Acute tracheobronchitis is an acute respiratory disease that occurs with an inflammatory lesion of the mucous membrane of the trachea and bronchi. Disease is characterized by a strong cough (initially unproductive, then with the release of mucopurulent sputum), stinging pain behind the sternum, subfebrility, general weakness. Diagnostics includes physical examination, lung x-ray, clinical analysis of blood and sputum. Treatment is carried out with the help of pharmacotherapy (expectorants, antitussives), thermal procedures (mustard plasters, cans), alkaline inhalations.
Acute tracheobronchitis is an infectious and inflammatory process that engulfs the lower respiratory tract (trachea and bronchial tree) and resolves within three weeks. Every year, the disease is carried by 5% of the adult population; the peak of visits to the doctor falls on the autumn-winter period – the time of epidemic outbreaks of SARS. Pathology is often combined with lesions of the upper respiratory tract: rhinitis, pharyngitis, laryngitis. In pulmonology, acute (lasting up to 3 weeks), prolonged (up to 1 month) and chronic (up to 3 or more months) tracheobronchitis are distinguished. The course of disease can be uncomplicated and complicated – the latter option is more common in immunocompromised individuals (with HIV status, receiving chemotherapy), heart failure.
Causes of acute tracheobronchitis
Up to 90% of all cases of acute tracheobronchitis are caused by seasonal respiratory viral infection. The lesion of the underlying respiratory tract is most often initiated by influenza viruses, adenoviruses, coronaviruses, enteroviruses, rhinoviruses, metapneumoviruses; in children – MS virus and type III parainfluenza virus. Most respiratory viruses cause damage to the epithelium of the lower respiratory tract, activation of inflammatory mediators and impaired function of the bronchial mucociliary apparatus.
Less than 10% of cases of acute tracheobronchitis, according to epidemiological studies, are associated with Chlamydophila pneumoniae and Mycoplasma pneumoniae. It has been proven that pertussis and paracoccussis bacteria (B. pertussis and B. Parapertussis) can cause acute tracheobronchitis in immunized adults. In patients undergoing tracheostomy or endotracheal intubation, bacterial inflammation of the trachea and bronchi caused by nosocomial infection (S. pneumoniae, H.influenzae, St.aureus, Moraxella catarrhalis) is possible.
In some cases, disease may have an allergic or toxic-chemical nature. Non-infectious factors of inflammation can be atmospheric pollutants, tobacco smoke, heavy metals, dust, animal hair, etc. Chronic diseases, postinfectious asthenia, hypovitaminosis, hypothermia, stressful situations contribute to increased susceptibility to causally significant agents; in children – exudative diathesis, hypotrophy, rickets, poor care.
Acute tracheobronchitis symptoms
Usually acute tracheobronchitis is preceded by signs of acute respiratory infections: general malaise, fever, aches throughout the body, headache, rhinitis, pharyngitis. Unpleasant sensations in the nasopharynx quickly descend, covering the trachea and large bronchi.
The leading symptom of acute tracheobronchitis is a strong, paroxysmal cough, especially pronounced at night. At first, the cough is dry, unproductive, accompanied by sore throat and pain behind the sternum. A deep breath causes soreness, provokes another paroxysm of coughing, as a result of which breathing becomes shallow, rapid. In young children, coughing attacks can be accompanied by vomiting, cyanosis of the nasolabial triangle, excitement.
After a few days, the stage of “dry” catarrhal inflammation is replaced by “wet” inflammation. There is a productive cough with mucosal discharge (sometimes mucopurulent sputum). As the discharge of sputum becomes easier, the cough ceases to deliver painful sensations, the general condition improves. Under normal conditions (sufficient immunoreactivity of the body, timely and adequate treatment), acute tracheobronchitis is resolved within one to two weeks.
During periods of seasonal influenza epidemics, a special form of the disease occurs – acute hemorrhagic tracheobronchitis, which has a severe, sometimes fatal course. This form of tracheobronchitis is often complicated by hemorrhagic pneumonia, laryngeal edema with the threat of asphyxia.
Therapeutic and diagnostic measures for acute tracheobronchitis are usually carried out on an outpatient basis by a pediatrician, therapist or pulmonologist. With a pronounced allergic component, a consultation with an allergist-immunologist is indicated. Persons with a severe course of acute tracheobronchitis (for example, hemorrhagic form), as well as with a burdened general somatic background, are subject to hospitalization.
During auscultative examination, hard breathing with dry (later – moist medium- and small-bubbly) wheezes is heard. Lung x-ray is important mainly to exclude acute pneumonia. As part of the exclusion of bacterial infection, sputum (general analysis, bacteriological culture) and peripheral blood (blood test, CRP, procalcitonin) are examined. To confirm or deny the allergic nature of acute tracheobronchitis, skin allergic tests are carried out.
Differential diagnosis of acute tracheobronchitis is carried out with a wide range of diseases: laryngitis, bronchial asthma, COPD, pulmonary aspergillosis, respiratory mycoplasmosis, eosinophilic bronchitis, tumors of the trachea and bronchi, pneumonia, tuberculosis, whooping cough, foreign bodies of the respiratory tract.
Acute tracheobronchitis treatment
Effective therapy of acute tracheobronchitis involves a combination of non-medicinal and medicinal methods of exposure. The first of them include: elimination of factors irritating the respiratory tract, sufficient humidification of the air in the room, warm alkaline drinking, in the absence of elevated temperature – thermal procedures (jars, mustard plasters, foot baths). Alkaline inhalations have a good anti-inflammatory and expectorant effect.
Drug therapy consists of antiviral therapy, taking immunomodulators, antihistamines, mucolytic and expectorants. With a strong cough, short-term prescription of antitussive drugs is indicated. Antibiotic therapy can be justified only in the case of a high risk of severe complications against the background of comorbid conditions.
Preventive measures include seasonal vaccination against influenza, increasing the level of the body’s defenses, avoiding hypothermia and contact with patients with acute respiratory infections. In most cases, disease ends with complete recovery without consequences. Complicated forms and chronic inflammation occur in individuals with a burdened premorbid background.
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