Chronic bronchitis is an inflammatory process in the bronchi caused by the fact that the airways have been irritated by some substances for a long time or damaged as a result of a viral or bacterial infection.
As a result, a morphological rearrangement of the mucous membrane of the bronchi occurs, mucus begins to be actively developed, and the cleansing function of the organ is disrupted. The manifestations of this process are persistent cough and sputum production.
Features of diagnosis and the main causes of the disease
Many people confuse chronic bronchitis and chronic obstructive pulmonary disease (COPD). As a result, even pulmonologists often do not have clear criteria for when to diagnose COPD, and when - chronic bronchitis.
In recent years, WHO has developed certain criteria when even the first signs of chronic bronchitis can be diagnosed.
So, bronchitis means that inflammation occurs in the wall of the bronchial tree, although it can affect its various layers. This disease is considered chronic if there is a productive (i.e. sputum) cough for at least three months for two consecutive years.
In this case, chronic bronchitis (HB) can be both primary and secondary. Primary bronchitis is considered as an independent disease, that is, it is in no way associated with other processes in the respiratory system or with the defeat of other systems. It is characterized by diffuse damage to the bronchi.
Secondary HB is always associated with some kind of disease. This is not always a pathology of the respiratory system (for example, tuberculosis). Sometimes we are talking about other diseases - for example, congestive heart failure. Secondary bronchitis is usually manifested by local inflammation.
Exogenous causes of HB
It is not enough to know the signs of chronic obstructive bronchitis. It is necessary to understand its causes, so that you can eliminate them and prevent a relapse of the disease. And for this you need to understand why the mucous membrane of the bronchi is needed.
The fact is that it represents a protective barrier that prevents the effects of bacteria or other harmful factors of external origin. On the mucous membrane is a layer of bronchial secretion, which prevents foreign particles and microbes from penetrating further. A ciliary epithelium allows this mucus to be evacuated along with harmful elements.
A person who does not have violations of the protective function, practically can not get chronic bronchitis.
To the violation of this function leads to prolonged exposure to irritating agents:
- tobacco smoking;
- various professional pollutants (dust and gases in production);
- pollutants contained in the air of megacities and large industrial cities.
Sometimes the disease develops against the background of an atypical bacterial infection. Influenza virus, adenovirus, pneumococcal infection, hemophilus bacillus are not so much the cause of chronic kidney disease as they provoke its exacerbation.
Endogenous causes of HB
The main internal (endogenous) cause of the disease is various hereditary, congenital or acquired pathologies almost in infancy.
In such cases, computed tomography of the chest is performed - CT. Signs of chronic bronchitis will be manifested by various violations of the development of the bronchial tree and bronchiectasis (expansion of individual airways).
In this case, the doctor often prescribes an additional examination, since the primary ciliary insufficiency or Kartagener syndrome gives a similar picture.
The endogenous factors that lead to the development of this disease also include various pathologies of the nasopharynx, repeated acute respiratory viral infections, and violation of local immunity. And, paradoxically, obesity associated with metabolic disorders can also be a cause of pathology.
Classification
Although there is currently no generally accepted classification that would be approved by WHO, the following forms of this disease can be distinguished:
- catarrhal;
- catarrhal-purulent;
- purulent;
- hemorrhagic;
- fibrinous.
The last two forms of CB are rare. These forms differ in the nature of the inflammatory process. Sometimes in the literature you can find another classification, when chronic bronchitis occurs with or without airway obstruction.
Also, depending on the level of damage to the organ, two forms are distinguished:
- proximal HB, in which large bronchi are affected;
- distal CB, in which small bronchi are affected.
Any of these diagnoses can be made only after a full examination. That is, if there are signs of chronic bronchitis in adults without fever, this is not enough for diagnosis. At least one more X-ray examination is necessary.
Symptoms
The symptoms of chronic bronchitis in adults without fever are of interest to many people suffering from frequent coughing. Indeed, the main manifestation of the disease is precisely the latter with the release of sputum.
However, there are still symptoms of a general nature:
- weakness;
- decreased performance;
- excessive sweating;
- chronic fatigue or fatigue.
Sometimes a slight increase in body temperature is also possible. These symptoms can sometimes occur only with an exacerbation of the disease. But in some cases they make themselves felt almost constantly, as they are the result of prolonged intoxication. This happens with a purulent form of HB. And sometimes weakness and dizziness often appear due to the fact that CB leads to the development of respiratory failure, which causes hypoxia.
With a mild form of HB, it often happens that patients practically do not encounter unpleasant phenomena, exacerbations in them occur no more than twice a year. Moreover, it usually occurs either in late spring or early autumn, since temperature differences are characteristic of this time, and changes in air humidity become especially pronounced.
Efficiency even in such periods is maintained at a good level, since with a mild form the cough is unproductive, almost dry, sputum usually leaves in the morning, during washing, and there is no particular deterioration in well-being. But with an unfavorable development of the disease, serious complications can occur.
Cough for chronic bronchitis
At the very beginning of the disease, the cough can be almost dry, but then its nature changes. According to its features, one can even assume the form of HB. For example, with catarrhal bronchitis, a small amount of sputum mucosa is secreted, mainly in the morning or after physical exertion. At first, the cough practically does not bother the patient, but then it becomes paroxysmal, becomes barking, and painful sensations arise.
With a purulent form of CB, the patient is more worried about sputum production. In the exacerbation phase, it increases even more, and an intoxication syndrome occurs, accompanied by a strong cough. Pain can even occur when swallowing, exacerbate various chronic diseases of the nasopharynx. During remission, the cough may become dry again.
Hemoptysis with coughing often indicates that a person has a vulnerable surface of the mucous membrane. But sometimes this is an indicator of the hemorrhagic form of bronchitis or even more serious pathology.
Diagnostic Methods
If there are signs of chronic bronchitis in adults, treatment can only begin after a diagnosis.
As a rule, if physical symptoms have already appeared, then auscultation will help to make the initial diagnosis. When listening, the doctor will note stiff breathing, the presence of dry rales of an absent-minded nature. The timbre of the latter largely depends on which area is affected.
If medium and large bronchi are involved in the process, then wheezing can be described as buzzing, and if small - as wheezing. Applied during the examination and methods of instrumental diagnostics.
When is x-ray done?
A chest x-ray is done if the doctor suspects a chronic kidney disease. However, in this case there are some nuances.
The fact is that in most cases the signs of chronic bronchitis on an X-ray are practically invisible, sometimes even changes in the lungs are absent. But there is a situation where radiography helps to reveal mesh deformation of the pulmonary pattern, which indicates the development of pneumosclerosis. And with a prolonged course of CB, symptoms of emphysema may appear.
In general, it is not the radiological signs of chronic bronchitis that are important, but the ability to distinguish the disease from other pathologies, the identification of concomitant diseases (for example, tuberculosis or tumors), as well as the diagnosis of complications, including pneumonia and bronchiectasis.
Bronchoscopy as a diagnostic method
As already noted, a CT scan of the chest organs mainly helps to identify either anomalies in the structure of the organs or bronchiectasis. Sometimes doctors prescribe an additional bronchoscopy. In general, it can play an important role in the diagnosis of HB, since it performs several tasks at once:
- allows you to confirm or deny the presence of inflammatory processes and even determine the degree of their activity;
- evaluates the nature of the inflammation, in particular, the hemorrhagic and fibrinous forms of CB mentioned above can only be diagnosed by this method;
- helps to identify dysfunction of the bronchial tree and tracheal dyskinesia;
- reveals organic organ damage, including tumors and structures.
In addition, with the help of bronchoscopy, the contents of the bronchi are obtained for further serological, microbiological and cytological studies.
The basic principles of treatment
If there are signs of chronic bronchitis, exacerbation, treatment becomes an extremely urgent issue. Basically, its goal is to slow down the rate of diffuse damage to this organ, reduce the frequency of exacerbations, lengthen periods of remission, and improve the quality of life of the patient. Also, in the case of adequate therapy, it is possible to increase tolerance to moderate physical exertion.
The main direction of therapy is the elimination of the exogenous causes described above, that is, the prohibition of smoking, the rejection of secondhand smoke if possible, and the change of job if it comes to professional risks.
As for specific treatment methods, their choice should be differentiated, depending on the form of the disease, on signs of exacerbation, on the presence of complications.
Therapeutic methods can be divided into two large groups - pathogenetic and etiotropic treatment. The latter is aimed at eliminating the inflammatory process in the bronchi.
Antibiotics for the treatment of HB
If there are signs of chronic bronchitis, treatment can be done with antibiotics. They are prescribed after identifying the causative agent of the disease (for this, an analysis of sputum is done). Its sensitivity to certain active substances is determined, and taking this into account, an antibiotic is prescribed. As a rule, this is Amoxicillin, and if there is intolerance to it, then funds from the macrolide group.
The doctor most often prescribes oral drugs. For example, dispersible tablets "Flemoxin Solutab" - such a dosage form helps to ensure that the amoxicillin contained in the drug begins to be released in the intestine, that is, in the area where its maximum absorption occurs, which makes it possible to achieve high efficiency.
In case of infectious exacerbation of CB, in the presence of concomitant diseases such as diabetes mellitus or heart failure, the so-called protected aminopenicillin is prescribed, in particular, it is amoxicillin / clavulanate (Flemoklav Solutab, which has the advantage of the drug described above).
If such treatment does not give a result, such an approach is applied as parenteral administration of antibiotics of another group - third-generation cephalosporins, which can be administered both intravenously and intramuscularly.
Pathogenetic treatment of HB
The goal of pathogenetic treatment is to improve pulmonary ventilation, normalize bronchial patency. For this, oxygen therapy is carried out, physiotherapy exercises are prescribed.
To relieve bronchospasm and improve patency, bronchodilator drugs, mucolytic and expectorant drugs are used. The first include Eufillin, anticholinergics (for example, Ipratropium bromide).
As mucolytics take Ambroxol and Acetylcysteine, sometimes Bromhexine. The duration of the course of therapy is two weeks.
Herbal preparations like Thermopsis and Mukaltin are considered less effective, but sometimes they are also prescribed.
Maintenance Therapy and Prevention
Supportive therapy mainly uses physiotherapeutic methods. Chest massage and therapeutic breathing exercises are combined with electrophoresis of calcium chloride and hardening of the body.
Moreover, at first they are engaged in gymnastics under the supervision of a doctor, but in general it needs to be done independently, not only during an exacerbation, but also during remission, that is, constantly.
In severe forms, spa treatment is also indicated. Prevention of acute respiratory infections and vaccination against influenza play an important role.