Bronchitis (simple acute, recurrent, chronic, obstructive) comprise a large group of bronchial inflammatory diseases of different etiology, mechanisms of occurrence and clinical course. For obstructive bronchitis in pulmonology include cases of acute and chronic inflammation of the bronchi, occurring with the syndrome of bronchial obstruction that occurs on a background of mucosal edema, mucus hypersecretion, and bronchospasm. Acute obstructive bronchitis often develops in young children, chronic obstructive bronchitis – in adults.
Chronic obstructive bronchitis, along with other diseases proceeding with progressive airway obstruction ( emphysema , asthma ), usually attributed to chronic obstructive pulmonary disease (COPD). In the UK and the US in COPD group also included cystic fibrosis , obliterative bronchiolitis , and bronchiectasis .
Causes of obstructive bronchitis
Acute obstructive bronchitis etiologically associated with the respiratory syncytial virus , viruses, influenza , parainfluenza virus type 3, adenovirus, rhinovirus , viral and bacterial associations. In the study flush with the bronchi in patients with recurrent obstructive bronchitis often isolated DNA of persistent infectious agents – herpes virus , mycoplasma , chlamydia . Acute obstructive bronchitis occurs mainly in young children. The development of acute obstructive bronchitis is most susceptible children, often suffering from SARS who have a weakened immune system and increased allergic background, genetic predisposition.
The main factors contributing to the development of chronic obstructive bronchitis, are smoking (passive and active), occupational hazards (contact with the silicon, cadmium), air pollution (mainly sulfur dioxide), antiproteases deficiency (alpha1-antitrypsin) and others. The group risk of developing chronic obstructive bronchitis includes miners, construction workers, metal and agricultural industry, railroad, staff offices, associated with printing on laser printers, and others. chronic obstructive bronchitis sick men are more likely.
The pathogenesis of obstructive bronchitis
Summation of genetic predisposition and environmental factors leads to the development of the inflammatory process, which involved the bronchi of small and medium caliber and peribronchial tissue. This causes a disturbance of movement of the cilia of ciliated epithelium, and then his metaplasia, loss of the ciliated type of cell and the increase in the number of goblet cells. Following mucosal morphological transformation changes the composition of bronchial secretions with the development and mukostaza blockade bronchial tubes, which leads to disruption of ventilation-perfusion balance.
The bronchi secret content decreases nonspecific factors of local immunity, providing antiviral and antimicrobial protection: lactoferrin, lysozyme, and interferon. Thick and viscous bronchial secretion with reduced bactericidal properties is a good breeding ground for various pathogens (viruses, bacteria, fungi). In the pathogenesis of bronchial obstruction plays a significant role of cholinergic activation of the autonomic nervous system factors that cause the development of bronchospastic reactions.
The complex of these mechanisms leads to swelling of the bronchial mucosa, mucus hypersecretion and spasm of smooth muscle, t. E. The development of obstructive bronchitis. In the case of irreversible airflow, obstruction component should think about COPD – accession emphysema and peribronchial fibrosis.
Symptoms of acute obstructive bronchitis
As a rule, acute obstructive bronchitis develops in children during the first 3 years of life. The disease has an acute onset and occurs with infectious toxicosis symptoms and bronchial obstruction.
Infectious and toxic manifestations are characterized by low-grade body temperature, headache , dyspepsia, weakness. Leading the clinic obstructive bronchitis are respiratory disorders. Children worried about the dry or a wet cough, compulsive, not bringing relief and increasing at night, shortness of breath. Noteworthy nasal flaring inspiratory part in the act of respiration auxiliary muscles (muscles of the neck, shoulders, abdominals), retraction compliant sections of the chest when breathing (intercostal spaces, the jugular fossa, over-and subclavian area). For obstructive bronchitis typical elongated whistling breath and dry ( “music”), wheezing, audible in the distance.
Acute obstructive bronchitis duration – from 7-10 days to 2-3 weeks. In the case of recurrence of acute episodes of obstructive bronchitis and more than three times a year, speak of recurrent obstructive bronchitis; If symptoms persist for two years a diagnosis of chronic obstructive bronchitis.
Symptoms of chronic obstructive bronchitis
The basis of the clinical picture of chronic obstructive bronchitis, shortness of breath and cough up. Coughing is usually separated by a small amount of mucous expectoration; during periods of exacerbation increases the amount of phlegm and her character becomes mucopurulent or purulent. A cough is permanent and is accompanied by wheezing. Against the background of hypertension may experience episodes of hemoptysis.
Expiratory dyspnea in chronic obstructive bronchitis is usually joined later, but in some cases, the disease may soon make his debut with dyspnea. The severity of dyspnea varies widely: from lack of air sensation under load to severe respiratory failure . The degree of dyspnea depends on the severity of obstructive bronchitis exacerbations, comorbidity.
Exacerbation of chronic obstructive bronchitis can be triggered by respiratory infections, exogenous damaging factors, physical activity, spontaneous pneumothorax , arrhythmias , use of certain medicines, decompensation of diabetes and other. Factors. At the same time picking up signs of respiratory failure, there is low-grade fever, sweating, fatigue, myalgia.
Objective status in chronic obstructive bronchitis is characterized by an elongated exhalation, involving more muscles in breathing, remote wheezing, swelling of the neck veins, a change in the form of nails ( “hour glass slides’). With an increase in hypoxia appears cyanosis.
The severity of chronic obstructive bronchitis, according to the guidelines of the Russian Society of Chest Physicians, measured by FEV1 indicator (forced expiratory volume in 1 sec.).
- Stage I of chronic obstructive bronchitis is characterized by the value of FEV1 greater than 50% of the normative value. At this stage, the disease does not significantly affect the quality of life. Patients do not need constant monitoring dispensary pulmonologist .
- Stage II chronic obstructive bronchitis is diagnosed with a decrease in FEV1 to 35-49% of the normative value. In this case, the disease significantly affects the quality of life; patients need systematic observation pulmonologist.
- Stage III chronic obstructive bronchitis corresponds to the index FEV1 less than 34% of the predicted value. This has been a sharp decrease in exercise tolerance, requires inpatient and outpatient treatment in pulmonology departments and offices.
Complications of chronic obstructive bronchitis are emphysema, pulmonary heart , amyloidosis, respiratory failure. For the diagnosis of chronic obstructive bronchitis and other causes of a dyspnea, cough should be eliminated, especially tuberculosis and lung cancer .
Diagnosis of obstructive bronchitis
The program of surveys of persons with obstructive bronchitis includes physical, laboratory, radiology, functional, endoskopichesike research.
Character physical findings depend on the form and stage of obstructive bronchitis. As the disease progresses weakened voice trembling, comes boxed percussion sound above lungs, reduced mobility of lung edges; auscultation revealed hard breathing, wheezing during forced exhalation during exacerbation – crackles. Key number or wheezing after expectoration change.
Radiography of the lungs eliminates local and disseminated lung lesions, detect co-morbidities. Usually 2-3 years current obstructive bronchitis bronchial detected gain pattern, deformation of the roots of the lungs, pulmonary emphysema.
An essential criterion for the diagnosis of obstructive bronchitis is a study of respiratory function. The most important are data spirometry (in Vol. H. With inhaled samples), peak flow , pneumotachometer . Based on the data determined by the existence, degree and reversibility of airflow obstruction, impaired pulmonary ventilation, stage of chronic obstructive bronchitis.
Therapeutic and diagnostic bronchoscopy with obstructive bronchitis allows you to inspect the bronchial mucosa, sputum implement fence, and bronchoalveolar lavage . In order to exclude bronchiectasis may need to perform bronhografii .
The complex laboratory diagnostics investigates common blood and urine tests, blood biochemistry (total protein and protein fractions, fibrinogen, sialic acid, bilirubin, aminotransferase, glucose, creatinine, and others.). In immunological assays defined subpopulation functional capacity of T-lymphocytes, immunoglobulins, CEC. Determination of CBS and blood gas allows to objectively evaluate the degree of respiratory failure in obstructive bronchitis.
Held microscopic and bacteriological examination of sputum and lavage fluid, and to exclude pulmonary tuberculosis – sputum analysis by PCR and KUB .
Exacerbation of chronic obstructive bronchitis should be differentiated from bronchiectasis, asthma, pneumonia , tuberculosis, lung cancer, pulmonary embolism .
Treatment of obstructive bronchitis
In acute obstructive bronchitis appointed rest, drinking plenty of fluids, air moisture, alkaline and medicinal inhalation .
Appointed causal antiviral therapy (interferon, ribavirin, and others.). In severe bronchial apply antispasmodic (papaverine, no-spa) and mucolytic (acetylcysteine Last van) means bronchodilator inhalers (salbutamol as the moment, Aerotek). To facilitate sputum discharge performed percussion massage chest, vibrating massage , back massage muscles , breathing exercises. Antibiotic therapy is only indicated for the secondary accession microbial infection.
The goal of treatment of chronic obstructive bronchitis is the slowing of disease progression, reduction in the frequency and duration of exacerbations, improve the quality of life. The basis of the pharmacotherapy of chronic obstructive bronchitis is basic and symptomatic therapy. It is imperative to stop smoking.
Basic therapy includes the use of bronchodilator medications: anticholinergics (Atrovent), b2-agonists (Aerotek salbutamol), xanthine (theophylline). In the absence of the effect of the treatment of chronic obstructive bronchitis using corticosteroids. Mucolytic agents (ambroxol, acetylcysteine, bromhexine) are used to improve bronchial patency. The formulations may be administered by mouth, in the form of inhalation aerosols, inhalation therapy or parenterally.
Layering bacterial component in periods of exacerbation of chronic obstructive bronchitis appointed macrolides, fluoroquinolones, tetracyclines, b-lactams, cephalosporins course of 7-14 days. In hypoxemia and hypercapnia, the mandatory component of the treatment of obstructive bronchitis is oxygen therapy .
Prediction and prevention of obstructive bronchitis
Acute obstructive bronchitis responds well to treatment. In children with allergic predisposition obstructive bronchitis may recur, leading to the development of asthmatic bronchitis or asthma. Go obstructive bronchitis in the chronic form prognostically less favorable.
Adequate therapy helps to delay the progression of the obstructive syndrome and respiratory failure. Unfavorable factors aggravating prognosis are older age patients, comorbidities, frequent exacerbations, continued smoking, a poor response to therapy, the formation of the pulmonary heart.
Measures of primary prevention of obstructive bronchitis are in leading healthy lifestyles, improving the overall resistance to infections, improvement of working conditions and environment. The principles of secondary prevention of obstructive bronchitis involve prevention and adequate treatment of exacerbations, can slow the progression of the disease.