Purulent bronchitis is an inflammation of the bronchial tree, which occurs with the formation and release of purulent secretions. The etiology of purulent bronchitis is always associated with a layer of bacterial infection. With purulent bronchitis, patients are worried about a wet cough with thick yellow-green sputum, subfebrile condition, sweating, shortness of breath. The diagnosis is established according to the data of x-ray of the lungs, bronchoscopy, examination of bronchial lavage water and sputum. Treatment of purulent bronchitis includes courses of antimicrobial therapy, intake of mucolytic and expectorant drugs, sanitation bronchoscopy, exercise therapy and breathing exercises, physiotherapy.
Purulent bronchitis is a clinical type of acute or chronic bronchitis, characterized by coughing up purulent sputum. Depending on the type of inflammatory process in pulmonology, catarrhal and purulent bronchitis are distinguished, as well as rare variants of inflammation (hemorrhagic and fibrinous bronchitis). In this case, purulent bronchitis can act as a primary, independent disease, and secondary, arising against the background of concomitant inflammatory pathology of the respiratory tract (bronchiectasis, respiratory tuberculosis, chronic pneumonia, etc.). In view of the latter circumstance, it is not possible to judge the true prevalence of purulent bronchitis.
In the development of purulent bronchitis, a combination of non-infectious and infectious, exogenous and endogenous factors is important. Among non-infectious exogenous influences, first of all, there are household and industrial pollutants, air pollution, inhalation of tobacco smoke during active and passive smoking, climatic and weather conditions (overheating, hypothermia). The listed factors have an irritating and damaging effect on the mucous membrane of the bronchi, thereby opening the way for the penetration of microbial flora. Recurrent acute respiratory infections (influenza, parainfluenza, rhinovirus and respiratory syncytial infection) contribute to the disturbance of local reactivity. Endogenous causes predisposing to the development of purulent bronchitis include old age, alcohol abuse, obesity, hypovitaminosis,
At the same time, the leading role in the occurrence of purulent bronchitis is played by a bacterial infection, mainly pneumococcus, Pseudomonas aeruginosa and Haemophilus influenzae. Foci of infection in the nasopharynx (sinusitis, chronic tonsillitis), COPD (bronchiectasis, chronic abscess, smoker’s bronchitis, chronic pneumonia) and specific processes (pulmonary tuberculosis) can support the course of the purulent-inflammatory process in the bronchi. Purulent bronchitis can develop as a result of improper treatment of acute bronchitis (with inadequate selection of antibiotics and microflora insensitivity to them), but more often this clinical form occurs in chronic bronchitis .
Prolonged irritation of the bronchial tree by mechanical, physical or chemical agents or the adhesion of viral pathogens to the epithelial cells of the bronchi cause a violation of the secretory function and self-purification (mucociliary clearance) of the latter. Due to the hyperfunction of secretory cells, the nature of bronchial secretion changes; there is hypercrinia (an increase in mucus formation) and discrimination (a change in its viscosity and composition). Such metamorphoses contribute to a decrease in the protective properties of bronchial secretions, delay and multiplication of bacterial flora in the bronchi. With microbial inflammation, the cellular composition of the contents of the bronchial tree undergoes changes – the number of neutrophilic leukocytes increases in it; the sputum becomes purulent, viscous and difficult to cough up.
Symptoms of purulent bronchitis
The first episode of acute purulent bronchitis or exacerbation of a chronic process is usually promoted by a cold, cold, allergic reaction, stress, activation of a chronic focus of infection, etc. Since bronchial infection is, as a rule, descending in nature, the appearance of symptoms of purulent bronchitis is often preceded by pharyngitis. rhinitis, tracheitis.
In the clinical picture of purulent bronchitis, intoxication syndrome, cough and shortness of breath play a leading role . In the acute period, subfebrile condition, weakness, sweating appear. Disturbed by a wet cough with the release of thick yellow or greenish sputum , sometimes with an unpleasant odor. In chronic bronchitis, purulent sputum can be released constantly or sporadically (during periods of exacerbation of the inflammatory process); in the acute phase, its amount can reach 250 ml per day. When performing physical activities, a patient with purulent bronchitis has shortness of breath, fatigue. In the anamnesis of some patients there are indications of hemoptysis, which is explained by the increased vulnerability of the bronchial mucosa.
With a protracted course of a purulent process due to the accumulation of secretions, hyperplastic and fibrous changes in the walls of the bronchi, bronchial obstruction can develop – purulent bronchitis becomes obstructive . In this case, shortness of breath becomes more pronounced, cough – harsh and less productive, breathing – wheezing. The addition of an obstructive component makes the course of purulent bronchitis worse, contributes to the formation of emphysema of the lungs and cor pulmonale .
Diagnosis of purulent bronchitis is based on an assessment of the history, symptoms (mainly the nature of sputum), physical and instrumental data. Often, patients clearly associate purulent inflammation in the bronchi with a previous episode of acute respiratory viral infections or indicate a history of chronic bronchitis. Listening to wet rales is characteristic, which may disappear after productive coughing up of sputum.
Indicators of a general blood test change towards moderate leukocytosis, shift of leukocyte leukoformula to the left, acceleration of ESR. A biochemical study in the blood serum reveals hyper-α1- and α2-globulinemia, increased CRP, seromucoid, haptoglobin and sialic acids.
X-ray data of the lungs in the diagnosis of purulent bronchitis are not indicative. On radiographs, an increase in the pattern and expansion of the roots of the lungs, signs of emphysema and peribronchial pneumosclerosis can be determined. Much more importance is attached to the results of bronchoscopy . During the endoscopic examination of the bronchi, signs of purulent endobronchitis are revealed: hyperemia and swelling of the mucous membrane, an abundance of purulent contents in the bronchi (after aspiration, the purulent secretion fills the lumen of the bronchi again).
Bronchoscopy is necessarily complemented by the collection of bronchial secretions for subsequent microscopic, cytological and bacteriological examination. This is especially valuable when patients (especially children), for whatever reason, are unable to donate sputum for analysis on their own. Instrumental and laboratory studies can distinguish purulent bronchitis from secondary bronchitis with EBB, tuberculosis, endobronchial cancer, pneumonia.
Purulent bronchitis treatment
In the acute period, it is necessary to observe bed rest, exclude smoking and other irritating factors of the bronchi. Hospitalization is advisable for severe intoxication and respiratory failure, especially in elderly patients.
The main method of therapy for purulent bronchitis is empiric antibiotic therapy with drugs of the aminopenicillin group (ampicillin, amoxicillin), combined drugs of amoxicillin with clavulanic acid and ampicillin with sulbactam, macrolides (azithromycin, clarithromycin), cephaloquinophilicin generations … These drugs are active against the most common pathogens of purulent bronchitis (S. Pneumoniae, H. influenzae, M. catarrhalis) and the ability to create a high concentration of the active substance in bronchial secretions.
In order to increase the hydration of sputum and improve its evacuation from the bronchial tree, mucolytics and expectorants (acetylcysteine, ambroxol, bromhexine, etc.), medicinal inhalations are prescribed. The speedy elimination of the purulent process in the bronchi is facilitated by sanitation bronchoscopy with bronchoalveolar lavage , local administration of antimicrobial and secretolytic drugs.
Pathogenetic treatment is combined with the use of biostimulants and multivitamins, exercise therapy and respiratory gymnastics. After the acute manifestations of purulent bronchitis subsided, chest massage, physical methods of therapy (inductothermy, microwave therapy, electrophoresis) are added. In severe forms of purulent bronchitis, extracorporeal hemocorrection (ultraviolet irradiation of blood, hemosorption, plasmapheresis) may be required .
Forecast and prevention
The prognosis for purulent bronchitis for life is relatively favorable; the ability to work is lost only during periods of exacerbation. Nevertheless, the prolonged course of purulent bronchitis significantly reduces the quality of life, can lead to repeated pneumonia, the development of DN, pulmonary emphysema, pulmonary hypertension.
Primary prevention measures for purulent bronchitis include a ban on smoking, improving working conditions, reducing dust and gas pollution of the environment, seasonal influenza vaccination , treatment of nasopharyngeal infections, etc. Secondary prevention is aimed at preventing exacerbations of chronic bronchitis under the supervision of a specialist pulmonologist.