Hospital therapy. Clinical picture of chronic bronchitis (CB) (the most important)

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Hospital therapy. Clinical picture of chronic bronchitis (CB) (the most important)

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27. Clinical picture of chronic bronchitis (CB)

clinical picture. The main symptoms of HB are cough, sputum production, shortness of breath. With an exacerbation of the disease or due to hypoxia with the development of pulmonary insufficiency and other complications, general symptoms (sweating, weakness, fever, fatigue, etc.) are revealed. Cough is the most typical manifestation of the disease. According to its nature and consistency of sputum, one can assume a variant of the course of the disease. With a non-obstructive variant of catarrhal bronchitis, the cough is accompanied by the release of a small amount of mucous watery sputum (more often in the morning, after exercise or due to increased breathing). At the beginning of the disease, cough does not bother the patient; the appearance of a paroxysmal cough indicates the development of bronchial obstruction. The cough acquires a barking shade and is paroxysmal in nature with a pronounced expiratory collapse of the trachea and large bronchi.

With purulent and mucopurulent bronchitis, patients are more concerned about coughing up sputum. In the event of an exacerbation of the disease, sputum acquires a purulent character, its amount increases, sometimes sputum is excreted with difficulty (due to bronchial obstruction during exacerbation).

In the obstructive variant of bronchitis, the cough is unproductive and hacking, accompanied by shortness of breath, with a small amount of sputum.

Shortness of breath occurs in all patients with chronic bronchitis at various times. The appearance of shortness of breath in "long-term coughing" patients initially with significant physical exertion indicates the addition of bronchial obstruction. As the disease progresses, shortness of breath becomes more pronounced and constant, i.e., respiratory (pulmonary) insufficiency develops.

In the non-obstructive variant, CB progresses slowly, shortness of breath usually appears 20-30 years after the onset of the disease. Such patients almost never fix the onset of the disease, but only indicate the appearance of complications or frequent exacerbations.

There is a history of hypersensitivity to cold, and most patients report long-term smoking. In a number of patients, the disease is associated with occupational hazards at work.

When analyzing a cough history, it is necessary to make sure that the patient has no other pathology of the bronchopulmonary apparatus (tuberculosis, tumors, bronchiectasis, pneumoconiosis, systemic diseases of the connective tissue, etc.), accompanied by the same symptoms.

Sometimes a history indicates hemoptysis due to mild vulnerability of the bronchial mucosa. Recurrent hemoptysis indicates a hemorrhagic form of bronchitis. In addition, hemoptysis in chronic, long-term bronchitis may be the first symptom of lung cancer or bronchiectasis.

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