Chronic obstructive bronchitis. Acute bronchitis in adults Etiology and pathogenesis

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ACUTE BRONCHITIS

Acute bronchitis (AB) - predominantly of infectious origin inflammatory disease bronchi, manifested by a cough (dry or with sputum) and lasting no more than 3 weeks.

ICD-10: J20 Acute bronchitis. Abbreviation: OB - acute bronchitis.

Epidemiology

The epidemiology of acute bronchitis (AB) is directly related to the epidemiology of influenza and other respiratory viral diseases. Usually typical peaks of increase in the frequency of occurrence of diseases are the end of December and the beginning of March. Special studies on the epidemiology of AB in Russia have not been conducted.

Prevention

one . Attention should be paid to compliance with the rules of personal hygiene A : Frequent hand washing minimizing eye-hand, nose-hand contact. Rationale: Most viruses are transmitted in this way by contact. Evidence: ad hoc studies of these prevention interventions in day hospitals for children

and adults showed their high efficiency.

2. Annual influenza prophylaxis reduces the incidence

occurrence of OBA.

Indications for annual influenza vaccination: all persons over 50 years of age persons with chronic diseases, regardless of age persons in closed groups children and adolescents receiving long-term aspirin therapy women in the second and third

trimesters of pregnancy during the influenza epidemic period.

Evidence of Effectiveness
Numerous multicenter randomized trials
studies have shown the effectiveness of vaccination campaigns. Even
by 50% and hospitalization by 40%.
in elderly debilitated patients, when immunogenicity and
the effectiveness of the vaccine is reduced, vaccination reduces mortality

Vaccination of middle - aged people reduces the number of influenza episodes and the resulting disability .

Vaccination of medical personnel leads to a decrease in mortality among elderly patients.

3 . Drug prevention antiviral drugs during the epidemic period reduces the frequency and severity of influenza C.

Indications for drug prophylaxis

In a proven epidemic period in non-immunized individuals with a high risk of influenza - taking rimantadine (100 mg 2 times a day per os) or amantadine (100 mg 2 times a day per os).

In the elderly and patients with kidney failure the dose of amantadine is reduced to 100 mg per day due to possible neurotoxicity.

Efficiency . Prevention is effective in 80% of individuals. Screening: no data.

Classification

There is no generally accepted classification. By analogy with other acute respiratory diseases, etiological and functional classification signs can be distinguished.

Etiology (Table 1). Usually, 2 main types of OB are distinguished: viral and bacterial, but other (more rare) etiological variants (toxic, burns) are also possible; they rarely occur in isolation, are usually a component of a systemic lesion, and are considered within their respective diseases.

	Table 1 . Etiology of acute bronchitis

	pathogens	Specific traits



	Influenza A virus	Major epidemics 1 time in 3 years, spectacular
		whole countries; the most common cause of clinical
		severe flu; severe illness and
		high mortality during epidemics
		high mortality during epidemics

	Influenza B virus	Epidemics once every 5 years, pandemics less and less
		severe course than with influenza A virus infection

	Parainfluenza (types 1–3)
		interconnected
		interconnected
	Adenoviruses	Isolated cases, epidemiologically not

	The end of the table. one



pneumococci	In middle-aged or elderly people
	Unexpected start
	Signs of damage to the upper respiratory tract

Mycoplasmas	In people over 30 years of age
	Signs of upper respiratory tract infection
	early stages
	Dry cough
Bordetella pertussis	Prolonged cough
	Smokers and patients with chronic bronchitis

Moraxella catarrhalis	Chronic bronchitis and people with immunodeficiency

Functional classification OB, taking into account the severity of the disease, has not been developed, since uncomplicated OB usually proceeds stereotypically and does not require a distinction in the form of a classification according to severity.

Diagnostics

The diagnosis of "acute bronchitis" is made in the presence of an acute cough that lasts no more than 3 weeks (regardless of the presence of sputum), in the absence of signs of pneumonia and chronic diseases lungs, which can cause coughing.

The diagnosis is based on the clinical picture, the diagnosis is made by exclusion.

The cause of the clinical syndrome of AB is various infectious agents (primarily viruses). The same agents can cause other clinical syndromes arising simultaneously with OB. Below is a summary of the data (Table 2) characterizing the main symptoms in patients with OB.

Given in table. 2 manifold clinical symptoms ABOUT suggest the need for careful differential diagnosis of coughing patients.

Possible causes of prolonged cough associated with disease-

mi of the respiratory system: bronchial asthma chronic bronchitis

chronic infectious diseases lungs, especially tuberculosis sinusitis postnasal drip syndrome gastroesophageal reflux sarcoidosis cough due to connective tissue diseases and their treatment asbestosis, silicosis

"farmer's lung" side effect drugs (ACE inhibitors,

Acute bronchitis

Table 2 . The frequency of clinical signs of acute bronchitis in adult patients

		Frequency (%)

	Complaints and anamnesis



Sputum production


Sore throat
Weakness

Headache

Flow of mucus from the nose into the upper respiratory tract





	wheezing

	Purulent discharge from the nose
	Muscle pain
	Fever

	sweating

	Pain in the paranasal sinuses

	Painful breathing

	Chest pain

	Difficulty swallowing
	Swelling of the throat

	Physical examination

	Redness of the throat

	Cervical lymphadenopathy

	Remote wheezing


	Sinus tenderness on palpation
	Purulent discharge from the nose

	Ear congestion

	Swelling of the tonsils

	Body temperature >37.8°C
	Body temperature >37.8°C

	Extended exhalation

	Decreased breath sounds

	Wet rales
	Wet rales
	Swelling of the tonsils

β-blockers, nitrofurans) lung cancer pleurisy

heart failure.

Modern standard methods (clinical, radiological-

cal, functional, laboratory) make it quite easy to make a differential diagnosis.

Prolonged cough in patients with arterial hypertension and heart disease

■ ACE inhibitors. If the patient is taking an ACE inhibitor, it is very likely that this drug is causing the cough. An alternative is the selection of another ACE inhibitor or switching to angiotensin II receptor antagonists, which usually do not cause cough.

■ β-blockers(including selective) can also cause cough, especially in patients predisposed to atopic reactions or with hyperreactivity of the bronchial tree.

■ Heart failure. It is necessary to examine the patient for the presence of heart failure. The first sign of mild heart failure is coughing at night. In this case, first of all, it is necessary to conduct an x-ray of the chest organs.

Prolonged cough in patients with connective tissue diseases

■ Fibrosing alveolitis- one of possible causes cough (sometimes in combination with rheumatoid arthritis or scleroderma). The first step is to take a chest x-ray. Typical find - pulmonary fibrosis, but in the early stages it may be radiologically invisible, although the diffusing capacity of the lungs, reflecting the exchange of oxygen in the alveoli, may already be reduced, and dynamic spirometry may reveal restrictive changes.

■ Influence of drugs. Cough may be due to exposure to drugs (a side effect of gold preparations, sulfasalazine, penicillamine, methotrexate).

Chronic cough in smokers. The most likely causes are prolonged acute bronchitis or chronic bronchitis. It is necessary to be aware of the possibility of cancer in middle-aged patients, especially in those over 50 years of age. It is necessary to find out if the patient has hemoptysis.

Acute bronchitis

Prolonged cough in people of certain occupations

Asbestosis. It is always necessary to be aware of the possibility of asbestosis if the patient has worked with asbestos First, chest X-ray and spirometry are performed (restrictive changes are detected) If asbestosis is suspected, it is necessary to consult with specialists.

Farmer's Lung. Employees Agriculture suspect farmer's lung (hypersensitivity pneumonitis due to moldy hay exposure) or asthma Initial chest x-ray, home PEF measurement, spirometry (including bronchodilator test) If farmer's lung is suspected, specialist advice should be sought.

Occupational bronchial asthma , starting with a cough, can develop in people of various professions associated with exposure to chemical agents, solvents (isocyanates, formaldehyde, acrylic compounds, etc.) in car repair shops, dry cleaners, plastics, dental laboratories, dental offices, etc. d.

Prolonged cough in patients with atopy, allergy or hypersensitivity to acetylsalicylic acid

The most likely diagnosis is bronchial asthma.

The most common symptoms are transient shortness of breath and mucus sputum.

Primary studies: measurement of PSV at home spirometry and a test with bronchodilators, if possible - determination of hyperreactivity of the bronchial tree (provocation with inhaled histamine or methacholine hydrochloride), assessment of the effect of inhaled corticosteroids.

Prolonged cough and fever with purulent sputum

Tuberculosis should be suspected, and in patients with lung disease, the possibility of developing an atypical pulmonary infection caused by atypical mycobacteria. Vasculitis (eg, periarteritis nodosa, Wegener's granulomatosis) may begin with such manifestations. It is also necessary to remember about eosinophilic pneumonia.

Primary studies: chest x-ray, smear and sputum culture, complete blood count, determination of the content of C-reactive protein in the blood serum (may increase with vasculitis).

Other causes of persistent cough

■ Sarcoidosis. Chronic cough may be the only manifestation of pulmonary sarcoidosis. Primary investigations include: chest X-ray (hilar hyperplasia) lymph nodes, infiltrates in the parenchyma) the level of ACE in the blood serum.

■ Nitrofurans (subacute pulmonary reaction to nitrofurans): Ask the patient if he or she has taken nitrofurans to prevent urinary tract infections. Subacute cases of eosinophilia may not be present.

■ Pleurisy. Cough may be the only manifestation of pleurisy. To identify the etiology should be carried out: a thorough objective examination of the puncture and biopsy of the pleura.

■ Gastroesophageal reflux- a common cause of chronic cough, occurring in 40% of coughing individuals. Many of these patients complain of reflux symptoms (heartburn or a sour taste in the mouth). However, 40% of individuals whose cough is caused by gastroesophageal reflux do not show symptoms of reflux.

■ Postnasal drip syndrome(postnasal drip syndrome - leakage of nasal mucus into the respiratory tract). The diagnosis of postnasal drip may be suspected in patients who describe a sensation of mucus running down the throat from the nasal passages or a frequent need to "clear" the throat by coughing. In most patients, the discharge from the nose is mucous or mucopurulent. With the allergic nature of postnasal drip, eosinophils are usually found in the nasal secretion. Postnasal drip can be caused by general cooling, allergic and vasomotor rhinitis, sinusitis, irritants external environment and drugs (for example, ACE inhibitors).

Differential Diagnosis

The most important in the differential diagnosis of OB are pneumonia, bronchial asthma, acute and chronic sinusitis.

■ Pneumonia. It is fundamentally important to differentiate OB from pneumatic

	monii, since it is this step that determines the purpose of the in-

	intensive antibiotic therapy. Below (Table 3)
	there are symptoms observed in coughing patients, indicating
	their diagnostic value for pneumonia.
	■ Bronchial asthma. In cases where bronchial asthma is
	■ Bronchial asthma. In cases where bronchial asthma is
	cause of cough, patients usually experience episodes of
	stinging breath. Regardless of the presence or absence of whistle-
Body temperature over 37.8°C
Heart rate > 100 per minute

Respiratory rate > 25 per minute

Dry wheezing

Wet rales



Egophony

Rubbing noise of the pleura

Dullness of percussion

respiratory function, in patients with bronchial asthma, when examining the function of external respiration, reversible bronchial obstruction is detected in tests with β2-agonists or in a test with methacholine. However, in 33% tests with β2-agonists and in 22% with methacholine can be false positive. If false-positive results of functional testing are suspected The best way diagnosis bronchial asthma- carrying out a trial therapy for a week with the help of β2-agonists, which, in the presence of bronchial asthma, should stop or significantly reduce the severity of coughing.

Whooping cough is not very common, but very important for epidemiological reasons, the cause of acute cough. Whooping cough is characterized by: cough lasting at least 2 weeks, coughing paroxysms with a characteristic inspiratory "scream" and subsequent vomiting without other visible reasons. in the diagnosis of pertussis

whooping cough is laboratory-proven.

Adults immunized against whooping cough childhood often do not show classic pertussis infection.

Availability of anamnestic and clinical data on contacts with children who were not immunized (for organizational or religious reasons) against whooping cough.

Identify risk groups among those in contact with infectious agents for adequate diagnosis.

Despite immunization during adolescence and childhood, whooping cough remains an epidemic risk due to suboptimal immunization in some children and

adolescents and due to a gradual (within 8–10 years after immunization) decrease in pertussis immunity.

Below (Table 4) are the main differential diagnostic signs of acute bronchitis.

Table 4. Differential diagnosis of acute bronchitis

Disease	Main features

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Society of Pulmonologists of Russia

Research Institute of Pulmonology MZMP RF

Central Research Institute of Tuberculosis RAMS

Definition: Chronic obstructive bronchitis (COB) is a disease characterized by chronic diffuse inflammation of the bronchi leading to a progressive impairment of pulmonary veigilation and gas exchange of the obstructive type and is manifested by cough, shortness of breath and sputum production, not associated with damage to other organs and systems.

Chronic obstructive bronchitis and pulmonary emphysema are collectively referred to as chronic obstructive pulmonary disease (COPD)

Chronic obstructive bronchitis is characterized by progressive airway obstruction and increased bronchoconstriction in response to nonspecific stimuli. Obstruction in COB was composed of irreversible and reversible components . Irreversible the component is determined by the destruction of the elastic collagen base of the lungs and fibrosis, changes in the shape and obliteration of the bronchioles. Reversible the component is formed due to inflammation by contraction of the smooth muscles of the bronchi and hypersecretion of mucus.

There are three known unconditional risk factors for developing COB:

Smoking,

Severe congenital deficiency of alpha-1 antitrypsin,

Increased levels of dust and gases in the air associated with occupational hazards and unfavorable environmental conditions.

Available many probabilistic factors Keywords: passive smoking, respiratory viral infections, socioeconomic factors, living conditions, alcohol consumption, age, gender, family and genetic factors, airway hyperreactivity.

hob diagnostics.

The diagnosis of COB is based on the identification of the main clinical signs of the disease, taking into account predisposing risk factors and

exclusion of lung diseases with similar symptoms.

Most patients are heavy smokers. The anamnesis is often the presence of respiratory diseases, mainly in winter.

The main symptoms of the disease, which force the patient to consult a doctor, are increasing shortness of breath, accompanied by coughing, sometimes sputum production and wheezing.

Dyspnea - can vary over a very wide range: from feeling short of breath during standard physical exertion to severe respiratory distress. Shortness of breath usually develops gradually. For patients with COB, shortness of breath is the main cause of deterioration in the quality of life.

Cough - in the vast majority - productive. The quantity and quality of sputum secreted may vary depending on the severity of the inflammatory process. However, a large amount of sputum is not typical for COB.

Diagnostic value objective examination with COB is negligible. Physical changes depend on the degree of airway obstruction, the severity of emphysema. The classic signs are wheezing with a single breath or with forced expiration, indicating a narrowing of the airways. However, these signs do not reflect the severity of the disease, and their absence does not exclude the presence of COB in a patient. Other signs, such as weakened breathing, limited chest expansion, participation of additional muscles in the act of breathing, central cyanosis, also do not indicate the degree of airway obstruction.

Steady progression of the disease - the most important symptom of COPD. The severity of clinical signs in COB patients is constantly increasing. To determine the progression of the disease, repeated determination of FEV 1 is used. Decrease in FEV1 by more than 50 ml. per year evidence of the progression of the disease.

The quality of life - an integral indicator that determines the patient's adaptation to the presence of the disease and the ability to perform the patient's usual functions related to his socio-economic status (at work and at home). To determine the quality of life, special questionnaires are used.

GENERAL

Bronchitis is a common disease, it ranks first in frequency of occurrence among diseases. respiratory system. Main risk group - children and the elderly. Men get sick 2-3 times more often than women, because among them there is a higher percentage of workers in hazardous industries and more smokers. The disease is most common in cold climates and regions with high humidity, and among people who are often in damp, drafty, unheated rooms.

Inflammation is provoked by infections and viruses that enter the mucous surface of the bronchi. In addition to them, the global cause of bronchitis is smoking. Smokers, regardless of gender and age, are up to 4 times more likely than others to develop bronchitis. Most of the time, their illness is chronic.

Tobacco smoke and other irritating microscopic elements damage the mucous surface of the upper respiratory tract. Trying to get rid of foreign particles, the bronchi respond with increased sputum production and a strong cough. The disease usually proceeds not severely with timely treatment and elimination of adverse factors that cause the chronic course of the disease.

CAUSES

The surface of the mucous membranes respiratory organs cover small lashes. Their main function is to cleanse bacteria and various irritants. If the work of the cilia is disturbed, the airways become vulnerable to infections, allergens and other irritants. The risk of inflammation increases dramatically.

In addition, oxygen saturation of tissues and organs of the body is significantly reduced, which often provokes heart failure, a decrease in general immunity and other serious health problems.

The main factors causing bronchitis:

viruses and infections, less often - fungi;
smoking, including passive;
poor ecology and unsuitable climate;
unfavorable living and working conditions;
susceptibility to other respiratory diseases;
hereditary deficiency of alpha-1 antitrypsin.

Alpha-1 antitrypsin is a special protein produced by the liver and designed to regulate defense mechanisms in the human lungs. It happens that as a result of gene failures, this protein is not produced in the human body, or its quantity is insufficient. In this case, they begin to develop chronic diseases respiratory organs.

CLASSIFICATION

The disease has many variants of the course.

Separate bronchitis primary and secondary:

Primary arises as an independent disease of the respiratory organs of the upper level.
Secondary - a consequence of complications after other diseases (flu, tuberculosis, whooping cough and a number of others).

It can be localized in different areas.

Focal bronchitis are divided into:

Tracheobronchitis - affects only the trachea and large bronchi.
Bronchitis - affects the bronchi of medium and small size.
Bronchiolitis - localized only in the bronchioles.

However, this division can only be found in initial stage diseases. As a rule, inflammation progresses rapidly and after a short time spreads to all branches of the bronchial tree and acquires a diffuse character.

Clinical forms of bronchitis

simple;
obstructive;
obliterating;
bronchiolitis.

Chronical bronchitis- this is an untreated acute bronchitis that occurs more than three times in 2 years. It happens:

purulent non-obstructive;
simple non-obstructive;
purulent-obstructive;
obstructive.

According to the severity of the course of bronchitis are:

catarrhal;
fibrinous;
hemorrhagic;
mucopurulent;
ulcerative;
necrotic;
mixed.

Often there is allergic tracheal bronchitis, the development of which may be accompanied by an asthmatic syndrome or proceed without it.

SYMPTOMS

Bronchitis begins as an acute respiratory disease - with general weakness, runny nose, fever, intoxication, discomfort in the throat. The mucous surfaces of the bronchi are hyperemic, edematous. The disease becomes severe when the epithelium of the bronchi is affected by erosions and ulcers, often in this pathological process it affects the submucosal layer and muscles of the walls of the bronchi, as well as the tissue surrounding them.

The main external symptom is dry persistent cough. At this stage, the most important task is to achieve the transition of a dry cough into a wet one. A productive wet cough brings relief and promotes the recovery of a person, allowing the bronchi to get rid of mucus. The expectorated sputum has a white, yellow or greenish tint, occasionally with an admixture of blood. Often cough worsens at night or if the patient goes into the supine position.

The lack of adequate timely treatment of the acute form of the disease, as well as the neglect of the rules for the prevention of relapses, contribute to its chronicity with damage to the entire bronchial system and lung tissues.

Symptoms of chronic bronchitis:

persistent cough, accompanied by the production of thick sputum, which greatly complicates breathing and gas exchange;
difficulty breathing, which is accompanied by wheezing and shortness of breath even with light physical exertion;
violation of oxygen metabolism in the body, as a result of which the skin turns pale and acquires a bluish tint;
increased fatigue, poor sleep.

DIAGNOSTICS

Therapist and pulmonologist are engaged in the diagnosis and treatment of diseases of the respiratory system.

To make a diagnosis, you can prescribe:

general and biochemical analyzes urine and blood;
bacteriological culture of sputum;
spirogram;
chest x-ray;
bronchoscopy.

When conducting a bronchoscopy, the doctor may take a biopsy for research, which will rule out the development of cancer.

TREATMENT

With a confirmed diagnosis, the patient will undergo systematic treatment, including a complex of medications, physiotherapy and auxiliary methods.

In the acute form of the disease, therapy is symptomatic.

Acute bronchitis is treated with:

Physiotherapy for acute bronchitis involves inhalation, therapeutic bronchoscopy, electroprocedures, special breathing exercises, percussion massage.

With adequate treatment and prevention of the transition of the disease into a chronic form, acute bronchitis does not last more than 5-7 days. Full recovery follows in 12-14 days. Chronic bronchitis continues for years even with qualified medical intervention.

Chronic bronchitis is not treatable, but it is categorically impossible to let the disease take its course. Depending on the stage of the disease and the severity of its course, the doctor prescribes a set of measures that allow the patient to maintain the quality of life and performance.

mandatory smoking cessation, maintaining a healthy lifestyle;
elimination of the risk of lung infections - elimination of irritants from the air, vaccination against influenza;
hardening to increase the body's resistance, exercise therapy and sports;
physiotherapy, oxygen therapy, inhalations, breathing exercises;
taking bronchodilators or steroid drugs to expand the lumen of the bronchi and facilitate breathing.

Sometimes when complex form disease or exacerbation, treatment is best done in a hospital setting.

COMPLICATIONS

Chronic bronchitis poses a risk of developing serious complications. Inflammatory reaction and viral intoxication dramatically reduce the drainage function of the bronchi. The discharge of sputum from the lower respiratory tract is difficult, the infection spreads down, causing pneumonia.

At the same time, prerequisites are created for bacterial embolism in the bronchi of a smaller diameter. Scars form on the surface of the mucous membrane of the small respiratory tract, the elasticity and strength of the lung tissue is disturbed, and it becomes difficult for the patient to breathe. In the future, this leads to emphysema and chronic obstructive pulmonary disease. There is a threat to human life.

Spasm and infiltration of the walls of the entire structure of the bronchi affects even the smallest bronchioles, sputum blocks the respiratory lumen - all this disrupts natural ventilation and blood circulation, leading to the development of arterial hypertension. The patient starts experience heart failure, which is accompanied by cyanosis, shortness of breath and cough with intense mucus separation. Cardiac progresses and vascular insufficiency, the liver increases, the legs swell.

In addition, prolonged chronic bronchitis leads to hyperreactivity of the bronchial mucosa. It thickens, swells, the airway narrows, this entails serious breathing problems, up to suffocation. Developing asthmatic syndrome and subsequently bronchial asthma. The presence of allergies in humans significantly accelerates these processes.

PROGNOSIS FOR RECOVERY

Acute bronchitis with timely access to a medical institution and correctly prescribed therapy, as a rule, responds well to treatment. Full recovery takes up to 10-14 days. Elderly and immunocompromised patients may take 3-4 weeks to recover.

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Bronchiolitis is an inflammatory lesion of the bronchioles - the smallest bronchi. In this case, as a result of a partial or complete decrease in their lumen.

How to treat chronic bronchitis?

Treatment chronic bronchitis- the process is lengthy. Success largely depends on the discipline of the patient, to whom doctors prescribe a long list of drugs. Along with taking medicines breathing exercises are of great importance.

To begin with, the patient is recommended to get rid of the factors that provoke the development of the disease. When smoking - give up bad habits. If you have to work in harmful conditions - change jobs. Otherwise, all treatment will go down the drain.

It is obligatory to follow a high-calorie diet, which helps to strengthen the body's defenses and restore damaged mucous membranes. The patient is advised to enrich the daily diet with protein foods, fruits, nuts, vegetables.

If possible, viral infections should be avoided, which can provoke an exacerbation of the disease. In the cold season, you need to take immunomodulators. After visiting places with a large crowd of people, it is advisable to gargle with salt water.

An important role in the development of chronic bronchitis is played by the quality of home air, so every day it is necessary to do wet cleaning in the apartment. It would be nice to get room air purifiers.

Drug therapy

With an exacerbation of the disease, treatment should be aimed at eliminating the acute inflammatory process in the bronchi. During this period, it is very important to pass sputum for bacteriological analysis, according to the results of which the doctor will be able to prescribe the appropriate antibiotic.

If it is not possible to conduct a study, the remedy is selected empirically. To begin with, the doctor prescribes antibacterial drug from the group of penicillins (Flemoxin, Augmentin). If after three days of therapy no signs of improvement are observed in the patient, the drug is replaced with a cephalosporin (Zinnat) or a macrolide (Azithromycin). Preference is given to tablet forms. In severe cases, injections (Cefatoxime) or droppers (Amoxiclav, Augmentin) may be indicated.

In case of poor sputum discharge, alkaline drink and expectorants (mucolytics) are prescribed. Bromhexine (orally 8 mg 3 times a day), ambroxol (30 mg 3 times a day) or acetylcysteine (200 mg up to 4 times a day) are recommended. The course of treatment with these drugs is 14 days. A good result is also given by ultrasonic inhalations with carbocysten or ambroxol. They are made 2 times a day for 10 days.

In the early stages of the disease, the anti-inflammatory drug Erespal is effective (in tablets or in the form of syrup). It is taken simultaneously with mucolytics (80 mg 3 times a day).

To eliminate spasms of the bronchi, use bronchodilators (bronchodilators). The safest are inhalation (Atrovent, Berotek) and oral (Eufillin) preparations.

With the release of purulent sputum, therapeutic bronchoscopy is done: through thin flexible tubes (endoscopes), the bronchi are washed with a solution of sodium chloride or furacilin. The procedure is performed on an empty stomach under local anesthesia. Sessions are repeated 3-4 times with a break of 3-7 days.

Otherwise, bronchitis is treated during periods of calm:

To increase the body's defenses, the patient is prescribed immunomodulators (Ribomunil, Broncho-munal) and vitamins (vitamin C, nicotinic acid, B vitamins).
Courses 2 times a year prescribe inhalations with alkaline mineral waters (Borjomi, Bzhni) or mucolytics (Ambroxol).
With difficulty breathing in small doses, it is recommended to take bronchodilators (Eufillin) at night.
With developed pulmonary heart failure, diuretics (Veroshpiron), agents that improve myocardial metabolism (Riboxin), cardiac glycosides (Digoxin), and oxygen therapy are indicated.

Non-drug measures

From non-drug methods the doctor may suggest:

Massage. Special vibration techniques improve blood circulation in the chest and rid the bronchi of excess phlegm.
postural drainage. The patient is placed on a couch, the foot end of which is slightly raised. Under the supervision of a nurse, the patient rolls over several times from back to stomach and from side to side for 20 minutes. This technique helps to facilitate the discharge of sputum. The procedure is repeated 2 times a day for 5-7 days.
Halotherapy ("salt cave"). For 30-40 minutes the patient is in a room, the floor and walls of which are lined with salt crystals. Salt vapors actively fight infection and facilitate coughing.
Hypoxic therapy ("mountain air"). Breathing with a mixture with a low oxygen content helps to train the immune system and adapt the body to hypoxia conditions. The procedure is carried out in special treatment rooms based on clinics or hospitals.
Physiotherapy: ultraviolet or infrared irradiation of the chest, calcium electrophoresis. The procedures are aimed at thinning the sputum in the bronchi.

All of these methods are effective both during exacerbations and during remissions of chronic bronchitis.

In all phases of the disease, it is necessary to perform daily breathing exercises. The simplest of them - according to Kuznetsov - includes the usual exercises with arm swings, which are accompanied by deep breaths and exhalations. More difficult gymnastics according to Strelnikova teaches breathing with the help of the abdominal muscles. It is better to master it under the guidance of an instructor in a medical institution.

During periods of rehabilitation, all patients benefit from:

Sanatorium-resort rest,
ski trips,
swimming,
hardening.

More about bronchitis (and bronchiectasis) tells the program "Live healthy!":

Prevention of chronic bronchitis: how to prevent the chronicization of the pathological process?

Prevention of chronic bronchitis is essential to maintain normal respiratory health. This pathology is a long-term progressive inflammatory process of the lower respiratory tract with a failure of the cleansing, protective and secretory functions.

Such violations are a factor that predisposes to the development of exacerbations and complications, the addition of infections. According to medical statistics, about 20% of all clinical cases inflammation of the lower respiratory tract are chronic bronchitis.

What causes bronchitis?

In chronic bronchitis, in all age categories of patients, an inflammatory process of the bronchopulmonary tract occurs. Usually, residents of large cities with developed infrastructure and industry suffer from the disease.

Important! Chronic bronchitis is diagnosed when the duration of the acute phase of the disease for 3 months or more, subject to the annual occurrence of a severe cough over the past 2 years.

Chronic bronchitis is the main factor that contributes to the occurrence of obstructive lesions of the lung tissues, emphysema, respiratory failure and other complications.

According to the medical classification, the disease differs in the following phases:

stage of the pathological process;
modification of the quality index of tissues;
development of obstructive processes;
variant of the clinical course.

The pathological process can spread to both large and small bronchi. According to the clinical picture, there may be an inflammatory process that rarely makes itself felt, but there are those that recur often. In some cases, chronic bronchitis occurs with complications (see Complications after various kinds bronchitis in adults).

Provoking factors

Etiological factors are quite diverse.

But, there are some risk factors that are more common than others:

entry into the respiratory tract of various chemical particles from the environment;
increased harmfulness of production;
exposure to tobacco;
chronic tracheitis;
wrong tactics of therapy of acute type of bronchitis;
accommodation in the area of large industrial facilities;
chronic laryngitis;
difficulty in nasal breathing;
lack of funds personal protection in hazardous production.

The reasons that led to the development of pathology, it is not always possible to determine for certain.

Attention! Chronic bronchitis requires such a definition, since otherwise there are great difficulties with the selection of optimal treatment tactics that will transfer the disease into a phase of stable remission.

For example, if inflammatory processes have arisen as a result of an infectious lesion, tactics will be aimed at eliminating the main pathogen, since bacteria enter the respiratory system from the ENT organs. Also, it is required to take into account that smoking in any form adversely affects the body and provokes the development of pathology.

Important! Smokers have pathological changes bronchial secretion, which stagnates and provokes obstructive processes. Nicotine contains a significant number of particles that can potentially lead to the development of inflammatory processes in the mucous membranes.

Inflammatory processes

The pathogenesis of the disease consists in violations that relate to the functionality of the mucous membranes of the lower respiratory organs. At the same time, the function of clearing the bronchi is significantly weakened and the process itself slows down.

In the course of inflammation, other factors also play a role, the main ones being:

increase in the viscosity of mucus;
stagnant processes of sputum;
decreased production of alpha-2 antitrypsin;
decrease in interferon volumes;
suppression of phagocytosis;
disruption of lysozyme production.

Violations also occur in immune system organism.

At the initial stage, with such changes, swelling is formed and there is an admixture of pus in the mucus. A prolonged course provokes atrophy, which later turns into respiratory failure. Prevention of chronic bronchitis in adults is to minimize the impact of harmful factors on the human body.

The video in this article will acquaint the reader with the basic rules for the prevention of bronchitis.

Diagnosis and therapy

With the correct diagnosis, it is not particularly difficult for a specialist to choose the optimal treatment tactics for a specialist.

Diagnostic measures involve the following manipulations:

auscultation;
determination of the speed of absorbed air;
study of external respiration.

The following pathological changes in the patient's respiratory function indicate the progression of the disease:

a certain boxed sound during listening;
wheezing of wet and dry nature;
increase in expiratory duration;
hard breathing;
decrease in lung volumes;
increase in respiratory volume;
decrease in expiratory duration;
symptoms associated with emphysema.

It is quite difficult to fully cure the chronic type of bronchitis, but it is quite possible. To do this, you must follow each appointment of the treating specialist exactly. National recommendations imply the application antibacterial agents in combination with physiotherapy.

Quit smoking completely.
Protect the respiratory tract from the effects of toxic substances.
Review your eating habits and consume quality food.
Take all the medicines prescribed by your doctor in the exact dosage and according to the recommended schedule.
Do certain breathing exercises.
More often to be in the green zone and travel outside the city to ecologically clean regions.
Treat all existing concomitant respiratory diseases.

Patients require regular intake of mucolytics and other expectorants. You may also need to take antibiotics. In addition to the above, treatment involves taking medications that expand the bronchi and immunostimulating drugs.

During periods of remission, patients are required to perform all preventive measures that can help get rid of chronic bronchitis not only for a long time, but also to cure it completely.

Fundamentals of Prevention

With the diagnosis of "chronic bronchitis" it is required to adjust your own rhythm of life to this disease, that is, to perform those actions that can leave the pathology in remission. To do this, the patient must follow these recommendations.

To alleviate the condition, with difficulty breathing, it is possible to periodically exhale with tightly closed lips. As for the main prevention of chronic bronchitis, it is divided into primary and secondary.

Key points for primary prevention

Since the main period of development and exacerbation of respiratory diseases occurs in autumn and spring, during these seasons, it is necessary to carefully carry out preventive measures.

Elementary preventive measures imply compliance with the following rules:

Personal hygiene- thorough cleaning of hands, the use of disposable wipes, a contrast shower after sleep. These actions will help strengthen the body and partly prevent the exacerbation of bronchitis.
During periods of epidemiological outbreaks, it is required to perform rinsing of the nasopharynx using a solution of sea salt and water.
Wet room cleaning using disinfectants allows you to increase humidity and reduce the concentration of pathogenic microorganisms in the air.
It is necessary to ventilate the rooms daily(subject to the relative purity of the air in the street).
It is required to maintain a healthy microclimate in the living room. This implies a humidity level not exceeding 70% and a room temperature within 20-25̊ C.
Taking medicines in preventive purposes - means vitamin-mineral complexes, immunomodulatory drugs and other methods of prevention.
Avoiding prolonged exposure to large crowds- This will significantly reduce the likelihood of an infectious disease.
Vaccination is one of the most important preventive measures, as it helps to prevent the patient from accidentally infecting the patient with any disease that can push bronchitis to the active phase.

In the presence of any chronic diseases, patients are required to be vaccinated annually.

Attention! There are certain contraindications to vaccination. Only a doctor can determine the feasibility of immunization.

Principles of secondary prevention

Chronic bronchitis involves long-term therapy, while secondary prevention measures are aimed at minimizing the likelihood of the transition of the disease to an exacerbated form and a complete revision of the principles and quality of life of the patient. The rehabilitation program is chosen individually by the attending physician.

Basically, secondary prevention involves the implementation of the following measures by the patient:

In the chronic form of bronchitis, it is required to undergo a sanatorium-resort rehabilitation. The instruction of generally accepted norms suggests holding wellness procedures 2 times per year.
Hardening allows you to reduce the likelihood of exacerbations, but you need to harden gradually (the water temperature from the usual one drops by 1̊ C every 3 days, not more often) and perform the procedures regularly.
With diagnosed chronic bronchitis, it is required to regularly perform breathing exercises.
Breathing exercises should be moderate, as excessive fanaticism can lead to negative consequences. The best option is gymnastics according to Strelnikova.
Excessively intense physical activity should be avoided, as they can lead to a deterioration in respiratory function in chronic bronchitis.
Interaction with any substances that can potentially cause allergic reactions should also be kept to a minimum. You should refuse to work in harmful conditions, because the price is the health and full life of the patient.
It is required to abandon activities in enterprises with a high degree of harmfulness, since in this way it is possible to provoke not only chronic bronchitis, but also the development of more severe pathologies of the respiratory tract.

Also, in order to prevent exacerbation of chronic bronchitis, it is required not to forget about the general principles of a healthy lifestyle and adhere to them. Full sleep for 6-8 hours should fall on the dark time of the day, while falling asleep preferably no later than midnight.

It is also desirable to avoid stressful factors and often be in the green urban area, taking walks. It has been proven that moving to regions with favorable environmental conditions is highly desirable for patients suffering from diseases of the upper respiratory tract.

Competent prevention in chronic bronchitis can greatly reduce the likelihood of its exacerbation and lead to a cure for the patient from this pathology.

Bronchitis is one of the most common diseases of the lower respiratory system, which occurs in both children and adults. It can occur due to the action of factors such as allergens, physico-chemical influences, bacterial, fungal or viral infection.

In adults, there are 2 main forms - acute and chronic. On average, acute bronchitis lasts about 3 weeks, and chronic bronchitis lasts at least 3 months during the year and at least 2 years in a row. In children, another form is distinguished - recurrent bronchitis (this is the same acute bronchitis, but repeated 3 or more times throughout the year). If the inflammation is accompanied by a narrowing of the lumen of the bronchi, then they speak of obstructive bronchitis.

If you get sick with acute bronchitis, then for a speedy recovery and to prevent the transition of the disease into a chronic form, you should adhere to the following recommendations of specialists:

On days when the temperature rises, observe bed or semi-bed rest.
Drink plenty of fluids (at least 2 liters per day). It will facilitate the cleansing of the bronchi from sputum, because it will make it more liquid, and also help to remove toxic substances from the body resulting from the disease.
If the air in the room is too dry, take care of humidifying it: hang wet sheets, turn on the humidifier. This is especially important in winter during the heating season and in summer when it is hot, as dry air increases coughing.
As your condition improves, start doing breathing exercises, ventilate the room more often, and spend more time in the fresh air.
In the case of obstructive bronchitis, be sure to exclude contact with allergens, do wet cleaning more often, which will help get rid of dust.
If this is not contraindicated by a doctor, then after the temperature has returned to normal, you can do a back massage, especially drainage, put mustard plasters, rub the chest area with warming ointments. Even simple procedures such as a hot foot bath to which you can add mustard powder can help improve blood circulation and speed up recovery.
To alleviate a cough, ordinary steam inhalations with soda and decoctions of anti-inflammatory herbs will be useful.
To improve sputum discharge, drink milk with honey, tea with raspberries, thyme, oregano, sage, alkaline mineral waters.
Make sure that on sick days, the diet is enriched with vitamins and proteins - eat fresh fruits, onions, garlic, lean meat, dairy products, drink fruit and vegetable juices.
Take the medicines prescribed by your doctor.

As a rule, in the treatment of acute bronchitis, the doctor recommends the following groups of drugs:

Thinning sputum and improving its discharge - for example, Ambroxol, ACC, Mukaltin, licorice root, marshmallow.
In case of obstruction phenomena - Salbutamol, Eufillin, Teofedrin, antiallergic drugs.
Strengthening the immune system and helping to fight viral infection- Groprinosin, vitamins, preparations based on interferon, eleutherococcus, echinacea, etc.
In the early days, if a dry and unproductive cough is exhausting, antitussives are also prescribed. However, on the days of their intake, expectorant drugs should not be used.
With a significant increase in temperature, antipyretic and anti-inflammatory drugs are indicated - for example, Paracetamol, Nurofen, Meloxicam.
If a second wave of temperature occurs or sputum becomes purulent, then antibiotics are added to the treatment. For the treatment of acute bronchitis, amoxicillins protected by clavulanic acid are most often used - Augmentin, Amoxiclav, cephalosporins, macrolides (Azithromycin, Clarithromycin).
If the cough lasts more than 3 weeks, then it is necessary to take an x-ray and consult a pulmonologist.

In case of recurrent or chronic bronchitis, the implementation of the recommendations of specialists can reduce the frequency of exacerbations of the disease, and in most cases prevent the occurrence of diseases such as lung cancer, bronchial asthma of an infectious-allergic nature, progression of respiratory failure.

Quit smoking completely, including passive inhalation of tobacco smoke.
Don't drink alcohol.
Annually undergo preventive examinations by a doctor, chest x-ray, ECG, take a general blood test, sputum tests, including for the presence of Mycobacterium tuberculosis, and in case of obstructive bronchitis, also do spirography.
Strengthen your immune system by leading a healthy lifestyle, doing physical therapy, breathing exercises, harden, and in the autumn-spring period, take adaptogens - preparations based on echinacea, ginseng, eleutherococcus. If bronchitis is of a bacterial nature, then it is recommended to complete a full course of therapy with Bronchomunal or IRS-19.
With obstructive bronchitis, it is very important to avoid work that involves the inhalation of any chemical fumes or dust containing particles of silicon, coal, etc. Also avoid being in stuffy, unventilated areas. Make sure you get enough vitamin C daily.
Outside of exacerbation, sanatorium treatment is indicated.

During an exacerbation of chronic or recurrent bronchitis, the recommendations are consistent with those for the treatment of the acute form of the disease. In addition, the introduction of drugs using a nebulizer is widely used, as well as the sanitation of the bronchial tree using a bronchoscope.

Bronchitis is one of the most common diseases. Both acute and chronic cases rank high among respiratory pathologies. Therefore, they require high-quality diagnostics and treatment. Summarizing the experience of leading experts, relevant clinical recommendations on bronchitis are created at the regional and international levels. Compliance with the standards of care is an important aspect of evidence-based medicine, which allows you to optimize diagnostic and therapeutic measures.

Causes and mechanisms

None of the recommendations can do without considering the causes of the pathology. It is known that bronchitis has an infectious and inflammatory nature. The most common causative agents of the acute process are viral particles (influenza, parainfluenza, respiratory syncytial, adeno-, corona- and rhinoviruses), and not bacteria, as previously thought. Outside of seasonal outbreaks, it is possible to establish a certain role for other microbes: whooping cough, mycoplasmas and chlamydia. But pneumococcus, moraxella and Haemophilus influenzae can cause acute bronchitis only in patients who have undergone surgery on the respiratory tract, including tracheostomy.

Infection plays a crucial role in the development of chronic inflammation. But bronchitis at the same time has a secondary origin, arising against the background of a violation of local protective processes. Exacerbations are provoked mainly by the bacterial flora, and the long course of bronchitis is due to the following factors:

Smoking.
Professional hazards.
Air pollution.
Frequent colds.

If during acute inflammation there is swelling of the mucous membrane and increased production of mucus, then the central link of the chronic process is the violation of mucociliary clearance, secretory and protective mechanisms. The long course of the pathology often leads to obstructive changes, when due to thickening (infiltration) of the mucosa, sputum stagnation, bronchospasm and tracheobronchial dyskinesia, obstacles are created for the normal passage of air through the respiratory tract. This leads to functional disorders with further development of pulmonary emphysema.

Bronchitis is provoked by infectious agents (viruses and bacteria), and acquires a chronic course under the influence of factors that violate the protective properties of the respiratory epithelium.

Symptoms

Assume pathology at the initial stage will allow the analysis of clinical information. The doctor evaluates the anamnesis (complaints, onset and course of the disease) and conducts a physical examination (examination, auscultation, percussion). So he gets an idea of the symptoms, on the basis of which he makes a preliminary conclusion.

Acute bronchitis occurs on its own or against the background of SARS (most often). In the latter case, it is important to pay attention to the catarrhal syndrome with a runny nose, perspiration, sore throat, as well as fever with intoxication. But pretty soon there are signs of bronchial damage:

Intense cough.
Expulsion of scanty mucous sputum.
Expiratory dyspnea (difficulty exhaling predominantly).

Even chest pains may appear, the nature of which is associated with muscle strain during a hacking cough. Shortness of breath appears only with the defeat of the small bronchi. Percussion sound, as well as voice trembling, are not changed. Auscultation reveals hard breathing and dry rales (buzzing, whistling), which become moist during the resolution of acute inflammation.

If the cough lasts more than 3 months, then there is every reason to suspect chronic bronchitis. It is accompanied by sputum discharge (mucous or purulent), less often it is unproductive. At first this is observed only in the morning, but then any increase in the frequency of breathing leads to expectoration of the accumulated secret. Shortness of breath with prolonged exhalation joins when obstructive disorders appear.

In the acute stage, there is an increase in body temperature, sweating, weakness, the volume of sputum increases and its purulence increases, the intensity of cough increases. The periodicity of chronic bronchitis is quite pronounced, inflammation is especially activated in the autumn-winter period and with sudden changes in weather conditions. The function of external respiration in each patient is individual: in some, it remains at an acceptable level for a long time (non-obstructive bronchitis), while in others, shortness of breath with ventilation disorders appears early, which persists during periods of remission.

On examination, one can notice signs indicating chronic respiratory failure: chest expansion, pallor of the skin with acrocyanosis, thickening of the terminal phalanges of the fingers (“drumsticks”), changes in the nails (“watch glasses”). The development of cor pulmonale may indicate swelling of the legs and feet, swelling of the jugular veins. Percussion with simple chronic bronchitis does not give anything, and obstructive changes can be assumed from the box shade of the sound received. The auscultatory picture is characterized by hard breathing and scattered dry rales.

It is possible to assume bronchitis by clinical signs that are revealed during a survey, examination and using other physical methods (percussion, auscultation).

Additional diagnostics

Clinical recommendations contain a list of diagnostic measures that can be used to confirm the doctor's assumption, determine the nature of the pathology and its causative agent, and identify concomitant disorders in the patient's body. On an individual basis, such studies can be prescribed:

General blood analysis.
Blood biochemistry (acute phase indicators, gas composition, acid-base balance).
Serological tests (antibodies to pathogens).
Analysis of swabs from the nasopharynx and sputum (cytology, culture, PCR).
Chest X-ray.
Spirography and pneumotachometry.
Bronchoscopy and bronchography.
Electrocardiography.

The study of the function of external respiration plays a key role in determining violations of bronchial conduction in a chronic process. At the same time, two main indicators are evaluated: the Tiffno index (the ratio of forced expiratory volume in 1 second to the vital capacity of the lungs) and peak expiratory flow rate. Radiologically, with simple bronchitis, only an increase in the pulmonary pattern can be seen, but prolonged obstruction is accompanied by the development of emphysema with an increase in the transparency of the fields and a low standing diaphragm.

Treatment

Having diagnosed bronchitis, the doctor immediately proceeds to therapeutic measures. They are also reflected in the clinical guidelines and standards that guide specialists when prescribing certain methods. Central to acute and chronic inflammation is drug therapy. In the first case, the following drugs are used:

Antiviral (zanamivir, oseltamivir, rimantadine).
Expectorants (acetylcysteine, ambroxol).
Antipyretics (paracetamol, ibuprofen).
Antitussives (oxeladin, glaucine).

The last group of drugs can be used only with intense hacking cough, which is not stopped by other means. And it should be remembered that they should not inhibit mucociliary clearance and be combined with drugs that increase mucus secretion. Antibiotics are used only in cases where the bacterial origin of the disease is clearly proven or there is a risk of developing pneumonia. In the recommendations after bronchitis there is an indication of vitamin therapy, immunotropic drugs, refusal bad habits and hardening.

Acute bronchitis is treated with medications that affect the infectious agent, disease mechanisms, and individual symptoms.

The treatment of chronic pathology involves various approaches during the period of exacerbation and remission. The first direction is due to the need to sanitize the respiratory tract from infection and involves the appointment of such medications:

Antibiotics (penicillins, cephalosporins, fluoroquinolones, macrolides).
Mucolytics (bromhexine, acetylcysteine).
Antihistamines (loratadine, cetirizine).
Bronchodilators (salbutamol, fenoterol, ipratropium bromide, aminophylline).

Drugs that eliminate bronchospasm occupy an important place not only during exacerbation, but also as a basic therapy for chronic inflammation. But in the latter case, preference is given to prolonged forms (salmeterol, formoterol, tiotropium bromide) and combined drugs (Berodual, Spiolto Respimat, Anoro Ellipta). At severe course obstructive bronchitis add theophyllines. Inhaled corticosteroids, such as fluticasone, beclomethasone, or budesonide, are indicated for the same category of patients. Like bronchodilators, they are used for long-term (basic) therapy.

The presence of respiratory failure requires oxygen therapy. The set of recommended measures also includes influenza vaccination to prevent exacerbations. An important place in the rehabilitation program is occupied by individually selected breathing exercises, high-calorie and fortified diet. And the appearance of single emphysematous bullae may suggest their surgical removal, which favorably affects the ventilation parameters and the condition of patients.

Bronchitis is a very common disease of the respiratory tract. It occurs in acute or chronic form, but each of them has its own characteristics. Methods for diagnosing bronchial inflammation and methods for its treatment are reflected in international and regional recommendations that guide the doctor. The latter are designed to improve the quality of rendering medical care, and some have even been put into practice at the legislative level in the form of relevant standards.

Smoking.
Professional hazards.
Air pollution.
Frequent colds.

Bronchitis is provoked by infectious agents (viruses and bacteria), and acquires a chronic course under the influence of factors that violate the protective properties of the respiratory epithelium.

Symptoms

Intense cough.
Expulsion of scanty mucous sputum.
Expiratory dyspnea (difficulty exhaling predominantly).

It is possible to assume bronchitis by clinical signs that are revealed during a survey, examination and using other physical methods (percussion, auscultation).

Additional diagnostics

General blood analysis.
Blood biochemistry (acute phase indicators, gas composition, acid-base balance).
Serological tests (antibodies to pathogens).
Analysis of swabs from the nasopharynx and sputum (cytology, culture, PCR).
Chest X-ray.
Spirography and pneumotachometry.
Bronchoscopy and bronchography.
Electrocardiography.

Treatment

Having diagnosed bronchitis, the doctor immediately proceeds to therapeutic measures. They are also reflected in the clinical guidelines and standards that guide specialists when prescribing certain methods. Drug therapy is central to acute and chronic inflammation. In the first case, the following drugs are used:

Antiviral (zanamivir, oseltamivir, rimantadine).
Expectorants (acetylcysteine, ambroxol).
Antipyretics (paracetamol, ibuprofen).
Antitussives (oxeladin, glaucine).

Acute bronchitis is treated with medications that affect the infectious agent, disease mechanisms, and individual symptoms.

Antibiotics (penicillins, cephalosporins, fluoroquinolones, macrolides).
Mucolytics (bromhexine, acetylcysteine).
Antihistamines (loratadine, cetirizine).
Bronchodilators (salbutamol, fenoterol, ipratropium bromide, aminophylline).

Drugs that eliminate bronchospasm occupy an important place not only during exacerbation, but also as a basic therapy for chronic inflammation. But in the latter case, preference is given to prolonged forms (salmeterol, formoterol, tiotropium bromide) and combined drugs (Berodual, Spiolto Respimat, Anoro Ellipta). In severe cases of obstructive bronchitis, theophyllines are added. Inhaled corticosteroids, such as fluticasone, beclomethasone, or budesonide, are indicated for the same category of patients. Like bronchodilators, they are used for long-term (basic) therapy.

Bronchitis is a very common disease of the respiratory tract. It occurs in acute or chronic form, but each of them has its own characteristics. Methods for diagnosing bronchial inflammation and methods for its treatment are reflected in international and regional recommendations that guide the doctor. The latter were created to improve the quality of medical care, and some have even been put into practice at the legislative level in the form of relevant standards.

The diagnosis of bronchitis is usually clinical.

The diffuse nature of wheezing, low temperature, the absence of toxicosis, percussion changes and leukocytosis make it possible to exclude pneumonia and make a diagnosis of bronchitis without resorting to chest x-ray.

Complaints and anamnesis

Acute bronchitis (viral) - occurs predominantly in preschool children school age. It is characterized by an acute onset with subfebrile (rarely febrile) temperature, catarrhal symptoms (cough, rhinitis). Cough can appear from 2-3 days of illness. Clinical signs bronchial obstruction (expiratory dyspnea, wheezing, wheezing) are absent. Signs of intoxication are usually absent, usually lasting 5-7 days. In infants with RS-viral infection and in older children with adenovirus infection, it can last up to 2 weeks. Cough lasting ≥2 weeks in schoolchildren may be indicative of pertussis infection.

Bronchitis due to Mycoplasma pneumoniae . Possible persistent febrile temperature in the absence of toxicosis, redness of the conjunctiva ("dry conjunctivitis" with usually scanty other catarrhal phenomena). Uncommon signs of obstruction. Without treatment, fever and wheezing can persist for up to 2 weeks.

Chlamydial bronchitis due to C. trachomatis observed in children aged 2-4 months with intranatal infection from the mother. The condition is disturbed a little, the temperature is usually normal, the cough intensifies within 2-4 weeks, sometimes paroxysmal "whooping cough", but without reprisals. Shortness of breath is moderate. In favor of chlamydial infection, there are signs of urogenital pathology in the mother, persistent conjunctivitis in the 1st month of the child's life.

Chlamydial bronchitis due to C. pneumoniae , in adolescents is rarely diagnosed, sometimes occurs with bronchial obstruction. Clinical picture it may be accompanied by pharyngitis and lymphadenitis, however, it has not been studied enough due to the difficulties of etiological diagnosis.

Acute bronchitis with bronchial obstruction syndrome : repeated episodes of bronchial obstruction syndrome are observed quite often - against the background of another respiratory infection and require the exclusion of bronchial asthma in the patient. They, as a rule, are accompanied by wheezing and prolongation of expiration, which appear as early as 1-2 days of illness. The respiratory rate rarely exceeds 60 in 1 minute, dyspnea may not be expressed, but sometimes its sign is the child's anxiety, a change in posture in search of the most comfortable. Not infrequently oxygenation is not reduced. The cough is unproductive, the temperature is moderate. The general condition thus usually remains satisfactory.

Physical examination

In acute bronchitis, it is recommended to assess the general condition of the child, the nature of the cough, conduct an examination of the chest (pay attention to the retraction of the intercostal spaces and the jugular fossa on inspiration, the participation of auxiliary muscles in the act of breathing); percussion and auscultation of the lungs, assessment of the state of the upper respiratory tract, counting the respiratory rate and heart rate. In addition, a general routine examination of the child is recommended.

A comment:

In acute bronchitis (viral) - auscultatory in the lungs can be detectedscattered dry and moist rales. There is no bronchial obstruction. Atthere are usually no signs of intoxication.

Bronchitis caused by Mycoplasma pneumoniae. on auscultation of the lungs - an abundancecrepitating and small bubbling rales on both sides, but, unlike the virusleg bronchitis, they are often asymmetrical, with a predominance in one of the lungs. Notseldom bronchial obstruction is defined.

Chlamydial bronchitis caused by C. trachomatis: auscultation in the lungssmall and medium bubbling rales are sewn.

Chlamydial bronchitis due to C. pneumoniae: auscultatory in the lungs whobronchial obstruction can be detected. Can be detected magnifiedlymph nodes and pharyngitis.

Acute bronchitis with bronchial obstruction syndrome: auscultatorywhistling wheezing against the background of an extended exhalation.

Laboratory diagnostics

In typical cases of acute bronchitis in children, routine laboratory research.

A comment:In acute bronchitis, changes in general analysis blood, as a rule, are insignificant, the number of leukocytes<15∙109/л. Diagnostic value for pneumonia is leukocytosis above 15x109/l, increased levels of C-reactive protein (CRP) >30 mg/l and procalcitonin (PCT) >2 ng/ml.

. The routine use of virological and bacteriological studies in acute bronchitis caused by M. pneumoniae is not recommended, because in most cases, the results do not affect the choice of therapy. Specific IgM antibodies appear only by the end of the second week of illness, polymerase chain reaction (PCR) can reveal carriage, and an increase in IgG antibodies indicates a previous infection.