Acute tracheobronchitis is an acute respiratory disease occurring with inflammatory lesions of the mucous membrane of the trachea and bronchi. Acute tracheobronchitis is characterized by a strong cough (at first unproductive, then with the release of mucopurulent sputum), sore chest pain, subfebrile condition, general weakness. Diagnosis includes physical examination, chest x-ray, and CBC and sputum tests. Treatment of acute tracheobronchitis is carried out with the help of pharmacotherapy (expectorants, antitussives), thermal procedures (mustard plasters, cans), alkaline inhalations.
Acute tracheobronchitis is an infectious and inflammatory process that captures the lower respiratory tract (trachea and bronchial tree) and resolves within three weeks. 5% of the adult population carries the disease every year; the peak of visits to a doctor falls on the autumn-winter period – the time of epidemic outbreaks of ARVI . Acute tracheobronchitis is often combined with lesions of the upper respiratory tract: rhinitis , pharyngitis , laryngitis . In pulmonologydistinguish between acute (up to 3 weeks), protracted (up to 1 month) and chronic (up to 3 or more months) tracheobronchitis. The course of acute tracheobronchitis can be uncomplicated and complicated – the latter option is more common in immunocompromised individuals (with HIV status , receiving chemotherapy ), patients with COPD , heart failure .
Causes of acute tracheobronchitis
Up to 90% of all cases of acute tracheobronchitis are due to seasonal respiratory viral infection. The defeat of the lower respiratory tract is most often initiated by influenza viruses , adenoviruses , coronaviruses, enteroviruses , rhinoviruses , metapneumoviruses; in children – RS virus and parainfluenza virus type III. Most respiratory viruses damage the epithelium of the lower respiratory tract, activate inflammatory mediators and impair the function of the mucociliary apparatus of the bronchi.
Less than 10% of cases of acute tracheobronchitis, according to epidemiological studies, are associated with Chlamydophila pneumoniae and Mycoplasma pneumoniae. It has been shown that the bacteria whooping cough and parapertussis (B. pertussis and B. parapertussis) can cause acute tracheobronchitis in immunized adults. In patients undergoing tracheostomy or endotracheal intubation, bacterial inflammation of the trachea and bronchi caused by nosocomial infection (S. pneumoniae, H. influenzae, St. aureus, Moraxella catarrhalis) is possible.
In some cases, acute tracheobronchitis can be allergic or toxic-chemical in nature. Non-infectious factors of inflammation can be atmospheric pollutants, tobacco smoke, heavy metals, dust, animal hair, etc. Chronic diseases, post-infectious asthenia , hypovitaminosis , hypothermia , stressful situations contribute to increased susceptibility to causally significant agents ; in children – exudative diathesis , hypotrophy , rickets , poor care.
Symptoms of acute tracheobronchitis
Usually acute tracheobronchitis is preceded by signs of acute respiratory infections: general malaise, fever, body aches, headache, rhinitis, pharyngitis. Unpleasant sensations in the nasopharynx quickly descend, covering the trachea and large bronchi.
The leading symptom of acute tracheobronchitis is a strong, paroxysmal cough , especially pronounced at night. At first, the cough is dry , unproductive, with sore throat and chest pain. A deep breath causes pain, provokes another paroxysm of cough, as a result of which breathing becomes shallow, rapid. In young children, coughing fits may be accompanied by vomiting, cyanosis of the nasolabial triangle, and agitation.
A few days later the stage of “dry” catarrhal inflammation is replaced by “wet” inflammation. A productive cough appears with the release of mucous membranes (sometimes mucopurulent sputum). As the sputum discharge becomes easier, the cough ceases to deliver painful sensations, and the general condition improves. Under normal conditions (sufficient immunoreactivity of the body, timely and adequate treatment), acute tracheobronchitis resolves within one to two weeks.
During periods of seasonal flu epidemics, a special form of the disease occurs – acute hemorrhagic tracheobronchitis, which has a severe, sometimes fatal course. This form of tracheobronchitis is often complicated by hemorrhagic pneumonia , laryngeal edema with the threat of asphyxia .
Diagnostics of the acute tracheobronchitis
Therapeutic and diagnostic measures for acute tracheobronchitis are usually carried out on an outpatient basis by a pediatrician , therapist or pulmonologist. With a pronounced allergic component, a consultation with an allergist-immunologist is indicated. Hospitalization is subject to persons with a severe course of acute tracheobronchitis (for example, hemorrhagic form), as well as with a burdened general somatic background.
During auscultatory examination, hard breathing with dry (hereinafter – wet medium and fine bubbling) wheezing is heard. Radiography of the lungs is important mainly to exclude acute pneumonia . As part of the exclusion of a bacterial infection, sputum (general analysis, bacteriological culture) and peripheral blood ( CBC , CRP , procalcitonin) are examined. To confirm or deny the allergic nature of acute tracheobronchitis, allergic skin tests are performed.
Differential diagnosis of acute tracheobronchitis is carried out with a wide range of diseases: laryngitis, bronchial asthma, COPD , pulmonary aspergillosis , respiratory mycoplasmosis , eosinophilic bronchitis, tumors of the trachea and bronchi , pneumonia , tuberculosis , whooping cough, foreign bodies of the respiratory tract.
Treatment of acute tracheobronchitis
Effective therapy of acute tracheobronchitis involves a combination of non-drug and drug treatment methods. The first of them include: elimination of factors that irritate the respiratory tract, sufficient humidification of the air in the room, warm alkaline drink, in the absence of elevated temperature – thermal procedures (banks, mustard plasters, foot baths ). Alkaline inhalations have a good anti-inflammatory and expectorant effect .
Drug therapy for acute tracheobronchitis consists of antiviral therapy, taking immunomodulators, antihistamines, mucolytic and expectorant drugs (ambroxol, ACC, mucaltin). With a strong cough, a short-term prescription of antitussive drugs (prenoxdiazine, butamirate) is indicated. Antibiotic therapy can be justified only in the case of a high risk of developing severe complications against the background of comorbid conditions .
Preventive measures include seasonal influenza vaccination , increasing the level of the body’s defenses, avoiding hypothermia and contact with patients with acute respiratory infections. In most cases, acute tracheobronchitis ends with complete recovery without consequences. Complicated forms and chronicity of inflammation are found in persons with a burdened premorbid background.