Hospital pediatrics. Treatment of chronic bronchitis (most important)

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Hospital pediatrics. Treatment of chronic bronchitis (most important)

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56. Treatment of chronic bronchitis

Treatment. In the phase of exacerbation of chronic bronchitis, therapy is aimed at eliminating the inflammatory process, improving bronchial patency, as well as restoring impaired general and local immunological reactivity. Anti-biotibacterial therapy is prescribed, which is selected taking into account the sensitivity of the sputum microflora, administered orally or parenterally, and sometimes combined with intratracheal administration. Inhalations are indicated. Use expectorants, mucolytic and bronchospasmolytic drugs, and drink plenty of fluids to restore and improve bronchial patency.

Herbal medicine using marshmallow root, mother and stepmother leaves, plantain. Proteolytic enzymes (trypsin, chymotrypsin) are prescribed, which reduce the viscosity of sputum, but are currently rarely used. Acetylcysteine has the ability to break disulfide bonds of mucus proteins and promotes strong and rapid liquefaction of sputum. Bronchial drainage is improved with the use of mucoregulators that affect secretions and the production of glycoproteins in the bronchial epithelium (bromhexine). In case of insufficient bronchial drainage and existing symptoms of bronchial obstruction, bronchospasmolytics are added to treatment: aminophylline, anticholinergic blockers (atropine in aerosols), adrenergic stimulants (ephedrine, salbutamol, Berotec). In a hospital setting, intratracheal lavage for purulent bronchitis must be combined with sanitation bronchoscopy (3-4 sanitation bronchoscopy with a break of 3-7 days). When restoring the drainage function of the bronchi, physical therapy, chest massage, and physiotherapy are also used. When allergic syndromes develop, calcium chloride and antihistamines are used; if there is no effect, a short course of glucocorticoids can be prescribed to relieve allergic syndrome, but the daily dose should not be more than 30 mg. The danger of activation of infectious agents does not allow long-term use of glucocorticoids. In patients with chronic bronchitis, complicated respiratory failure and chronic cor pulmonale, the use of veroshpiron (up to 150-200 mg/day) is indicated.

The food of patients should be high-calorie and fortified. Use ascorbic acid 1 g per day, nicotinic acid, B vitamins; if necessary, aloe, methyluracil. With the development of complications of a disease such as pulmonary and pulmonary-heart failure, oxygen therapy and auxiliary artificial ventilation are used.

Anti-relapse and maintenance therapy is prescribed in the subsiding phase of exacerbation, carried out in local and climatic sanatoriums, this therapy is prescribed during medical examination.

It is recommended to allocate 3 groups of dispensary patients.

1st group. It includes patients with cor pulmonale, severe respiratory failure and other complications, and loss of ability to work.

2nd group. It includes patients with frequent exacerbations of chronic bronchitis, as well as moderate dysfunction of the respiratory system.

3rd group. It includes patients in whom anti-relapse therapy led to a subsidence of the process and the absence of relapses for 2 years.

Author: Pavlova N.V.

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