In childhood, parents often told us: donāt drink cold - you will catch a cold, donāt walk with your hats ā you will get pneumonia, donāt get your feet wet ā your throat will hurt. But we did not obey and fell ill. Either out of obstinacy, or for the sake of research interest, they checked their body for strength. So, after all, what causes bronchitis and what is it?
Acute bronchitis
Bronchitis is an inflammatory disease of the lower respiratory tract, with the symptoms of which most often people around the world go to the hospital. The causes of bronchitis can be very diverse: bacteria, viruses or protozoa.
In this case, damage to the lung tissue does not occur, and the inflammatory process is localized exclusively in the bronchial tree.
The following types of bronchitis are distinguished :
- acute, when the volume of bronchial secretion increases and a reflex cough appears;
- chronic, when at the cellular level there is a change in the mucous membrane, which leads to hypersecretion and impaired ventilation.
Etiology
As already mentioned above, the causes of bronchitis can be very different. Of the bacterial spectrum, the most common pathogens are streptococci, mycoplasmas, chlamydia, anaerobic flora. Viral etiology is represented by influenza, parainfluenza and rhinovirus.
Bronchitis caused by chemical or toxic effects on the body is slightly less common. But in this case, the secondary infection is inevitable. According to the International Classification of Diseases of the tenth revision, acute bronchitis caused by established pathogens and unspecified acute bronchitis are isolated.
According to the duration of the disease, there are:
- acute (up to three weeks);
- protracted course (more than a month).
Acute bronchitis can occur with or without spasm of the bronchi. According to localization, tracheobronchitis can be distinguished when inflammatory changes are concentrated in the upper part of the bronchial tree, and bronchiolitis (the pathological process affects small bronchioles and alveoli). By the nature of the exudate, purulent, catarrhal and necrotic bronchitis are distinguished.
Pathophysiology
How does bronchitis develop? Symptoms and treatment in adults directly depend on the mechanism of the onset of the disease, since therapy is aimed specifically at the links of the pathological process.
Etiological factors somehow damage the cells of the bronchial mucosa and cause their necrosis. These "gaps" in protection create the conditions for the penetration of the pathogen. If the epithelium initially colonized the virus, then after two or three days some bacterium, usually pneumococcus, will join it.
Inflammatory tissue reactions (edema, redness, increased local temperature and impaired function) cause a violation of the blood flow in the capillary bed, compression of the nerve endings and the formation of blood clots.
If the dynamics of the process are positive and treatment is scheduled on time, then after the disappearance of inflammation, the mucosa is restored within a few months. But in a small percentage of patients this does not happen. Then the disease becomes chronic. If the changes affected only the mucous membrane, then this will not affect human life too much. But the defeat of all layers of the bronchus can cause hemorrhages in the lung tissue, as well as staining of sputum with blood.
Clinic
Causes of obstructive bronchitis, such as bacteria or viruses, cause characteristic clinical manifestations. In the prodromal period, there is an increase in body temperature to febrile numbers, weakness, drowsiness, loss of appetite, headaches, sweating, palpitations.
Patients describe their sensations as sore or sore in the throat and behind the sternum, which intensify when inhaling cold air. In addition, they are bothered by a dry barking cough, which does not bring relief. After two to three days, patients develop thick sputum from mucus or pus. Coughing may be accompanied by pain in the lower chest. This is due to overstrain of the pectoral muscles.
During a general examination, excessive moisture of the skin, its redness against the background of cyanosis of the lips, attracts attention. Muscles with each breath are drawn into the intercostal spaces, auxiliary muscles are used for breathing.
On average, uncomplicated bronchitis lasts about two weeks and ends with a full recovery.
Diagnostics
The causes of bronchitis are easy to identify if properly used diagnostic tools. After a visual examination, it is necessary to conduct physical research methods, such as palpation, percussion and auscultation. Feeling and tapping in this case will not show anything unusual, but in the phonendoscope you can hear hard breathing, accompanied by scattered wheezing. When sputum appears, wheezing becomes wet coarse.
In a general blood test, an increase in the number of white blood cells and an increase in the erythrocyte sedimentation rate (ESR) will be observed. In the analysis of urine, as a rule, there are no changes, but at the height of the fever, the appearance of protein is possible. A biochemical blood test allows you to see the appearance of C-reactive protein and an increase in the alpha fraction of proteins. Fibrin, white blood cells, desquamated bronchial epithelium and red blood cells are found in sputum. In addition, the laboratory makes inoculation of the contents of the bronchi for bacteria and viruses.
There will be no specific changes on the radiograph, except perhaps an increase in the pulmonary pattern. Spirograms will assess the presence and degree of obstruction.
Treatment
The causes of bronchitis also determine the choice of therapeutic tactics in each case. Depending on the severity of the pathological process, acute bronchitis can be treated both on an outpatient and inpatient basis, under round-the-clock supervision of doctors.
Therapy should include an antiviral or antibacterial component, as well as drugs that expand the bronchi. In addition, it is necessary to eliminate factors that will contribute to the progression of infection. The course of treatment must go to the end, regardless of whether the symptoms of the disease persist or not.
Currently, doctors are actively including physiotherapy, massage, gymnastics in therapy. This helps to better evacuate the secretion from the bronchi, and also allows you to change the methods of drug administration into the body.
Chronical bronchitis
The main reason for the development of bronchitis is damage to the epithelium of the mucosa of the lower respiratory tract. You can talk about chronic bronchitis four weeks after the onset of the disease, provided that the clinical picture and pathomorphological changes in the lungs are preserved.
This condition is characterized by diffuse damage to the wall of the bronchi, which is associated with a long inflammatory process leading to tissue sclerosis. The secretory apparatus of the bronchi undergoes a number of changes and is tuned to increased production of mucus.
Classification
There are several clinical classifications of chronic bronchitis. The following clinical forms of the disease are distinguished:
- simple (or catarrhal);
- purulent nonobstructive;
- simple form with violation of ventilation;
- purulent obstructive;
- special, for example, fibrous or hemorrhagic.
According to the level of damage, bronchitis of large and small bronchi is divided. The presence of an asthmatic symptom complex and its severity are taken into account. By the nature of the course, like other inflammatory diseases, bronchitis is latent, with rare exacerbations, and constantly recurring.
Complications after suffering chronic bronchitis are:
- emphysema;
- hemoptysis;
- the formation of respiratory failure;
- chronic pulmonary heart.
Causes
The chronic course, as a rule, is preceded by acute bronchitis. The causes of this process can focus both inside the body and outside it. First of all, it is necessary to take into account the readiness of immunity. If it is too strong or too weak, it can cause protracted inflammation and tissue damage. In addition, reduced immunity will attract ever new colonies of bacteria and viruses, so the disease will occur again and again.
In addition, prolonged, over the years, irritation of the bronchial mucosa with too dry and cold air, tobacco smoking, dust, carbon monoxide and other chemicals found in some industries can adversely affect the course of the disease.
There is evidence that some genetic diseases can also contribute to the chronicity of inflammatory processes in the lungs.
Pathogenesis
The causes of bronchitis are directly related to the mechanism of the formation of the disease. First of all, local bronchopulmonary defense is reduced, namely: slowing down the fibers of the ciliated epithelium, reducing the amount of surfactant, lysozyme, interferons and immunoglobulins A, various groups of T cells and alveolar macrophages.
Secondly, a pathogenetic triad develops in the bronchi:
- hyperfunction of the mucous glands of the bronchi (hypercrinium);
- increased viscosity of sputum (dyskrinia);
- stagnation of secretion in the bronchi (mucostasis).
And thirdly, the development of sensitization to the pathogen and cross-reaction with the cells of your own body. These three points provide inflammation for more than four weeks.
Symptoms
The disease manifests itself with a strong cough with sputum up to one hundred and fifty milliliters per day, usually in the morning. At times of exacerbation of inflammatory reactions, there may be rises in temperature, sweating, and weakness.
With the progression of respiratory and heart failure, a thickening of the phalanges of the fingers (ādrumsticksā) and thickening of the nail plates (āwatch glassesā) develop. Pain with bronchitis occurs only if the pleura is involved in the inflammatory process or during an extended attack of coughing the auxiliary muscles become too tense.
Laboratory and instrumental studies
The diagnosis of bronchitis is made on the basis of laboratory and instrumental studies. In a general blood test, an increase in leukocytes, a shift in the leukocyte formula to the left, an increase in the erythrocyte sedimentation rate are observed. Biochemically in the blood the amount of sialic acids, seromucoids, alpha and gamma globulins is increased, a C-reactive protein appears. Sputum is mucous or purulent, may be streaked with blood. It contains epithelial cells, red blood cells and neutrophils.
For morphological confirmation of the diagnosis, bronchoscopy is performed. The radiograph shows an increase in the pulmonary pattern and its mesh deformation, as well as signs of emphysema. Spirography helps guide the doctor about the presence or absence of signs of bronchial obstruction.
Treatment
What to do after the diagnosis of "chronic bronchitis" is established? Symptoms and treatment in adults are not much different from those in the acute form. Usually, the doctor prescribes several combinations of drugs in the hope of influencing the etiological factor of the inflammatory reaction. If this fails, then it is necessary to stabilize the patient's condition. To do this, use the following groups of drugs:
- antibiotics;
- expectorant;
- bronchodilators;
- antihistamines;
- inhalations and physiotherapeutic procedures.