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

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

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30. Treatment of chronic bronchitis (CB)

Treatment. It includes a set of measures that differ during the period of exacerbation and remission of the disease. During the exacerbation of chronic bronchitis, two directions of treatment are distinguished: etiotropic and pathogenetic.

Etiotropic treatment is aimed at eliminating the inflammatory process in the bronchi: therapy with antibiotics, sulfanilamide drugs, antiseptics, phytoncides, etc. is indicated. Treatment is started with antibiotics of the penicillin series (penicillin, ampicillin) or a group of cephalosporins (cefamesin, tseporin), and in the absence of effect, antibiotics of the group are used reserve (gentamicin, etc.). The most preferred route of administration is intratracheal (aerosol or fill with a laryngeal syringe through a bronchoscope).

Pathogenetic treatment is aimed at improving pulmonary ventilation; restoration of bronchial patency; control of pulmonary hypertension and right ventricular failure.

The restoration of pulmonary ventilation, in addition to the elimination of the inflammatory process in the bronchi, is facilitated by oxygen therapy and exercise therapy.

The main thing in the treatment of chronic bronchitis - the restoration of bronchial patency - is achieved by improving their drainage and eliminating bronchospasm.

To improve bronchial drainage, expectorants are prescribed (hot alkaline drink, decoctions of herbs, mukaltin, etc.), mucolytic drugs (acetylcysteine, bromhexine; with purulent viscous secretion - aerosols of proteolytic enzymes - chymopsin, trypsin); therapeutic bronchoscopy is used. To eliminate bronchospasm, eufillin is used (intravenously, in suppositories, tablets), ephedrine, atropine; single appointments in an aerosol of sympathomimetic drugs are possible: fenoterol, orciprenaline sulfate (asthmopenta) and a new domestic drug "Soventol", anticholinergic drugs: atrovent, troventol. Effective preparations of prolonged aminophylline (teopec, teodur, theobelong, etc.) - 2 times a day.

In the absence of the effect of such therapy, small doses of corticosteroids are administered orally (10-15 mg of prednisolone per day) or intratracheally (hydrocortisone suspension - 50 mg).

As an additional therapy, appoint:

1) antitussive drugs: with an unproductive cough - libexin, tusuprex, bromhexine, with a hacking cough - codeine, dionin, stoptussin;

2) drugs that increase the body's resistance: vitamins A, C, group B, biogenic stimulants.

Currently, in the treatment of chronic bronchitis, immunocorrective drugs are increasingly being used: T-activin or thymalin (100 mg subcutaneously for 3 days); inside - catergen, sodium nucleinate or pentoxyl (within 2 weeks), levamisole (decaris).

Physiotherapy treatment: prescribe diathermy, calcium chloride electrophoresis, quartz on the chest area, chest massage and breathing exercises.

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