Bronchitis – a common disease of the lower respiratory tract, characterized by inflammation in the mucous membrane of the bronchi. The symptoms of bronchitis and the tactics of treatment depend on the form of the disease: acute or chronic, as well as the stage of development of the disease. It is necessary to treat bronchitis of any forms and stages timely and fully: the inflammatory process in the bronchi does not only affect the quality of life, but is also dangerous with serious complications, pneumonia, chronic obstructive pulmonary disease, pathologies and impaired cardiovascular function, etc.
- Causes of the disease
- Classification of the disease bronchitis
- Acute bronchitis: symptoms and characteristics
- Acute nonobstructive form
- Acute obstructive form of bronchitis
- Chronic disease
- Different forms of bronchitis: signs and symptoms
- Symptoms in adults
- Acute form in adults
- Symptoms and stages of the chronic form of the disease
- Symptoms in children
- Acute nonobstructive form in children
- Acute obstructive form in children: symptoms and stages of the disease
- Bronchiolitis in children as a type of bronchitis: symptoms and treatment
- Diagnosis of the disease
- Therapies for different forms of the disease
Causes of the disease
Bronchitis in children and adults in the vast majority of cases is the primary disease of infectious etiology. The disease most often develops under the influence of an infectious agent. Among the most common causes of primary bronchitis are the following pathogens:
- viruses: parainfluenza, influenza, adenovirus, rhinovirus, enterovirus, measles;
- bacteria (staphylococci, streptococci, hemophilus bacilli, respiratory forms of mycoplasma, chlamydophilia, whooping cough pathogen);
- fungal (candida, aspergillus).
In 85% of cases, viruses become a provocateur of the infection process. However, often with reduced immunity, the presence of a viral infection, favorable conditions arise for the activation of conditionally pathogenic flora (staphylococci, streptococci present in the body), which leads to the development of an inflammatory process with mixed flora. Identification of the primary and active components of the pathogenic flora is a prerequisite for effective treatment of the disease.
Bronchitis of a fungal etiology is rather rare: with normal immunity, it is practically impossible to activate the fungal flora in the bronchi. Mycotic lesion of the bronchial mucosa is possible with significant disruptions in the immune system: with congenital or acquired immunodeficiencies, after a course of radiation or chemotherapy, while taking cytotoxic drugs oncological patients.
Other factors in the etiology of acute and chronic forms of the disease that provoke the development of the inflammatory process in the lungs include:
- foci of chronic infection in the upper respiratory tract;
- prolonged inhalation of polluted air (dust, bulk materials, smoke, fumes, gases), including tobacco smoking;
- pathology of the structure of organs of the bronchopulmonary system.
Classification of the disease bronchitis
In the classification of the disease there are two main forms: acute and chronic. They differ in their manifestations, signs, symptoms, course of the disease and methods of therapy.
Acute bronchitis: symptoms and characteristics
The acute form occurs suddenly, proceeds rapidly and lasts with the correct therapy on average 7-10 days. After this period, the affected cells of the bronchial walls begin to regenerate, full recovery from inflammation of viral and / or bacterial etiology occurs after 3 weeks.
By the nature of the disease emit mild, moderate and severe degree. Classification is based on:
- severity of respiratory failure;
- blood test, sputum;
- X-ray examination of the bronchial lesion area.
Different types are also distinguished according to the nature of the inflammatory exudate:
- mixed catarrhal-purulent;
Classification is based on sputum analysis: for example, purulent bronchitis is accompanied by the presence of abundant white blood cells and macrophages in the exudate.
The degree of bronchial obstruction determines such types of diseases as acute obstructive and non-obstructive bronchitis. In children under the age of 1, acute obstructive bronchitis occurs in the form of bronchiolitis, accompanied by blockage of both deep and small bronchi.
Acute nonobstructive form
The acute non-obstructive, or simple form is characterized by the development of a catarrhal inflammatory process in the bronchi of large and medium caliber and the absence of bronchial obstruction with inflammatory contents. The most common cause of this form is viral infection and non-infectious agents.
As the disease progresses with appropriate treatment, sputum leaves the bronchi in the process of cough, respiratory failure does not develop.
Acute obstructive form of bronchitis
This form is especially dangerous for preschool children due to narrow airways and a tendency to bronchospasm with a small amount of sputum.
The inflammatory process, usually purulent or catarrhal-purulent, covers the bronchi of medium and small caliber, and their lumen is blocked with exudate. Muscle walls reflexively contracted, causing a spasm. Respiratory failure occurs, leading to oxygen starvation of the body.
In chronic form, signs of the inflammatory process in the walls of the bronchi are observed for three or more months. The main symptom of chronic bronchitis is an unproductive cough, usually in the morning, after sleep. You may also experience shortness of breath, aggravated by physical exertion.
Chronic inflammation that occurs with periods of exacerbation and remission. The most common cause of chronic forms are constantly acting aggressive factors: occupational hazards (smoke, fumes, soot, gases, chemical vapors). The most common provocateur is tobacco smoke with active or passive smoking.
Chronic form is characteristic of the adult population. In children, it can develop only in the presence of immunodeficiencies, abnormalities of the structure of the lower part of the respiratory system, severe chronic diseases.
Different forms of bronchitis: signs and symptoms
Symptomatology varies depending on the form of the disease, and in different age periods.
Symptoms in adults
Formed respiratory system, immunity and longer-term than in children, the impact of negative factors determines the main differences between the manifestations of both acute and chronic forms of the disease in adulthood.
Acute form in adults
Most often (in 85% of cases) occurs as a result of acute respiratory viral infection. It features a rapid onset of the disease, starting with the onset of discomfort in the chest, painful attacks of dry unproductive cough, worse at night, when lying down, causing pain in the pectoral and diaphragmatic muscles.
With bronchitis on the background of acute respiratory viral infections there are common symptoms of a viral disease: intoxication of the body (weakness, headaches, feeling of aches in muscles, joints), hyperthermia, possible layering of catarrhal symptoms (rhinitis, sore throat, tearing, etc.)
Cough with this disease is a protective mechanism that helps the conclusion of inflammatory exudate from the bronchi. With proper treatment, 3-5 days after the onset of the disease, the stage of productive cough with sputum comes, which brings some relief. When breathing in the chest with a stethoscope or without instrumental examination can be heard wet rales.
In acute respiratory viral infections, the stage of productive cough usually coincides with the beginning of recovery from acute respiratory viral infections: manifestations of intoxication of the body are reduced, body temperature is normalized (or kept within subfebrile limits). If there is no such phenomenon for 3-5 days from the onset of the disease, a diagnosis of probable accession of a bacterial infection and / or development of complications is necessary.
The total duration of the cough period is up to 2 weeks, until the bronchial tree is completely cleansed of sputum. About 7-10 days after the end of the cough lasts the period of regeneration of epithelial cells in the walls of the bronchi, after which comes full recovery. The average duration of the acute form of the disease in adults is 2-3 weeks, in healthy people without bad habits, an uncomplicated acute form ends with the restoration of full health of the lower respiratory tract.
Acute obstructive form
Acute obstructive form in adults is much less common than in children, and, due to physiology, is much less dangerous to health and life, although the prognosis is based mainly on the severity of respiratory failure in a patient.
Respiratory failure with obstructive acute form of the disease depends on the degree of bronchial lumen obstruction with inflammatory exudate and the scope of bronchospasm.
Acute obstructive form is typical mainly for people with a diagnosis of bronchial asthma, smokers, the elderly, and chronic forms of lung or heart disease.
The first symptoms are shortness of breath due to oxygen deficiency, including at rest, an unproductive cough with prolonged painful attacks, wheezing in the chest with marked increase in inspiration.
With moderate and severe respiratory failure, the patient tends to half-sitting position, sitting, leaning on the forearm. The auxiliary muscles of the thorax are involved in the process of respiration, visually noticeable expansion of the wings of the nose during inhalation. With significant hypoxia, cyanosis is noted in the area of the nasolabial triangle, darkening of the tissues under the nail plates on the hands and feet. Any effort causes shortness of breath, including the process of speaking.
Relief with proper therapy comes on 5-7 days with the onset of productive cough and removal of sputum from the bronchi. In general, the disease takes longer than the non-obstructive form, the healing process takes up to 4 weeks.
Symptoms and stages of the chronic form of the disease
The chronic stage is diagnosed with a bronchial cough for at least three months, as well as a history of certain risk factors for developing the disease. The most frequent factor is smoking, most often active, but passive inhalation of smoke also often leads to an inflammatory process in the walls of the bronchi.
The chronic form may occur in a blurred form or in the alternation of the acute phase and remission. As a rule, the exacerbation of the disease is observed against the background of a viral or bacterial infection, however, the acute phase in the presence of the chronic form differs from acute bronchitis against the general health of the bronchi by the severity of symptoms, duration, frequent adherence to complications of bacterial etiology.
An exacerbation can also be triggered by a change in climatic conditions, a stay in a cold, humid environment. Without appropriate therapy, the chronic form of the disease is progressing, respiratory failure is increasing, exacerbations are becoming increasingly difficult.
In periods of remission in the early stages of the disease, the patient may experience occasional coughing after a night’s sleep. As the inflammatory process increases, the clinical picture expands, complementing shortness of breath during exertion, increased sweating, fatigue, coughing attacks at night and during rest periods lying.
Late stages of the chronic form cause a change in the shape of the chest, pronounced frequent wet rales in the chest during breathing. Coughing attacks are accompanied by the release of purulent exudate, the integuments acquire an earthy hue, cyanosis of the nasolabial triangle area is noticeable, first after exercise, then at rest. The late stage of the chronic form of bronchitis is difficult to treat; without treatment, it usually turns into chronic obstructive pulmonary disease.
Symptoms in children
Among the main causes of the disease in children, there are not only pathogens, but also allergens. Acute bronchitis can also be a period in which childhood diseases such as measles, whooping cough, rubella can occur.
Risk factors for the development of bronchitis are prematurity and insufficient body weight in newborns, especially when fed with artificial breast milk substitutes, the abnormal structure and pathologies of the bronchopulmonary system, immunodeficiency states, nasal breathing disorders due to nasal septum curvature, chronic diseases accompanied by proliferation of adenoid tissue, chronic foci of infection in the organs of the respiratory system and / or the oral cavity.
The acute form of the disease in preschool children is quite common and makes up 10% of all acute respiratory diseases in this age period, which is due to the anatomical features of the structure of the organs of the respiratory system of a child.
Acute nonobstructive form in children
Acute non-obstructive form in children proceeds in the same way as in adult patients: starting with dry cough and signs of intoxication of the body, the disease passes into the stage of sputum for 3-5 days. The total duration of the disease in the absence of complications is 2-3 weeks.
This form is considered the most favorable prognosis for recovery, but it is more common in schoolchildren and adolescents. Preschool children, due to the nature of the respiratory system, are more likely to develop obstructive bronchitis and bronchiolitis.
Acute obstructive form in children: symptoms and stages of the disease
Acute obstructive bronchitis is diagnosed in children under 3 years of age with a frequency of 1: 4, that is, every fourth child under the age of three years old at least once is ill with this form of the disease. Children are also prone to recurrent episodes of the disease; several obstructive inflammatory processes in the bronchi during the year may indicate a manifestation of bronchial asthma. Frequent recurring episodes of the disease also increase the likelihood of developing a chronic form, bronchiectasis, emphysema.
Acute obstructive form occurs on the background of the defeat of the bronchi of small and medium caliber with the accumulation of inflammatory exudate in the deep parts of the respiratory system, blockage of gaps and the occurrence of bronchospasm. The increased likelihood of developing obstruction is due to the anatomical narrowness of the bronchi and the increased tendency of the muscle tissue to decrease in response to stimuli in the form of sputum, which is characteristic of the children’s age period. Obstructive form in children is manifested primarily by wheezing in the chest, shortness of breath, increased during speaking, physical activity, increased frequency of respiratory movements, difficulty breathing out.
Cough is not a mandatory symptom, it may be absent in infants or weakened children. Respiratory failure leads to symptoms such as cyanosis (blue skin) of the nasolabial triangle, nails on the hands and feet. When breathing, the movement of intercostal spaces, the expansion of the wings of the nose are expressed. Body temperature is usually kept in the subfebrile range, not exceeding 38 ° C. With a concomitant viral infection, catarrhal manifestations may occur: runny nose, sore throat, tearing, etc.
Bronchiolitis in children as a type of bronchitis: symptoms and treatment
Acute bronchiolitis is the most dangerous type of inflammatory lesion of bronchial tissues in childhood. Most often bronchiolitis is diagnosed in children under 3 years of age. The disease is dangerously high in the number of deaths (1% of cases); children of 5-7 months of age, prematurely born, underweight, fed by artificial compounds, and also babies with congenital anomalies of the respiratory organs and the cardiac system are most susceptible to it.
The prevalence of bronchiolitis is 3% in children of the first year of life. The most dangerous is a viral infection: PB-viruses with tropism to the tissue of the mucous membrane of the surface of the small bronchi, provoke a significant part of the bronchiolitis in children.
The following pathogens are also distinguished:
- human herpes virus;
- varicella-zoster virus (chickenpox);
The most common infection occurs in the womb or during childbirth, the disease develops with a decrease in innate immunity, especially in the absence of breast milk feeding.
The disease can be complicated by the addition of a bacterial inflammatory process during the activation of opportunistic microorganisms present in the body (streptococci, staphylococci).
The development of the disease is sudden, rapid. Primary manifestations are limited to symptoms of intoxication (lethargy, drowsiness, moodiness), a slight increase in body temperature, discharge from the nasal passages.
For 2-3 days, wheezing when breathing, shortness of breath join, the child expresses anxiety, turns out to be from food, cannot suck the breast, the nipple, the pacifier. The respiration rate reaches 80 respiratory movements per minute, the pulse is accelerated to 160-180 beats / min. Cyanosis of the nasolabial triangle, blanching or blueness of the skin, especially the fingers, toes, is determined. There is pronounced lethargy, drowsiness, the absence of a revitalization complex, and a reaction when circulating.
Bronchiolitis in infants requires urgent emergency hospitalization.
Diagnosis of the disease
To diagnose the disease, determine its causes, stage of development and the presence of complications, the following research methods are used:
- collection of anamnesis, analysis of patient’s complaints, visual examination, listening to breathing tones using a stethoscope;
- complete blood count;
- general sputum analysis
- X-ray examination to rule out or confirm pneumonia as a complication of bronchitis
- spirographic examination to determine the degree of obstruction and respiratory failure;
- bronchoscopy for suspected anatomical developmental abnormalities, the presence of a foreign body in the bronchi, tumor changes;
- CT scan on indications.
Therapies for different forms of the disease
Depending on the cause of the development of the disease, first of all, it is prescribed drugs acting on the causative agent: antiviral drugs, antibiotics, antifungal agents, etc.
Symptomatic treatment is necessarily used in etiotropic therapy: antipyretic drugs, mucolytic drugs (acetylcysteine, Ambroxol), drugs that suppress the cough reflex, with pronounced painful attacks of cough, bronchodilators.
Both general and local drugs are used (through inhalers, nebulizers, instillation and sprays into nasal passages, etc.).
Methods of physical therapy, gymnastics, massage are attached to drug therapy to facilitate the separation and withdrawal of sputum.
In the therapy of the chronic form, the exclusion of a factor provoking the inflammatory process in the tissues of the bronchi: occupational hazards, environmental conditions, and smoking has a major role. After exclusion of this factor, long-term treatment is carried out with mucolytic, bronchodilator drugs, and general-strengthening medications. You can use oxygen therapy, spa treatment.