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Causes, symptoms and treatment of chronic bronchitis

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What is chronic bronchitis?

Chronic bronchitis is called a sluggish or progressive inflammation in the bronchi. Talking about it is necessary in cases when the Central symptom of the disease – cough occurs in a patient over a three-month period (total for the year or simultaneously), at least 2 years in a row. All other cases of prolonged cough because of confirmed inflammation in the bronchi include either acute or recurrent bronchitis.

The allocation of these strict time frames for the diagnosis of chronic bronchitis is not accidental. Since, diseases of the bronchial tree are among the most frequent imposed such restrictions. If every case of prolonged cough was perceived as chronic bronchitis, there would not be a single person, who is not registered to this diagnosis. This is especially true among smokers and persons with harmful working conditions in respect of the broncho-pulmonary system. Constant irritation of the bronchial mucosa leads to the maintenance of the inflammatory process.

Another point of relevance for the allocation of a time frame for chronic bronchitis is the pathogenetic mechanisms of the disease. This means that only the inflammatory process that exists for a certain time, can cause structural changes in the bronchi. Result in a violation of bronchial obstruction, the outflow of bronchial secretion, mechanisms of local immunity, which makes it impossible to complete the cure of the disease. Their background aktiviziruyutsya infection. In case of further progression of the inflammation process becomes chronic obstructive pulmonary disease. Short title abbreviation COPD. In such cases, we start talking about clinical manifestations not only in the form of coughing, but the signs of respiratory distress.


Symptoms of chronic bronchitis

Cough

Among the main symptoms of uncomplicated chronic bronchitis. Its characteristics are determined for specific clinical variants of the disease. It can be by both dry and wet. Cough withthe expectoration speaks about lack of mukotiliarnogo clearance and refers to the protective mechanisms of natural purification of the bronchial tree from the excess of mucus. The mechanism of its occurrence is associated with reflex effects, which are caused by irritation of the receptor apparatus of the mucosa of the bronchi and trachea. The pulses are concentrated in the cough center of the brain, which leads to reflex contraction of the respiratory muscles. With small bronchi, the situation is much harder because the receptors they are practically absent. Consequently, the spread of the inflammatory process in this mute zone, with a narrow lumen leads to its rapid and complete obturation. The protective mechanism in the form of cough, did not arise.

If chronic bronchitis is initially accompanied by manifestations of bronchial obstruction as a result of bronchoconstriction, this causes a dry, unproductive cough. Sometimes it becomes paroxysmal, hoarse. It ends this attack with expectoration of a small quantity of mucus. The accompanied by a dry cough remote by wheezing during forced exhalation, indicates the presence of impaired patency of the bronchial tubes.

Shortness of breath

Typical cases of chronic bronchitis without bronchial mast not accompanied by shortness of breath. Arise the inflammatory process must be either a very active and progressive increase, or leaking a long time (tens of years). Such patients can't even clearly mark the time when they got sick. Dry cough with scanty sputum, especially in the morning is their usual norm and not perceived to be a pathology at all. Therefore, the occurrence of dyspnea in the complication of chronic bronchitis respiratory failure patients is marked as the beginning of the disease. The most typical such clinical variant of the appearance of shortness of breath for smokers with a greater Smoking history and individuals with frequent and seasonal exacerbations of cough.

Quite differently, the shortness of breath manifests itself is seen in obstructive forms of chronic bronchitis. In such cases, it occurs almost the very beginning of the disease. In the initial stages of the process it may occur only during physical exertion, accompanied by cough. But quickly enough, observed progression of this symptom, with its appearance with minimal exertion and even at rest.

Sputum

In the initial stages of chronic bronchitis, and in remission a long process may be scarce. In this case, it is represented by the mucous secretions at the end of the coughing spell. Painting it may becolorless transparent to yellow-brown or black (the miners). It all depends on the cause of the disease.

The progression of the disease or its aggravation is marked by the expectoration of Muco-purulent or purulent sputum. She has greenish color and high viscosity. The emergence of such phlegm says about the activation of the microbial flora and requires appropriate medical treatment. The number and time allocation of purulent sputum can be expected to determine the presence of complications of chronic bronchitis. If once in the morning a large amount (about 60-100 ml) of purulent discharge from the respiratory tract along with cough, it indicates the presence of bronchiectasis (saccular extensions of the bronchi, where the accumulated mucus with pus).

More: the color Value of sputum in bronchitis

Wheezing

If the lumen of the bronchus of any caliber is phlegm, this hinders airflow. As a result, there are air turbulence, which is manifested by wheezing. The characteristics of this symptom can be used to roughly determine what the bronchi involved in the inflammatory process and the nature of its flow. For remission of chronic bronchitis the most characteristic dry wheezing, which are determined by auscultation. If the process escalates, increasing the number of sputum and can be auscultated moist rales (coarse, medium or finely), respectively, the diameter of the affected bronchi. About the progression of bronchial obstruction of the bronchi of small caliber says the emergence of high-pitched rale exhalation that can be heard in the distance.

Hemoptysis

Does not apply to the typical manifestations of chronic bronchitis. It can arise only in the long course of this disease and always talks about its progression or serious complications. According to the degree of severity of hemoptysis can be defined with their presence. Of course, if it is a small streaks of blood stained with blood or mud-brown sputum, its appearance at the end of the coughing fit can be considered quite natural. But, when blood is often or in large quantities, you should think about a cancerous transformation of the bronchial mucosa or hemorrhagic bronchitis.

Asthmatic symptoms

Characteristic only for chronic bronchitis with the presence of bronchial obstruction. It may be due to how long a chronic inflammatory process, which results in a narrowing of the bronchus and its rigidity,and bronchospasm. This suggests that the asthmatic symptoms in the form of attacks of shortness of breath and feeling short of breath with difficulty exhaling, may occur at any stage of the disease. It all depends on the reactivity of the bronchi of the patient on the impact of environmental factors (tobacco smoke, indoor dust, changes in temperature). Over time, these coughing spells begin to occur not only in the morning, but at night and during the day.

Cyanosis

Typical cases of uncomplicated chronic bronchitis does not lead to discoloration of the skin. But obstructive forms, accompanied by the accession of respiratory failure almost always causes cyanosis. It can be represented by acrocyanosis – cyanosis of the extremities, tip of nose and ears, or diffuse cyanosis of the skin over the entire surface. His appearance tells about decompensation of the disease and permanent loss of the ability to adequately bronchi conduct air to the lungs. This dramatically reduced blood oxygenation. Such blood is not able to provide normal metabolic processes in the tissues, which causes them to hypoxia. In practice, this is manifested by cyanosis.

Along with the obstruction of air flow suffers and the possibility of removing waste breathing gas. As a result, excess carbon dioxide in the alveolar lumen and blood. Clinically it is manifested by the strengthening of cyanosis, sleep disturbance and insomnia, headaches and dizziness, sweating and weakness. The continued existence of hypoxia leads to additional features in the form of deformation of the nail plate (like hour glasses) and thickening of the distal phalanges of the finger (like drum sticks).

Auscultation data

Refer to the important element of diagnosis of chronic bronchitis. With the transition process in COPD, there is a change not only the bronchi but also the restructuring of the lung tissue. Auscultation, it is like hard breathing, a possible weakening of emphysema, and scattered dry rales of different timbre. The appearance of wheezes wheezing type, mainly in the expiratory phase talks about the defeat of the small bronchi.

Chronic bronchitis with no signs of bronchial obstruction in remission generally does not manifest itself. In the acute phase may appear coarse rales on the background of hard breathing, and in the presence of sputum and moist rales. Their character depends on the caliber of the affected bronchus. In chronic bronchitis under COPD auscultation picture is supplemented by signs of cardiopulmonary insufficiency in the form of accent 2 tone on the pulmonary artery, and hepatomegaly, tension of the neck veins.
id="part3" In the occurrence of chronic inflammation in the bronchi may be involved such reasons:

  1. Infection. They presented the bacterial, viral and atypical pathogens. Very rare only this factor is sufficient for the emergence of a chronic process. Must be combined with other causes, will support the negative influence each other. Crucial in this regard chronic foci of infection in the tonsils, sinuses and caries of the teeth;

  2. Genetic predisposition and innate characteristics of the bronchial tree. A very important group of causes in which the bronchi are initially susceptible to any harmful environmental factors. Minimum provocateurs cause bronchoconstriction and increased mucus production. Difficult its outflow contributes to the revitalization of the infection, keeping inflammation with the possibility of development of bronchial mast;

  3. Tobacco smoke. The main risk for the development of chronic bronchitis are smokers;

  4. Work in conditions of occupational hazards. In such cases, the constant inhalation of air contaminated with coal or other types of dust, leads to its deposition in the bronchi. Natural body's response to foreign particles is an inflammatory. Naturally, in the context of the ongoing revenues of the dust particles self-cleaning mechanisms can't withdraw all of the accumulated sediments. This is the basis of the chronicity of the process;

  5. Chemical pollutant. All chemical compounds that couples who regularly inhaled the person, like dust cause a reaction of the bronchi in the form of inflammation or bronchospasm;

  6. Climatic conditions. Climatic conditions are rarely the primary cause of chronic bronchitis. But they have a General adverse background, which are implemented by all other causes. These include low temperature, high humidity and industrial air pollution;

  7. Decrease in immunity. Getting a favorable backdrop for the launch of a microbial factor as one of the causes of chronic bronchitis.

The trigger chronic inflammatoryprocess in the wall of the bronchus is quite complicated. It is impossible to highlight only one factor that first implements it. The exception is professional and chronic bronchitis smokers.

Chronic bronchitis in children

Chronic bronchitis in children has its own characteristics in relation to the reasons for the development and course of the inflammatory process. In the first place, it is necessary to specify that the rule about the three months of coughing of the year for two consecutive years in pediatric practice does not always work. This means that children up to the age of three, such a diagnosis generally can not be delivered. It is this age group of kids can get sick with bronchitis for most of the year, even hospitalized, but the sound is the diagnosis of recurrent, acute or obstructive bronchitis. But it never becomes chronic.

The explanation for this approach is spontaneous resolution of all inflammatory changes in the bronchi with a child reaches a certain age. Usually, this critical period occurs after three years. Most children with persistent bronchitis rid of this problem forever. Only the part of the sick kids, which this did not happen and the symptoms of bronchitis, continue to remind yourself regular exacerbations, cough with sputum and signs of disturbances of bronchial patency diagnosis of chronic bronchitis becomes eligible. This is logical and from a pathogenetic point of view, as in the bronchi of these children have already registered structural adjustment, in violation of mucociliary clearance and natural purification of the bronchi.

Causes of chronic bronchitis in children

If adults in the etiology of chronic bronchitis the main place is given to Smoking and polluted air, the children are at the forefront of infection. This is due to the imperfection of the mechanisms of immune protection of the child's body on the background of constant contact with various pathogens. In educational and preschool institutions among limited groups of children circulating pathogens characterized by their aggressiveness. Chief among them is respiratory viruses (adenovirus, parainfluenza viruses, RS viruses), Haemophilus influenzae, Moraxella, staphylococci, and streptococci, pneumococci and atypical pathogens.

Embedded in the bronchi of the child, the infection may not always be fully neutralized by immune cells, leading to itsspread to lymph nodes, or persistent introduction in the mucosal epithelium. Therefore, even after clinical improvement to the treatment of bronchitis, any hypothermia General or inhalation of cool air can cause re-aggravation of the process.

The last cause of chronic bronchitis in children is the increased reactivity of the bronchial tree. The outcome is excessive secretion of mucus and bronchial spasms. These causal mechanisms underlie obstructive forms of chronic bronchitis. The cough reflex is also a bit retarded compared to adults, resulting in impaired excretion sputum with a worsening condition.

Clinical features

Among the symptoms of chronic bronchitis in children to the fore not so much the cough, how much violation of the General condition. The younger the child, the more this pattern can be traced. Almost every exacerbation is accompanied by hyperthermic response to a decrease in appetite and activity of child. To follow the nature of the sputum is possible only in older children, as they may be collected for analysis. Kids in the younger age groups can not do this because, simply, stuck .

As adults, the phlegm can be clear mucous or yellow-green mucopurulent. Chronic bronchitis with bronhoobstruktive always causes the child anxiety, shortness of breath, wheezing, which can be auscultated even at a distance (remote wheezing). They can be wet mixed and whistling, dry, vyslushivaesh on the exhale, or in both phases of the respiratory cycle. Emphysema and persistent signs of respiratory distress occur only in children with long course of chronic bronchitis.


Treatment of chronic bronchitis

In the treatment of chronic bronchitis applies etiopathogenetic drug therapy. It is not always possible to completely get rid of this problem, but to stabilize the condition and the maximum deceleration of the progression of the disease is quite real. This can be used:

  1. Antibacterial agents;

  2. Expectorant drugs;

  3. Bronchodilators;

  4. Anti-inflammatory and antihistamines;

  5. Inhalation therapy;

  6. Physiotherapy (halotherapy);

  7. Normalizationlifestyle.

Antibiotic therapy in chronic bronchitis

Is assigned in the case of aggravation of the process, which is accompanied by signs of intoxication, fever or expectoration Muco-purulent sputum in large quantities. Can be assigned to semi-synthetic aminopenicillin, potenzirovania the beta-lactamase inhibitors (Augmentin, Amoxiclav), macrolides (azithromycin, macropen), cephalosporins (Ceftriaxone, cefuroxime), fluoroquinolones (levofloxacin, cipro, Avelox). Antibiotic obligatorily taking into account the results of sputum culture.

List of antibiotics: Antibiotics for bronchitis in adults and children

Expectorant drugs in chronic bronchitis

Assigned in all cases. Use two groups of funds: the shortening of sputum and expectorant. First, contribute to the transformation of viscous sputum in the liquid, the second is to improve mucociliary clearance. The amount obtained facilitating excretion of sputum with cough. Used ACC, Mucosolvan, flamed, bromhexin.

Read more: List expectorants bronchitis

Bronchodilators and anti-inflammatories

This group of drugs helps to improve bronchial patency by widening of the lumen of the respiratory tract. Glucocorticoid anti-inflammatory drugs reduce the amount of mucus secretion and activity of inflammatory cells in the mucosa. There are several types of such funds. They differ in the impact on different ways of bronchodilatation and eliminate obstruction:

  1. Direct relaxation of smooth muscles of bronchial tubes: aminophylline, theophylline, neofelis;

  2. The action on the cholinergic receptor (anticholinergics): ipratropium bromide (atrovent), serotropin bromide (Spiriva);

  3. Agonists of adrenergic receptors: salbutamol (ventolin), fenoterol (berotek);

  4. Reducing inflammation and the secretion of bronchial mucus: fluticasone (flixotide);

  5. Tool combination: flomax, symbicort, seretide.

All of these funds, with the exception of aminophylline and its analogues, produced in the form of individual metered minigastrin. Their convenience is that the patient can carry the drug and use it as needed. The active ingredient, which falls into the area of inflammation at the time of breath fairly quickly relieves the symptoms of the disease.

Inhalation in chronicbronchitis

Along with individual inhalers, there are special ultrasonic devices – nebulizers. These devices are capable of grind of liquid medicines so that they can get into the smallest bronchioles together with the inhaled air. Is the correct and rational use of medicinal basics inhalations in chronic bronchitis, the main method of treatment.

The cost of the nebulizer allows you to buy almost every patient with chronic bronchitis. This has not only medical but also economic feasibility. After all, as a medicinal product used during inhalation can be a tool of any group which is in a liquid state.

Namely:

  1. Dioxidine – antiseptic with wide antibacterial spectrum of action. Used for bacterial exacerbation of chronic bronchitis. For inhalation, the drug is diluted with saline 1:4. A single dose of 4 ml;

  2. Often a local antiseptic drug. The solution is prepared by dilution with saline 1:10. Single dose prepared mixture, about 4 ml;

  3. Alkaline solutions. This can be either the finished product of baking soda (sodium bicarbonate) or cooked at home (one teaspoon of soda in 200 ml of physiological solution);

  4. Atrovent – anticholinergic bronchodilators type of action. Implemented in pharmacies in liquid form. For inhalation, dilute 2 ml of drug in 2 ml of saline. This is a single dose;

  5. Berotek – agonist beta-adrenergic receptors of prolonged action. Inhalation is used for 0.5-1.5 ml of product. Necessarily diluted with saline to 4 ml;

  6. Ventolin – beta-agonist short action type. Available in special nebulah that contain a single dose of the drug. Diluted with saline 1:1;

  7. Flixotide – glucocorticoids inhaled the hormone fluticason. It is available in ready nebulah. For one inhalation need one nebula, the contents of which is diluted with saline to a 3-4 ml;

  8. Acetylcysteine (fluimucil) – a drug, loosening the phlegm. The tool is intended for inhalation, therefore, provides ready-diluted drug mixture. A single dose of 4 ml;

    9. Mucosolvan is a mucolytic and remedy for cough. Available in special vials for inhalation administration. A single dose of the prepared solution of 3-5 ml.

Need drugs just filled in a special receiver nebulizer and inhaled after switching it on. The multiplicity of reception and specific funds must be set and controlled exclusively by the relevant specialist.

Read more: Inhalation bronchitis with nebulizer


How to cure chronic bronchitis forever?

The answer to this question lies in the way of life and characteristics of the air that he breathes. Based on this more ancient people noticed that all respiratory diseases are cured after a stay in deep salt caves. Nowadays the number of this disease increased significantly, but the opportunity to visit these natural caves are almost there. Therefore, scientists were able to recreate these perfect natural microclimate conditions that help the body deal with chronic bronchitis. Noticed a positive effect not only against this disease but many other diseases.

This method of treatment is called halotherapy. Sessions are conducted in a special salt chamber, which creates optimal microclimatic conditions. It is, first and foremost, is a clean air with optimum humidity and temperature indicators, enriched with different aerosol components, which always is a saline component. This method is very simple, requires no manipulation and medications. It is desirable to include it in the treatment of any chronic bronchitis. Mild forms of the disease could be cured forever, but severe greatly facilitate its flow and require lower doses of drugs. It is enough to 2 meals a day 3 to 4-week course of treatment per year. The number of daily sessions is not limited. The main thing that between them were small time intervals.

Conducted, randomized studies have shown that effectiveness of halotherapy for different diseases:

  1. Bronchial asthma, chronic bronchitis (simple and obstructive). Improvement in the study group was 76%;

  2. Chronic sinusitis (maxillary sinusitis, frontal sinusitis, sphenoidal, ethmoidal). The condition of the patients improved on average by 71%;

  3. Skin-allergic diseases. Positive dynamicsmade 89-92%;

  4. Depressive and anxiety syndromes. The improvement noted but 71-72%;

  5. Rheumatic. Dynamics positive by 80%;

  6. Asthenic-vegetative syndrome and fatigue. The result of the improvement of 94%;

  7. Immune dysfunction of various origins. Indicators immunograms were improved in 72% of cases.

Read more: Halotherapy is a modern way to treat bronchitis