Hospital therapy. Etiology and pathogenesis of chronic bronchitis (CB) (most important)

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Hospital therapy. Etiology and pathogenesis of chronic bronchitis (CB) (most important)

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26. Etiology and pathogenesis of chronic bronchitis (CB)

Chronic obstructive bronchitis is a diffuse non-allergic inflammatory lesion of the bronchial tree, caused by prolonged irritating effects on the bronchi of various agents, which has a progressive course and is characterized by obstructive pulmonary ventilation, mucus formation and the draining function of the bronchial tree, which is manifested by cough, sputum and shortness of breath.

Chronic bronchitis is divided into primary and secondary.

Primary chronic bronchitis is an independent disease that is not associated with other bronchopulmonary processes or damage to other organs and systems, in which there is a diffuse lesion of the bronchial tree.

Secondary HB develops against the background of other diseases - both pulmonary and extrapulmonary.

Etiology. In the development of CB play a role as exogenous factors.

Obstructive syndrome develops due to a combination of a number of factors:

1) spasm of smooth muscles of the bronchi as a result of irritating effects of exogenous factors and inflammatory changes in the mucous membrane;

2) hypersecretion of mucus, changes in its rheological properties, leading to disruption of mucociliary transport and blockage of the bronchi with a viscous secret;

3) epithelium metaplasia from cylindrical to stratified squamous and its hyperplasia;

4) violations of the production of surfactant;

5) inflammatory edema and mucosal infiltration;

6) collapse of small bronchi and obliteration of bronchioles;

7) allergic changes in the mucous membrane. Various ratios of changes in the mucous membrane cause the formation of a certain clinical form:

1) with catarrhal non-obstructive bronchitis, superficial changes in the structural and functional properties of the mucous membrane prevail;

2) with mucopurulent (purulent) bronchitis, the processes of infectious inflammation predominate. However, a situation is also possible when long-term catarrhal bronchitis due to the addition of an infection can become mucopurulent, etc. In the non-obstructive variant of all clinical forms of chronic bronchitis, ventilation disorders are slightly pronounced;

3) obstructive disorders initially appear only against the background of an exacerbation of the disease and are caused by inflammatory changes in the bronchi, hyper- and dyskrinia, bronchospasm (reversible components of obstruction), but then they persist constantly, while the obstructive syndrome grows slowly.

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