Chronic obstructive bronchitis

Description:

The disease which is characterized by a chronic diffusion not allergic inflammation of bronchial tubes, leading to the progressing disturbance of lung ventilation and shown the cough, short wind and expectoration which are not connected with defeat of other bodies and systems.

Cough not less than 3 months in a year, not less than 2 years in a row. At an exception of other diseases at which cough - chronic bronchitis is characteristic.

In Russia, by calculations with use of epidemiological markers, there have to be about 11 million patients with chronic obstructive bronchitis. However in official medical statistics about half a million patients with chronic obstructive bronchitis are registered, i.e. diagnosis in late stages of a disease when the most modern medical programs are not able to slow down steady progressing of a disease is available. It is the main reason for high mortality of patients of a hronicheskma with obstructive pulmonary diseases. In spite of the fact that these approximate figures demand specification, the social and economic importance of this eurysynusic disease does not raise doubts.

Reasons of chronic obstructive bronchitis:

Risk factors:
Smoking - 80-90% of cases of chronic obstructive bronchitis.
Deficit α1-antitrypsin (α1 - AAT) Is the only well studied genetic pathology leading to chronic obstructive bronchitis and chronic obstructive pulmonary diseases now (the alpha 1 antitrypsin comes to light less, than in 1% of cases).
Acute influence of air pollution on the person.
Risk of the professional nature (cadmium, silicon). Professions with the increased risk of development of chronic obstructive bronchitis:
miners;
the construction workers connected with cement;
workers of metallurgical industry (hot processing of metals);
railroad workers;
the workers occupied with processing of grain, cotton and production of paper;
office workers connected with the press on laser printers (laser printers throw out harmful substances and finely divided dust in air, toner powder also contains toxic agents).

Owing to summation of risk factors of the environment and genetic predisposition inflammatory process in which all morphological structures of bronchial tubes of different caliber, intersticial (peribronchial) fabric and alveoluses are involved develops. The inflammation developing on classical canons of a pathophysiology is the main consequence of action of risk factors. But localization of an inflammation and feature of starting factors define specifics of pathological process. Schematically all chain of events, developing at sick HOB, it is possible to divide into primary and secondary mechanisms.

Etiological environmental factors create "an oxidative stress", i.e. promote allocation of a large number of free radicals in pneumatic ways.

Under the influence of risk factors there is a disturbance of the movement of cilia up to a full stop, an epithelium metaplasia to loss of cells of a ciliate epithelium, increase in number of scyphoid cells. The structure of a bronchial secret changes: the phase of sol becomes less, being replaced with a gel phase that breaks the movement much of the thinned cilia. It promotes emergence of the mukostaz causing blockade of small pneumatic ways. The last always leads to disturbance of ventilating and perfused ratios.

Also, in a bronchial secret the maintenance of the nonspecific components of local immunity having antiviral and antimicrobic activity decreases: interferon, lactoferrin and lysozyme.

Dense and viscous bronchial slime with a reduced bactericidal potential – a good medium for various microorganisms (viruses, bacteria, mushrooms). All this complex of mechanisms of an inflammation leads to formation of two main processes characteristic of chronic obstructive bronchitis:
disturbance of bronchial passability;
development of centrolobular emphysema.

Disturbance of bronchial passability at patients with chronic obstructive bronchitis conditionally is divided into two components: reversible and irreversible.

Existence of a reversible component gives identity to chronic obstructive bronchitis and allows to allocate it in a separate nosological form. In the course of progressing of a disease patients with chronic obstructive bronchitis gradually (OFV1 - the volume of the forced exhalation for 1 sec.) lose a reversible component.

The reversible component consists of a spasm of smooth muscles, hypostasis mucous bronchial tubes and the hypersecretion of slime arising under the influence of a big range of pro-inflammatory mediators. Disturbance of bronchial passability at chronic obstructive bronchitis rather resistant, is not subject to daily changes more than for 15%.

Loss of a reversible component of bronchial obstruction it is conditionally considered to be a situation when after a 3-month course of adequate therapy the patient had no improvement of OFV1 (the volume of the forced exhalation for 1 sec.).

Symptoms of chronic obstructive bronchitis:

The clinical picture of chronic obstructive bronchitis depends on a stage of a disease, speed of progressing of a disease and preferential level of defeat of a bronchial tree. Chronic obstructive bronchitis as the main component of chronic obstructive pulmonary diseases develops in the conditions of action of risk factors slowly and progresses gradually. So, in standards of the American thoracic society it is emphasized that emergence of the first clinical symptoms in patients with chronic obstructive bronchitis is usually preceded by smoking, at least, of 20 cigarettes a day for 20 and more years. Speed of progressing and expressiveness of symptoms of chronic obstructive bronchitis depends on intensity of influence of etiological factors and their summation.

The first signs with which patients usually see a doctor is the cough and short wind which sometimes are followed by goose breathing with expectoration. These symptoms are most expressed in the mornings. The earliest symptom appearing by 40–50 years of life is cough. By the same time during cold seasons the episodes of a respiratory infection which are not connected in the beginning in one disease begin to arise. The asthma felt in the beginning at an exercise stress arises on average for 10 years after emergence of cough.

The phlegm is allocated in a small amount (seldom more than 60 ml/days) in the morning, has mucous character and gains purulent character only during infectious episodes which are usually regarded as an aggravation.

In process of progressing of chronic obstructive bronchitis intervals between aggravations become shorter.

Results of a physical research of patients chronic obstructive bronchitis depend on degree of manifestation of bronchial obstruction, weight of a pulmonary hyperinflation and a constitution. In process of progressing of a disease goose breathing, the most notable joins cough at the accelerated exhalation. Quite often at auscultation dry raznotembrovy rattles come to light. An asthma can vary in very wide limits: from feeling of shortage of air at standard exercise stresses to heavy respiratory insufficiency. In process of progressing of bronchial obstruction and increase of a hyperinflation of lungs the perednezadny size of a thorax increases. Mobility of a diaphragm is limited, the auskultativny picture changes: expressiveness of rattles decreases, the exhalation is extended.

Sensitivity of physical methods for definition of severity of a chronic obstructive pulmonary disease is small. Among classical signs it is possible to call the whistling exhalation and the extended exhalation time (> 5 sec.) which can demonstrate bronchial obstruction.

Diagnosis:

Establishment of the diagnosis of chronic obstructive bronchitis is based on identification of the main clinical signs taking into account action of risk factors and an exception of diseases of lungs with similar signs. Most of patients – heavy smokers, in the anamnesis – frequent respiratory diseases, is preferential in cold season.

Physical inspection is not enough for establishment of the diagnosis of a disease, it gives only reference points for the further direction of diagnostic testing using tool and laboratory methods.

Conditionally all diagnostic methods can be divided into methods of the obligatory minimum used at all patients (the general blood test, urine, phlegms, a thorax X-ray analysis, a research of the function of external respiration (FER), an ECG), and the additional methods applied according to special indications.

For daily clinical work with patients with chronic obstructive bronchitis in addition to all-clinical tests the research of function of external respiration (OFV1, the forced vital capacity of lungs or ZhEL), the test with bronchodilators (b2-agonists and cholinolytics), a thorax X-ray analysis is recommended. Other methods of a research are recommended to be applied according to special indications depending on disease severity and the nature of its progressing.

The great value in diagnosis of chronic obstructive bronchitis and objective assessment of severity of a disease has a research of the function of external respiration (FER). Thanks to good reproducibility and simplicity of measurement of volume of the forced exhalation in 1 second (OFV1) is the conventional indicator for assessment of extent of obstruction now. On the basis of this indicator also severity of chronic obstructive bronchitis is defined.
Easy severity – OFV1> 70% of due sizes;
average – 50–69%;
heavy degree – less than 50%.

This gradation is recommended by the European Respiratory Society and taken for the worker in Russia.

In daily practice at patients with chronic obstructive bronchitis tests with bronchodilators (b-agonists and/or cholinolytics) which in a certain measure characterize ability to bystry regression of bronchial obstruction, in other words, a "reversible" component of obstruction are applied.

Increase during the OFV1 test more than for 15% of initial indicators conditionally can be characterized as reversible obstruction.
So, diagnosis of chronic obstructive bronchitis is carried out in the presence:
clinical signs, of which cough and expiratory short wind are main;
risk factors;
disturbances of bronchial passability (decrease in volume  of the forced OFV1 exhalation) at a research of the function of external respiration (FER). An important component of diagnosis is progressing of a disease. An indispensable condition of diagnosis is the exception of other diseases which can lead to emergence of similar symptoms.

Treatment of chronic obstructive bronchitis:

Tactics of recovery treatment at an aggravation:

1. Smoking cessation and restriction of action of external factors of risk. First obligatory step. The patient has to be well informed on the harm done to it by smoking. The specific program on restriction and smoking cessation is formed. In cases of nicotine addiction use of nikotinzameshchayushchy drugs is reasonable. Involvement of psychotherapists, iglorefleksoterapevt is possible.

2. Training of patients. Rather new stage. The patient has to be well informed on essence of a disease and features of its current. He has to be the active, conscious participant of medical process. At this stage the doctor develops individual treatment planning. It is very important that when scheduling treatment the real, feasible purposes taking into account expressiveness of bronchial obstruction, the importance of its reversible component and the nature of progressing of a disease were set. Statement of impracticable tasks causes disappointment in the patient, reduces belief in expediency of implementation of the medical program and, finally, breaks readiness of the patient to follow recommendations of the attending physician. The patient has to be trained in the correct use of medicines, and also the basic rules of self-checking including with use of pikfloumetr. At the same time he has to be able to estimate objectively the condition and if necessary to undertake measures for rendering acute management to. The educational program has to include also data and taking measures to restriction of harmful influence of ecology of the dwelling. Such, for example, as decrease or an exception of use of the house of the cleaners containing chlorine and other harmful components of chemistry.

Now maintenance of purity in our house without chemistry is a reality. For cleaning of the apartment it is possible to use the cleaning wipes made of ultramicrofiber. These napkins have the excellent cleaning properties, are long-lasting in use, allow to reduce use of chemical funds by 85%. Treat cleaning wipes a guillemot terry, a guillemot universal, a guillemot a skrabber, a guillemot for optics. For cleaning of the apartment it is also possible to use mops with special nozzles for dry and wet cleaning made also of ultramicrofiber. For decrease in release of chlorine with tap water it is necessary to use filters. For example: the filter for a shower of Reynshou, Vitalizatora.

3. Bronkhodilatiruyushchy therapy.

As obstruction of bronchial tubes is considered one of the central origins of chronic obstructive bronchitis, and basic therapy is bronkhodilatiruyushchy drugs (cholinolytics, beta two - agonists, methylxanthines).

For a bronkhodilatation the good assistant is Mikrogidrin – the most powerful antioxidant from known now, neutralizes and neutralizes the free radicals which are formed in an organism in the course of its life activity.

Microhydrin is capable to structure water and liquids of an organism. It reduces a water surface tension, doing by it biologically acquired that promotes hydration of cells and fabrics that is important for increase in the general function and health of cells.

Microhydrin is universal and absolutely safe stimulator of development of energy in an organism. At reception of microhydrin in cells there is an active synthesis of ATP – the molecule providing with energy all biochemical processes proceeding in cells.

4. Mukoregulyatorny therapy.

Improvement of mukotsiliarny clearance is substantially reached at purposeful impact on a bronchial secret using mukoregulyatornny drugs (Ambroxol, N-Acetylcysteinum, Bromhexine).
Alternative drugs are:
Set of herbs No. 3 (Combination Three). One dose (1 tablet) contains: mg calcium carbonate 110., vegetable collecting (bark of an elm brown, pleural root, feltwort leaves, grass of a thyme, eriodiktion Californian) 425 mg. (Young bark of an elm – possesses the knitting, krovoochistitelny, anesthetizing and antiinflammatory action. A pleural root – expectorant, spasmolytic, sudorific, anti-inflammatory drug. A thyme – the expectorant, antiseptic, spasmolytic, calming and diuretic action. It contains methyl-isopropyl phenol which possesses antiseptic, disinfecting and bactericidal action. A feltwort – anesthetic, the spasmolytic, mucolytic and knitting action. Eriodiktion Californian – expectorant and antimicrobic means, removes a spasm of smooth muscles of bronchial tubes.)
Root of a glycyrrhiza (Licorice Root). One dose (1 tablet) contains: root of a glycyrrhiza of 490 mg., calcium carbonate of 55 mg., cellulose, maltodextrin, stearic acid, magnesium stearate.

5. Anti-infectious therapy.

In official medicine during aggravations it is accepted to appoint antibiotics, at manifestation of clinical signs of intoxication and purulent elements in a phlegm.
As the alternative can be used:
Bark of an ant tree (Pau D’Arco). One dose (1 capsule) contains: bark of an ant tree of 500 mg, gelatin, water, magnesium stearate. (The ant tree grows in Central and South America. Curative properties of bark of this plant are known throughout the millennia. Still ancient Inca used it as medicine. Antibacterial property of bark of an ant tree is caused lapakholy – the connection allocated from bark extract in 1882. Lapakhol prevents growth and reproduction gram-positive (for example, staphylococcus and streptococci) and gram-negative (for example, brucellas) microorganisms. Antiviral activity of Cora of an ant tree is caused by its immunomodulatory properties. Antifungal properties – are connected with existence in it of a ksilodin who together with lapakholy oppresses growth of fungi in various bodies and fabrics. Antiparasitic action is expressed in its ability to inhibit reproduction and development of intracellular parasites (for example, a malarial plasmodium).
Colloid silver (Silver - Max). One dose contains the purified silver (colloid) in concentration of 10 ppm, the purified water. Has bactericidal, fungicidal and antiparasitic activity. (Colloid silver represents colloidal solution of the midget particles of silver which are in suspension in demineralized water. The quantity of suspended particles of silver in solution is measured in ppm (parts per million, a million share) 1 million share corresponds to 1 milligram of substance on 1 liter of solution. Such concentration effectively influences pathogenic bacteriums and is safe for useful microflora. Colloid silver – one of the most universal antibacterial agents of a broad spectrum of activity. Its action extends to 650 species of bacteria whereas the known antibiotics are active only against 5-10 species of bacteria. Antimicrobic effect of colloid silver is caused by ability of ions of silver to block sulfogidridny groups of fermental systems of microorganisms. Ions of silver are occluded by a cellular cover, breaking processes of division in a cell; getting in a cell, they break process of oxidizing phosphorylation, as a result the cell perishes. Uses of synthetic antibiotics result from modification of bacteria and viruses – causative agents of the diseases steady against influence of the majority of the known antibiotics (L-form). Influences microorganisms so that they do not gain to it stability. Any pathogenic microorganism is not capable to survive at presence even of the minimum concentration of silver, especially in colloidal state. Besides, "Colloid silver" does not destroy the cells of fabrics producing useful enzymes).
Garlic. One dose (1 capsule) contains: oil of garlic of 3 mg., soy oil, gelatin, glycerin, water. Has antibacterial, antiinflammatory, antioxidant and antineoplastic properties, reduces cholesterol level in blood, risk of development of cardiovascular diseases, promotes strengthening of immune system and improvement of an organism in general.

6. Treatment of dysbacteriosis.

During inflammatory processes in an organism disturbance of a quantitative and qualitative ratio of microflora of an organism develops that aggravates process of a disease even more.
Punished the Probiotic - it is синбиотик, representing unique combination of probiotics (Lactobacillus and Bifidobacterium longum) and prebiotics (inulin). Provides complex protection of microflora, having positive effect at dysbacteriosis, intoxication, disturbance of microflora after a course of antibiotics.

7. Organism food.

For the best recovery of an organism there has to be a good nutrition at the cellular level.
Fat of a liver of a shark – strengthening of immune system, bystry recovery after the postponed diseases, stresses.
Activin - Contains: Extract of grape seeds, soy sprouts, vitamin E, uterine milk, red alga of a dunaliyell, muir of a puam, элеутерококк prickly, thistle milk, ginkgo of a bilob, extract of green tea, vitamin C, mix of probiotics (lakto-and bifidobacteria), chelate minerals: zinc, germanium, manganese, molybdenum, chrome, copper, selenium. Increases endurance and acceleration of processes of recovery.
ВитАлоэ – excellent fortifying means at such states as the weakened immunity, recovery of an organism after the postponed diseases, viral, bacterial infections.
Green gold – the natural combined product. Has tonic effect on all systems of an organism, the expressed immunopromoting effect, Antioxidant action.
Calcium меджик is a major macrocell in a human body, necessary for everyone. It is necessary in the rehabilitation period after injuries, operations, diseases.

Tactics during remission:

1. Maintenance of a water balance.

One of the most important tasks for maintenance of health is maintenance of a water balance. It is necessary to drink the pure structured water of 30 ml. on kg. body weights in day.

Punished Main - is mineral composition for cleaning and enrichment of drinking water with easily available vital microelements. "Punished Main" eliminates excess acidity and returns to an organism necessary acid-base equilibrium.

2. Cleaning programs.

In order that the organism could cope adequately with any problems, maintenance acid – alkaline balance (рН) on upper figures of norm is very important. For this purpose it is necessary to pass cleaning programs. It can be simple antiparasitic drugs:
A set of herbs No. 7 – consists of garlic, leaves of black nut and leaves of a cassia.
Leaves of Black nut – antivermicular, antibacterial, antiinflammatory.

Also it makes sense to carry out deeper cleaning programs:
Лакс – Max. – connects and bring slags and toxins out of an organism, recovers useful microflora.
Kolo-WADA Plus – the organism detoxication, antivermicular, antimicrobic action, strengthens an organism and has antioxidant effect.