Obstructive bronchitis is a diffuse inflammation of the bronchi of small and medium caliber, occurring with a sharp bronchial spasm and progressive violation of pulmonary ventilation. Disease is manifested by coughing with sputum, expiratory shortness of breath, wheezing, respiratory failure. The diagnosis is based on auscultative, radiological data, the results of the study of the function of external respiration. The therapy includes the appointment of antispasmodics, bronchodilators, mucolytics, antibiotics, inhaled corticosteroids, respiratory gymnastics, massage.
J44.8 Other specified chronic obstructive pulmonary disease
Bronchitis (simple acute, recurrent, chronic, obstructive) is a large group of inflammatory diseases of the bronchi, different in etiology, mechanisms of occurrence and clinical course. Pathology in pulmonology includes cases of acute and chronic inflammation of the bronchi, occurring with bronchial obstruction syndrome, occurring against the background of mucosal edema, mucus hypersecretion and bronchospasm. Acute form develops more often in young children, chronic form – in adults.
Chronic form, along with other diseases occurring with progressive airway obstruction (pulmonary emphysema, bronchial asthma), is commonly referred to as chronic obstructive pulmonary disease (COPD). In the UK and the USA, the COPD group also includes cystic fibrosis, obliterating bronchiolitis and bronchiectatic disease.
Causes of obstructive bronchitis
Acute obstructive bronchitis is etiologically associated with respiratory syncytial viruses, influenza viruses, type 3 parainfluenza virus, adenoviruses and rhinoviruses, viral-bacterial associations. In the study of bronchial flushing in patients with recurrent obstructive bronchitis, DNA of persistent infectious pathogens – herpes, mycoplasma, chlamydia – is often isolated. Acute obstructive bronchitis mainly occurs in young children. The development of acute form is most susceptible to children, often suffering from acute respiratory viral infections, having weakened immunity and an increased allergic background, genetic predisposition.
The main factors contributing to the development of chronic form are smoking (passive and active), occupational risks (contact with silicon, cadmium), air pollution (mainly sulfur dioxide), deficiency of antiproteases (alpha1-antitrypsin), etc. The risk group for the development of chronic form includes miners, construction workers, metallurgical and agricultural industries, railway workers, office employees associated with printing on laser printers, etc. Chronic form is more common in men.
The summation of genetic predisposition and environmental factors leads to the development of an inflammatory process, which involves small and medium-sized bronchi and peribronchial tissue. This causes a violation of the movement of the cilia of the ciliated epithelium, and then its metaplasia, loss of ciliated cells and an increase in the number of goblet cells. Following the morphological transformation of the mucosa, the composition of bronchial secretions changes with the development of mucostasis and blockade of small bronchi, which leads to a violation of the ventilation-perfusion balance.
In the secret of the bronchi, the content of nonspecific factors of local immunity that provide antiviral and antimicrobial protection decreases: lactoferin, interferon and lysozyme. Thick and viscous bronchial secretions with reduced bactericidal properties are a good breeding ground for various pathogens (viruses, bacteria, fungi). In the pathogenesis of bronchial obstruction, an essential role belongs to the activation of cholinergic factors of the autonomic nervous system that cause the development of bronchospastic reactions.
The complex of these mechanisms leads to edema of the bronchial mucosa, mucus hypersecretion and smooth muscle spasm, i.e. the development of obstructive bronchitis. If the component of bronchial obstruction is irreversible, one should think about COPD – the addition of emphysema and peribronchial fibrosis.
Symptoms of acute obstructive bronchitis
As a rule, acute obstructive bronchitis develops in children of the first 3 years of life. The disease has an acute onset and proceeds with symptoms of infectious toxicosis and bronchial obstruction.
Infectious and toxic manifestations are characterized by subfebrile body temperature, headache, dyspeptic disorders, weakness. Respiratory disorders are leading in the clinic of obstructive bronchitis. Children are worried about dry or wet obsessive cough, which does not bring relief and increases at night, shortness of breath. Attention is drawn to the inflating of the wings of the nose on inspiration, the participation in the act of breathing of auxiliary muscles (neck muscles, shoulder girdle, abdominal press), the retraction of compliant areas of the chest during breathing (intercostal spaces, jugular fossa, supra- and subclavian region). Obstructive bronchitis is characterized by an elongated whistling exhalation and dry (“musical”) wheezing, audible at a distance.
The duration of acute obstructive bronchitis is from 7-10 days to 2-3 weeks. In case of recurrence of episodes of acute obstructive bronchitis three or more times a year, they talk about recurrent obstructive bronchitis; if symptoms persist for two years, a diagnosis of chronic form is established.
Symptoms of chronic obstructive bronchitis
The basis of the clinical picture of chronic form is cough and shortness of breath. When coughing, a small amount of mucosal sputum is usually separated; during periods of exacerbation, the amount of sputum increases, and its character becomes mucopurulent or purulent. The cough is permanent and is accompanied by wheezing breathing. Against the background of arterial hypertension, episodes of hemoptysis may occur.
Expiratory dyspnea in chronic form usually joins later, but in some cases the disease can debut immediately with dyspnea. The severity of shortness of breath varies widely: from feelings of lack of air during exercise to severe respiratory failure. The degree of shortness of breath depends on the severity of obstructive bronchitis, the presence of exacerbation, concomitant pathology.
Exacerbation of chronic form can be provoked by respiratory infection, exogenous damaging factors, physical exertion, spontaneous pneumothorax, arrhythmia, the use of certain medications, decompensation of diabetes mellitus, and other factors. At the same time, signs of respiratory failure increase, subfebrility, sweating, fatigue, myalgia appear.
The objective status in chronic form is characterized by prolonged exhalation, the participation of additional muscles in breathing, remote wheezing, swelling of the neck veins, changing the shape of nails (“watch glasses”). With an increase in hypoxia, cyanosis appears.
Complications of chronic obstructive bronchitis are emphysema of the lungs, pulmonary heart, amyloidosis, respiratory failure. To diagnose chronic form, other causes of shortness of breath and cough, primarily tuberculosis and lung cancer, should be excluded.
The examination program of persons with this disease includes physical, laboratory, X-ray, functional, endoscopic studies. The nature of physical data depends on the form and stage of obstructive bronchitis. As the disease progresses, the vocal tremor weakens, a box percussion sound appears over the lungs, the mobility of the pulmonary edges decreases; auscultation reveals hard breathing, wheezing with forced exhalation, with exacerbation – wet wheezing. The tone or amount of wheezing changes after clearing your throat.
Lung x-ray allows to exclude local and disseminated lung lesions, to detect concomitant diseases. Usually, after 2-3 years of obstructive bronchitis, an increase in the bronchial pattern, deformation of the roots of the lungs, and emphysema of the lungs are detected. Therapeutic and diagnostic bronchoscopy for obstructive bronchitis allows you to examine the bronchial mucosa, collect sputum and bronchoalveolar lavage. In order to exclude bronchiectasis, bronchography may be required.
A necessary criterion for the diagnosis of obstructive bronchitis is the study of the function of external respiration. The most important data are spirometry (including with inhalation samples), peak flowmetry, pneumotachometry. Based on the data obtained, the presence, degree and reversibility of bronchial obstruction, pulmonary ventilation disorders, and the stage of chronic obstructive bronchitis are determined.
In the complex of laboratory diagnostics, blood test and urinalysis, biochemical blood parameters (total protein and protein fractions, fibrinogen, sialic acids, bilirubin, aminotransferases, glucose, creatinine, etc.) are examined. In immunological samples, the subpopulation functional ability of T-lymphocytes, immunoglobulins, and CEC is determined. Determination of the ABB and the gas composition of the blood allows you to objectively assess the degree of respiratory failure in obstructive bronchitis.
Microscopic and bacteriological examination of sputum and lavage fluid is carried out, and in order to exclude pulmonary tuberculosis, sputum analysis by PCR is carried out. Exacerbation of chronic obstructive bronchitis should be differentiated from bronchiectatic disease, bronchial asthma, pneumonia, tuberculosis and lung cancer, PE.
Treatment of obstructive bronchitis
In acute obstructive bronchitis, rest, copious drinking, humidification, alkaline and medicinal inhalations are prescribed. Etiotropic antiviral therapy (interferon, ribavirin, etc.) is prescribed. With severe bronchial obstruction, antispasmodic (papaverine, drotaverine) and mucolytic (acetylcysteine, ambroxol) agents, broncholytic inhalers (salbutamol, orciprenaline, phenoterol hydrobromide) are used. To facilitate the discharge of sputum, percussion chest massage, vibration massage, back muscle massage, breathing exercises are performed. Antibacterial therapy is prescribed only when a secondary microbial infection is attached.
The purpose of treatment of chronic obstructive bronchitis is to slow down the progression of the disease, reduce the frequency and duration of exacerbations, and improve the quality of life. The basis of pharmacotherapy for chronic obstructive bronchitis is basic and symptomatic therapy. Smoking cessation is a mandatory requirement.
Basic therapy includes the use of bronchodilating drugs: cholinolytics (ipratropium bromide), b2-agonists (phenoterol, salbutamol), xanthines (theophylline). If there is no effect from the treatment of chronic obstructive bronchitis, corticosteroid drugs are used. Mucolytic drugs (ambroxol, acetylcysteine, bromhexine) are used to improve bronchial patency. The drugs can be administered orally, in the form of aerosol inhalations, nebulizer therapy or parenterally.
When the bacterial component is layered during periods of exacerbation of chronic obstructive bronchitis, macrolides, fluoroquinolones, tetracyclines, b-lactams, cephalosporins are prescribed for a course of 7-14 days. In hypercapnia and hypoxemia, oxygen therapy is an obligatory component of the treatment of obstructive bronchitis.
Prognosis and prevention
Acute obstructive bronchitis responds well to treatment. In children with an allergic predisposition, obstructive bronchitis can recur, leading to the development of asthmatic bronchitis or bronchial asthma. The transition of obstructive bronchitis to a chronic form is prognostically less favorable.
Adequate therapy helps to delay the progression of obstructive syndrome and respiratory failure. The unfavorable factors aggravating the prognosis are the elderly age of patients, concomitant pathology, frequent exacerbations, continued smoking, poor response to therapy, and the formation of a pulmonary heart.
Measures of primary prevention of obstructive bronchitis consist in maintaining a healthy lifestyle, increasing overall resistance to infections, improving working conditions and the environment. The principles of secondary prevention of obstructive bronchitis presuppose the prevention and adequate treatment of exacerbations, allowing to slow down the progression of the disease.