Tracheobronchitis is a diffuse inflammatory process that covers the lower airways – the trachea and bronchi. The duration and features of the course of tracheobronchitis are closely related to its form; symptoms usually include cough (dry or productive), soreness and chest pain, temperature reaction, malaise, wheezing, shortness of breath. The assessment of auscultative data, the results of lung radiography, tracheobronchoscopy, sputum examination, allergodiagnostics contributes to the verification of the diagnosis. In the treatment of tracheobronchitis, pharmacotherapy (expectorant, mucolytic, antiviral, antihistamines) and non-drug methods (inhalation, massage) are used.
ICD 10
J40 Bronchitis, not specified as acute or chronic
Meaning
Tracheobronchitis is an acute or chronic inflammation of the mucous membrane of the tracheobronchial tree, initiated by infection, allergens and other agents. Taking into account the reasons, there are tracheobronchitis of infectious (viral, bacterial, viral-bacterial) origin; allergic genesis; caused by chemical and physical factors and mixed. Acute tracheobronchitis usually has a viral nature. The peak incidence of tracheobronchitis occurs in the off-season and is closely associated with SARS epidemics. Often, inflammation passes to the trachea and bronchi from the upper respiratory tract. The course of allergic tracheobronchitis can be recurrent or chronic. Chronic tracheobronchitis in most cases is associated with the constant presence in the body or external influence of a causal factor.
Causes of tracheobronchitis
Acute tracheobronchitis, as a rule, becomes a continuation of MS infection, adenovirus infection, influenza and parainfluenza, measles. Less often, the disease develops against the background of whooping cough, paracoccussis, respiratory mycoplasma or chlamydia infection. One of the causes of purulent tracheobronchitis can be prolonged artificial ventilation of the lungs. The so-called “intubation” tracheobronchitis develops in 35-40% of patients. Such a high frequency of pathology is caused by a violation of the evacuation of secretions from the trachea and bronchi, often by aspiration of gastric contents and blood into the respiratory tract. This is a trigger factor for the reproduction of bacterial flora and the development of the inflammatory process.
The “victims” of chronic tracheobronchitis are most often heavy smokers; persons who have been in conditions of dustiness, gas contamination and smoke, air pollution with chemical agents for a long time. In addition, patients who neglect treatment or self-medicate acute tracheobronchitis are subject to chronization of the process. The incidence of chronic tracheobronchitis is higher in people suffering from chronic nasopharyngeal infections (caries, tonsillitis, sinusitis). Allergic tracheobronchitis is closely related to respiratory allergies that occur in contact with a variety of agents (dust, pollen, animal hair, mold, perfumes, etc.). The toxic-chemical form of tracheobronchitis can be caused by damage to the respiratory tract by military or industrial toxic gases, drugs (for example, potassium iodide or bromide).
The occurrence of any form of tracheobronchitis is favored by the following factors: hypothermia, nervous and physical fatigue, weakened immunity, unfavorable climatic conditions (cold, dry or humid air), smoking, hypovitaminosis. In such conditions, the activation of conditionally pathogenic microflora of the mucous membranes of the upper respiratory tract and its acquisition of pathogenic properties may occur.
Pathogenesis
Pathological changes in tracheobronchitis affect the mucous membrane of the trachea, large and medium bronchi. Small bronchi usually remain intact, which explains the absence of bronchial obstruction attacks even with an allergic form of tracheobronchitis. In acute inflammation, the walls of the tracheobronchial tree are diffusely hyperemic; in allergic and chronic they have a pale pink hue, the mucous membrane is swollen, loosened, hypersecretion of mucus is noted. When bacterial inflammation dominates, a purulent secret is present in the lumen of the bronchi. In chronic tracheobronchitis, the mucous membrane of the respiratory tract undergoes atrophic or hypertrophic changes.
Symptoms of tracheobronchitis
The clinical criterion for a particular pathogenetic form of tracheobronchitis is the duration of the preservation of pathological symptoms: signs of acute inflammation are stopped within three weeks (on average for 10-14 days), a protracted process lasts up to one month, chronic – persists for three or more months. The disease proceeds with moderately pronounced respiratory and general intoxication phenomena.
Acute tracheobronchitis
It is usually a complication of acute respiratory infection, therefore it begins with the phenomena of rhinopharyngitis: nasal congestion, rhinorrhea, sore throat, dryness in the nasopharynx, pain when swallowing, hoarseness of voice. As the infection spreads to the lower respiratory tract, painful and painful sensations in the chest, tearing dry and painful cough join. Breathing becomes hard, dry wheezing is heard during auscultation. After 2-3 days, the nature of the cough changes to moist and productive; mucous or mucopurulent sputum begins to separate. Body temperature is often subfebrile, lasts for several days. General well-being is characterized by a feeling of weakness and a decrease in performance. Recovery in typical cases occurs after 8-10 days, the residual cough can persist for up to 3 weeks.
Moderate course of acute tracheobronchitis may be accompanied by shortness of breath, tension and soreness of the abdominal muscles and diaphragm due to severe cough, remitting fever. In children of the first three years of life, acute tracheobronchitis occurs with increased pulse and breathing, vomiting at the height of coughing attacks, cyanosis of the lips and face, convulsions. Complications of acute tracheobronchitis may include the development of a chronic form of the disease, pneumonia, obstructive bronchitis.
Chronic tracheobronchitis
It proceeds with alternating periods of remissions and exacerbations. Outside of exacerbation, the symptoms are erased: periodic coughing, shortness of breath may occur when performing physical work. Most patients with chronic tracheobronchitis report moderate but persistent chest pain.
The acute phase is characterized by the appearance of coughing, wheezing, shortness of breath at rest or under normal loads, subfebrility, sweating, weakness. Cough may have different intensity and character, accompanied by the release of a small or copious amount of sputum, having a different color and consistency (more often serous-purulent or purulent). The outcomes of chronic tracheobronchitis are often COPD, emphysema of the lungs.
Individual etiological forms
With allergic tracheobronchitis, exacerbation of respiratory symptoms occurs with direct contact with the allergen. Cough comes to the fore, mostly dry or with a slight mucous discharge. It is usually combined with other allergic manifestations: itching, nasal congestion, rhinitis, lacrimation. Body temperature, as a rule, remains normal. There are no attacks of suffocation. Elevated levels of eosinophils are detected in the blood. Allergic tracheobronchitis is often accompanied by atopic dermatitis, hay fever and other allergoses.
Intubation tracheobronchitis develops in more than half of cases 2-3 days after extubation. Patients note the sensation of a foreign body of the trachea, chest pain. Especially troubling are the attacks of coughing, which end with the discharge of viscous yellow-green sputum in moderate amounts. Body temperature can be raised to subfebrile values and higher. Intoxication syndrome is more pronounced than in other forms of tracheobronchitis. In general, the clinical picture resembles a purulent bronchitis clinic.
Diagnostics
When making a diagnosis of tracheobronchitis, anamnesis data are taken into account (the connection of the disease with acute respiratory viral infections, allergies, bronchial irritating substances), clinical and auscultative picture, the results of objective studies. The patient is referred for consultation to a pulmonologist and an allergist.
In acute tracheobronchitis, lung x-ray is uninformative, but the chronic course of the disease leaves its imprint on the pulmonary pattern, often deforming it. In addition, the presence of infiltrative changes in the lungs is radiologically excluded. The most informative study confirming the inflammatory process in the lower respiratory tract is tracheobronchoscopy. Endoscopic imaging may reveal swelling and hyperemia of the mucosa, fibrinous overlays, purulent secretions, ulceration of the mucous membrane.
Microscopic examination of sputum makes it possible to exclude diseases such as tuberculosis, lung cancer, bronchial asthma, etc. To determine the bacterial pathogen, sputum back-seeding is performed. The allergic genesis of tracheobronchitis is confirmed by the results of skin allergic tests.
Tracheobronchitis treatment
Treatment of uncomplicated forms is carried out at home; severe and complicated cases – in the department of pulmonology. In the first days, when a painful dry cough bothers, antitussive agents (prenoxdiazine, codeine, butamirate) are prescribed. Alkaline inhalations, mucolytic and expectorant drugs (ambroxol, mukaltin, thermopsis), phytotherapy contribute to the stimulation of sputum discharge. Warming compresses, jars, mustard plasters, rubbing with warming ointments help to restore the drainage function of the bronchi.
With tracheobronchitis of an allergic nature, antihistamines are prescribed; antiviral drugs can be effective in diseases caused by viral agents. For bacterial complications, antibiotics are used: local and systemic (penicillins, cephalosporins, fluoroquinalones). Taking immunomodulators and vitamins is necessary to increase the overall resistance of the body.
Of the physiotherapy procedures, UFO therapy, chest electrophoresis, laser therapy, UHF, percussion and vibration massage, halotherapy, breathing exercises are usually used. In severe forms of tracheobronchitis, oxygen therapy may be required.
Prevention
The leading method of prevention of acute tracheobronchitis is timely and rational therapy of acute respiratory viral infections, prevention of contact with patients with viral infections. Reduces the risk of the incidence of tracheobronchitis by quitting smoking, elimination of industrial hazards, rehabilitation of chronic foci in the nasopharynx. In case of allergic alertness, the exclusion of contact with the allergen is of paramount importance.
