitis:
- purulent;
- bleeding (blood in the discharge from the bronchi);
- fibrinous.
Depending on which of the bronchial tree department amazed diagnose proximal bronchitis (large bronchi) or distal (affecting the bronchial tubes).
In accordance with the presence or absence of bronchospastic component obstructive bronchitis and divided into non-obstructive. The disease may be in remission or exacerbation be uncomplicated or complicated (e.g., emphysema).
Causes in adults
The first and main cause of chronic bronchitis is smoking, including passive: according to statistics, the disease is 5 times more likely to suffer smokers.
Another reason - the inhalation of contaminated air. Especially it concerns the residents living in metropolitan areas where the air polluting emissions of vehicles and emissions mills and factories.
Also, as the causes of the disease should be noted and industrial hazards (exposure to dust, fumes and gases of various chemicals, work in extremely hot or, conversely, too cold conditions).
Do not forget about the weather or environmental conditions (living in a damp and cold climates).
Not the least role in the occurrence of chronic bronchitis is acute bronchitis and the presence of history. The role of infection remains controversial among pulmonologists, many of them believe that it is only a worsening of the disease.
Infrequently occurring etiological factor in the development of the disease - a genetic predisposition.
Predispose to bronchitis following conditions:
- chronic pathology of the upper airways;
- chronic foci of infection in the body (e.g., caries or chronic pyelonephritis);
- impaired nasal breathing due to various reasons (nasal polyps, Broken nasal septum);
- pulmonary congestion (e.g., due to heart failure);
- alcoholism;
- chronic renal failure.
Symptoms of chronic bronchitis
Leading signs of the disease are:
- cough;
- dyspnea;
- sputum.
Cough can be both dry and moist nature, it is accompanied by coughing up of sputum binding, the amount of which varies. Its volume - from a few milliliters to 150 grams per day. Sputum can be different: watery and transparent mucosa with blood and pus, purulent.
Depending on how viscous sputum, can be judged on its ease of separation. The thicker it is, the intensity and duration of cough, which tires the patient. At the beginning of chronic bronchitis it is observed only in the morning, with the progression of the disease is to cough during the day.
May provoke sputum or physical stress, or rapid breathing (e.g., during fast walking or running). Physical effort is also provoke dyspnea, this suggests starting bronchial obstruction. May cause hemoptysis.
Another symptom is excessive sweating that occurs, usually at night. When the number of exacerbations of bronchitis sputum increases, deteriorating overall health, the patient feels fatigue and weakness, its performance decreases.
Defined by weakening or strengthening of breath, it is hard, listened and multiple scattered dry rales. If the process involves large bronchi, the wheezing have character dry and buzzing. The smaller diameter bronchi covered by a pathological process, the higher the pitch wheezing. So, with the defeat of the bronchioles are wheezing whistling sound.
Diagnostics
When the diagnosis is important to differentiate chronic bronchitis, bronchiectasisTuberculosis bronchus and bronchus cancer.
During the diagnosis must be carefully collected history and complaints, conduct auscultation of the chest.
From additional methods used radiography: in images visualized mesh deformation and increased lung pattern. In 30% of patients diagnosed with emphysema.
Be sure to investigate the discharge of the bronchi: analyze viscosity, color and character of sputum. When plated on a nutrient medium is isolated pathogens and determining their sensitivity to antibiotics. If it is difficult to collect sputum, bronchial lavage performed or is analyzed bronchial washings.
Showing such diagnostic methods such as bronchoscopy bronchography and in which excluded bronchiectasis.
It held as spirometry (study of respiratory function).
From clinical tests are appointed by the biochemical analysis of blood (CRP, Fibrin, total protein, etc.), and in the case of respiratory failure examined the gas composition of blood and blood acid-base status.
Treatment of chronic bronchitis
Treatment of chronic bronchitis has been doctor-pulmonologist.
As a rule, patients are treated as outpatients. Hospitalization is shown:
- in severe acute illness;
- due to the beginning of respiratory failure;
- the development of right ventricular failure;
- if necessary, surgery.
Treatment starts with eliminating the causes of disease (smoking ban, and so on). Patients assigned medical table with a high content of vitamins and protein (protein lost in the sputum).
Antibiotic treatment depends on the selected pathogen in sputum and carried out in view of sensitivity microbe thereto. The most frequently prescribed drugs from the group of macrolides (sumamed) and tetracyclines (doxycycline). Also shown receiving sulfonamides (Biseptolum) and nitrofurans (furazolidone). Duration depends on the patient and the presence of signs of improvement.
antiseptics are also assigned (dioxidine) which are introduced either intravenously or endotracheally. When bronchoscopy sanitize using furatsillina bronchi and other antiseptics.
When obstructive bronchitis treatment is aimed at bronchodilation (bronchodilation to increase, i.e. the removal of spasm).
To do this, appointed
- aerosols (berotek salbutamol),
- Teofedrin, aminophylline orally or parenterally.
To facilitate the expectoration of sputum recommend expectorants and mucolytics
- infusion of herbs marshmallow, Thermopsis,
- mukaltin, chest collection.
It does not lose its value and physiotherapy. In chronic bronchitis shown:
- massage;
- drainage position;
- UFO;
- physiotherapy.
The remission patients recommend sanatorium treatment.
Consequences and outlook
Chronic bronchitis is dangerous development of the following complications:
- emphysema;
- pulmonary hypertension;
- pulmonary heart disease;
- cardio-pulmonary insufficiency;
- pneumonia;
- asthma.
Forecast for life relatively favorable, worsens with disease duration and frequency of exacerbations.
