Bronchitis

Description:

Bronchitis – a nonspecific disease of bronchial tubes which is characterized first of all inflammatory reaction in a mucous membrane of bronchial tubes of various caliber.
Bronchitis – one of the most widespread diseases of a respiratory organs. On a current distinguish acute and chronic bronchitis which represents independent diseases.
So wide circulation of bronchitis is connected with distribution of the nonspecific reasons which cause it: work on pulverulent productions, the increased content of toxic substances in air, smoking, frequent cases of flu, etc. True prevalence of bronchitis is unknown as only a part of patients, with a severe disease, is forced to ask for medical care and therefore, are included in the statistical reporting.

Bronchitis reasons:

Acute and chronic bronchitis arise owing to various reasons.
Risk factors of developing of bronchitis include chronic diseases of a respiratory organs with frequent aggravations, primary and secondary immunodeficience, advanced, children's age, active or passive smoking, influence of air pollyutant (dust, chemical agents).
The most often etiological agent at an acute bronchitis are viruses of a parainfluenza, flu, rhinoviruses, adenoviruses, pertussoid and clumsy activators. Quite often during the late period the bacterial flora from which Chlamydia pneumoniae, Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae and other microorganisms meets more often joins. Under the influence of adverse factors saprophytic microflora can be activated and start inflammatory process. Happens that the acute bronchitis develops without primary infection, for example, against the background of inhalation of local irritative, caustic vapors or toxic  agents, influence of hot and cold air. The infection joins for the second time.  
Exogenous factors among which into the forefront smoking acts act as the main reason for chronic bronchitis. Active or passive smoking causes chronic bronchitis of the smoker. More than 700 harmful components which at the same time affect a human body and, in particular, a mucous membrane of bronchial tubes are a part of tobacco smoke. Weight and rates of development of a disease are directly connected with duration of an experience of smoking and quantity of the smoked cigarettes. An important role is played by environmental pollution, increase in content of harmful substances in air. Chronic bronchitis is caused by long influence and irritation of a mucous membrane cement, quartz, coal dust. Communication climatic conditions from incidence is also known – at frigid and crude climate cases of detection of bronchitis are more often.

Pathogeny:

Let's consider a bronchitis pathogeny on the example of an acute disease. At the beginning adhesion ("sticking") of the bacterial or virus activator to the epithelial cells covering mucous a trachea and bronchial tubes is observed. Further development of an inflammation is promoted by disturbance of local mechanisms of protection, such as filtering of the air passing in lungs, its moistening and clarification. The large role at an invasion of the activator is played also by decrease in the general  resistance, failures in immune system, a sensitization of an organism and microcirculator disturbances.
At an invasion of the pathogenic activator the mucous membrane of bronchial tubes answers with a hyperemia and hypostasis, exfoliating of a cylindrical epithelium. Finally mucous or mucopurulent exudate is formed. Implementation of the etiological agent is promoted by decrease in phagocytal activity of neutrophils and alveolar macrophages.
The Mukotsiliarny clearance is broken under the influence of the activator. Reduction in the rate of removal of particles from a gleam of bronchial tubes is observed during the smoking and influence of adverse factors, including production.
Obstruction of a bronchial tree develops at desquamation of a bronchial epithelium, hypostasis of a mucous membrane and hypersecretion of bronchial glands.  Defects of an epithelium of bronchial tubes are recovered for 2 weeks. Closing of damages of a submucosal layer and at pan-bronchitis can take up to 3 months.

Bronchitis symptoms:

The symptomatology at an acute bronchitis and an exacerbation of chronic bronchitis practically does not differ from each other. The main symptom of bronchitis – emergence of cough which diseases has in the beginning dry, unproductive character and in 2-3 days begins to separate a phlegm. The phlegm has mucous character more often, however when joining the infectious agent becomes purulent or mucopurulent. At long cough, it is frequent with an asthmatic component, in a phlegm blood streaks are found. The patient is disturbed by a pharyngalgia, the burning pain behind a breast. At interest of small bronchial tubes there is expiratory asthma, cyanosis of integuments, the phenomena of respiratory insufficiency. The picture of intoxication includes fervescence to febrile figures, weakness, a headache.

Diagnosis:

Except poll of the patient it is necessary to perform inspection and some additional methods of inspection. When determining voice trembling and a percussion sound no changes are found. When listening respiratory noise rigid breath is defined. Depending on a disease stage, dry or wet rattles are observed.
The general blood test finds a moderate leukocytosis and small increase in SOE. Bakissledovany phlegms, using coloring on Gram, allows to define typology of pathogenic microorganisms that is decisive at prescription of antibiotics. For the purpose of an exception tuberculosis at long cough needs a bakissledovaniye using coloring according to Tsilyu-Nielsen.
The research of the function of external respiration (FER) is conducted by means of the spirography that allows to find disturbances of passability of bronchial tubes timely. Record curve "flow volume" is carried out or the pikfloumetriya method is applied. Bronkhoobstruktion is especially characteristic at accession of a bronchiolitis.
At a rentgenobsledovaniye of specific displays of bronchitis does not come to light, however there can be strengthening of the pulmonary drawing. Radiological inspection is surely appointed by the patient with long cough, in case of lack of data on passing of fluorography within the last 2 years.
Bronkhoskopiya uses much less often, and has no great diagnostic value. At a diagnostic bronkhoskopiya it is possible to exclude new growths of bronchial tubes.

Treatment of Bronchitis:

Treatment of chronic bronchitis in the period of an aggravation as also acute, it is generally carried out on an outpatient basis. However there are situations demanding hospitalization of the patient in pulmonary (or therapeutic) department, namely:
1. Increase  of the phenomena of respiratory insufficiency or development acute respiratory insufficiency.
2. Complications in the form of pneumonia or pheumothorax;
3. Development and increase of right ventricular insufficiency, "pulmonary heart";
4. For the purpose of holding diagnostic procedures;
5. Existence of indications for surgical intervention.
The bed rest, strict prohibition of smoking, plentiful drink (especially fruit and vegetable juice), dietary table No. 10 is appointed. Use of mustard plasters, cans or pepper plasters is not recommended for the purpose of self-treatment.
If the course of bronchitis is followed by allocation of a large number of a phlegm, the patient should resupply proteins – in the form of protein-rich food or intravenous infusions of solutions of amino acids. Such solutions as альвезин or polyamine are the most popular.
As a symptomatic treatment apply antiinflammatory (paracetamol, aspirin), expectorating (tablet Bromhexine on 8 mg 34 times a day within 7 days; 3% solution of potassium iodide - on 1 tablespoon to 6 times a day; infusion of a thermopsis is applied in a dose on 1 tablespoon to 8 times a day, etc.), antibechic (libexinum, codeine) and other drugs.
The drugs expectorating and liquefying a phlegm can be used also in the form of inhalation. The best effect gives purpose of solution of hydrosodium carbonate, inhalation of anisic or eucalyptus oil.  Inhalation course duration – up to 5 days. In the absence of specialized inhalers in house conditions it is possible to apply thermal procedures.
The most available way for "house" inhalation – use usual a pan in which it is necessary to heat water with the medicinal substances diluted in it, for example, of 10 drops of tincture of iodine, leaves or oil of an eucalyptus.
Carrying out bronchoalveolar lavage is effective. This procedure assumes washing of respiratory tracts antiseptic, antiinflammatory solutions that allows to reduce considerably inflammatory process and to facilitate otkhozhdeny phlegms. At inefficiency of symptomatic therapy during the first 3-x days, strengthening of weight of a state it is necessary to appoint antibacterial drugs – antibiotics and streptocides. Antibacterial drugs are appointed at a bacterial etiology of bronchitis since they do not affect viruses.
Antibiotics are appointed a course up to 10-14 days. About efficiency of the picked-up scheme of an antibioticotherapia judge by a reduction of inflammatory reaction, improvement of overall health,  acquisition of a phlegm of mucous character, normalization of indicators of blood test. Antibiotics are entered orally (in the form of tablets, capsules, syrup, etc.), parenterally (intravenously, intramusculary), endobronkhialno, endotrakhealno.
The endotracheal and endobronchial way of introduction of antibiotics allows to influence directly in the defeat center.
The research of a phlegm allows to identify the activator and to carry out sensitivity assessment to an antibiotic. It is necessary to consider that the hemophilic stick is insensitive to erythromycin, penicillin, ampicillin. It is known that Str. pneumoniae practically резистентен to penicillin, tetracycline, macroleads. About 80% of strains of a microbe of a maroksella produce V-laktamazu enzyme and therefore even the combined drugs (for example, ampicillin and clavulanic acid) are not always effective in relation to them. In such cases Biseptolum or Bactrimum is shown.
For convenience of the choice of antibacterial therapy there is a classification of patients by groups:
1. Patients with post-viral bronchitis. The viscous phlegm of purulent character is characteristic. In addition to the coughing-up means and phytocollecting antibacterial therapy is appointed: ampicillin, amoxicillin, erythromycin, tetracycline.
2. Patients with chronic bronchitis of the smoker. The recommendations stated above are suitable for patients of this group.
3. In the presence of the accompanying intercurrent diseases, and also at resistant strains of microorganisms V-lactamazostable cephalosporins or ftorfinolona are shown.
4. Carry patients with the created bronchiectasias, pneumonia to this group. Except the drugs recommended to the 3rd group are applied an ampicillin combination with sulbaktamy. Besides, purpose of physiotherapy is reasonable.
At a hlamidiozny, mycoplasmal and legionellezny etiology of bronchitis will be effective суммамед (250 mg a day), drives (300 mg a day), Spheromycinum (9 million ME a day).
Sulfanamide drugs show high chemotherapeutic activity both at gram-negative, and at gram-positive flora. Apply Biseptolum, Sulfatonum and others.
Broad application was found by antiseptic agents, such as a dioxidin, Furacilin.