Causes of bronchitis. Types of bronchitis, symptoms and treatment in adults

In childhood, we were often told by parents: do not drink cold - you will catch a cold, do not walk with caps - earn pneumonia, do not wet your legs - your throat aches. But we did not obey and fell ill. Either from stubbornness, or for the sake of research interest, we checked our body for strength. So, after all, what is bronchitis and what is it?

Acute bronchitis

Bronchitis is an inflammatory disease of the lower respiratory tract, with the symptoms of which most often people around the world go to the hospital. The causes of bronchitis can be very diverse: bacteria, viruses or protozoa.

In this case, lung tissue damage does not occur, and the inflammatory process is localized exclusively in the bronchial tree.

There are the following types of bronchitis :

- acute, when the volume of bronchial secretion increases and reflex cough appears;
- chronic, when at the cellular level there is a change in the mucous membrane, which leads to hypersecretion and the violation of ventilation.

Etiology

As already mentioned above, the causes of bronchitis can be very different. From the bacterial spectrum, the most common pathogens are streptococci, mycoplasmas, chlamydia, anaerobic flora. Viral etiology is represented by influenza, parainfluenza and rhinovirus.

Bronchitis caused by chemical or toxic effects on the body is slightly less common. But in this case, the addition of a secondary infection is inevitable. According to the International Classification of Diseases of the tenth revision, acute bronchitis caused by established pathogens and non-specified acute bronchitis are isolated.

The duration of the disease is distinguished:
- acute (up to three weeks);
- Longevity (more than a month).

Acute bronchitis can occur as with bronchial spasm, and without it. By localization, it is possible to distinguish between tracheobronchitis, when inflammatory changes are concentrated in the upper part of the bronchial tree, and bronchiolitis (the pathological process affects small bronchioles and alveoli). By the nature of the exudate distinguish purulent, catarrhal and necrotic bronchitis.

Pathophysiology

How does bronchitis develop? Symptoms and treatment in adults directly depend on the mechanism of the onset of the disease, since the therapy is directed precisely at the links of the pathological process.

Etiological factors somehow damage the cells of the bronchial mucosa and cause their necrosis. These "gaps" in the protection create conditions for the penetration of the pathogen. If the virus was initially colonized by the epithelium, then within a few days or two any bacterium, as a rule, pneumococcus, will join it.

Inflammatory tissue reactions (swelling, redness, increased local temperature, and impaired function) cause blood flow disturbance in the capillary bed, compression of the nerve endings, and formation of thrombi.

If the dynamics of the process is positive and treatment is scheduled on time, then after the inflammation disappears, the mucosa is restored within a few months. But a small percentage of patients do not. Then the disease passes into a chronic course. If the changes affect only the mucous membrane, then this will not greatly affect a person's life. But the defeat of all layers of the bronchus can cause hemorrhages in the lung tissue, as well as staining the sputum with blood.

Clinic

The causes of obstructive bronchitis, such as bacteria or viruses, cause characteristic clinical manifestations. In the prodromal period there is an increase in body temperature to febrile digits, weakness, drowsiness, loss of appetite, headaches, sweating, palpitations.

Patients describe their sensations as a perspiration or saddening in the throat and behind the sternum, which are amplified by the inhalation of cold air. In addition, they are disturbed by a dry barking cough that does not bring relief. After two or three days, patients get thick sputum from mucus or pus. Cough can be accompanied by pain in the lower part of the chest. This is due to overstrain of the pectoral muscles.

During a general examination, attention is drawn to the excessive moisture of the skin, its redness against the background of cyanotic lips. Muscles with each inspiration are drawn into the intercostal spaces, for respiration, the auxiliary musculature is used.

On average uncomplicated bronchitis lasts about two weeks and ends with complete recovery.

Diagnostics

Causes of bronchitis can be easily identified if properly used diagnostics. After a visual examination, it is necessary to conduct physical research methods, such as palpation, percussion and auscultation. Feeling and tapping in this case will not show anything unusual, but here in the phonendoscope you can hear a hard breathing, accompanied by scattered wheezing. When sputum appears, wheezing becomes wet with large bubbles.

In the general blood test, there will be an increase in the number of leukocytes and an increase in the rate of erythrocyte sedimentation (ESR). In the analysis of urine, as a rule, there is no change, but at the height of the fever, the appearance of a protein is possible. Biochemical analysis of blood allows you to see the appearance of C-reactive protein and increase the alpha-fraction of proteins. In sputum, fibrin, leukocytes, depleted bronchial epithelium and erythrocytes are found. In addition, the laboratory makes sowing the contents of the bronchi for the presence of bacteria and viruses.

On the roentgenogram there will be no specific changes, except that only the enhancement of the pulmonary pattern. Conducting a spirogram will assess the presence and extent of obstruction.

Treatment

The causes of bronchitis determine the choice of therapeutic tactics in each case. Depending on the severity of the pathological process, acute bronchitis can be treated both outpatiently and permanently, under the supervision of doctors around the clock.

Therapy should include an antiviral or antibacterial component, as well as drugs that expand the bronchi. In addition, it is necessary to eliminate the factors that will contribute to the progression of the infection. The course of treatment must necessarily go to the end, regardless of whether the symptoms persist or not.

Currently, doctors actively include in the therapy physiotherapy, massage, gymnastics. This helps the best evacuation of the secretion from the bronchi, and also allows you to change the way you inject drugs into the body.

Chronical bronchitis

The main cause of bronchitis is damage to the epithelium of the mucosa of the lower respiratory tract. Talk about chronic bronchitis can be four weeks after the onset of the disease, subject to the preservation of the clinical picture and pathomorphological changes in the lungs.

This condition is characterized by a diffuse lesion of the bronchi wall, which is associated with a prolonged inflammatory process leading to sclerosis of the tissues. The secretory apparatus of the bronchi undergoes a number of changes and is tuned for increased production of mucus.

Classification

There are several clinical classifications of chronic bronchitis. The following clinical forms of the disease are distinguished:
- simple (or catarrhal);
- purulent non-obstructive;
- a simple form with a violation of ventilation;
- purulent obstructive;
- special, for example, fibrous or hemorrhagic.

By the level of lesions, bronchitis of large and small bronchi is divided. Consider the presence of an asthmatic symptom complex and its severity. By the nature of the course, like other inflammatory diseases, bronchitis is latent, with rare exacerbations, and constantly recurring.

Complications after a chronic bronchitis is:
- emphysema;
- hemoptysis;
- formation of respiratory failure;
- chronic pulmonary heart.

Causes

The chronic course is usually preceded by acute bronchitis. The causes of this process can be concentrated both inside the organism and outside it. First of all, one must take into account the readiness of immunity. If it is too strong or too weak, it can cause prolonged inflammation and tissue damage. In addition, reduced immunity will attract all new colonies of bacteria and viruses, so the disease will occur again and again.

In addition, prolonged, over the years, irritation of bronchial mucosa with too dry and cold air, tobacco smoking, dust, carbon monoxide and other chemicals found in some industries, may adversely affect the course of the disease.

There are reports that some genetic diseases can also contribute to chronic inflammation in the lungs.

Pathogenesis

The causes of bronchitis are directly related to the mechanism of disease formation. First of all, local bronchopulmonary protection decreases, namely: slowing of villi of ciliated epithelium, reduction of surfactant, lysozyme, interferon and immunoglobulin A, various groups of T cells and alveolar macrophages.

Secondly, the pathogenetic triad develops in the bronchi:
- hyperfunction of the bronchial mucous glands (hypercrinia);
- increasing the viscosity of sputum (discrinia);
- stasis of secretion in the bronchi (mucostasis).

And thirdly, the development of sensitization to the pathogen and cross-reacting with the cells of their own organism. These three points ensure the maintenance of inflammation for more than four weeks.

Symptoms

The disease is manifested by a strong cough with separation of sputum to one hundred and fifty milliliters per day, usually in the morning. In moments of exacerbation of inflammatory reactions, there may be temperature rises, sweating, and weakness.

With the progression of respiratory and heart failure, thickening of the phalanges of the fingers ("drumsticks") and thickening of the nail plates ("watch glass") develops. Pain in bronchitis can occur only if the pleural fluid is involved in the inflammatory process, or during an extended attack of cough, the auxiliary musculature is too strained.

Laboratory and instrumental research

Diagnosis "bronchitis" is exposed on the basis of laboratory and instrumental studies. In the general analysis of blood, there is an increase in leukocytes, a shift of the leukocyte formula to the left, an increase in the rate of erythrocyte sedimentation. Biochemically, the amount of sialic acids, seromucoids, alpha and gamma globulins is increased in the blood, a C-reactive protein appears. Sputum is mucous or purulent, it may be with blood streaks. It contains epithelial cells, erythrocytes and neutrophils.

For a morphological confirmation of the diagnosis, bronchoscopy is performed. On the roentgenogram, the enhancement of the pulmonary pattern and its reticular deformation, as well as signs of emphysema, are seen. Spirography helps to orient the doctor about the presence or absence of signs of bronchial obstruction.

Treatment

What to do after the diagnosis of "chronic bronchitis" is established? Symptoms and treatment in adults do not differ much from that in acute forms. Usually, the doctor prescribes several combinations of drugs in the hope of influencing the etiological factor of the inflammatory reaction. If this fails, then it is necessary to stabilize the patient's condition. To do this, use the following groups of drugs:
- antibiotics;
- expectorants;
- bronchodilators;
- antihistamines;
- inhalations and physiotherapy procedures.