Federal state educational institution of higher education «Bashkir State medical University Ministry of Health of the Russian Federation» Department of Internal medicine Acute and chronic bronchitis Lecture for students Specialty – General medicine Associate Professor A.V. Tyurin Acute bronchitis - a disease manifested by acute inflammation of the mucous membrane of the tracheobronchial tree. Acute bronchitis is one of the most common respiratory diseases (34.5%). Etiology etiological factors of acute bronchitis : • infectious(viruses,bacteria) • physical (excessively dry, hot or cold air) • chemicals (acids,alkali, etc.) • allergic (organic dust, plant pollen) Predisposing factors: - climatic factors - tobacco smoking - alcoholism - congestive changes in the lungs in heart failure Clinical picture of acute bronchitis. Patients complain about: - dry, irritating cough -feelings of soreness or chest pain - if the smaller bronchi are damaged, symptoms of airway obstruction appear (paroxysmal cough, shortness of breath). -on the 2nd - 3rd day, a small amount (up to 50 ml per day) of mucous or mucopurulent sputum sometimes with an mixture of blood. -most patients have pain in the lower chest associated with cough and convulsive contraction of the diaphragm - general weakness, malaise - - back and limb pain - Sometimes sweating - the temperature is normal or subfebrile in severe cases, the temperature rises to 37.5-38 ° C. -With percussion over the lungs a clear pulmonary sound is determined. -On auscultation in the first days of the disease, hard breathing, dry whistling or buzzing rales are determined. - after 2-3 days, wet rales of various sizes may join, which disappear after an energetic cough. Flow acute bronchitis usually mild with gradual subsidence and complete cessation of coughing. The duration of clinical manifestations is most often 7-14 days, followed by recovery. Complications of acute bronchitis • Bronchopneumonia • Transition to a chronic form. Treatment of acute bronchitis. Treatment is most often done on an outpatient basis. The exception is patients With severe intoxication and serious concomitant (pulmonary, cardiovascular) pathology. Treatment is mainly symptomatic: 1. Antipyretic, painkillers funds: - analgin - acetylsalicylicacid - paracetamol 0.5 g - 3 times a day, etc.) 2.Vitamines, especially C 0.1 g 3 times a day and A 3 mg 3 times a day. 3. It is recommended to drink plenty of warm liquids (tea with lemon or raspberry jam). The condition of patients is also facilitated by mustard plasters or pepper plaster on the sternum and steam inhalations. 4. With damage to the nasopharynx apply aerosol forms. These drugs have an antiseptic, anti-inflammatory and local anesthetic effect. 5. In order to relieve a painful dry cough, prescribe antitussives funds: - libexin 0.1 g - 3-4 times a dayday - drugs containing codeine (codeterpine). 6. If a viral infection acts as an etiological factor,application possible antiviral drugs: rimantadine (infirst 24-78 hours of illnessinfluenza) - interferon or umifenovir, ergoferon, viferon etc. 7. In the absence of the effect of symptomatic therapy, the appearance of purulent sputum is prescribed antibacterial preparations taking into account the microbial spectrum. 1.aminopenicillins: -amoxicillin 0.5 g 3 times a day - 7-10 days 2.macrolides: -erythromycin -azithromycin(sumamed 0.5) g 1 time per day -3 days -ruled 150 mg - 2 times a day 3. Oral cephalosporins III generations 5. When obstructive bronchitis: -sympathomimetics (salbutamol,berotek) - Anticholinergics (atrovent) - theophyllines (eufillin, theopak) These patients also have indications for the use expectorants (mucoregulators): -ambroxol -acetylcestein Chronical bronchitis - a chronic inflammatory disease of the bronchi, accompanied by a persistent cough with sputum for at least 3 months a year for 2 or more years, while these symptoms are not associated with any other diseases. Chronic bronchitis is a widespread disease and occurs in 16% of the adult population. Etiology play an important role in the development of chronic bronchitis pollants: 1.tobacco smoke 2. pollutants of an industrial nature Climatic factors can also cause a provoking effect. The development and exacerbation of chronic bronchitis is facilitated by a damp and cold climate. Exacerbations usually occur in autumn, winter, early spring. The infectious factor plays a secondary role in the development of chronic bronchitis. Factors predisposing to the development of chronic bronchitis: • Chronic tonsillitis • rhinitis • WithInusit • carious teeth • Violation nasal breathing (polyposisnose, etc.) • alcohol abuse Classification of chronicbronchitis 1. The nature of the inflammatory process in the bronchi: - simple (catarrhal) bronchitis - purulent bronchitis - mucopurulent bronchitis - hemorrhagic bronchitis - fibrinous bronchitis with the separation of very viscous sputum, rich in fibrin) 2. By functional characteristic: - non-obstructive - obstructive (COPD) 3.According tothe level of damage to the bronchial tree: -with priority damage to the large bronchi (proximal bronchitis) - with a primary lesion of small bronchi (distal bronchitis). four. 4. With the flow: - latent -with rare exacerbations -with frequent exacerbations - continuously recurrent. 5.By process phase: - exacerbation - remission Clinical picture of chronic bronchitis. - The main complaints are cough with phlegm (for nonobstructive bronchitis) -Shortness of breath with decreased exercise tolerance (with chronic obstructive bronchitis). - Smokers have a slight cough, dry or with mucus sputum, mainly in the morning - "smoker's cough". -Gradually, the cough becomes more pronounced, worse in cold and damp weather, after hypothermia, and is accompanied by periodic release of mucopurulent or purulent sputum. - When damage to the small bronchi develops dyspnea (at first, shortness of breath bothers during physical exertion, then it becomes constant). -cyanosis -paroxysmal unproductive cough, which increases with the transition from a warm room to a cold one. Percussion: percussion sound in uncomplicated cases is not changed, with bronchial obstruction it has a tympanic tinge. Emphysema is evidenced by a boxed sound, low standing of the diaphragm, restriction of respiratory excursion of the lungs. On auscultation breathing can be both increased and weakened. Uniform weakening of breathing indicates emphysema. Chronic bronchitis is characterized by hard breathing and dry scattered wheezing. When a wet secret appears in the bronchi, moist rales are often heard, the caliber of which depends on the level of damage to the bronchial tree. Chronic simple bronchitis is characterized: - dry cough or sputum up to 20 ml per day - shortness of breathoccurs only with significant physical load - Violations ventilation during functional studies is not detected. Chronic purulent bronchitis is different from simple: - mild shortness of breath without obvious signs of bronchial obstruction. - persistent cough during an exacerbation, with the release of mucopurulent sputum up to 100 ml per day - shortness of breath occurs during normal physical activity - The general condition of the patient worsens slightly. There is no cyanosis. Chronic obstructive bronchitis is characterized by: - shortness of breath on exertion - increased dyspnea under the influence of irritants - hacking unproductive cough with sputum difficult to separate - prolongation of the expiratory phase - high-pitched dry rales in the expiratory phase Prevention of chronic bronchitis. The basis of primary preventionis the prevention of factors contributing to the development of the disease. It is possible to significantly reduce the incidence of chronic bronchitis by solving environmental problems, reducing the impact of harmful dust and gases at work. Of great importance is the fight against smoking, a thorough examination of persons employed, associated with occupational hazards and periodic preventive examination of workers. Secondary prevention primarily includes early diagnosis of the disease. The effectiveness of clinical examination is the higher, the more early forms of the disease are taken to the dispensary. In all cases, rational employment of patients, careful treatment of inflammatory diseases of the nasopharynx, prevention of viral respiratory diseases, training of patients in measures that improve bronchial drainage and increase the body's resistance are necessary. Depending on the course and complications obstructive bronchitis carry out continuous basic therapy bronchodilators means.
