Tracheobronchitis is a diffuse inflammatory process that covers the lower airways – the trachea and bronchi. The duration and features of the course of tracheobronchitis are closely related to its form; symptoms usually include cough (dry or productive), chest rawness and pain, temperature reaction, malaise, wheezing, shortness of breath. Verification of the diagnosis is facilitated by the assessment of auscultatory data, the results of X-ray of the lungs, tracheobronchoscopy, sputum examination, and allergy diagnostics. In the treatment of tracheobronchitis, pharmacotherapy (expectorant, mucolytic, antiviral, antihistamines) and non-drug methods (inhalation, FTL, massage) are used.
Tracheobronchitis is an acute or chronic inflammation of the mucous membrane of the tracheobronchial tree, initiated by infection, allergens and other agents. Taking into account the reasons, tracheobronchitis of infectious (viral, bacterial, viral-bacterial) origin is distinguished; allergic genesis; due to chemical and physical factors and mixed. Acute tracheobronchitis is usually viral in nature. The peak incidence of tracheobronchitis occurs in the off-season and is closely associated with acute respiratory viral infections . Often, inflammation passes to the trachea and bronchi from the upper respiratory tract. The course of allergic tracheobronchitis can be recurrent or chronic. Chronic tracheobronchitis in most cases is associated with the constant presence in the body or external influence of a causative factor.
Acute tracheobronchitis, as a rule, becomes a continuation of MS infection , adenovirus infection , influenza and parainfluenza, measles . Less commonly, the disease develops against the background of whooping cough , parapertussis , respiratory mycoplasma or chlamydial infection. One of the causes of purulent tracheobronchitis can be prolonged artificial ventilation of the lungs…. The so-called “intubation” tracheobronchitis develops in 35-40% of patients. Such a high frequency of pathology is due to a violation of the evacuation of secretions from the trachea and bronchi, often – aspiration of gastric contents and blood into the respiratory tract. This is a triggering factor for the multiplication of bacterial flora and the development of the inflammatory process.
Heavy smokers most often become “victims” of chronic tracheobronchitis; persons who are for a long time in dusty, gas and smoky conditions, air pollution by chemical agents. In addition, patients who neglect treatment or self-medicate acute tracheobronchitis are susceptible to chronicity of the process . The incidence of chronic tracheobronchitis is higher in people suffering from chronic infections of the nasopharynx ( caries , tonsillitis , sinusitis). Allergic tracheobronchitis is closely related to respiratory allergy that occurs in contact with a variety of agents (dust, pollen, animal hair, mold, perfume, etc.). The toxic-chemical form of tracheobronchitis can be caused by damage to the respiratory tract by military or industrial poisonous gases, drugs (for example, iodide or potassium bromide).
The following factors favor the emergence of any form of tracheobronchitis: hypothermia , nervous and physical fatigue, weakening of immunity, unfavorable climatic conditions (cold, dry or humid air), smoking, hypovitaminosis . Under such conditions, the conditionally pathogenic microflora of the mucous membranes of the upper respiratory tract can be activated and acquire pathogenic properties.
Pathological changes in tracheobronchitis affect the mucous membrane of the trachea, large and medium bronchi. Small bronchi usually remain intact, which explains the absence of attacks of bronchial obstruction even with an allergic form of tracheobronchitis. In acute inflammation, the walls of the tracheobronchial tree are diffusely hyperemic; in allergic and chronic cases, they have a pale pink tint. The mucous membrane is edematous, loosened, and hypersecretion of mucus is noted. With the predominance of bacterial inflammation in the lumen of the bronchi, a purulent secretion is present. In chronic tracheobronchitis, the mucous membrane of the respiratory tract undergoes atrophic or hypertrophic changes.
Symptoms of tracheobronchitis
The clinical criterion for a particular pathogenetic form of tracheobronchitis is the duration of the persistence of pathological symptoms: signs of acute inflammation are stopped within three weeks (on average, 10-14 days), a protracted process lasts up to one month, chronic – persists for three or more months. The disease proceeds with moderately pronounced respiratory and general intoxication phenomena.
Usually it is a complication of an acute respiratory infection, therefore it begins with the phenomena of rhinopharyngitis : nasal congestion, rhinorrhea, sore throat , dryness in the nasopharynx, pain when swallowing, hoarseness. As the infection spreads to the lower respiratory tract, sore and painful sensations in the chest, an abrupt dry and painful cough join . Breathing becomes hard, dry wheezing is heard on auscultation. After 2-3 days, the character of the cough changes to moist and productive; mucous or mucopurulent sputum begins to separate… Body temperature is often subfebrile, it lasts for several days. General health is characterized by a feeling of weakness and decreased performance. Recovery in typical cases occurs within 8-10 days, residual cough can persist for up to 3 weeks.
A moderate course of acute tracheobronchitis may be accompanied by shortness of breath, tension and soreness of the abdominal muscles and diaphragm due to severe cough, remitting fever. In children of the first three years of life, acute tracheobronchitis proceeds with increased pulse and respiration, vomiting at the height of coughing attacks, cyanosis of the lips and face, and convulsions. Complications of acute tracheobronchitis may include the development of a chronic form of the disease, pneumonia , obstructive bronchitis .
It proceeds with alternating periods of remission and exacerbations. Without exacerbation, the symptoms are erased: there may be periodic coughing, shortness of breath when performing physical work. Most patients with chronic tracheobronchitis note moderate but persistent chest pain.
The acute phase is characterized by the appearance of cough, wheezing, shortness of breath at rest or during normal exertion, subfebrile condition, sweating, weakness. The cough can be of varying intensity and character, accompanied by the release of a small or abundant amount of sputum, which has a different color and consistency (more often serous-purulent or purulent). The outcomes of chronic tracheobronchitis are often COPD , pulmonary emphysema .
Separate etiological forms
In allergic tracheobronchitis, respiratory symptoms are exacerbated by direct contact with the allergen. Cough comes to the fore, mostly dry or with insignificant mucous discharge. It is usually combined with other allergic manifestations: itchy skin, nasal congestion, rhinitis , lacrimation. Body temperature usually remains normal. There are no attacks of suffocation. An increased level of eosinophils is found in the blood. Allergic tracheobronchitis is often accompanied by atopic dermatitis , hay fever and other allergies.
Intubation tracheobronchitis in more than half of cases develops 2-3 days after extubation. Patients note the sensation of a foreign body of the trachea , chest pain. Particularly disturbing are attacks of hacking cough, which end in moderate amounts of viscous sputum of yellow-green color. Body temperature can be increased to subfebrile values and higher. Intoxication syndrome is more pronounced than with other forms of tracheobronchitis. In general, the clinical picture resembles the clinic of purulent bronchitis .
When diagnosing tracheobronchitis, anamnesis data (connection of the disease with acute respiratory viral infections, allergies, bronchial irritants), clinical and auscultatory picture, and the results of objective studies are taken into account. The patient is sent for a consultation with a pulmonologist and an allergist.
In acute tracheobronchitis, radiography of the lungs is not very informative, however, the chronic course of the disease leaves its mark on the pulmonary pattern, often deforming it. In addition, the presence of infiltrative changes in the lungs is excluded by X-ray. The most informative study confirming the inflammatory process in the lower respiratory tract is tracheobronchoscopy. Endoscopic imaging may reveal edema and hyperemia of the mucous membrane, fibrinous overlays, purulent secretions, ulceration of the mucous membrane.
Microscopic examination of sputum (with determination of VC and atypical cells) makes it possible to exclude diseases such as tuberculosis , lung cancer , bronchial asthma , etc. To determine the bacterial pathogen, sputum bacterial culture is performed. Allergic genesis of tracheobronchitis is confirmed by the results of allergic skin tests.
Treatment of tracheobronchitis
Treatment of uncomplicated forms is carried out at home; severe and complicated cases – in the department of pulmonology. In the early days, when a painful dry cough worries, antitussives (prenoxdiazine, codeine, butamirate) are prescribed. Stimulation of sputum discharge is facilitated by alkaline inhalations , mucolytic and expectorant drugs (ambroxol, mukaltin, thermopsis), herbal medicine. Warming compresses, banks, mustard plasters, rubbing with warming ointments help to restore the drainage function of the bronchi.
With tracheobronchitis of an allergic nature, antihistamines are prescribed; antiviral drugs can be effective for viral disease. For bacterial complications, antibiotics are used: local and systemic (penicillins, cephalosporins, fluoroquinalones). Taking immunomodulators and vitamins is necessary to increase the overall resistance of the body.
Of the physiotherapeutic procedures, UFO therapy , chest electrophoresis , laser therapy , UHF , percussion and vibration massage , halotherapy, and breathing exercises are usually used . In severe forms of tracheobronchitis, oxygen therapy may be required .
The leading method for the prevention of acute tracheobronchitis is timely and rational therapy of acute respiratory viral infections, avoiding contact with patients with viral infections. Reduces the risk of tracheobronchitis morbidity, smoking cessation, elimination of industrial hazards, sanitation of chronic foci in the nasopharynx. In allergic alertness, avoiding contact with the allergen is of paramount importance.