Obstructive bronchitis is a diffuse inflammation of the bronchi of small and medium caliber, occurring with a sharp bronchial spasm and progressive impairment of pulmonary ventilation. Obstructive bronchitis is manifested by cough with sputum, expiratory dyspnea, wheezing, and respiratory failure. Diagnosis of obstructive bronchitis is based on auscultatory, radiological data, and the results of a study of the function of external respiration. Therapy of obstructive bronchitis includes the appointment of antispasmodics, bronchodilators, mucolytics, antibiotics, inhaled corticosteroid drugs, breathing exercises, massage.
Bronchitis (simple acute, recurrent, chronic, obstructive) constitutes a large group of inflammatory diseases of the bronchi, different in etiology, mechanisms of occurrence and clinical course. Obstructive bronchitis in pulmonology includes cases of acute and chronic inflammation of the bronchi, occurring with the syndrome of bronchial obstruction, which occurs against the background of mucosal edema, mucus hypersecretion and bronchospasm . Acute obstructive bronchitis often develops in young children, chronic obstructive bronchitis – in adults.
Chronic obstructive bronchitis, along with other diseases occurring with progressive airway obstruction ( emphysema , bronchial asthma ), is usually referred to as chronic obstructive pulmonary disease (COPD). In the UK and USA, the COPD group also includes cystic fibrosis , bronchiolitis obliterans and bronchiectasis .
Acute obstructive bronchitis is etiologically associated with respiratory syncytial viruses , influenza viruses , parainfluenza virus type 3, adenoviruses and rhinoviruses , viral-bacterial associations. When examining the lavage from the bronchi in patients with recurrent obstructive bronchitis, DNA of persistent infectious pathogens is often isolated – herpesvirus , mycoplasma , chlamydia . Acute obstructive bronchitis occurs predominantly in young children. The development of acute obstructive bronchitis is most susceptible to children who often suffer from ARVIhaving a weakened immune system and an increased allergic background, a genetic predisposition.
The main factors contributing to the development of chronic obstructive bronchitis are smoking (passive and active), occupational risks (contact with silicon, cadmium), air pollution (mainly with sulfur dioxide), deficiency of antiproteases (alpha1-antitrypsin), etc. The risk for the development of chronic obstructive bronchitis includes miners, construction workers, metallurgical and agricultural industries, railway workers, office workers associated with printing on laser printers, etc. Men are more likely to develop chronic obstructive bronchitis.
The summation of genetic predisposition and environmental factors leads to the development of an inflammatory process, in which the bronchi of small and medium caliber and peribronchial tissue are involved. This causes a disruption in the movement of cilia of the ciliated epithelium, and then its metaplasia, loss of ciliated cells and an increase in the number of goblet cells. Following the morphological transformation of the mucous membrane, the composition of the bronchial secretion changes with the development of mucostasis and blockade of small bronchi, which leads to a violation of the ventilation-perfusion balance.
In the secretion of the bronchi, the content of nonspecific factors of local immunity decreases, providing antiviral and antimicrobial protection: lactoferin, interferon and lysozyme. A thick and viscous bronchial secretion with reduced bactericidal properties is a good breeding ground for various pathogens (viruses, bacteria, fungi). In the pathogenesis of bronchial obstruction, an essential role belongs to the activation of cholinergic factors of the autonomic nervous system, which cause the development of bronchospastic reactions.
The complex of these mechanisms leads to edema of the bronchial mucosa, hypersecretion of mucus and spasm of smooth muscles, i.e., the development of obstructive bronchitis. If the component of bronchial obstruction is irreversible, one should think about COPD – the addition of emphysema and peribronchial fibrosis.
Symptoms of Acute Obstructive Bronchitis
As a rule, acute obstructive bronchitis develops in children during the first 3 years of life. The disease has an acute onset and proceeds with symptoms of infectious toxicosis and bronchial obstruction.
Infectious and toxic manifestations are characterized by subfebrile body temperature, headache , dyspeptic disorders, and weakness. Respiratory disorders are leading in the clinic for obstructive bronchitis. Children are worried about dry or moist obsessive cough, which does not bring relief and worsens at night, shortness of breath . Attention is drawn to the inflation of the wings of the nose during inhalation, participation in the act of breathing of the auxiliary muscles (muscles of the neck, shoulder girdle, abdominal press), retraction of the compliant sections of the chest during breathing (intercostal spaces, jugular fossa, supra- and subclavian region). For obstructive bronchitis, an elongated wheezing exhalation and dry (“musical”) wheezing, heard from a distance, are typical.
The duration of acute obstructive bronchitis is from 7-10 days to 2-3 weeks. In case of recurrence of episodes of acute obstructive bronchitis three or more times a year, they speak of recurrent obstructive bronchitis; if symptoms persist for two years, chronic obstructive bronchitis is diagnosed.
Chronic obstructive bronchitis symptoms
The basis of the clinical picture of chronic obstructive bronchitis is cough and shortness of breath. When coughing, a small amount of mucous sputum is usually excreted; during periods of exacerbation, the amount of sputum increases, and its character becomes mucopurulent or purulent. The cough is persistent and accompanied by wheezing. Against the background of arterial hypertension , episodes of hemoptysis may occur .
Expiratory dyspnea in chronic obstructive bronchitis usually joins later, but in some cases the disease can debut immediately with shortness of breath. The severity of shortness of breath varies widely: from feelings of lack of air during exertion to severe respiratory failure . The degree of shortness of breath depends on the severity of obstructive bronchitis, the presence of an exacerbation, and concomitant pathology.
An exacerbation of chronic obstructive bronchitis can be provoked by a respiratory infection, exogenous damaging factors, physical exertion, spontaneous pneumothorax , arrhythmia , the use of certain medications, decompensation of diabetes mellitus, and other factors. At the same time, signs of respiratory failure are increasing, subfebrile condition, sweating, fatigue, and myalgia appear.
Objective status in chronic obstructive bronchitis is characterized by prolonged expiration, the participation of additional muscles in breathing, distant wheezing, swelling of the neck veins, and a change in the shape of the nails (“watch glasses”). With an increase in hypoxia, cyanosis appears.
The severity of the course of chronic obstructive bronchitis, according to the methodological recommendations of the Russian society of pulmonologists, is assessed by the FEV1 indicator (forced expiratory volume in 1 sec.).
- Stage I chronic obstructive bronchitis is characterized by a FEV1 value exceeding 50% of the standard value. At this stage, the disease does not significantly affect the quality of life. Patients do not need constant follow-up by a pulmonologist .
- Stage II of chronic obstructive bronchitis is diagnosed with a decrease in FEV1 to 35-49% of the standard value. In this case, the disease significantly affects the quality of life; patients require systematic observation by a pulmonologist.
- Stage III chronic obstructive bronchitis corresponds to an FEV1 indicator of less than 34% of the required value. At the same time, there is a sharp decrease in stress tolerance, inpatient and outpatient treatment is required in the conditions of pulmonary departments and offices.
Complications of chronic obstructive bronchitis are pulmonary emphysema, cor pulmonale , amyloidosis, respiratory failure. For the diagnosis of chronic obstructive bronchitis, other causes of dyspnea and cough must be ruled out, most notably tuberculosis and lung cancer .
The examination program for persons with obstructive bronchitis includes physical, laboratory, radiological, functional, endoscopic examinations. The nature of the physical findings depends on the form and stage of obstructive bronchitis. As the disease progresses, the voice tremor weakens, a boxed percussion sound appears over the lungs, the mobility of the pulmonary edges decreases; auscultation reveals hard breathing, wheezing wheezing during forced exhalation, during exacerbation – wet wheezing. The tone or amount of wheezing changes after coughing.
Radiography of the lungs allows you to exclude local and disseminated lesions of the lungs, to detect concomitant diseases. Usually, after 2-3 years of the course of obstructive bronchitis, an increase in the bronchial pattern, deformation of the roots of the lungs, and emphysema of the lungs are revealed. Therapeutic and diagnostic bronchoscopy for obstructive bronchitis allows you to examine the bronchial mucosa, collect sputum and bronchoalveolar lavage . In order to exclude bronchiectasis, bronchography may be required .
A necessary criterion for the diagnosis of obstructive bronchitis is the study of the function of external respiration. The data of spirometry (including with inhalation tests), peak flowmetry , pneumotachometry are of the greatest importance . Based on the data obtained, the presence, degree and reversibility of bronchial obstruction, impaired pulmonary ventilation, stage of chronic obstructive bronchitis are determined.
The complex of laboratory diagnostics examines general blood and urine tests, blood biochemical parameters (total protein and protein fractions, fibrinogen, sialic acids, bilirubin, aminotransferases, glucose, creatinine, etc.). In immunological tests, the subpopulation functional ability of T-lymphocytes, immunoglobulins, CEC is determined. Determination of CBS and blood gas composition makes it possible to objectively assess the degree of respiratory failure in obstructive bronchitis.
Microscopic and bacteriological examination of sputum and lavage fluid is carried out, and in order to exclude pulmonary tuberculosis – sputum analysis by PCR and CFB. Exacerbation of chronic obstructive bronchitis should be differentiated from bronchiectasis, bronchial asthma, pneumonia, tuberculosis and lung cancer, PE.
Obstructive bronchitis treatment
In acute obstructive bronchitis, rest, drinking plenty of fluids, humidifying the air, alkaline and drug inhalations are prescribed. Etiotropic antiviral therapy is prescribed (interferon, ribavirin, etc.). With severe bronchial obstruction, antispasmodic (papaverine, drotaverine) and mucolytic (acetylcysteine, ambroxol) agents, bronchodilator inhalers (salbutamol, orciprenaline, fenoterol hydrobromide) are used. To facilitate the discharge of sputum, percussion massage of the chest, vibration massage, massage of the back muscles , breathing exercises are performed . Antibiotic therapy is prescribed only when a secondary microbial infection is attached.
The goal of treating chronic obstructive bronchitis is to slow down the progression of the disease, reduce the frequency and duration of exacerbations, and improve the quality of life. The basis of pharmacotherapy for chronic obstructive bronchitis is basic and symptomatic therapy. Smoking cessation is a mandatory requirement.
Basic therapy includes the use of bronchodilators: anticholinergics (ipratropium bromide), b2-agonists (fenoterol, salbutamol), xanthines (theophylline). In the absence of an effect on the treatment of chronic obstructive bronchitis, corticosteroid drugs are used. To improve bronchial patency, mucolytic drugs (ambroxol, acetylcysteine, bromhexine) are used. The drugs can be administered orally, in the form of aerosol inhalation, nebulizer therapy, or parenteral.
When the bacterial component is layered during periods of exacerbation of chronic obstructive bronchitis, macrolides, fluoroquinolones, tetracyclines, b-lactams, cephalosporins are prescribed for a course of 7-14 days. With hypercapnia and hypoxemia, oxygen therapy is a mandatory component of the treatment of obstructive bronchitis .
Prognosis and prevention of obstructive bronchitis
Acute obstructive bronchitis responds well to treatment. In children with an allergic predisposition, obstructive bronchitis can recur, leading to the development of asthmatic bronchitis or bronchial asthma. The transition of obstructive bronchitis to the chronic form is prognostically less favorable.
Adequate therapy helps to delay the progression of obstructive syndrome and respiratory failure. The unfavorable factors aggravating the prognosis are the elderly age of patients, concomitant pathology, frequent exacerbations, continued smoking, poor response to therapy, and the formation of cor pulmonale.
Primary prevention measures for obstructive bronchitis include maintaining a healthy lifestyle, increasing overall resistance to infections, and improving working conditions and the environment. The principles of secondary prevention of obstructive bronchitis involve the prevention and adequate treatment of exacerbations to slow the progression of the disease.