Internal illnesses. Chronic bronchitis (most important)

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Internal illnesses. Chronic bronchitis (most important)

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28. CHRONIC BRONCHITIS

A diffuse inflammatory-degenerative process in the bronchial mucosa and peribronchial tissue, manifested by a constant or periodic cough with sputum for at least 3 months a year for 2 years or more.

Etiology. Causative factors: smoking, infection (viral or bacterial), toxic exposure, occupational hazards, deficiency of β-1-antitrypsin, household air pollution.

Pathogenesis. Hyperplasia of goblet cells of the bronchial glands occurs, hypersecretion of mucus in the bronchi and changes in its properties, inflammatory edema and infiltration of the bronchial mucosa, disruption of bronchial patency and drainage function of the bronchi, imbalance between proteinase inhibitors (a-1-antitrypsin) and proteinases (neutrophil elastase).

Clinic. With simple chronic bronchitis, cough, malaise, weakness, increased fatigue are noted, auscultatory: hard breathing, sometimes weakened. With mucopurulent chronic bronchitis, moist, sonorous fine bubbling rales may occur.

In chronic obstructive bronchitis, there is an increase in cough, sputum, shortness of breath, diffuse cyanosis (lips, earlobes, acrocyanosis), rare deep breathing, barrel-shaped chest. Percussion displacement of the borders of the lungs down, their immobility, boxed sound. Auscultatory - uniform weakened breathing with prolonged expiration, scattered dry buzzing rales, disappearing after coughing.

Diagnostic study. A general blood test is performed (leukocytosis, increased ESR in simple and mucopurulent bronchitis during exacerbations, hematocrit in obstructive bronchitis in men more than 52%, in women more than 47%). Immunological blood test (decreased activity of nonspecific and humoral components of the immune response, increased activity of the cellular component in obstructive bronchitis), sputum examination (macro- and microstudy - cytology, flora). The functional state of the lungs is examined (determination of volume and velocity indicators) - peak fluometry, spirography, and pneumotachometry are used. Computed tomography (morphological changes in the lungs, their location, size), ECG (exclusion of cardiac origin of symptoms, determination of hypertrophy of the right heart.

Complications. Focal pneumonia, emphysema, respiratory failure, chronic cor pulmonale, secondary erythrocytosis, bronchiectasis.

Treatment. In the acute phase, antibacterial therapy (in the presence of purulent sputum), M-anticholinergics, b2-agonists, methylxanthines, mucolytics, antihistamines, oxygen therapy, therapeutic bronchoscopy, physiotherapeutic procedures, physical therapy, treatment of complications.

In the remission phase, bronchodilators (if indicated), mucolytics (used for symptoms of mucostasis), physiotherapy, spa treatment.

Flow. Recurrent, chronic, progressive.

Prevention. The following: timely treatment of acute bronchitis and respiratory diseases, early detection and treatment of the initial stages of chronic bronchitis, hardening of the body.

Author: Myshkina A.K.

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