Bronchitis is a diffuse inflammatory disease of the bronchi, affecting the mucous membrane or the entire thickness of the bronchial wall. Damage and inflammation of the bronchial tree can occur as an independent, isolated process (primary bronchitis) or develop as a complication against the background of existing chronic diseases and infections (secondary bronchitis). Damage to the mucous epithelium of the bronchi disrupts the production of secretions, the motor activity of the cilia and the process of cleansing the bronchi. Acute and chronic form are divided, differing in etiology, pathogenesis and treatment.
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The acute course of disease is characteristic of many acute respiratory infections (ARI). The most common cause of acute form are parainfluenza viruses, respiratory syncytial virus, adenoviruses, less often – influenza virus, measles, enteroviruses, rhinoviruses, mycoplasmas, chlamydia and mixed viral-bacterial infections. Acute bronchitis rarely has a bacterial nature (pneumococci, staphylococci, streptococci, hemophilic bacillus, the causative agent of whooping cough). The inflammatory process first affects the nasopharynx, tonsils, trachea, gradually spreading to the lower respiratory tract – bronchi.
Viral infection can provoke the reproduction of conditionally pathogenic microflora, aggravating catarrhal and infiltrative changes in the mucosa. The upper layers of the bronchial wall are affected: there is hyperemia and swelling of the mucous membrane, pronounced infiltration of the submucosal layer, dystrophic changes and rejection of epithelial cells occur. With proper treatment, acute form has a favorable prognosis, the structure and functions of the bronchi are fully restored after 3-4 weeks. Acute bronchitis is very often observed in childhood: this fact is explained by the high susceptibility of children to respiratory infections. Regularly recurring bronchitis contributes to the transition of the disease into a chronic form.
Chronic form is a long-term inflammatory disease of the bronchi that progresses over time and causes structural changes and dysfunction of the bronchial tree. Chronic form occurs with periods of exacerbations and remissions, often has a latent course. Recently, there has been an increase in the incidence of chronic bronchitis due to environmental degradation (air pollution with harmful impurities), widespread bad habits (smoking), and a high level of allergization of the population. With prolonged exposure to adverse factors on the mucous membrane of the respiratory tract, gradual changes in the structure of the mucous membrane develop, increased sputum secretion, impaired drainage ability of the bronchi, decreased local immunity. With chronic form, hypertrophy of the bronchial glands occurs, thickening of the mucous membrane. The progression of sclerotic changes in the bronchial wall leads to the development of bronchiectasis, deforming bronchitis. The change in the air-conducting ability of the bronchi significantly disrupts lung ventilation.
Classification of bronchitis
Bronchitis is classified according to a number of signs:
According to the severity of the course:
- to moderate
- to severe
According to the clinical course:
- acute bronchitis
- chronic bronchitis
Acute bronchitis, depending on the etiological factor, can be:
- of infectious origin (viral, bacterial, viral-bacterial)
- of non-infectious origin (chemical and physical harmful factors, allergens)
- of mixed origin (combination of infection and the action of physico-chemical factors)
- of unspecified etiology
According to the area of inflammatory lesion , there are:
- bronchitis with a predominant lesion of the bronchi of medium and small caliber
According to the mechanism of occurrence, primary and secondary acute bronchitis are distinguished. According to the nature of the inflammatory exudate, disease is distinguished: catarrhal, purulent, catarrhal-purulent and atrophic.
Depending on the nature of inflammation, catarrhal chronic bronchitis and purulent chronic bronchitis are distinguished. According to the change in the function of external respiration, obstructive bronchitis and non-obstructive form of the disease are distinguished. According to the phases of the process, exacerbations and remissions alternate during chronic bronchitis.
The main factors contributing to the development of acute bronchitis are:
- physical factors (damp, cold air, a sharp temperature drop, exposure to radiation, dust, smoke);
- chemical factors (presence of pollutants in the atmospheric air – carbon monoxide, hydrogen sulfide, ammonia, chlorine vapors, acids and alkalis, tobacco smoke, etc.);
- bad habits (smoking, alcohol abuse);
- stagnant processes in the small circle of blood circulation (cardiovascular pathologies, violation of the mechanism of mucociliary clearance);
- the presence of foci of chronic infection in the oral cavity and nose – sinusitis, tonsillitis, adenoiditis;
- hereditary factor (allergic predisposition, congenital disorders of the bronchopulmonary system).
It has been established that smoking is the main provoking factor in the development of various bronchopulmonary pathologies, including chronic form. Smokers suffer from chronic bronchitis 2-5 times more often than non-smokers. The harmful effects of tobacco smoke are observed both during active and passive smoking.
Predisposes to the occurrence of chronic bronchitis long-term exposure to harmful production conditions: dust – cement, coal, flour, wood; vapors of acids, alkalis, gases; uncomfortable temperature and humidity conditions. Atmospheric air pollution by emissions from industrial enterprises and transport, fuel combustion products has an aggressive effect primarily on the human respiratory system, causing damage and irritation of the bronchi. A high concentration of harmful impurities in the air of large cities, especially in calm weather, leads to severe exacerbations of chronic bronchitis.
Repeated acute respiratory infections, acute form and pneumonia, chronic diseases of the nasopharynx, kidneys can further cause the development of chronic form. As a rule, the infection is layered on the already existing lesion of the respiratory mucosa by other damaging factors. The damp and cold climate contributes to the development and exacerbation of chronic diseases, including bronchitis. An important role belongs to heredity, which under certain conditions increases the risk of chronic bronchitis.
Symptoms of bronchitis
The main clinical symptom of acute form – low chest cough – usually appears against the background of already existing manifestations of acute respiratory infection or simultaneously with them. The patient has an increase in temperature (to moderately high), weakness, malaise, nasal congestion, runny nose. At the beginning of the disease, the cough is dry, with scanty, difficult to separate sputum, increasing at night. Frequent coughing attacks cause painful sensations in the abdominal muscles and chest. After 2-3 days, sputum (mucous, mucopurulent) begins to flow abundantly, and the cough becomes moist and soft. Dry and wet wheezes are heard in the lungs. In uncomplicated cases of acute form, shortness of breath is not observed, and its appearance indicates the defeat of small bronchi and the development of obstructive syndrome. The patient’s condition normalizes within a few days, the cough may continue for several weeks. Prolonged high temperature indicates the addition of bacterial infection and the development of complications.
Chronic bronchitis occurs, as a rule, in adults, after repeatedly suffering acute form, or with prolonged irritation of the bronchi (cigarette smoke, dust, exhaust gases, chemical vapors). The symptoms of chronic bronchitis are determined by the activity of the disease (exacerbation, remission), the nature (obstructive, non-obstructive), the presence of complications.
The main manifestation of chronic bronchitis is a prolonged cough for several months for more than 2 years in a row. Cough is usually moist, appears in the morning, accompanied by the release of a small amount of sputum. Cough intensification is observed in cold, wet weather, and subsiding – in the dry, warm season. The general well-being of patients at the same time almost does not change, cough for smokers becomes a common phenomenon. Chronic form progresses over time, the cough intensifies, acquires the character of seizures, becomes annoying, unproductive. There are complaints of purulent sputum, malaise, weakness, fatigue, sweating at night. Shortness of breath joins with loads, even minor ones. In patients with a predisposition to allergies, bronchospasm phenomena occur, indicating the development of obstructive syndrome, asthmatic manifestations.
Bronchopneumonia is a frequent complication in acute bronchitis, develops as a result of a decrease in local immunity and the stratification of bacterial infection. Repeatedly transferred acute bronchitis (3 or more times a year), lead to the transition of the inflammatory process into a chronic form. The disappearance of provoking factors (quitting smoking, climate change, change of place of work) can completely relieve the patient from chronic bronchitis. With the progression of chronic form, repeated acute pneumonia occurs, and with a prolonged course the disease can turn into chronic obstructive pulmonary disease. Obstructive changes in the bronchial tree are considered as a pre-asthma condition (asthmatic bronchitis) and increase the risk of bronchial asthma. Complications appear in the form of emphysema of the lungs, pulmonary hypertension, bronchiectatic disease, cardiopulmonary insufficiency.
Diagnosis of various forms of bronchitis is based on the study of the clinical picture of the disease and the results of studies and laboratory tests:
- Blood test and urinalysis;
- Immunological and biochemical blood tests;
- Lung x-ray;
- Spirometry, peak flowmetry;
- Bronchoscopy, bronchography;
- ECG, echocardiography;
- Microbiological analysis of sputum.
Treatment of bronchitis
In the case of bronchitis with a severe concomitant form of ARVI, treatment in the department of pulmonology is indicated, with uncomplicated bronchitis, outpatient treatment is indicated. Bronchitis therapy should be comprehensive: fighting infection, restoring bronchial patency, eliminating harmful provoking factors. It is important to undergo a full course of treatment for acute bronchitis in order to exclude its transition to a chronic form. In the first days of the disease, bed rest, copious drinking (1.5 – 2 times more than normal), a dairy-vegetable diet is indicated. Smoking cessation is mandatory for the duration of treatment. It is necessary to increase the humidity in the room where the patient with bronchitis is located, since the cough increases in dry air.
Therapy of form bronchitis may include antiviral drugs: interferon (intranasally), for influenza – remantadine, ribavirin, for adenovirus infection – RNA-azu. In most cases, antibiotics are not used, except in cases of bacterial infection, with a prolonged course of acute bronchitis, with a pronounced inflammatory reaction according to the results of laboratory tests. To improve sputum excretion, mucolytic and expectorant agents are prescribed (bromhexine, ambroxol, expectorant herbal collection, inhalations with soda and saline solutions). In the treatment of bronchitis, vibration massage, therapeutic gymnastics, physiotherapy are used. With a dry unproductive painful cough, the doctor may prescribe medications that suppress the cough reflex – oxeladin, prenoxdiazine, etc.
Chronic form requires long-term treatment, both during exacerbation and during remission. With exacerbation of bronchitis, with purulent sputum, antibiotics are prescribed (after determining the sensitivity of the isolated microflora to them), diluting sputum and expectorant drugs. In the case of the allergic nature of chronic bronchitis, antihistamines are necessary. The regime is semi–bed, necessarily warm, plentiful drink (alkaline mineral water, tea with raspberries, honey). Sometimes a therapeutic bronchoscopy is performed, with the washing of the bronchi with various medicinal solutions (bronchial lavage). Respiratory gymnastics and physiotherapy (inhalation, UHF, electrophoresis) are shown. At home, you can use mustard plasters, medical jars, warming compresses. Vitamins and immunostimulants are taken to strengthen the body’s resistance. Outside of exacerbation of bronchitis, sanatorium treatment is desirable. Walking in the fresh air is very useful, normalizing respiratory function, sleep and general condition. If there are no exacerbations of chronic form for 2 years, the patient is removed from the dispensary observation by a pulmonologist.
Acute bronchitis in uncomplicated form lasts about two weeks and ends with a complete recovery. In the case of concomitant chronic diseases of the cardiovascular system, there is a prolonged course of the disease (a month or more). The chronic form of bronchitis has a long course, a change of periods of exacerbations and remissions.
Preventive measures to prevent many bronchopulmonary diseases, including acute and chronic bronchitis, include: elimination or weakening of the effects on the respiratory system of harmful factors (dust, air pollution, smoking), timely treatment of chronic infections, prevention of allergic manifestations, increased immunity, a healthy lifestyle.