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55. Clinical manifestations and diagnosis of chronic bronchitis
Chronic bronchitis is the most common form of chronic nonspecific lung disease.
The onset of the disease is gradual. The first and main symptom is a cough in the morning with sputum discharge, gradually the cough begins to occur at any time of the day, intensifies in cold weather and becomes constant over the years. The amount of sputum increases, the sputum becomes mucopurulent or purulent. Shortness of breath appears. With purulent bronchitis, purulent sputum may occasionally be released, but bronchial obstruction is not very pronounced.
Obstructive chronic bronchitis is manifested by persistent obstructive disorders. Purulent-obstructive bronchitis is characterized by the release of purulent sputum and obstructive ventilation disorders. Frequent exacerbations during periods of cold damp weather: coughing increases, shortness of breath, the amount of sputum increases, malaise appears, fatigue. The body temperature is normal or subfebrile, hard breathing and dry rales over the entire lung surface can be determined.
Diagnostics. A slight leukocytosis with a band shift in the leukocyte formula is possible. With exacerbation of purulent bronchitis, a slight change in the biochemical parameters of inflammation occurs (reactive protein, sialic acids, fibronogen, seromucoid, etc. increase). Sputum examination: macroscopic, cytological, biochemical. With a severe exacerbation, the sputum becomes purulent in nature: a large number of neutrophilic leukocytes, an increased content of acidic mucopolysaccharides and DNA fibers, the nature of the sputum, predominantly neutrophilic leukocytes, an increase in the level of acidic mucopolysaccharides and DNA fibers, which increase the viscosity of the sputum, a decrease in the amount of lysozyme, etc.
Bronchoscopy, which evaluates the endobronchial manifestations of the inflammatory process, the stages of development of the inflammatory process: catarrhal, purulent, atrophic, hypertrophic, hemorrhagic and its severity, but mainly to the level of subsegmental bronchi.
Differential diagnosis is carried out with chronic pneumonia, bronchial asthma, tuberculosis. Unlike chronic pneumonia, chronic bronchitis always develops with a gradual onset, with widespread bronchial obstruction and often emphysema, respiratory failure and pulmonary hypertension with the development of chronic cor pulmonale. In x-ray examination, the changes are also diffuse in nature: peribronchial sclerosis, increased transparency of the lung fields due to emphysema, expansion of the branches of the pulmonary artery. Chronic bronchitis differs from bronchial asthma in the absence of asthma attacks, with pulmonary tuberculosis it is associated with the presence or absence of symptoms of tuberculosis intoxication, Mycobacterium tuberculosis in sputum, the results of X-ray and bronchoscopic examination, tuberculin tests.
Author: Pavlova N.V.
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