Obstructive bronchitis is a lung disease associated with obstruction. When applied to the bronchi they say bronchial obstruction. The name comes from the Latin obstructio, which means “obstacle”. In medicine, there are synonyms for translation - blockage or obstruction.

During the development of obstructive bronchitis, when the patency of the bronchial tree is impaired, respiratory failure occurs. It is characteristic that along with inflammation, damage to the bronchial mucosa occurs. The tissues swell, narrowing the lumen of the bronchi by almost half, and the walls of the bronchi spasm. All these manifestations significantly complicate ventilation of the lungs and sputum discharge.

In the structure of general morbidity, respiratory diseases remain unchanged leaders by prevalence. The leading place among them belongs to diseases of the respiratory tract, which include bronchitis.

Attention. Bronchitis is often a manifestation of acute respiratory viral infection (ARVI). These are acute conditions that can be treated. Sometimes the disease becomes protracted and chronic. Chronic obstructive bronchitis leads to severe consequences, including permanent disability.

For reference. is an inflammatory disease of an infectious or non-infectious nature that diffusely affects the bronchial tree. Obstructive bronchitis is one of the types of this pathology.

There are several forms of bronchitis:

• Simple bronchitis is a common manifestation of ARVI. Cough during a cold most often occurs due to simple bronchitis.
• Bronchiolitis is an inflammation of the smallest branches of the bronchi - bronchioles. This is an intermediate stage between bronchitis and pneumonia and often occurs in children.
• Obstructive bronchitis is an inflammation of the bronchial tree, which is accompanied by obstruction.

Obstruction is a decrease or disappearance of the lumen of the bronchi, as a result of which the breathing process becomes difficult. When the lumen of the bronchial tree is blocked, it is difficult for the patient to exhale, therefore one of the manifestations of obstructive inflammation of the bronchi is expiratory shortness of breath.

Obstructive bronchitis is usually divided into acute and chronic. An acute process is said to occur when the symptoms of the disease last no more than three weeks and recur three times a year. This pathology is more common in children and less common in adults. The transition of the disease to a chronic form indicates the irreversibility of the process.

Acute obstructive bronchitis occurs when there is increased secretion of mucus, swelling of the bronchial mucosa and bronchospasm. All these processes are reversible, therefore such a pathological process passes without a trace. Chronic obstructive bronchitis occurs when the structure of the bronchial wall changes, it becomes less elastic and turns the distensible bronchi into narrow tubes.

Attention. Currently, there is no such diagnosis as chronic obstructive bronchitis in ICD 10. It was replaced by the term chronic obstructive pulmonary disease (COPD) - a collective concept that combines several nosologies.

This is due to the common pathogenesis and clinical manifestations of all the diseases included here. COPD includes not only chronic bronchitis, but also other pathologies of the respiratory system, as well as a number of heart and vascular diseases that lead to shortness of breath.

Etiology of obstructive inflammation

Acute bronchitis, as a rule, has a viral etiology. He is called:

• respiratory syncytial viruses,
• parainfluenza,
• adenoviruses,
• some types of enteroviruses.

For reference. Sometimes a bacterial flora joins the viral flora, then they talk about purulent obstructive bronchitis.

This pathology is extremely rare in adults. The fact is that the bronchial tree of adults is quite wide. Inflammatory changes in it are not enough to lead to obstruction. In children, the bronchi are small and narrow, so closure of the lumen occurs quickly.

The exact etiological nature of chronic obstructive bronchitis is unknown. There are a number of risk factors that can lead to the occurrence of this disease. Among them, smoking occupies a leading place.

Attention. In the vast majority of cases, COPD in people under 40 years of age occurs precisely because of smoking. In addition, passive smoking in children is a separate risk factor. People who inhale cigarette smoke as children are more likely to develop chronic obstructive bronchitis as adults.

In addition to smoking, occupational hazards occupy an important place among the risk factors. First of all, increased dustiness of the workplace. COPD is often found in miners, metallurgists and construction workers. Dust containing large amounts of silicon is especially dangerous.

Residents of large cities are more susceptible to chronic obstructive bronchitis, which is associated with a polluted environment and high dust levels in the air.

For reference. Irreversible pulmonary obstruction may be the outcome of bronchial asthma. A distinctive feature of the latter is the reversibility of bronchospasm. When bronchial asthma is uncontrolled, obstruction becomes irreversible and COPD develops.

At the moment, there is an assumption about another predisposing factor - hereditary. The fact that predisposition to chronic bronchitis is transmitted genetically is evidenced by the frequent occurrence of the disease in close relatives.

Pathogenesis of the disease

Bronchial obstruction can be a reversible or irreversible process. The first is characteristic of acute obstructive bronchitis.
In a chronic course, the ability to reverse the development of the process is lost, and the obstruction becomes permanent.

The pathogenesis of reversible obstruction is:

• Inflammatory swelling of the mucous membrane of the bronchial tree. The etiological factor damages the mucous membrane, causing an inflammatory reaction in it. One of the components of this reaction is pronounced swelling of the mucous membrane, which reduces the lumen of the bronchi.
• Hypersecretion. Epithelial cells of the bronchial mucosa always secrete small amounts of substances that moisturize the surface and prevent hazardous substances from entering the lungs. When the mucosa is damaged, the secretory activity of cells increases. In addition, the permeability of bronchial vessels increases, which leads to exudation of fluid into the lumen of the bronchial tree.
• Hyper-reactivity. Due to the inflammatory process, a large number of mediators act on the bronchi, which lead to spasm of the bronchial tree and narrowing of its lumen.

The pathogenetic links of irreversible obstruction are as follows:

• Epithelial metaplasia. Normally, the bronchial mucosa is covered with cylindrical ciliated epithelium, which is capable of producing mucus and clearing the bronchial tree of particles that enter it. With prolonged exposure to risk factors, the epithelium becomes flat. It is not able to protect the bronchi, as a result of which a cascade of further changes is triggered.
• Changes in the connective tissue part of the bronchial wall. Normally, the bronchi contain a large number of elastic fibers that can stretch and return to their original position during breathing. In chronic bronchitis, these fibers are replaced by collagen fibers, which are not capable of stretching and turn the bronchi into thin tubes.

For reference. In case of chronic obstructive bronchitis, during the period of remission in the patient, the lumen of the bronchial tree remains narrowed, as a result of which some of the complaints persist. During the period of exacerbation, bacterial flora joins in, resulting in inflammation again. Chronic bronchitis always occurs with exacerbations and remissions.

Ultimately, complications arise such as: emphysema, bronchiectasis, hypertension in the pulmonary circulation, cor pulmonale.

Acute obstructive bronchitis - symptoms

This pathology is more common in young children. Two syndromes come to the fore - intoxication and respiratory.

Intoxication causes:

• refusal to eat,
• significant decrease in appetite,
• weakness,
• fatigue,
• increase in body temperature.

For reference. With obstructive bronchitis, even in young children, fever rarely exceeds 38 degrees.

Respiratory syndrome includes two manifestations: cough and frequent shallow difficulty breathing. The cough at the beginning of the disease is dry and hacking; later, scanty, viscous, transparent sputum may appear. If there is a lot of sputum and it acquires a greenish tint, then there is a bacterial infection in the pathological focus.

The shortness of breath is expiratory in nature; it is more difficult for the patient to exhale than to inhale. At the same time, breathing becomes noticeably faster. As you exhale, you can hear distant wheezing - noises that can be heard without a phonendoscope when approaching the patient.

For reference. Respiratory failure is accompanied by cyanosis. Initially, the cyanosis spreads to the nasolabial triangle and fingers and toes, and then to the entire body. Total cyanosis indicates severe respiratory failure. Such patients find it difficult to breathe. From the outside, it seems that the hands and face are involved in breathing - when breathing, the shoulders seem to rise, and the nose expands.

In the acute course of the disease, all symptoms gradually disappear within three weeks.

Chronic obstructive bronchitis - symptoms

Obstructive bronchitis in adults flows in waves, the patient’s condition either improves or worsens. During improvement the following manifestations are present:

• Cough. He appears first among all manifestations. Cough occurs most often in the morning when changing body position from horizontal to vertical; as the disease progresses, the cough torments the patient throughout the day.
• Sputum. Doesn't appear right away. At first, the cough is dry, and then a scant amount of very viscous, difficult-to-clean sputum appears. The cough usually becomes productive in the morning. While the patient is sleeping, sputum stagnates in the bronchi, and when the position changes to vertical, it irritates the bronchi and a productive cough occurs. There is no sputum during the day.
• Dyspnea. This is a typical symptom of obstructive bronchitis, but it does not appear immediately. Chronic bronchitis progresses over a very long time, and shortness of breath occurs years after the onset of the disease. It is expiratory in nature. It is difficult for the patient to exhale, causing breathing to become more shallow and frequent. First, difficulty breathing occurs during physical exercise, and then at rest.
• Forced body position. This symptom is the most recent and occurs along with severe respiratory failure. In order to ensure adequate gas exchange, the patient has to use all the auxiliary respiratory muscles, and for this it is necessary to fix the shoulder girdle. This is why such patients often sit or stand with their hands resting on a hard surface.

During exacerbations, bacterial flora joins the existing pathology.

Attention. In patients with chronic bronchitis, the airways cannot protect themselves from infection, so exacerbations occur frequently.

During the period of exacerbation, patients have a lot of sputum, it thins out and acquires a green tint. The cough is wet and bothers the patient all day. At the same time, manifestations of respiratory failure intensify. High temperature is not a characteristic sign of bronchitis, but some patients experience a fever.

Diagnostic methods

Bronchitis does not always require special confirmation. In the acute course of the disease, the diagnosis is made based on clinical symptoms. Often this disease does not require confirmation; diagnostic methods are uninformative. Chronic bronchitis requires more reliable confirmation.

A patient with suspected acute inflammation of the respiratory tract is prescribed a chest x-ray and a clinical blood test to rule out pneumonia.

For reference. On an x-ray with bronchitis, the pattern of the bronchial tree is enhanced; in some patients, emphysematous areas of clearing in the lungs are observed. If infiltration is visible in the lungs, then the patient has pneumonia. In a general blood test, leukocytosis with lymphocytosis is more common in bronchitis, and with neutrophilia in pneumonia.

These data are nonspecific and may occur in other pathologies of the respiratory system. The most informative is bronchoscopy - a method that allows you to see the bronchial tree from the inside and assess the condition of the bronchial mucosa. Bronchoscopy is rarely used, since the method is invasive and causes discomfort to the patient.

In chronic obstructive bronchitis, it is necessary not only to confirm the presence of obstruction, but also to exclude other pathologies. To confirm chronic bronchitis, X-rays and a clinical blood test are used.

For reference. Changes characteristic of bronchial obstruction are detected more often than in the acute course of the disease. The main method of confirming the diagnosis is spirometry.

Spirometry is a study of the function of the respiratory system. The patient is asked to take a deep breath and exhale, and then breathe at a normal pace into a special device. A computer program evaluates its results and prints them out.

During spirometry, two parameters are determined (FVC and FEV1) and their ratio is calculated. FVC is the amount of air that a person can exhale after a full inhalation. This parameter shows how much the lung tissue can stretch (the volume of air inhaled depends on this, which affects the enrichment of the blood with oxygen).

FEV1 is a measure of the speed at which air moves through the bronchi. With obstruction, that is, with blockage of the bronchi, the speed, of course, decreases.

To assess the type of violation, an indicator called the Tiffno Index was derived. This is the ratio of FEV1 to FVC.

In chronic obstructive bronchitis, there is a decrease in forced expiratory volume in the first second (FEV1) of less than 80% of normal. The Tiffno index decreases (norm 0.7).

Attention. The same changes are characteristic of bronchial asthma, therefore a test with salbutamol is a mandatory test.

The patient is given spirometry, then the drug is given and spirometry is performed again. If the indicators increase by 15% or more, we can talk about reversible bronchial obstruction. This confirms bronchial asthma. If the indicators increase slightly, remain unchanged or worsen, obstructive bronchitis is confirmed.

Spirometry allows not only to confirm the diagnosis, but also to determine the stage of the disease.

Obstructive bronchitis - treatment in adults and children

Acute inflammation of the bronchi is etiotropically treated with interferons, adding symptomatic therapy to them. The latter consists of prescribing mucolytic drugs (bromhexine, ACC). For severe obstruction, short-acting bronchodilators (ipratropium, salbutamol) are also prescribed.

If the patient has chronic obstructive bronchitis, treatment is prescribed according to the regimen. During the period of remission, such patients are prescribed mucolytics in the morning to thin the sputum and remove it. For severe obstruction, bronchodilators (salmeterol, pentoxifylline) are indicated. During an exacerbation, if the sputum becomes purulent, antibacterial drugs are added. If severe inflammation occurs, inhaled glucocorticosteroids are administered.

Attention. Respiratory failure of the third degree is an indication for oxygen therapy.

Of great importance in the treatment of the disease is changing habits, quitting smoking, moderate physical activity, relaxing at seaside resorts, and humidifying the air in the house.

Prognosis and prevention

Acute obstructive bronchitis has a good prognosis. With proper treatment, the disease goes away without a trace. Children can suffer from this form of bronchitis quite often, but get rid of all its manifestations in adulthood.

Prevention of acute inflammation of the respiratory tract is a nonspecific increase in immunity:

• proper nutrition,
• daily routine,
• walks in the fresh air,
• timely treatment of viral diseases.

Attention. Chronic obstructive bronchitis has a poor prognosis. Obstruction is irreversible and cannot be reduced, but progression of the disease can be prevented.

Primary prevention includes quitting active smoking, following the rules of personal protection in the workplace, and strengthening the immune system. Secondary prevention of chronic obstructive bronchitis consists of proper treatment of the disease and following the doctor’s recommendations. COPD often causes disability for the patient.

Content

According to the ICD, this term is characterized by inflammatory processes of a diffuse nature that occur in the bronchi. Obstructive bronchitis in chronic form can provoke serious changes in the structure and functioning of the lungs. Therefore, it is extremely important to detect the disease in time and begin its treatment.

Causes of bronchial obstruction

Chronic obstructive bronchitis can occur as a result of exposure to the following factors:

• Working conditions that pose a risk to the respiratory tract. These include working with varnishes and paints, construction mixtures, chemicals and other toxic materials. Those at risk include miners, office workers, construction workers, workers at metallurgical plants and people living in large cities.
• Smoking. This bad habit provokes the deposition of large amounts of nicotine, tar and other combustion products in the bronchi.
• Upper respiratory tract infections. The resistance of the lungs and bronchi decreases under the influence of the virus.
• Predisposition inherent in the genetic code. This cause is characterized by a hereditary deficiency of the protein alpha1-antitrypsin, which performs protective functions in the lungs.

Symptoms of obstructive bronchitis

The main signs of chronic obstructive bronchitis:

• Cough. In the initial stages of the disease, it is dry and accompanied by whistling. As the disease progresses, sputum appears. Traces of blood may appear.
• Dyspnea. At first, this symptom appears only during physical activity, then difficulty breathing is also noted in a calm state.
• Fatigue. The patient feels tired very quickly, even if his load is minimal.
• Temperature. It does not rise because the immune system's response does not work.

Emphysematous type

An emphysematous type of disease is found in elderly people. It is characterized by the appearance and progression of shortness of breath, which does not cause blueness of the skin. It occurs under stress. Manifestations of the development of this type of chronic bronchitis are a small wet non-allergic cough, and a decrease in body weight is observed. In later stages, pulmonary hypertension, hypoxemia and left ventricular failure may occur. When diagnosing, specialists detect signs of emphysema on the lung.

Bronchitic type

A mild degree of shortness of breath suggests a bronchitis type of disease. In this case, patients experience swelling and cyanosis. This type of disease is characterized by a productive cough, and examination reveals wheezing or whistling sounds. Chronic obstructive pulmonary disease of this type manifests itself at an early age and contributes to the development of hypoxia. On X-rays of patients, signs of fibrosis and increased contours of the lung pattern can be detected.

How to diagnose bronchitis

At the initial stages, the clinical picture of the obstructive type of disease does not have specific signs, so studies will be aimed at excluding other diseases. To establish a diagnosis, the following procedures are performed:

• examination of sputum for bacteria content;
• inhalation procedures with beta2-adrenergic agonists to exclude asthmatic syndrome;
• radiography;
• study of respiratory function of the lungs;
• smoker index calculation;
• blood tests;
• bronchoscopy.

Conducting FVD

External respiration function testing is used to identify pathologies in the lungs and bronchi when obstructive bronchitis is suspected. It is carried out on an empty stomach, and at least 2 hours should pass after the last meal. Smoking patients are advised not to take up this bad habit during the day before FVD. In addition, you should not drink coffee or strong tea or drink alcoholic beverages. 30 minutes before the start of the study you need to calm down and avoid physical activity. FVD rules require the patient to wear something light.

During the procedure, the person must sit in a chair with their hands on the armrests. A special clip is placed on his nose, and the patient breathes through his mouth into a special device - a spirometer. This device measures the volume of air that is released when you inhale and exhale. First you need to take a deep breath. Then, gradually exhale all the air into the device. The next action is similar, but is performed not calmly, but sharply. At the last stage, you need to inhale as much as possible and exhale quickly. A decrease in indicators means the presence of obstructive bronchitis.

Chest X-ray and fluorography

No changes in the lungs will be detected on x-ray during obstructive disease in the initial stage. Fluorography is done to determine the progression of the disease, which is expressed in complications. In this case, the following indicators may be reflected in the images:

• greater severity of the pulmonary pattern;
• changes in the roots of the lungs;
• signs of emphysema;
• hardening and thickening of smooth muscle.

Treatment of chronic obstructive bronchitis in adults

Various types of treatment are used to relieve symptoms and eliminate the causes of obstructive bronchitis. The basis of therapy is effective medications that should clear the respiratory tract of phlegm and germs. In addition to pills, patients with obstructive bronchitis are entitled to physiotherapy and special exercises, the implementation of which will help restore proper breathing.

Bronchodilator therapy

To treat COPD, 2 types of bronchodilators are used:

• Bronchodilators. These medications are prescribed without fail. Among them are:

• Ipratropium bromide. The drug is used in the form of inhalations, which can be carried out using a can or nebulizer. Berodual combines this substance with beta2-adrenergic agonists. Such products are approved for long-term use.
• Fenoterol (salbutamol, terbutaline) is used during exacerbation of a chronic disease.
• Salmeterol (formoterol) is an inhalation that has a prolonged effect. Prescribed for severe symptoms of obstructive disease.
• Doctors prescribe complex therapy with these medications for severe cases of the disease, accompanied by inflammatory processes.
• Glucocorticoids. Medicines of this group are prescribed in the most serious cases of chronic bronchitis, if the drugs of the first type do not produce results. It is prescribed to take a dose of 30 mg orally per day. The course of treatment is 1-1.5 weeks. If low effectiveness is detected, inhalations are prescribed.

Use of mucolytics

Expectorants are an important part of the treatment of chronic bronchitis. Their components reduce the viscosity of sputum and restore the ability of mucosal cells to regenerate. In addition, the drugs help improve the effectiveness of other drugs. The most popular medications of the group:

• Lazolvan;
• Bromhexine;
• Carbocysteine;
• Fluimucin.

Correction of respiratory failure

Treatment of chronic obstructive bronchitis in adults involves the use of special breathing exercises and oxygen therapy. The latter type of recovery can be used both in a hospital setting and at home. Gymnastics exercises for obstructive bronchitis are selected by the doctor individually for each patient. Non-invasive ventilation devices and oxygen concentrators are suitable for home oxygen therapy procedures.

Antibiotics

Indications for the use of antibiotics for the treatment of obstructive chronic bronchitis:

• secondary microbial infection;
• old age;
• severe course of the disease during the period of exacerbation;
• the appearance of pus among the sputum released when coughing;
• if the cause of the disease is a disorder in the immune system.

The choice of an anti-inflammatory antimicrobial drug for chronic bronchitis should be made by a doctor, based on the indications of tests and studies, and the individual characteristics of the body. If these measures have not been taken, broad-spectrum antibiotics are prescribed. Such drugs include:

• Augmentin;
• Levofloxacin;
• Amoxiclav;
• Erythromycin.

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Obstructive bronchitis is the occurrence of reflex spasms that prevent mucus from coming out. Obstruction may be periodic, especially in the chronic form. The peculiarity of such bronchitis is that it can occur latently.

Causes and predisposition

Most often, obstructive bronchitis does not show the usual symptoms of bronchitis. Even a cough, a prerequisite for the disease, looks harmless: coughing throughout the day with aggravation in the morning. Outwardly, this is similar to the usual clearing of the respiratory tract by the body itself. Coughing several times or clearing your throat in the morning after sleep is a completely healthy norm. It is difficult to guess here that this is obstructive bronchitis. Therefore, it quickly becomes chronic and only then becomes obvious during exacerbations.

Another feature is that it does not always require special treatment. For example, a patient works in a dusty room. His cough is not a consequence of the disease, but the consequences of harmful work. It is enough to change jobs or change conditions to more acceptable ones, and bronchitis disappears. This happens when the only cause of the disease is external factors.

Many experts claim that the main cause of bronchial obstruction is viral. And they say the main culprit is a previous cold, flu, or acute respiratory infection. However, recent observations carried out in Russia have shown the inconsistency of this statement. In fact, bronchitis is most common in those who smoke a lot or work in hazardous jobs. This is explained by the sensitivity of the bronchi to foreign substances and particles. Here the immune system and protective barriers are powerless: dust and resins enter the body and settle on the mucous membranes immediately in the bronchi, as they are inhaled.

By building a logical sequence of reasons, you can get the following list (from the most frequent to the least):

• Smoking. Whether you smoke or near you is not essential for triggering the disease;
• Exposure to external factors: dust, flour, toxins, heavy metals;
• Virus or bacteria. Damage to the bronchi is a secondary disease;
• Allergy. An enemy agent provokes a disease.

Predisposition to respiratory diseases is significant. A tendency to laryngitis, sinusitis, and colds is often provoked by various bronchitis. This group of people suffers from pneumonia more often than others.

First signs

Symptoms depend on the type of bronchitis itself and the provocateur of the disease. If this is a latent form or chronic, then the cough will be minor during the day. Coughing, sometimes dry cough, sometimes with sputum. It doesn’t always bother you right away and cause inconvenience. It may worsen in the morning or closer to the morning. Here the cough becomes annoying, dull, hysterical to the point of “scratching” in the throat. In addition, there are several “identifying” signs and symptoms of obstructive bronchitis:

1. temperature jump;
2. the appearance of purulent impurities in the mucus;
3. severe shortness of breath without exercise;
4. dry cough;
5. sweating and weakness;
6. headaches;
7. loss of appetite and sleep.

Symptoms of obstructive bronchitis may appear all at once, or they may show only one or two. Symptoms may change: today there is a cough without sputum, tomorrow it is wet. That is, the appearance of all signs is not necessary.

Diagnostics

The patient is prescribed an x-ray after examination, listening to the bronchi and lungs

A blood test is almost useless in diagnosing bronchial obstruction. Exception: allergic nature. In other cases, the blood clinic will show a certain number of leukocytes, which will only indicate the presence of a focus of inflammation. Therefore, the patient is prescribed an x-ray after examination, listening to the bronchi and lungs.

Pain in the ear and throat on one side, what to do about it is indicated in this article.

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If necessary, x-rays are taken in several projections. The study is necessary to assess the condition of the bronchi and lungs and identify foci of inflammation. If necessary, spirometry and ECG may be prescribed.

How to treat at home and in hospital

Medication

The ultimate goal of treatment is to eliminate spasm, remove sputum and completely eliminate obstruction. For this purpose, algorithms of treatment regimens are used, which combine modern drugs - antispasmodics and bronchodilators. Obstructive bronchitis will not go away quickly; it will take patience for complete healing.

To expand the lumens in the bronchi, anticholinergic blockers are prescribed: Beradual or Bromide (as tolerated). To stop the process, hormones are added, most often Prednisolone. It is important to increase dilution during treatment, so the regimen must include expectorants: Bromhexine, Ambroxol.

If infection occurs, then broad-spectrum antibiotics are added; the doctor may also prescribe antibiotics for the nebulizer for bronchitis. For allergic obstruction, antihistamines. Be sure to follow general recommendations:

1. bed rest;
2. humid air in the room;
3. drinking plenty of water;
4. following a soft diet.

Be sure to eat fermented milk, lots of vegetables and lean meat and fish. Try not to overload your stomach, eat small portions, but eat enough. But all this will be meaningless if a person does not eliminate the root cause: change harmful jobs, stop smoking.

Folk remedies

Infusion of lemon balm and mint is one of the effective folk remedies for the treatment of obstructive bronchitis

Treatment of bronchitis with herbs must be carried out carefully and competently. For a quick recovery, the patient should drink plenty of fluids. Therefore, it will be ideal if a person drinks as much as possible: herbal teas, chamomile and sage decoctions. Be sure to include cranberries and rosehip decoction in your diet. These berries stabilize the immune system, kill infections, and have a mild diuretic effect.

What to do when you have a sore throat without fever or runny nose can be understood from the contents of the article.

You can see what a throat looks like with a sore throat in children from this article.

If coughing attacks severely tear your throat, especially if there is pain in the bronchi, make a tincture based on honey and propolis: 1/2 milk and a pinch of propolis. Drink 12 drops before the cough begins.

It’s great if you combine all the treatment with frequent inhalations. Inhalations can be done at home or using a nebulizer. The composition of the inhalation is very different:

1. coltsfoot decoction with chamomile;
2. infusion of mint and lemon balm;
3. steamed boiled potatoes;
4. inhalation of menthol vapors.

Inhalation works well to liquefy mucus, cough it up and reduce the activity of coughing attacks. Plus, the high temperature of the steam penetrating the body kills germs.

Complications

With complications of obstructive bronchitis, pulmonary insufficiency may appear

When obstruction develops, the lungs no longer receive the required amount of air. Inhalations become heavy, the diaphragm does not open completely. In addition, we inhale more than we exhale. Some part remains in the lungs and provokes pulmonary emphysema. In severe and chronic forms, pulmonary failure may occur, and this is a cause of mortality. Untreated bronchitis almost always ends in pneumonia, which is much more difficult to treat.

Video

What not to do when treating obstructive bronchitis - learn from this video:

Obstructive bronchitis can be dangerous due to its complications. Having a penchant for secrecy, he already poses a risk to our health. But in the normal course, it is important not to delay going to the pulmonologist. Do not forget that obstruction can lead to a chronic form, when healing will be impossible.

Main causes and symptoms of obstructive bronchitis

Obstructive bronchitis is the most common disease that affects the respiratory system. Today, bronchitis with obstruction is diagnosed in every 4 patients suffering from this disease. Both children and adults suffer from bronchial pathology. One of the most dangerous forms for health is acute obstructive bronchitis, which brings the patient a lot of discomfort and anxiety, since if the disease becomes chronic, it will be very, very difficult to cure it. In addition, during an advanced form, a person will have to take medications for the rest of his life. That is why, if a patient is suspected of acute obstructive bronchitis, it is important to immediately carry out treatment, because otherwise the patient will face unpleasant health consequences.

Epidemiology of the disease

Doctors classify chronic or acute obstructive bronchitis as an obstructive pathology of the respiratory tract.

The disease is characterized by the fact that not only inflammation develops in the bronchi, but also damage to the mucous membrane occurs, which causes:

• spasm of the bronchial walls;
• tissue swelling;
• accumulation of mucus in the bronchi.

Also, obstructive bronchitis in adults causes significant thickening of the walls of blood vessels, which leads to a narrowing of the bronchial lumen. In this case, the patient experiences difficulty breathing, difficulties with normal ventilation of the lungs, and a lack of rapid discharge of sputum from the lungs. If acute obstructive bronchitis is not treated promptly, a person may develop respiratory failure.

It is important to note that treatment of obstructive bronchitis in adults should not be carried out until the doctor determines the type of disease - acute or chronic.

In fact, these forms differ significantly from each other, namely:

• in the acute form, the alveolar tissue and small bronchi are not able to become inflamed;
• the chronic form leads to irreversible consequences as a result of the development of serious broncho-obstructive syndrome;
• in the acute form, emphysema does not form (the alveoli of the pulmonary cavity are stretched, as a result of which they lose the ability to contract normally - this causes a disturbance in gas exchange in the respiratory organs);
• during chronic bronchitis, impaired air flow causes hypoxemia or hypercapnia (a decrease or increase in carbon dioxide in the bloodstream).

It is worth noting that recurrent obstructive bronchitis mainly develops in children, as the chronic form of the disease is increasingly being diagnosed in adults. It is indicated by a strong cough with sputum production, which has troubled an adult for more than one year.

Why is obstructive bronchitis dangerous? Basically, the disease carries its danger when the respiratory organs are affected, as a result of which inflammation develops in them. There are no known cases of mortality from this disease, since recurrent obstructive bronchitis, in general, responds well to treatment and is diagnosed on time.

That is why patients with obstructive bronchitis need to closely monitor their health and immediately begin treatment when the first symptoms of the disease are detected. Obstructive bronchitis, the symptoms of which are known to many people, is expressed quite clearly, so only a minimal number of people can fail to notice inflammation of the bronchi.

Origin of the disease

The mechanism of development of the disease in the victim is as follows - under the negative influence of pathogenic factors on the bronchial cavity, the condition and performance of the cilia deteriorate. As a result, their cells quickly die, which leads to an increase in the number of goblet cells.

Also, with bronchitis, there is a significant change in the density and composition of the secretion located in the respiratory organ - this leads to the fact that the activity of the cilia is significantly worsened, and the movement becomes slower. If treatment of acute obstructive bronchitis was not carried out on time, the victim develops stagnation of sputum in the bronchial cavity, which causes blockage of the small airways.

As a result of the loss of normal viscosity, the bronchial secretion loses its protective qualities, which allow it to protect the respiratory system from dangerous bacteria, viruses and other microorganisms.

In addition, if a person constantly experiences an exacerbation of the disease and the attack lasts several days, this indicates a decrease in the concentration of the following substances in the bronchial cavity:

• lactoferrin;
• interferon;
• lysozyme

The reversible mechanism includes:

• bronchial swelling;
• bronchospasms;
• obstruction of the respiratory system resulting from poor coughing.

Irreversible mechanisms are:

• tissue changes;
• reduction of bronchial lumen;
• prolapse on the walls of the bronchi;
• lack of intake of large amounts of air due to the course of emphysema.

Obstructive bronchitis, which is important to treat immediately after signs of the disease are detected, can cause a variety of complications.

These include:

• development of emphysema of the pulmonary cavity;
• the appearance of cor pulmonale - expansion of some parts of the heart resulting from increased circulatory pressure;
• acute or chronic respiratory failure, which often causes an attack of illness;
• pulmonary hypertension;
• bronchiectasis.

Bronchitis with obstructive syndrome causes complications only if a person does not begin treatment for the disease for a long time. How long does obstructive bronchitis last?

Before answering the question of whether obstructive bronchitis is contagious, it is necessary to identify the causes that cause the development of the disease.

Today, doctors identify several main causes of bronchitis, which include:

1. Smoking. This addiction is responsible for the development of the disease in 90% of cases. To get rid of obstructive bronchitis caused by smoking, you should stop smoking so that nicotine, tar, and combustion substances from cigarettes do not irritate the mucous membranes and aggravate an attack of bronchitis.
2. Unfavorable working conditions for health and respiratory organs. Dirty air can also develop recurrent bronchitis. Miners, builders, office workers, residents of large cities, metallurgists, and so on are especially susceptible to the disease. How long does it take to treat obstructive bronchitis in the case of constant negative effects of dirty air on the lungs? In this case, treatment can be carried out throughout your life, maintaining your own condition with medications and procedures. To completely cure the disease, the victim will have to change the area and try to visit the sea, mountains or coniferous areas more often, where the air will help avoid attacks of the disease, as well as quickly get rid of it.
3. Frequent flu, nasopharyngeal diseases and colds. In this case, acute bronchitis develops due to the fact that the lungs are weakened by the influence of viruses, bacteria and other dangerous microorganisms. Obstructive bronchitis can be cured only with complete restoration of the respiratory system and nasopharynx.
4. Heredity. The symptom of obstructive bronchitis often affects a healthy person as a result of unfavorable heredity. This happens due to the fact that there is an insufficient amount of antitrypsin protein in the body, which constantly protects the lungs from harmful bacteria. Unfortunately, this disease cannot be cured; the patient will have to constantly take maintenance medications. Is it possible to get infected with this type of bronchitis? No, the hereditary form is not contagious, so the patient cannot harm anyone. If the patient’s condition worsens, the patient must receive emergency care, since the consequences of the hereditary form can be disastrous.

Symptoms of obstructive bronchitis

It is important to remember that the signs of obstructive bronchitis do not make themselves known immediately - usually with obstructive bronchitis in adults and children, they appear only when the disease has already developed and is fully affecting the bronchial cavity.

Of course, the main complaint of a patient with obstructive bronchitis is a strong, long, cutting and unpleasant cough. However, this does not mean that the victim develops bronchitis. Therefore, it is important for any person to know all the symptoms of the disease in order to catch it in time and visit a doctor.

Signs of the disease include:

1. Cough. With the development of pathology, it is dry, sparse, sometimes whistling, without sputum production. It mainly attacks the patient at night, when the person is lying down, because at this time bronchial secretions fill the airways and cause their blockage. The cough can intensify in cold weather - in this case, the body will take a long time to survive. After a few days, the person begins to gradually cough up phlegm and clots of secretion. In older people, blood can be found in it.
2. High temperature. How long does the patient have a fever? On average, it goes away within 3-6 days after the start of treatment. If the temperature persists and then disappears, this indicates that a person’s bronchitis occurs in a non-contagious form. Bronchitis without fever means that the disease appeared as a result of smoking or frequent exposure to acute respiratory viral infections or colds. If a patient develops a viral or bacterial infection, it will certainly be accompanied by a high fever.
3. Difficulty breathing. When the bronchial lumen is narrowed, a person cannot inhale a portion of air normally and without straining the body. This is especially noticeable during the infectious course of the disease, which is quite easy to become infected with. If the deterioration of breathing is constantly repeated, the patient is prescribed special medications for obstructive bronchitis, which will help relieve inflammation and swelling, as well as normalize the unhindered penetration of air into the body.
4. Dyspnea. It usually appears 10 minutes after the end of a long and strong cough. If obstructive bronchitis in an adult, the symptoms and treatment of which have not been fully studied by a doctor, is characterized by shortness of breath during exercise, this is not a chronic course of the disease. But if shortness of breath affects the patient even at rest, this indicates the development of an advanced form, which needs to be treated as the diagnosis is carried out.
5. Acrocyanosis. This is a blue discoloration of the fingers, nose and lips. If the patient still has a fever, the obstruction will only be relieved after 2-4 months of treatment. In this case, this symptom may constantly disappear and appear again.

Additional symptoms of the disease include:

• muscle pain;
• sweating;
• frequent fatigue;
• change in the appearance of the fingers;
• bronchitis without fever, but with a feeling of heat;
• layering of nails and changes in their appearance.

How to cure obstructive bronchitis? To do this, it is important to identify signs of the disease in time, with the help of which the doctor can quickly assess the state of health and prescribe the correct and effective treatment to the patient. With repeated manifestations of relapses of the disease, the obstruction will no longer be considered acute, which means that the patient will need complex treatment.

Treatment of the disease

When obstructive bronchitis is diagnosed, the identified symptoms and prescribed treatment can quickly put a person back on his feet, but it requires long and careful treatment, which will help prevent another attack, as well as restore bronchi with blockage from phlegm.

When contacting a doctor, he must first determine whether bronchitis is contagious or not, as well as how the patient can get rid of airway obstruction forever. After the doctor conducts a diagnosis, which includes bronchoscopy, examination of the bronchi, and radiography, he will prescribe therapeutic measures that are aimed at reducing the rate of development of the disease.

During the course of the disease, the victim must be prescribed bed rest. After 3-6 days, the patient is allowed to go out into the fresh air, especially at a time when it is quite humid.

In order to permanently overcome bronchitis as a very dangerous disease for health, the patient will need to take certain medications.

So, how to treat the disease in order to recover faster from obstructive bronchitis:

• adrenergic receptors (Terbutaline, Salbutamol) - these drugs increase the bronchial lumen and also allow you to relieve unpleasant symptoms of the disease (you need to take such medications for more than one day to achieve a quick treatment result);
• bronchodilators (Eufillin, Teofedrine) – if a person experiences bronchospasm, this group of drugs quickly treats the disease (the duration of such treatment is prescribed by a doctor);
• mucolytics (Lazolvan, Bromhexine, Sinekod, Ambroxol) - these drugs get rid of sputum, since they dilute it well and remove it;
• anticholinergics (Bekotide, Ingacort) – these medications restore the body, reduce swelling and inflammation.

A patient needs emergency help if there is a danger of complete blockage of the airways - in this case, the longer a person hesitates, the sooner he will need help. What to do if the condition worsens?

The patient should consult a doctor who will prescribe treatment in a hospital, namely:

• dropper;
• taking mucolytics (Sinekod);
• antibiotics (if the pathology is contagious, since bacteria and viruses are transmitted instantly).

How is the disease transmitted? Bronchitis spreads quickly from person to person through airborne droplets, and the time of such spread of the pathogen is instantaneous.

Today, cases of infection of the disease from a sick person to a healthy person continue - and 1 patient is capable of infecting not one or two people, but everyone who is close to him. That is why sometimes treatment and prevention of obstructive bronchitis takes place in an isolated room or at home.

In addition to taking medications, obstruction is also treated with other methods:

• you can get rid of the disease using steam inhalations or healing infusions (there are no negative consequences from this method of treatment);
• obstruction is treated by performing physiotherapeutic procedures, which are often used as emergency first aid (for this, the doctor must know everything about the etiology of the disease);
• treatment with folk remedies - many are interested in the question of whether it is possible to get rid of bronchitis using folk methods and what consequences such treatment entails: in fact, this method of treatment is considered one of the most effective and efficient.

If signs of bronchitis reappear, you should immediately seek help from a doctor, because the disease can quickly spread to healthy people, since its development requires very little - the bronchi of a healthy person.

Obstructive bronchitis in adults: symptoms and treatment

Bronchitis with obstruction is a serious disease among adults. Everyone should know the reasons in order to avoid possible consequences and complications.

What does obstructive bronchitis mean? This disease is determined by inflammation and damage to the bronchial mucosa. Breathing functions are complicated by spasms and narrowing of the bronchi, which leads to sputum retention. Disruption of the bronchial tubes complicates the patient's life: breathing is difficult, shortness of breath, wheezing, and cough appear. The obstructive form is treated continuously with only some breaks for recovery. At the first symptoms, it is necessary to begin their prompt elimination to alleviate the patient’s condition. Errors in therapy lead to the progression of the disease: it “passes” into the chronic stage, the treatment of which practically does not lead to remission.

What does recovery depend on?

Rehabilitation of bronchial function in obstructive forms depends not only on the activities of the attending physician, but also on the patient, his self-organization, and the accuracy of following recommendations. A successful result also depends on related factors:

• age category of the patient;
• bad habits;
• damage to other organs;
• the nature of the disease;
• development of pathologies.

You can only get rid of the second factor. All smokers with experience suffer from chronic bronchial obstruction. To relieve cramps, it is enough to get rid of the bad habit.

Risk factors for the disease

Working conditions, as well as lifestyle, directly affect health. In almost all types of work there is a risk of obstruction. Work in chemical laboratories, metallurgical plants, and construction sites affects the functioning of internal organs. Being in an office also makes it difficult for your lungs to function by inhaling ink while printing documents.

After infections in the form of bacteria and viruses enter a healthy body, the bronchi are damaged and bronchitis occurs. It manifests itself after a viral illness. The main pathogens can be streptococcus, herpes, adenovirus, chlamydia, mycoplasma. With a weakened immune system, stressful working conditions, excessive respiratory tract diseases, poor nutrition, the patient is prone to pulmonary obstruction.

Allergy is the main factor in the manifestation of the disease. Adults who experience allergic reactions from an early age are more often affected. Inflammation of the bronchi due to allergies is the source of bronchial asthma.

Causes of obstructive bronchitis

The main group of factors that influence the development of bronchitis include all kinds of infectious and inflammatory diseases, which lead to deterioration of the lungs and further susceptibility to reagents.

The presence of allergies, increased activity of the bronchi - aggravates the clinical picture of the disease. Polluted environmental areas combined with bad habits will accelerate the process of inflammation of the mucous membrane of the respiratory tract. Almost all industries and premises contain microparticles of harmful substances that disrupt respiratory functions.

Residents in villages are less prone to the disease, compared to the number of patients among city residents.

Symptoms

Timely diagnosis of the symptoms of the disease will help stop the source of inflammation in time. Manifestations of the obstructive form of bronchitis include:

1. The appearance of shortness of breath and sweating when walking.
2. Increased patient fatigue, which occurs with minimal physical activity without stress. The old rhythm of life becomes impossible.
3. The main symptom of obstructive bronchitis is a severe cough with difficulty clearing sputum. For patients with non-obstructive bronchitis, this cause complicates life, depriving them of rest and sleep. In the chronic course of the disease, hypoxia occurs - lack of oxygen.

All symptoms bother the patient for 10 to 20 days with acute obstructive bronchitis in adults. Regular manifestation of symptoms more than three times a year serves as a reason to establish a history of recurrent nature. More frequent recurrences of shortness of breath, cough, and fatigue over 2 years indicate a chronic form of obstruction.

Diagnostics

For patients with signs of obstruction, diagnosis consists of a set of studies:

1. Physical parameters.
2. Laboratory tests.
3. X-ray.
4. Functional.
5. Endoscopic.

The research results will help the pulmonologist correctly determine the form and stage of obstruction. Physical parameters in a recurrent disease are manifested by weakened vocal tremor, decreased mobility of the edges of the lungs, and on auscultation - hard breathing, wheezing on forced exhalation.

To exclude lung damage, radiography is prescribed. Obstructive bronchitis with the onset of symptoms for 2 years has an enhanced bronchial pattern with deformation of the roots of the lungs.

Bronchoscopy is performed to examine the bronchial mucosa and collect sputum. In some cases, bronchography is prescribed - diagnostics to exclude obstruction by a foreign body.

Parameters of external respiration functions reliably diagnose the nature of the disease. Diagnosis is carried out using spirometry, peak flowmetry, and pneumotachometry. The results indicate: the severity of obstruction, reversibility, and the state of pulmonary parameters.

Diagnostics in the laboratory is aimed at studying the composition of urine and blood. When establishing a medical history and excluding pulmonary tuberculosis, sputum is examined.

Treatment of obstructive bronchitis in adults

For effective therapy, the patient must stop smoking, try to lead a healthy lifestyle, and follow the recommendations of the attending physician. If the cause of bronchitis with obstructive syndrome is found in hazardous working conditions, try to change jobs as soon as possible.

Treatment of the disease consists of:

1. Drugs intended to dilate the bronchi. The most effective is ipratropium bromide with an anticholinergic effect, its aerosol analogue is Atrovent. Medicines enter the bronchi in the form of small particles during inhalation during the first hour, maintaining the effect from 4 to 8 hours. Depending on the etiology of the disease, the doctor will prescribe 2 or 4 procedures 3 times a day. For mild symptoms, Berotec and Salbutamol are prescribed for preventive purposes in 3 divided doses. Be careful with the methylxanthine group, especially in heart failure. For example, aminophylline solution is used only for inpatient treatment.
2. Expectorant cough medicines. Acetylcysteine, Lazolvan, Ambroxol promote sputum discharge.
3. Prescribing antibiotics is advisable for bacterial infections, purulent sputum, and intoxication.
4. Corticosteroid therapy is prescribed on a limited basis, weighing overall recovery against side effects.
5. Gymnastics using the Buteyko method is recommended for all patients for the prevention of obstructive bronchitis.

Complications of the disease with attacks that cannot be stopped on an outpatient basis are treated in hospitals. Also reasons for treatment in a hospital are respiratory failure, pneumonia, and the need for bronchoscopy.

Treatment of obstructive bronchitis with folk remedies

Traditional medicine offers many recipes for eliminating bronchial obstruction. It is up to you to decide which method you choose - to take herbal medicines orally or in the form of compresses. Is it possible to cure bronchitis at home? Judging by numerous reviews, it is quite possible to get rid of the disease. We offer several simple and effective recipes.

Melt 50 grams of butter and honey, cool to room temperature and apply a thin layer on your back and chest. Wrap yourself up well and lie down for 30 minutes. Apply the compress at night for two weeks.

The most popular recipe is onion broth: boil the main ingredient in the peel with sugar for 30 minutes, cool and drink throughout the day. Use 100 grams of sugar for a medium onion.

Treatment of obstructive bronchitis at home with difficult sputum discharge consists of a simple set of exercises using specially developed methods to cleanse the bronchi, eliminate hypoxia, and restore lung function.

Conclusion and prevention of the disease

It is possible to cure acute obstructive bronchitis in an adult by prescribing an adequate treatment regimen, non-compliance with which leads to complications with relapse into a more complex stage - chronic.

The course of obstruction can be delayed by effective drug therapy, compliance with working conditions without harm to health, and moderate physical activity. The most susceptible to the disease are elderly people, smokers, and patients with congenital pathologies that aggravate the prognosis.

Prevention of obstructive bronchitis is aimed at maintaining a healthy lifestyle. It is important to consult a doctor with the first symptoms, the elimination of which will not cause more complex treatment and serious consequences.

Treatment of chronic obstructive bronchitis in most cases is an extremely difficult task. First of all, this is explained by the main pattern of development of the disease - the steady progression of bronchial obstruction and respiratory failure due to the inflammatory process and bronchial hyperreactivity and the development of persistent irreversible disorders of bronchial patency caused by the formation of obstructive pulmonary emphysema. In addition, the low effectiveness of treatment for chronic obstructive bronchitis is due to their late visit to the doctor, when there are already signs of respiratory failure and irreversible changes in the lungs.

Nevertheless, modern adequate comprehensive treatment of chronic obstructive bronchitis in many cases makes it possible to reduce the rate of progression of the disease leading to an increase in bronchial obstruction and respiratory failure, reduce the frequency and duration of exacerbations, increase performance and tolerance to physical activity.

Treatment of chronic obstructive bronchitis includes:

• non-drug treatment of chronic obstructive bronchitis;
• use of bronchodilators;
• prescription of mucoregulatory therapy;
• correction of respiratory failure;
• anti-infective therapy (for exacerbations of the disease);
• anti-inflammatory therapy.

Most patients with COPD should be treated on an outpatient basis, according to an individual program developed by the attending physician.

Indications for hospitalization are:

1. Exacerbation of COPD, not controlled in an outpatient setting, despite the course (persistence of fever, cough, purulent sputum, signs of intoxication, increasing respiratory failure, etc.).
2. Acute respiratory failure.
3. Increasing arterial hypoxemia and hypercapnia in patients with chronic respiratory failure.
4. Development of pneumonia against the background of COPD.
5. The appearance or progression of signs of heart failure in patients with chronic cor pulmonale.
6. The need for relatively complex diagnostic procedures (for example, bronchoscopy).
7. The need for surgical interventions using anesthesia.

The main role in recovery undoubtedly belongs to the patient himself. First of all, you need to give up the addiction to cigarettes. The irritating effect that nicotine has on lung tissue will nullify all attempts to “unblock” the functioning of the bronchi, improve blood supply to the respiratory organs and their tissues, eliminate coughing attacks and bring breathing to normal.

Modern medicine offers to combine two treatment options – basic and symptomatic. The basis of the basic treatment of chronic obstructive bronchitis consists of drugs that relieve irritation and congestion in the lungs, facilitate mucus discharge, expand the lumen of the bronchi and improve blood circulation in them. These include xanthine drugs and corticosteroids.

At the stage of symptomatic treatment, mucolytics are used as the main means to combat cough and antibiotics, in order to exclude the addition of a secondary infection and the development of complications.

Periodic physical procedures and therapeutic exercises are indicated for the chest area, which greatly facilitates the outflow of viscous mucus and ventilation of the lungs.

Chronic obstructive bronchitis - treatment with non-drug methods

A set of non-drug therapeutic measures for patients with COPD includes unconditional cessation of smoking and, if possible, elimination of other external causes of the disease (including exposure to household and industrial pollutants, repeated respiratory viral infections, etc.). Sanitation of foci of infection, primarily in the oral cavity, and restoration of nasal breathing, etc. are of great importance. In most cases, within a few months after quitting smoking, the clinical manifestations of chronic obstructive bronchitis (cough, sputum and shortness of breath) decrease and the rate of decline in FEV1 and other indicators of external respiratory function slows down.

The diet of patients with chronic bronchitis should be balanced and contain sufficient amounts of protein, vitamins and minerals. Particular importance is attached to additional intake of antioxidants, such as tocopherol (vitamin E) and ascorbic acid (vitamin C).

The diet of patients with chronic obstructive bronchitis should also include an increased amount of polyunsaturated fatty acids (eicosapentaenoic and docosahexaenoic) contained in seafood and having a unique anti-inflammatory effect due to a decrease in the metabolism of arachidonic acid.

In case of respiratory failure and acid-base disorders, a hypocaloric diet and limiting the intake of simple carbohydrates are advisable, which, due to their accelerated metabolism, increase the formation of carbon dioxide and, accordingly, reduce the sensitivity of the respiratory center. According to some data, the use of a hypocaloric diet in severe patients with COPD with signs of respiratory failure and chronic hypercapnia is comparable in effectiveness to the results of using long-term low-flow oxygen therapy in these patients.

Drug treatment of chronic obstructive bronchitis

Bronchodilators

The tone of bronchial smooth muscles is regulated by several neurohumoral mechanisms. In particular, bronchial dilatation develops when stimulated:

1. beta2-adrenergic receptors with adrenaline and
2. VIP receptors of the NANC (non-adrenergic, non-cholinergic nervous system) with vasoactive intestinal polypeptide (VIP).

On the contrary, narrowing of the bronchial lumen occurs when stimulated:

1. M-cholinergic receptors acetylcholine,
2. receptors for P-substance (NAH-system)
3. alpha adrenergic receptors.

In addition, numerous biologically active substances, including inflammatory mediators (histamine, bradykinin, leukotrienes, prostaglandins, platelet activating factor - PAF, serotonin, adenosine, etc.) also have a pronounced effect on the tone of bronchial smooth muscles, contributing mainly to reduction of the lumen of the bronchi.

Thus, the bronchodilation effect can be achieved in several ways, in which blockade of M-cholinergic receptors and stimulation of bronchial beta2-adrenergic receptors are currently most widely used. In accordance with this, M-anticholinergics and beta2-agonists (sympathomimetics) are used in the treatment of chronic obstructive bronchitis. The third group of bronchodilator drugs that are used in patients with COPD includes methylxanthine derivatives, the mechanism of action of which on bronchial smooth muscle is more complex

According to modern concepts, the systematic use of bronchodilators is the basis of basic therapy for patients with chronic obstructive bronchitis and COPD. This treatment of chronic obstructive bronchitis turns out to be more effective the more it is used. a reversible component of bronchial obstruction is expressed. True, the use of bronchodilators in patients with COPD, for obvious reasons, has a significantly less positive effect than in patients with bronchial asthma, since the most important pathogenetic mechanism of COPD is progressive irreversible obstruction of the airways, caused by the formation of emphysema in them. At the same time, it should be taken into account that some modern bronchodilator drugs have a fairly wide spectrum of action. They help reduce swelling of the bronchial mucosa, normalize mucociliary transport, reduce the production of bronchial secretions and inflammatory mediators.

It should be emphasized that often in patients with COPD the functional tests described above with bronchodilators turn out to be negative, since the increase in FEV1 after a single use of M-anticholinergics and even beta2-sympathomimetics is less than 15% of the expected value. However, this does not mean that it is necessary to abandon the treatment of chronic obstructive bronchitis with bronchodilators, since the positive effect from their systematic use usually occurs no earlier than 2-3 months from the start of treatment.

Inhalation administration of bronchodilators

It is preferable to use inhaled forms of bronchodilators, since this route of drug administration facilitates faster penetration of drugs into the mucous membrane of the respiratory tract and long-term maintenance of a sufficiently high local concentration of drugs. The latter effect is ensured, in particular, by the repeated entry into the lungs of medicinal substances, absorbed through the mucous membrane of the bronchi into the blood and passing through the bronchial veins and lymphatic vessels to the right side of the heart, and from there again to the lungs

An important advantage of the inhalation route of administration of bronchodilators is the selective effect on the bronchi and a significant reduction in the risk of developing side systemic effects.

Inhalation administration of bronchodilators is ensured by the use of powder inhalers, spacers, nebulizers, etc. When using a metered dose inhaler, the patient needs certain skills in order to ensure more complete penetration of the drug into the airways. To do this, after a smooth, calm exhalation, tightly clasp the mouthpiece of the inhaler with your lips and begin to inhale slowly and deeply, press the canister once and continue to inhale deeply. After this, hold your breath for 10 seconds. If two doses (inhalations) of the inhaler are prescribed, you should wait at least 30-60 seconds and then repeat the procedure.

In elderly patients who find it difficult to fully master the skills of using a metered dose inhaler, it is convenient to use so-called spacers, in which the medicine in the form of an aerosol is sprayed into a special plastic flask by pressing the canister immediately before inhalation. In this case, the patient takes a deep breath, holds his breath, exhales into the mouthpiece of the spacer, after which he takes a deep breath again without pressing the canister.

The most effective is the use of compressor and ultrasonic nebulizers (from Latin: nebula - fog), which spray liquid medicinal substances in the form of fine aerosols, in which the medicine is contained in the form of particles ranging in size from 1 to 5 microns. This can significantly reduce the loss of medicinal aerosol that does not enter the respiratory tract, as well as ensure a significant depth of penetration of the aerosol into the lungs, including medium and even small bronchi, whereas when using traditional inhalers, such penetration is limited to the proximal bronchi and trachea.

The advantages of inhaling drugs through nebulizers are:

• the depth of penetration of medicinal fine aerosol into the respiratory tract, including medium and even small bronchi;
• simplicity and convenience of inhalation;
• no need to coordinate inspiration with inhalation;
• the possibility of administering high doses of drugs, which allows the use of nebulizers to relieve the most severe clinical symptoms (severe shortness of breath, an attack of suffocation, etc.);
• the possibility of including nebulizers in the circuit of ventilators and oxygen therapy systems.

In this regard, the administration of drugs through nebulizers is used primarily in patients with severe obstructive syndrome, progressive respiratory failure, in elderly and senile people, etc. Through nebulizers, not only bronchodilators, but also mucolytic agents can be administered into the respiratory tract.

Anticholinergic drugs (M-cholinergics)

Currently, M-anticholinergics are regarded as the first choice drugs in patients with COPD, since the leading pathogenetic mechanism of the reversible component of bronchial obstruction in this disease is cholinergic bronchoconstruction. It has been shown that in patients with COPD, anticholinergics have a bronchodilator effect that is not inferior to beta2-adrenergic agonists and superior to theophylline.

The effect of these bronchodilators is associated with the competitive inhibition of acetylcholine on the receptors of the postsynaptic membranes of the smooth muscles of the bronchi, mucous glands and mast cells. As is known, excessive stimulation of cholinergic receptors leads not only to increased smooth muscle tone and increased secretion of bronchial mucus, but also to degranulation of mast cells, leading to the release of a large number of inflammatory mediators, which ultimately increases the inflammatory process and bronchial hyperreactivity. Thus, anticholinergics inhibit the reflex response of smooth muscles and mucous glands caused by activation of the vagus nerve. Therefore, their effect is manifested both when using the drug before the onset of irritating factors and when the process has already developed.

It should also be remembered that the positive effect of anticholinergics is primarily manifested at the level of the trachea and large bronchi, since this is where the maximum density of cholinergic receptors is located.

Remember:

1. Anticholinergics are the first choice drugs in the treatment of chronic obstructive bronchitis, since parasympathetic tone in this disease is the only reversible component of bronchial obstruction.
2. The positive effect of M-anticholinergics is:
   1. in reducing the tone of bronchial smooth muscles,
   2. decreased secretion of bronchial mucus and
   3. reducing the process of mast cell degranulation and limiting the release of inflammatory mediators.
3. The positive effect of anticholinergics is primarily manifested at the level of the trachea and large bronchi

In patients with COPD, inhaled forms of anticholinergic drugs are usually used - the so-called quaternary ammonium compounds, which penetrate poorly through the mucous membrane of the respiratory tract and practically do not cause systemic side effects. The most common of them are ipratropium bromide (Atrovent), oxytropium bromide, ipratropium iodide, tiotropium bromide, which are used mainly in metered aerosols.

The bronchodilator effect begins 5-10 minutes after inhalation, reaching a maximum after about 1-2 hours. The duration of action of ipratropium iodide is 5-6 hours, ipratropium bromide (Atrovent) is 6-8 hours, oxytropium bromide is 8-10 hours and tiotropium bromide - 10-12 hours

Side effects

Undesirable side effects of M-anticholinergics include dry mouth, sore throat, and cough. Systemic side effects of blockade of M-cholinergic receptors, including cardiotoxic effects on the cardiovascular system, are practically absent.

Ipratropium bromide (Atrovent) is available in the form of a metered dose aerosol. Prescribe 2 puffs (40 mcg) 3-4 times a day. Inhalation of Atrovent, even in short courses, significantly improves bronchial patency. Long-term use of Atrovent is especially effective for COPD, which significantly reduces the number of exacerbations of chronic bronchitis, significantly improves oxygen saturation (SaO2) in arterial blood, and normalizes sleep in patients with COPD.

For COPD of mild severity, a course of inhalation of Atrovent or other M-cholinergic agents is acceptable, usually during periods of exacerbation of the disease; the duration of the course should not be less than 3 weeks. For COPD of moderate and severe severity, anticholinergics are used constantly. It is important that with long-term therapy with Atrovent, drug tolerance and tachyphylaxis do not occur.

Contraindications

M-anticholinergic drugs are contraindicated for glaucoma. Caution should be exercised when prescribing them to patients with prostate adenoma

Selective beta2-agonists

Beta2-adrenergic agonists are rightfully considered the most effective bronchodilators, which are currently widely used for the treatment of chronic obstructive bronchitis. We are talking about selective sympathomimetics, which selectively have a stimulating effect on beta2-adrenoreceptors of the bronchi and have almost no effect on beta1-adrenoreceptors and alpha receptors, which are only present in small quantities in the bronchi.

Alpha adrenergic receptors are determined mainly in the smooth muscle of blood vessels, in the myocardium, central nervous system, spleen, platelets, liver and adipose tissue. In the lungs, a relatively small number of them are localized mainly in the distal parts of the respiratory tract. Stimulation of alpha-adrenergic receptors, in addition to pronounced reactions from the cardiovascular system, central nervous system and platelets, leads to increased tone of bronchial smooth muscles, increased secretion of mucus in the bronchi and the release of histamine by mast cells.

Beta1-adrenergic receptors are widely represented in the myocardium of the atria and ventricles of the heart, in the conduction system of the heart, in the liver, muscle and adipose tissue, in blood vessels and are almost absent in the bronchi. Stimulation of these receptors leads to a pronounced response from the cardiovascular system in the form of positive inotropic, chronotropic and dromotropic effects in the absence of any local response from the respiratory tract.

Finally, beta2-adrenergic receptors are found in the smooth muscles of blood vessels, the uterus, adipose tissue, as well as in the trachea and bronchi. It should be emphasized that the density of beta2-adrenergic receptors in the bronchial tree significantly exceeds the density of all distal adrenergic receptors. Stimulation of beta2-adrenergic receptors by catecholamines is accompanied by:

• relaxation of bronchial smooth muscles;
• decreased release of histamine by mast cells;
• activation of mucociliary transport;
• stimulation of the production of bronchial relaxation factors by epithelial cells.

Depending on the ability to stimulate alpha-, beta1- and/or beta2-adrenergic receptors, all sympathomimetics are divided into:

• universal sympathomimetics, acting on both alpha and beta adrenergic receptors: adrenaline, ephedrine;
• non-selective sympathomimetics that stimulate both beta1 and beta2 adrenergic receptors: isoprenaline (novodrine, isadrin), orciprenaline (alupept, asthmapent) hexaprenaline (ipradol);
• selective sympathomimetics that selectively act on beta2-adrenergic receptors: salbutamol (Ventolin), fenoterol (Berotec), terbutaline (Bricanil) and some prolonged forms.

Currently, universal and non-selective sympathomimetics are practically not used for the treatment of chronic obstructive bronchitis due to the large number of side effects and complications caused by their pronounced alpha and/or beta1 activity

Currently widely used selective beta2-adrenomimetics almost do not cause serious complications from the cardiovascular system and the central nervous system (tremor, headache, tachycardia, rhythm disturbances, arterial hypertension, etc.), characteristic of non-selective and especially universal sympathomimetics. Nevertheless It should be borne in mind that the selectivity of various beta2-agonists is relative and does not completely exclude beta1 activity.

All selective beta2-adrenergic agonists are divided into short-acting and long-acting drugs.

Short-acting drugs include salbutamol (Ventolin, fenoterol (Berotec), terbutaline (Brikanil), etc. Drugs in this group are administered by inhalation and are considered the drug of choice mainly for the relief of attacks of acute bronchial obstruction (for example, in patients with bronchial asthma) and treatment chronic obstructive bronchitis. Their action begins 5-10 minutes after inhalation (in some cases earlier), the maximum effect appears after 20-40 minutes, the duration of action is 4-6 hours.

The most common drug in this group is salbutamol (Ventolin), which is considered one of the safest beta-agonists. The drugs are more often used by inhalation, for example, using spinhaler, at a dose of 200 mm no more than 4 times a day. Despite its selectivity, even with inhaled use of salbutamol, some patients (about 30%) experience undesirable systemic reactions in the form of tremor, palpitations, headache, etc. This is explained by the fact that most of the drug settles in the upper respiratory tract, is swallowed by the patient and absorbed into the blood in the gastrointestinal tract, causing the described systemic reactions. The latter, in turn, are associated with the presence of minimal reactivity in the drug.

Fenoterol (Berotec) has slightly greater activity and a longer half-life than salbutamol. However, its selectivity is approximately 10 times less than salbutamol, which explains the worse tolerability of this drug. Fenoterol is prescribed in the form of dosed inhalations of 200-400 mcg (1-2 puffs) 2-3 times a day.

Side effects are observed with long-term use of beta2-agonists. These include tachycardia, extrasystole, increased frequency of angina attacks in patients with coronary artery disease, increased systemic blood pressure and others caused by incomplete selectivity of drugs. Long-term use of these drugs leads to a decrease in the sensitivity of beta2-adrenergic receptors and the development of their functional blockade, which can lead to exacerbation of the disease and a sharp decrease in the effectiveness of previously treated chronic obstructive bronchitis. Therefore, in patients with COPD, it is recommended, if possible, only sporadic (not regular) use of drugs in this group.

Long-acting beta2-agonists include formoterol, salmeterol (Sereven), saltos (slow-release salbutamol), and others. The prolonged effect of these drugs (up to 12 hours after inhalation or oral administration) is due to their accumulation in the lungs.

Unlike short-acting beta2-agonists, the effect of these long-acting drugs occurs slowly, so they are used primarily for long-term constant (or course) bronchodilator therapy to prevent the progression of bronchial obstruction and exacerbations of the disease. According to some researchers, long-acting beta2-agonists also have anti-inflammatory properties action, as they reduce vascular permeability, prevent activation of neutrophils, lymphocytes, and macrophages inhibiting the release of histamine, leukotrienes and prostaglandins from mast cells and eosinophils. A combination of long-acting beta2-agonists with the use of inhaled glucocorticoids or other anti-inflammatory drugs is recommended.

Formoterol has a significant duration of bronchodilator action (up to 8-10 hours), including when used inhaled. The drug is prescribed by inhalation at a dose of 12-24 mcg 2 times a day or in tablet form at 20, 40 and 80 mcg.

Volmax (salbutamol SR) is a long-acting preparation of salbutamol intended for oral administration. The drug is prescribed 1 tablet (8 mg) 3 times a day. Duration of action after a single dose of the drug is 9 hours.

Salmeterol (Serevent) is also a relatively new long-acting beta2-sympathomimetic drug with a duration of action of 12 hours. Its bronchodilator effect exceeds the effects of salbutamol and fenoterol. A distinctive feature of the drug is its very high selectivity, which is more than 60 times higher than that of salbutamol, which ensures a minimal risk of developing side systemic effects.

Salmeterol is prescribed at a dose of 50 mcg 2 times a day. In severe cases of broncho-obstructive syndrome, the dose can be increased by 2 times. There is evidence that long-term therapy with salmeterol leads to a significant reduction in the occurrence of exacerbations of COPD.

Tactics for the use of selective beta2-agonists in patients with COPD

When considering the advisability of using selective beta2-agonists for the treatment of chronic obstructive bronchitis, several important circumstances should be emphasized. Despite the fact that bronchodilators of this group are currently widely prescribed in the treatment of patients with COPD and are regarded as drugs for the basic treatment of these patients, it should be noted that in real clinical practice their use encounters significant, sometimes insurmountable, difficulties associated primarily with the presence of significant side effects in most of them. In addition to cardiovascular disorders (tachycardia, arrhythmias, a tendency to increase systemic blood pressure, tremor, headaches, etc.), these drugs, with long-term use, can aggravate arterial hypoxemia, since they help increase the perfusion of poorly ventilated parts of the lungs and further impair ventilation-perfusion relationships. Long-term use of beta2-agonists is also accompanied by hypocapnia, caused by the redistribution of potassium inside and outside the cell, which is accompanied by an increase in weakness of the respiratory muscles and deterioration of ventilation.

However, the main disadvantage of long-term use of beta2-adrenoceptors in patients with broncho-obstructive syndrome is the natural formation of tachyphylaxis - a decrease in the strength and duration of the bronchodilator effect, which over time can lead to rebound bronchoconstriction and a significant decrease in functional parameters characterizing the patency of the airways. In addition, beta2-adrenergic agonists increase bronchial hyperreactivity to histamine and methacholine (acetylcholine), thus worsening parasympathetic bronchoconstrictor effects.

Several important practical conclusions follow from the above.

1. Considering the high effectiveness of beta2-adrenergic agonists in relieving acute episodes of bronchial obstruction, their use in patients with COPD is indicated primarily at the time of exacerbations of the disease.
2. It is advisable to use modern, long-acting, highly selective sympathomimetics, for example, salmeterol (Serevent), although this does not at all exclude the possibility of sporadic (not regular) use of short-acting beta2-adrenergic agonists (such as salbutamol).
3. Long-term regular use of beta2-agonists as monotherapy for patients with COPD, especially elderly and senile patients, cannot be recommended as permanent basic therapy.
4. If patients with COPD continue to need to reduce the reversible component of bronchial obstruction, and monotherapy with traditional M-anticholinergics is not entirely effective, it is advisable to switch to modern combined bronchodilators, including M-cholinergic inhibitors in combination with beta2-adrenergic agonists.

Combined bronchodilators

In recent years, combined bronchodilator drugs are increasingly used in clinical practice, including for long-term therapy of patients with COPD. The bronchodilating effect of these drugs is achieved by stimulating beta2-adrenergic receptors in the peripheral bronchi and inhibiting cholinergic receptors in the large and medium bronchi.

Berodual is the most common combined aerosol drug containing the anticholinergic ipratropium bromide (Atrovent) and the beta2-adrenergic stimulant fenoterol (Berotec). Each dose of Berodual contains 50 mcg of fenoterol and 20 mcg of atrovent. This combination allows you to obtain a bronchodilator effect with a minimal dose of fenoterol. The drug is used both for the relief of acute attacks of asthma and for the treatment of chronic obstructive bronchitis. The usual dose is 1-2 aerosol doses 3 times a day. The onset of action of the drug is after 30 s, the maximum effect is after 2 hours, the duration of action does not exceed 6 hours.

Combivent is the second combination aerosol preparation containing 20 mcg. anticholinergic ipratropium bromide (Atroventa) and 100 mcg salbutamol. Combivent is used 1-2 doses of the drug 3 times a day.

In recent years, positive experience has begun to accumulate in the combined use of anticholinergics with long-acting beta2-agonists (for example, Atrovent with salmeterol).

This combination of bronchodilators of the two described groups is very common, since the combined drugs have a more powerful and persistent bronchodilator effect than both components separately.

Combination drugs containing M-cholinergic inhibitors in combination with beta2-adrenergic agonists have a minimal risk of side effects due to the relatively small dose of the sympathomimetic. These advantages of combined drugs allow us to recommend them for long-term basic bronchodilator therapy in patients with COPD when monotherapy with Atrovent is insufficiently effective.

Methylxanthine derivatives

If taking anticholiolytics or combined bronchodilators is not effective, methylxanthine drugs (theophylline, etc.) can be added to the treatment of chronic obstructive bronchitis. These drugs have been successfully used for many decades as effective drugs for the treatment of patients with broncho-obstructive syndrome. Theophylline derivatives have a very wide spectrum of action, going far beyond just the bronchodilator effect.

Theophylline inhibits phosphodiesterase, resulting in the accumulation of cAMP in the smooth muscle cells of the bronchi. This promotes the transport of calcium ions from myofibrils to the sarcoplasmic reticulum, which is accompanied by relaxation of smooth muscles. Theophylline also blocks purine receptors in the bronchi, eliminating the bronchoconstrictor effect of adenosine.

In addition, theophylline inhibits the degranulation of mast cells and the release of inflammatory mediators from them. It also improves renal and cerebral blood flow, enhances diuresis, increases the strength and frequency of heart contractions, lowers pressure in the pulmonary circulation, and improves the function of the respiratory muscles and diaphragm.

Short-acting drugs from the theophylline group have a pronounced bronchodilator effect; they are used to relieve acute episodes of bronchial obstruction, for example, in patients with bronchial asthma, as well as for long-term therapy of patients with chronic broncho-obstructive syndrome.

Euphylline (a compound of theophyllip and ethylenediamine) is available in ampoules of 10 ml of 2.4% solution. Eufillin is administered intravenously in 10-20 ml of isotonic sodium chloride solution for 5 minutes. With rapid administration, a drop in blood pressure, dizziness, nausea, tinnitus, palpitations, facial flushing and a feeling of heat may occur. Aminophylline administered intravenously lasts for about 4 hours. With intravenous drip administration, a longer duration of action can be achieved (6-8 hours).

Long-acting theophyllines have been widely used in recent years for the treatment of chronic obstructive bronchitis and bronchial asthma. They have significant advantages over short-acting theophyllines:

• the frequency of taking medications is reduced;
• the accuracy of drug dosing increases;
• provides a more stable therapeutic effect;
• prevention of asthma attacks in response to physical activity;
• drugs can be successfully used to prevent night and morning asthma attacks.

Long-acting theophyllines have a bronchodilator and anti-inflammatory effect. They significantly suppress both the early and late phases of the asthmatic reaction that occurs after inhalation of the allergen, and also have an anti-inflammatory effect. Long-term treatment of chronic obstructive bronchitis with long-acting theophyllines effectively controls the symptoms of bronchial obstruction and improves lung function. Since the drug is released gradually, it has a longer duration of action, which is important for the treatment of nocturnal symptoms of the disease that persist despite treatment of chronic obstructive bronchitis with anti-inflammatory drugs.

Long-acting theophylline preparations are divided into 2 groups:

1. 1st generation drugs last 12 hours; they are prescribed 2 times a day. These include: theodur, theotard, teopec, durophylline, ventax, theogard, theobid, slobid, aminophylline SR, etc.
2. 2nd generation drugs act for about 24 hours; they are prescribed once a day. These include: theodur-24, unifil, dilatran, eufilong, filocontin, etc.

Unfortunately, theophyllines act within a very narrow therapeutic concentration range of 15 mcg/mL. When the dose is increased, a large number of side effects occur, especially in elderly patients:

• gastrointestinal disorders (nausea, vomiting, anorexia, diarrhea, etc.);
• cardiovascular disorders (tachycardia, rhythm disturbances, up to ventricular fibrillation);
• dysfunction of the central nervous system (hand tremors, insomnia, agitation, convulsions, etc.);
• metabolic disorders (hyperglycemia, hypokalemia, metabolic acidosis, etc.).

Therefore, when using methylxanthines (short and long-acting), it is recommended to determine the level of theophylline in the blood at the beginning of treatment for chronic obstructive bronchitis, every 6-12 months and after changing doses and medications.

The most rational sequence for the use of bronchodilators in patients with COPD is as follows:

Sequence and volume of bronchodilator treatment of chronic obstructive bronchitis

• With mild and unstable symptoms of broncho-obstructive syndrome:
  • inhaled M-anticholinergics (Atrovent), mainly in the phase of exacerbation of the disease;
  • if necessary, inhaled selective beta2-adrenergic agonists (sporadicly - during exacerbations).
• For more persistent symptoms (mild to moderate):
  • inhaled M-anticholinergics (Atrovent) constantly;
  • in case of insufficient effectiveness - combined bronchodilators (Berodual, Combivent) constantly;
  • if the effectiveness is insufficient, additional methylxanthines are used.
• With low effectiveness of treatment and progression of bronchial obstruction:
  • consider replacing Berodual or Combivent with a highly selective long-acting beta2-adrenergic agonist (salmeterol) and combination with an M-anticholinergic;
  • modify methods of drug delivery (spensers, nebulizers),
  • Continue taking methylxanthines and theophylline parenterally.

Mucolytic and mucoregulatory agents

Improving bronchial drainage is the most important task in the treatment of chronic obstructive bronchitis. For this purpose, any possible effects on the body, including non-drug treatment methods, should be considered.

1. Drinking plenty of warm fluids helps reduce the viscosity of sputum and increase the sol layer of bronchial mucus, resulting in easier functioning of the ciliated epithelium.
2. Vibration chest massage 2 times a day.
3. Positional bronchial drainage.
4. Expectorants with an emetic-reflex mechanism of action (thermopsis herb, terpin hydrate, ipecac root, etc.) stimulate the bronchial glands and increase the amount of bronchial secretion.
5. Bronchodilators that improve bronchial drainage.
6. Acetylcysteine ​​(fluimucin) viscosity of sputum due to the rupture of disulfide bonds of mucopolysaccharides of sputum. Has antioxidant properties. Increases the synthesis of glutathione, which takes part in detoxification processes.
7. Ambroxol (lazolvan) stimulates the formation of tracheobronchial secretions of low viscosity due to the depolymerization of acidic mucopolysaccharides of bronchial mucus and the production of neutral mucopolysaccharides by goblet cells. Increases the synthesis and secretion of surfactant and blocks the breakdown of the latter under the influence of unfavorable factors. Enhances the penetration of antibiotics into bronchial secretions and the bronchial mucosa, increasing the effectiveness of antibacterial therapy and reducing its duration.
8. Carbocisteine ​​normalizes the quantitative ratio of acidic and neutral sialomucins in bronchial secretions, reducing the viscosity of sputum. Promotes regeneration of the mucous membrane, reducing the number of goblet cells, especially in the terminal bronchi.
9. Bromhexine is a mucolytic and mucoregulator. Stimulates the production of surfactant.

Anti-inflammatory treatment of chronic obstructive bronchitis

Since the formation and progression of chronic bronchitis is based on the local inflammatory reaction of the bronchi, the success of treatment of patients, including patients with COPD, is primarily determined by the possibility of inhibiting the inflammatory process in the respiratory tract.

Unfortunately, traditional nonsteroidal anti-inflammatory drugs (NSAIDs) are not effective in patients with COPD and cannot stop the progression of clinical manifestations of the disease and the steady decline in FEV1. It is believed that this is due to the very limited, one-sided effect of NSAIDs on the metabolism of arachidonic acid, which is a source of the most important inflammatory mediators - prostaglandins and leukotrienes. As is known, all NSAIDs, by inhibiting cyclooxygenase, reduce the synthesis of prostaglandins and thromboxanes. At the same time, due to the activation of the cyclooxygenase pathway of arachidonic acid metabolism, the synthesis of leukotrienes increases, which is probably the most important reason for the ineffectiveness of NSAIDs in COPD.

The mechanism of the anti-inflammatory effect of glucocorticoids, which stimulate the synthesis of a protein that inhibits the activity of phospholipase A2, is different. This leads to a limitation in the production of the very source of prostaglandins and leukotrienes - arachidonic acid, which explains the high anti-inflammatory activity of glucocorticoids in various inflammatory processes in the body, including COPD.

Currently, glucocorticoids are recommended for the treatment of chronic obstructive bronchitis in which other treatments have been ineffective. However, only 20-30% of patients with COPD can improve bronchial patency with the help of these drugs. Even more often it is necessary to abandon the systematic use of glucocorticoids due to their numerous side effects.

To resolve the issue of the advisability of long-term continuous use of corticosteroids in patients with COPD, it is proposed to carry out trial therapy: 20-30 mg/day. at the rate of 0.4-0.6 mg/kg (prednisolone) for 3 weeks (oral corticosteroids). The criterion for the positive effect of corticosteroids on bronchial patency is an increase in the response to bronchodilators in a bronchodilator test by 10% of the required FEV1 values ​​or an increase in FEV1 of at least 200 ml. These indicators may be the basis for long-term use of these drugs. At the same time, it should be emphasized that currently there is no generally accepted point of view on the tactics of using systemic and inhaled corticosteroids for COPD.

In recent years, a new anti-inflammatory drug, fenspiride (erespal), which effectively acts on the mucous membrane of the respiratory tract, has been successfully used to treat chronic obstructive bronchitis and some inflammatory diseases of the upper and lower respiratory tract. The drug has the ability to suppress the release of histamine from mast cells, reduce leukocyte infiltration, reduce exudation and the release of thromboxanes, as well as vascular permeability. Like glucocorticoids, fepspiride inhibits the activity of phospholipase A2 by blocking the transport of calcium ions necessary for the activation of this enzyme.

Thus, fepspiride reduces the production of many inflammatory mediators (prostaglandins, leukotrienes, thromboxanes, cytokines, etc.), providing a pronounced anti-inflammatory effect.

Fenspiride is recommended for use both during exacerbation and for long-term treatment of chronic obstructive bronchitis, being a safe and very well tolerated drug. In case of exacerbation of the disease, the drug is prescribed at a dose of 80 mg 2 times a day for 2-3 weeks. In case of stable COPD (stage of relative remission), the drug is prescribed in the same dosage for 3-6 months. There are reports of good tolerability and high effectiveness of fenspiride with continuous treatment for at least 1 year.

Correction of respiratory failure

Correction of respiratory failure is achieved through the use of oxygen therapy and respiratory muscle training.

Indications for long-term (up to 15-18 hours a day) low-flow (2-5 liters per minute) oxygen therapy both in hospital and at home are:

• decrease in arterial blood PaO2
• decrease in SaO2
• decrease in PaO2 to 56-60 mm Hg. Art. in the presence of additional conditions (edema due to right ventricular failure, signs of cor pulmonale, presence of P-pulmonale on the ECG or erythrocytosis with a hematocrit above 56%)

In order to train the respiratory muscles in patients with COPD, various schemes of individually selected breathing exercises are prescribed.

Intubation and mechanical ventilation are indicated in patients with severe progressive respiratory failure, increasing arterial hypoxemia, respiratory acidosis, or signs of hypoxic brain damage.

Antibacterial treatment of chronic obstructive bronchitis

During the period of stable COPD, antibacterial therapy is not indicated. Antibiotics are prescribed only during an exacerbation of chronic bronchitis in the presence of clinical and laboratory signs of purulent endobronchitis, accompanied by an increase in body temperature, leukocytosis, symptoms of intoxication, an increase in the amount of sputum and the appearance of purulent elements in it. In other cases, even during periods of exacerbation of the disease and exacerbation of broncho-obstructive syndrome, the benefit of antibiotics in patients with chronic bronchitis has not been proven.

It was already noted above that most often exacerbations of chronic bronchitis are caused by Streptococcus pneumonia, Haemophilus influenzae, Moraxella catanalis or the association of Pseudomonas aeruginosa with Moraxella (in smokers). In elderly, weakened patients with severe COPD, staphylococci, Pseudomonas aeruginosa and Klebsiella may predominate in the bronchial contents. On the contrary, in younger patients, the causative agent of the inflammatory process in the bronchi is often intracellular (atypical) pathogens: chlamydia, legionella or mycoplasma.

Treatment of chronic obstructive bronchitis usually begins with empirical antibiotics, taking into account the spectrum of the most common causative agents of exacerbations of bronchitis. The selection of an antibiotic based on the sensitivity of the flora in vitro is carried out only if empirical antibiotic therapy is ineffective.

First-line drugs for exacerbation of chronic bronchitis include aminopenicillins (ampicillin, amoxicillin), active against Haemophilus influenzae, pneumococci and moraxella. It is advisable to combine these antibiotics with ß-lactamase inhibitors (for example, clavulonic acid or sulbactam), which ensures high activity of these drugs against lactamase-producing strains of Haemophilus influenzae and Moraxella. Let us recall that aminopenicillins are not effective against intracellular pathogens (chlamydia, mycoplasmas and rickettsia).

II-III generation cephalosporins are broad-spectrum antibiotics. They are active against not only gram-positive, but also gram-negative bacteria, including strains of Haemophilus influenzae that produce ß-lactamases. In most cases, the drug is administered parenterally, although for mild to moderate exacerbations, oral second-generation cephalosporins (for example, cefuroxime) may be used.

Macrolides. New macrolides, in particular azithromycin, which can be taken only once a day, are highly effective for respiratory infections in patients with chronic bronchitis. A three-day course of azithromycin is prescribed at a dose of 500 mg per day. New macrolides affect pneumococci, Haemophilus influenzae, moraxella, as well as intracellular pathogens.

Fluoroquinolones are highly effective against gram-negative and gram-positive microorganisms, especially “respiratory” fluoroquinolones (levofloxacin, cifloxacin, etc.) - drugs with increased activity against pneumococci, chlamydia, mycoplasmas.

Treatment tactics for chronic obstructive bronchitis

According to the recommendations of the National Federal Program “Chronic Obstructive Pulmonary Diseases,” there are 2 treatment regimens for chronic obstructive bronchitis: treatment of exacerbation (maintenance therapy) and treatment of exacerbation of COPD.

In the remission stage (outside exacerbation of COPD), bronchodilator therapy is of particular importance, emphasizing the need for individual selection of bronchodilator drugs. At the same time, in the 1st stage of COPD (mild severity), the systematic use of bronchodilators is not provided, and only fast-acting M-anticholinergics or beta2-agonists are recommended as needed. Systematic use of bronchodilators is recommended to begin from the 2nd stage of the disease, with preference given to long-acting drugs. Annual influenza vaccination is recommended at all stages of the disease, the effectiveness of which is quite high (80-90%). The attitude towards expectorant drugs outside of exacerbation is restrained.

Currently, there is no medicine that can affect the main significant feature of COPD: the gradual loss of lung function. Medicines for COPD (in particular, bronchodilators) only relieve symptoms and/or reduce the incidence of complications. In severe cases, rehabilitation measures and long-term low-intensity oxygen therapy play a special role, while long-term use of systemic glucocorticosteroids should be avoided if possible, replacing them with inhaled glucocorticoids or fenspiride.

With exacerbation of COPD, regardless of its cause, the significance of various pathogenetic mechanisms in the formation of the symptom complex of the disease changes, the importance of infectious factors increases, which often determines the need for antibacterial agents, respiratory failure increases, and decompensation of the cor pulmonale is possible. The basic principles of treatment of exacerbation of COPD are the intensification of bronchodilator therapy and the prescription of antibacterial agents according to indications. Intensification of bronchodilator therapy is achieved by both increasing doses and modifying methods of drug delivery, using spacers, nebulizers, and in case of severe obstruction, intravenous administration of drugs. Indications for the use of corticosteroids are expanding, and their systemic administration (oral or intravenous) in short courses is becoming preferable. In case of severe and moderate exacerbations, the use of methods for correcting increased blood viscosity - hemodilution - is often required. Treatment of decompressed cor pulmonale is carried out.

Chronic obstructive bronchitis - treatment with traditional methods

Treatment with some folk remedies helps relieve chronic obstructive bronchitis. Thyme is the most effective herb for combating bronchopulmonary diseases. It can be consumed as tea, decoction or infusion. You can prepare the medicinal herb at home by growing it in the beds of your garden or, in order to save time, purchase the finished product at the pharmacy. How to brew, infuse or boil thyme is indicated on the pharmacy packaging.

Thyme tea

If there are no such instructions, then you can use the simplest recipe - make tea from thyme. To do this, take 1 tablespoon of chopped thyme herb, put it in a porcelain teapot and pour boiling water over it. Drink 100 ml of this tea 3 times a day, after meals.

Decoction of pine buds

Excellently relieves congestion in the bronchi, reduces the amount of wheezing in the lungs by the fifth day of use. It is not difficult to prepare such a decoction. You don’t have to collect pine buds yourself; they are available at any pharmacy.

It is better to give preference to the manufacturer who took care to indicate on the packaging the recipe for preparation, as well as all the positive and negative effects that may occur in people taking a decoction of pine buds. Please note that pine buds should not be taken by people with blood disorders.

The breast mixture is prepared as an infusion and taken half a glass 2-3 times a day. The infusion should be taken before meals so that the medicinal effect of the herbs can take effect and have time to “reach” the problem organs through the bloodstream.

Chronic obstructive bronchitis will be overcome by treatment with drugs from both modern and traditional medicine, coupled with persistence and faith in a complete recovery. In addition, you should not write off a healthy lifestyle, alternating work and rest, as well as taking vitamin complexes and high-calorie foods.

Content

This is an insidious form of inflammation of the bronchi. Obstructive bronchitis causes dangerous complications. It is important to identify and eliminate the pathological process in time, otherwise the disease will become a serious chronic illness that will have to be treated for the rest of life.

What is obstructive bronchitis

It is known that obstruction is a narrowing of the lumens of the bronchi, which becomes an obstacle to the free flow of air into the lungs and the release of sputum. Is there a difference in the diagnoses of “acute bronchitis” and “acute obstructive bronchitis”? What these diseases have in common is the presence of an inflammatory process. The significant difference is that in the first case the mucous membranes of the bronchi are not affected, but in the second they are severely damaged.

What's happening? The walls of the bronchi swell and thicken. The lumens of the respiratory vessels are filled with sputum, which loses its bactericidal properties and becomes thick, viscous mucus, favorable for the spread of infection. The bronchi are seized by spasms: they either sharply narrow, then return to their original state. However, as the disease progresses, the respiratory vessels lose their ability to expand.

This pathology manifests itself in acute and chronic forms. An acute obstructive process is characterized by the rapid development of bronchial inflammation. Adults suffer mainly from chronic bronchitis, which periodically worsens. This is its distinctive feature. Obstructive pathology in acute form is typical for children. Infants whose respiratory system is still imperfect suffer most often.

In children

The younger the child, the more rapidly the inflammatory processes progress in the delicate, very sensitive bronchi. Types of disease in children:

• acute bronchitis, in which there is no decrease in the lumen of the respiratory vessels;
• acute obstructive bronchitis - inflammation with swelling, narrowing, spasms of the bronchi and excess mucus;
• bronchiolitis is a very serious disease of narrowed bronchioles, often affecting children under 3 years of age, especially infants.

The disease develops in a child much more often if his health condition predisposes him to the development of this disease. High-risk group:

• children with weak immune systems;
• premature babies;
• passive smokers;
• babies with congenital pathologies.

In adults

Since this disease in its chronic form complicates the life of, as a rule, older people, its course is more severe. Diseases of worn-out blood vessels and the heart, as well as age-related decline in immunity, take their toll. Inflammation of the bronchial tree can develop very sluggishly and manifest itself with subtle symptoms, so it is often detected when the disease is severely advanced and difficult to treat.

Chronic obstructive process worsens very easily. This traditionally occurs during the inclement autumn-winter period and cold spring. Activation of bronchial inflammation is often caused by hypothermia, ARVI, influenza, and inhalation of vapors of toxic substances. As the disease worsens, its symptoms become pronounced and its course becomes rapid.

Why does bronchial obstruction occur?

The most common reasons:

• frequent viral infections;
• smoking;
• occupational diseases due to chemically contaminated working conditions;
• hereditary predisposition.

Children are also more often affected by a viral infection than a bacterial one. In addition, today it is rare that a baby does not suffer from allergies. This is a powerful factor that predisposes to irritation and inflammation of the bronchi. Respiratory vessels react to allergens with hyperreactivity - spasms, which are pathological disruptions in their physiological mechanism. The next stage is acute bronchitis in a child.

Symptoms of bronchitis in adults and children

The disease manifests itself with clear signs. Symptoms of acute bronchitis in adults are:

• severe, debilitating cough, wheezing in the lungs;
• shortness of breath even with little physical effort;
• rapid onset of fatigue;
• rise in temperature.

In children with acute obstructive bronchitis, almost the same symptoms appear. A dry, persistent cough often worsens at night. The child breathes noisily, with whistling sounds. In babies, the wings of the nose widen, the neck muscles tense, and the shoulders rise. With acute obstructive bronchitis, the vast majority of children suffer from shortness of breath. Weakness, fatigue, headaches are either absent or do not have a significant effect on the child’s condition.

Treatment of obstructive bronchitis in children and adults

Young children should absolutely not inhale with essential oils or rub their chest or back with ointments or cough balms. Instead of benefit, it often brings great harm. It is better to hospitalize the child. In the hospital, complex drug therapy is prescribed, which includes:

• medications that relieve spasms of the bronchi and dilate them (No-shpa, Papaverine, Salbutamol);
• expectorants (Lazolvan, Doctor IOM, ACC);
• antibiotics (Erythromycin, Amoxiclav, Azithromycin) – in the presence of a bacterial infection;
• antihistamines (Loratadine, Erius), if the child is allergic;
• general strengthening drugs (vitamin-mineral complexes).

In addition, the following are assigned:

• light vibration massage of the collar area;
• physiotherapeutic procedures (electrophoresis, amplipulse);
• therapeutic exercises;
• hypoallergenic diet.

Treatment of obstructive bronchitis in adults leads to complete recovery only when the acute disease has not yet become chronic. Bed rest is required. Treatment has the main goal: to slow the progression of the disease. For this purpose, drugs of the same pharmacological groups are used in the form of tablets, injections and droppers, herbal decoctions according to traditional medicine recipes, inhalations, and massage. An extremely important condition for successful therapy is smoking cessation.

How is bronchial obstruction diagnosed?

Basic methods for diagnosing pathology:

• chest x-ray;
• sputum culture;
• bronchoscopy;
• general, biochemical, immunological blood tests.

Why is bronchitis with obstruction dangerous?

The consequence of the disease after discharge from the hospital is often a residual cough, which may not go away for a long time. Obstructive bronchitis is dangerous due to severe complications. Among them:

• emphysema;
• bronchial asthma;
• the appearance of a pulmonary (enlarged) heart;
• bronchiectasis;
• pulmonary hypertension.

• quit smoking;
• take regular walks in the fresh air;
• harden the body against colds;
• avoid dusty and chemically aggressive air environments;
• systematically carry out wet cleaning in the house;
• Get vaccinated against influenza annually.

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