Treatment of chronic obstructive bronchitis in most cases is 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. Besides, low efficiency treatment of 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.

However, modern adequate complex treatment 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 uncontrolled 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 back 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 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 physiotherapy 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 treatment measures for patients with COPD includes unconditional cessation of smoking and, if possible, elimination of other external reasons diseases (including exposure to household and industrial pollutants, repeated respiratory viral infections, etc.). Great value have sanitization of foci of infection, primarily in the oral cavity, and restoration of nasal breathing, etc. 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 products 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 NANC (non-adrenergic, non-cholinergic nervous system) 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 ideas, 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 above-described functional tests 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), in which liquid medicinal substances are sprayed 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 approximately 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, 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 when long-term therapy atroventom, tolerance to the drug 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, only in large quantities presented 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 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 reaction 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.

To medicines short acting include salbutamol (ventolin, fenoterol (Berotec), terbutaline (bricanil), etc. Drugs in this group are administered by inhalation and are considered the drug of choice mainly for relieving attacks of acute bronchial obstruction (for example, in patients with bronchial asthma) and treating chronic obstructive bronchitis. Action they begin 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 inhalation use salbutamol, some patients (about 30%) experience unwanted 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 bloodstream. 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 sharp decline the effectiveness of previous treatment of 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 life clinical practice their use encounters significant, sometimes insurmountable, difficulties associated, first of all, with the presence of pronounced 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 long-term use beta2-adreiommetic drugs 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 in patients with COPD there remains a 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 for relief acute attacks suffocation, 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 benefits combination 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 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 has 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 and moderate severity):
  • 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 low-viscosity tracheobronchial secretions 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 penetration of antibiotics into bronchial secretion 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 local inflammatory reaction 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 ineffectiveness of NSAIDs for 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, for the treatment of chronic obstructive bronchitis and some inflammatory diseases upper and lower respiratory tract, the new anti-inflammatory drug fenspiride (erespal), which effectively acts on the mucous membrane of the respiratory tract, has been successfully used. 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 safe and very well tolerated medicine. 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 in permanent 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 are as in inpatient conditions, 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 exacerbation of chronic bronchitis in the presence of clinical and laboratory signs 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 classified as antibiotics wide range actions. 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. High efficiency at respiratory infections In patients with chronic bronchitis, new macrolides are available, in particular azithromycin, which can be taken only once a day. 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 exacerbations (maintenance therapy) and treatment of exacerbations 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-term active 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, 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 main 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. The indications for prescribing corticosteroids are expanding, and their systemic administration (oral or intravenous) in short courses is becoming preferable. With severe and moderate exacerbations, the use of correction methods is often required increased viscosity blood - hemodilution. 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.

Magic licorice root

Medicinal mixtures can be presented in the form of an elixir or a breast mixture. Both are purchased ready-made at the pharmacy. The elixir is taken in drops, 20-40 an hour before meals, 3-4 times a day.

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.

Treatment with drugs and modern and traditional medicine coupled with persistence and faith in full recovery. In addition, one should not write off a healthy lifestyle, alternating work and rest, as well as taking vitamin complexes and high-calorie foods.

Chronic obstructive bronchitis must be understood as a disease that is chronic in nature and characterized by diffuse damage to the bronchial tree. In parallel with this, the formation of processes of irritation and inflammation is observed, which leads to impaired ventilation of the lungs.

A characteristic feature of the course of chronic obstructive bronchitis (COB) is obstruction of the airway lumen and increased bronchoconstriction. This disease can have two course options:

1. Irreversible, in which there is destructive process collagen membrane of the lungs and fibrosis of bronchioles.
2. Reverse, characterized by the formation of an inflammatory process, which in turn leads to a reduction in the smooth muscles of the lungs, swelling of the bronchi and an increase in the production of mucus from the lungs. If adequate treatment is not carried out in time, reversible processes become irreversible.

Obstructive chronic bronchitis is considered very dangerous, widespread and serious illness. Given pathological condition accompanied by the formation of the process inflammatory in nature, damage to the mucous membranes of the bronchi and disruption of their ventilation. All of these processes cause stagnation of mucus and suffocation. Quite often, COB is diagnosed after suffering from:

• influenza and ARVI;
• inflammatory process of the nasopharynx;
• bronchitis of allergic origin;
• tracheitis.

As for the causes of chronic obstructive bronchitis, there are a considerable number of them, but the most common are considered to be:

• the presence of large amounts of dust, cadmium and silicon in the atmospheric air;
• a profession whose place of work is related to the conditions higher level air pollution;
• availability bad habits, especially smoking;
• passive smoking;
• hereditary predisposition;
• atmospheric air pollution.

Please note that smoking is considered to be the main provoking factor in the appearance of COB, because it leads to the formation of an inflammatory process that has a harmful effect on the lungs. The smoke that a person inhales while smoking contains harmful impurities that have the ability to damage the ciliated epithelium and lead to the formation of various types of infections.

The cause of the formation of chronic obstructive bronchitis can also be work in steel shops, coal mines, textile factories, and construction.

Studies have revealed an interesting connection between the occurrence of COB and excessive consumption of sausages, canned food and dishes made from bacon on a regular basis.

Clinical picture

The symptoms of the disease and the intensity of their manifestations will depend on what stage of the disease it is at, as well as on the degree of damage to the bronchi and lungs and the speed of spread of the pathological process. All this, in turn, is closely related to how strongly unfavorable factors of exogenous origin exert their influence.

Therefore, the pathological manifestations of chronic obstructive bronchitis include:

• cough, which is accompanied by discomfort and pain;
• sudden changes in body temperature;
• change in skin color, it becomes pale;
• accelerated heartbeat;
• the appearance of shortness of breath when performing even minor exertions;
• increased level of fatigue;
• an increase in the amount of sweat produced by the body;
• hard breathing;
• listening to wheezing with a whistle that appears on exhalation.

The first alarm bell of chronic obstructive bronchitis is the appearance of shortness of breath with difficulty exhaling, which in the first stages appears only after doing some work; over time it becomes permanent. The peculiarity of this pathological symptom is that most often it manifests itself in the morning, after sleep.

In parallel with shortness of breath, a person begins to be bothered by a cough with difficulty in sputum discharge, which has a paroxysmal character and is accompanied by painful sensations. The peculiarity of cough is that it and shortness of breath most often bother the patient in the morning.

If a person, along with COPD, is also diagnosed with heart failure, then in this case other pathological symptoms that arise as a result of oxygen deficiency in the body will manifest themselves, namely:

• swelling on lower limbs permanent nature;
• bluish tint to the lips, nose, ears and fingers;
• epigastric pulsation.

Quite often, difficulty breathing and coughing lead to the fact that a person is forced to sleep in a sitting position.

With exacerbation of COB, the formation of pulmonary hypertension, an inflammatory process that is localized in the alveoli and gas exchange disorders can be observed. Quite often, this course of the disease is accompanied by the addition of a secondary infection, which leads to the release of purulent sputum.

When the slightest symptoms appear, it is very important to seek help from a qualified specialist who can conduct a full examination and make a correct diagnosis. After all, only in this case will the correct treatment regimen be selected, which will help alleviate the patient’s condition and prevent the disease from progressing to a more severe form.

Activities are aimed at diagnosing the disease

In order to install correct diagnosis The doctor collects the patient’s medical history and complaints, and also prescribes:

1. Study of the functional capacity of the lungs and bronchi by testing vital capacity, determining respiratory rate and using bronchodilators.
2. Spirometry, it is endowed with the ability to determine the number of inhalations and exhalations that a person takes and the volume of the lungs. This test also measures the degree of obstruction.
3. Survey venous blood to oxygen and carbon.
4. Determination of nitric oxide levels in the lungs.
5. An X-ray examination of the chest, the picture of which makes it possible to identify all the pathological symptoms of the disease.
6. Computed tomography, which allows you to determine the size of the lung pockets. The results of this examination allow us to determine the severity of the disease.
7. Sputum examination, general blood and urine analysis. The results of the examinations will indicate the presence of an inflammatory process in the human body in the acute phase.
8. Bronchoscopy. Carrying out this examination is considered justified if there is a suspicion of the presence of a neoplasm.

Treatment

Therapeutic therapy for chronic obstructive bronchitis is aimed at reducing the manifestations of damage to the bronchi and lungs. After all, it is precisely such actions that will reduce the number of cases of exacerbations, prevent the formation of increasing respiratory failure and improve the quality of life of a sick person.

The course of treatment for COB consists of:

1. Measures aimed at expanding the bronchi. For this purpose, anticholinergics are prescribed, which have a bronchodilator effect, beta-2 antagonists - which can somewhat reduce the pathological manifestations of the disease, methylxanthines - which lead to a decrease in vascular resistance and an increase in cardiac output.

To eliminate the manifestations of bronchospasm, Teofedrine, Salmeterol, as well as inhaled medications such as Salbutamol, Berodual are prescribed.

If the need arises, drugs of the glucocorticoid group are used, which do not have any effect on the functioning of the adrenal glands - Pulmicort, Beclomet.

1. Measures aimed at thinning mucus and facilitating its release. For this purpose, the following mucolytic drugs are used: Ambrobene, Mucaltin, ACC, Lazolvan, Flimucil. Quite often, medicinal herbal preparations are used for the same purpose.
2. Anti-infective measures. For this purpose it is prescribed antibacterial drugs broad spectrum of action, namely Erythromycin, Azithromycin or Amoxicillin.
3. Prescription of medications whose action is aimed at eliminating the manifestations of intestinal dysbiosis. This need is explained by the fact that treatment of COB requires the prescription of a large number of medications that negatively affect the condition of the gastrointestinal tract.
4. General strengthening therapy. Vitamin and mineral complexes are prescribed to help strengthen immune system body.

The selection of the correct treatment regimen is considered a very important point, because this will not only improve the general condition of the patient, but also prolong his life, reduce the risk of complications and give him a chance to live a full life.

Characteristic features of COB in children

Although chronic obstructive bronchitis is considered a disease of smokers, unfortunately, it also affects children. Quite often, frequent colds and bronchitis lead to its formation.

This pathological condition is considered especially dangerous for infants. This is explained by the fact that they can only be prescribed a small portion of medications, they are bothered by frequent attacks of suffocation, and it is impossible to collect a complete medical history from them. Therefore, it is very important to consult a doctor in time and not self-medicate in order to avoid the formation of severe complications and even death.

Chronic is considered to be obstructive bronchitis that recurs quite often in a child. According to observations, children under five years of age are considered the most vulnerable to relapse.

Chronic obstructive bronchitis in children can occur due to:

• infectious processes of adenoviral origin;
• mycoplasmosis;
• rhinovirus infection;
• allergies.

Chronic bronchitis in children can also cause the formation of COB.

Treatment of COB should consist of the child taking medications, physiotherapeutic procedures and massage. Treatment in most cases is long-term and can last several months. However, following all the doctor’s recommendations, severe cough and shortness of breath disappear quite quickly. Usually children are prescribed:

• physiotherapeutic procedures – UHF, SUF, electrophoresis;
• mucolytics, haloaerosols and vibration massage;
• inhalation;
• oxygen therapy;
• electrical stimulation of the diaphragm;
• immunomodulators;
• anti-inflammatory drugs.

Please note that chronic bronchitis in children of an obstructive nature leads to the formation of irreversible changes in the lungs, which have a negative impact on the condition and development of the child throughout life, leading to a decrease in the body's resistance and the development of complications.

It is important that if a child begins to be bothered by shortness of breath, a cough with the release of mucous sputum and a bluish tint to the lips, it is necessary to seek help from a doctor as soon as possible, because timely treatment can stop the development of the disease.

Course of COB in adults

Although COB in adults was discussed above, we will try to understand the features of its formation and course in a little more detail.

The most vulnerable category of people is considered to be those over 40 years of age. After all, it is at this age that people begin to be indifferent to their health, which is already undermined by hard work and bad habits.

As for the causes of the disease, the most dangerous contributing factor is considered to be smoking outside in winter, because there is a double burn of the mucous membrane of the respiratory tract with cold air and smoke. Other factors contributing to the development of COB include:

• frequent consumption of excessive amounts of alcoholic beverages;
• decreased body resistance due to a large number of diseases;
• old age;
• diseases of a neurological and mental nature;
• lack of balanced and nutritious nutrition;
• prolonged exposure to stressful situations;
• untreated or improperly treated colds.

In addition to the clinical manifestations of the disease in adults listed above, the following are also added:

• deterioration of memory and memorization as a result of insufficient oxygen supply;
• obesity;
• disorders of the functioning of the cardiovascular system;
• increased blood pressure;
• sleep and falling asleep disorders.

It is very important to start treatment at an early stage of COB, because only in this case can one hope for a positive prognosis.

Prevention

In any case, preventing a disease is much easier than treating it. First of all, you need to give up bad habits, especially smoking. Particular attention should also be paid to maintaining a healthy lifestyle, hardening, and visiting medical and resort institutions. Positive influence There are also walks in the fresh air, sports, cycling and breathing exercises.

Remarkable preventative methods are:

• holiday at sea;
• balanced and nutritious nutrition;
• carrying out timely treatment of respiratory diseases, including infectious ones;
• undergoing annual preventive examinations.

All listed preventive measures help not only prevent the formation of COB, but also reduce the risk of developing severe complications and alleviate the course of the disease.

As a result, it should be noted that, first of all, it is necessary to be especially attentive to your health and the health of your loved ones, if even minor pathological symptoms You should definitely consult a doctor.

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.

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 mucus 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, a violation of 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.

Is obstructive bronchitis contagious or not, and should a person be afraid if he has another attack? In this case, the contagiousness of the disease depends on the cause of the disease - if inflammation in the bronchi develops due to damage to the respiratory organ by viruses or bacteria, the pathology will be considered contagious.

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.

Quiz: How susceptible are you to bronchitis?

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This test will allow you to determine how susceptible you are to bronchitis.

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• You lead a healthy lifestyle and you are not at risk of bronchitis

  You are a fairly active person who cares and thinks about your respiratory system and health in general, continue to play sports, lead a healthy lifestyle, and your body will delight you throughout your life, and no bronchitis will bother you. But do not forget to undergo examinations on time, maintain your immunity, this is very important, do not overcool, avoid severe physical and strong emotional overload.

• It's time to think about what you are doing wrong...

  You are at risk, you should think about your lifestyle and start taking care of yourself. Physical education is required, or even better, start playing sports, choose the sport that you like most and turn it into a hobby (dancing, cycling, gym, or just try to walk more). Do not forget to treat colds and flu promptly, they can lead to complications in the lungs. Be sure to work on your immunity, strengthen yourself, and be in nature and fresh air as often as possible. Do not forget to undergo scheduled annual examinations, treat lung diseases initial stages much simpler than in a neglected form. Avoid emotional and physical overload; if possible, eliminate or minimize smoking or contact with smokers.

• It's time to sound the alarm! In your case, the likelihood of getting bronchitis is huge!

  You are completely irresponsible about your health, thereby destroying the functioning of your lungs and bronchi, have pity on them! If you want to live a long time, you need to radically change your entire attitude towards your body. First of all, get examined by such specialists as a therapist and a pulmonologist; you need to take radical measures, otherwise everything may end badly for you. Follow all the doctors’ recommendations, radically change your life, perhaps you should change your job or even your place of residence, completely eliminate smoking and alcohol from your life, and reduce contact with people who have such bad habits to a minimum, toughen up, strengthen your immune system as much as possible spend more time in the fresh air. Avoid emotional and physical overload. Completely eliminate all aggressive products from everyday use and replace them with natural ones. natural remedies. Do not forget to do wet cleaning and ventilation of the room at home.

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   How often do you undergo a lung examination (eg fluorogram)?

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   Do you play sports?

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   Do you snore?

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   Do you treat acute respiratory infections, acute respiratory viral infections, influenza and other inflammatory or infectious diseases?

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   Do you take care of your immunity?

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   Have any relatives or family members suffered from serious lung diseases (tuberculosis, asthma, pneumonia)?

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   Do you live or work in an unfavorable environment(gas, smoke, chemical emissions from enterprises)?

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   Do you have heart disease?

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   How often are you in damp, dusty or moldy environments?

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    Do you often get sick with acute respiratory infections or acute respiratory viral infections?

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    Do you have any allergic diseases?

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    What kind of lifestyle do you lead?

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    Does anyone in your family smoke?

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    Do you smoke?

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    Do you have air purification devices in your home?

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    Do you often use household chemicals(cleaning products, aerosols, etc.)?

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 make it possible to protect the respiratory organs from dangerous bacteria, viruses and other microorganisms.

In addition, if a person constantly has 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

How to treat obstructive bronchitis? To do this, it is necessary to understand exactly what mechanism of the disease develops in a person - reversible or irreversible.

The reversible mechanism includes:

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

Irreversible mechanisms are:

• tissue changes;
• decrease in 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 the person for a long time does not begin treatment of the disease. How long does obstructive bronchitis last?

If the pathology is properly combated, the disease can be completely cured in 3-6 months. However, for this it is important to strictly follow the doctor’s treatment, as well as perform all procedures, then acute bronchitis will quickly recede and will not cause complications.

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 in 90% of cases it is responsible for the development of the disease. 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 is obstructive bronchitis treated in case of persistent negative influence on lungs of dirty air? In this case, treatment can be carried out throughout your life, maintaining your own condition with medications and procedures. For complete cure If the disease occurs, 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 the body contains insufficient quantity antitrypsin protein, 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 assistance, since the consequences of hereditary form can be disastrous.

The causes of the pathology may be other, but they are observed in the patient quite rarely.

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 persisted and then disappeared, 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. 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 severe cough. If obstructive bronchitis in an adult, the symptoms and treatment of which have not been fully understood by a doctor, is characterized by shortness of breath during exercise, this is not considered chronic course diseases. 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.

To prevent this from happening, any person needs prevention of obstructive bronchitis, which will help to forget about the disease forever. However, if a person again discovers the main symptom of the pathology, it is necessary to treat it with full responsibility.

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. With repeated manifestations of relapses of the disease, the obstruction will no longer be considered acute - which means the patient will need complex treatment.

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 medicines.

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.

During treatment, patients must follow all the recommendations of the attending physician so that bronchitis does not become chronic. If the disease can be transmitted to a healthy person, treatment should be carried out at home.

Urgent Care the patient needs it if there is a danger of complete blockage of the respiratory tract - in this case, than longer person will hesitate, 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 ( negative consequences there is no treatment for this method);
• 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.

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Bronchitis obstructive – a disease characterized by an inflammatory process in the bronchi and lung tissue and the formation of edema. The disease affects the mucous membrane of the upper and middle bronchi, causing spasm and narrowing of the tissues and difficulty breathing. There are acute and chronic obstructive bronchitis. Obstructive bronchitis in children usually occurs before the age of 4 years.

Chronic obstructive bronchitis - a chronic progressive disease based on degenerative-inflammatory non-allergic lesions of the mucous membrane of the tracheobronchial tree, usually developing as a result of prolonged irritation of the airways by harmful agents with restructuring of the secretory apparatus and sclerotic changes in the bronchial wall, characterized by cough with sputum production for at least 3 months. for more than 2 years in a row. The diagnosis is made after excluding others possible reasons prolonged cough.

Types of chronic bronchitis:

• simple (catarrhal) chronic obstructive bronchitis;
• mucopurulent chronic obstructive bronchitis;
• purulent chronic obstructive bronchitis.

Symptoms of obstructive bronchitis:

Symptoms characteristic of obstructive bronchitis are as follows:

• difficulty breathing;
• hypoxia (lack of oxygen);
• dyspnea;
• noises, whistling when breathing;
• paroxysmal cough with sputum production;
• high temperature;
• increased sweating(especially palms);
• arterial hypertension;
• general weakness body.

In young children, active participation of the chest, shoulder body, and abdominal muscles in the respiratory process can be observed.

Signs of chronic obstructive bronchitis:

Chronic cough(paroxysmal or daily, often lasting all day, or occasionally, only at night) and chronic sputum production - at least 3 months for more than 2 years. Expiratory shortness of breath that increases over time, varying over a very wide range - from a feeling of shortness of breath with minor physical exertion to severe respiratory failure, determined even with minor physical exercise and at rest.

Causes of obstructive bronchitis:

• hereditary factor;
• frequent illnesses nasopharynx (ARVI, influenza);
• acute allergic reaction;
• smoking, including smoking by parents in the presence of children;
• unfavorable environmental conditions;
• hypothermia.

Most important factor the risk of chronic obstructive bronchitis is smoking, tobacco smoke, ozone. This is followed by dust and chemicals (irritants, vapors, fumes) in the workplace, residential air pollution from fossil fuel combustion products, ambient air pollution, passive smoking, and respiratory tract infections in early childhood.

Diagnosis of obstructive bronchitis:

To diagnose obstructive bronchitis, a pulmonologist:

• prescribes a general blood and urine test;
• conducts immunological tests;
• listens to the lungs with a phonendoscope;
• performs bronchoscopy;
• conducts examination of sputum and washings of the upper respiratory tract;
• prescribes an X-ray examination of the lungs;
• performs a computed tomography scan of the lungs.

Treatment of obstructive bronchitis:

Treatment of obstructive bronchitis includes:

• antispasmodics;
• bronchodilators;
• non-steroidal anti-inflammatory drugs;
• antipyretic drugs;
• antitussives;
• expectorants;
• inhalation;
• drinking plenty of fluids;
• chest massage.

Treatment tactics for chronic obstructive bronchitis:

When treating chronic obstructive bronchitis, the main thing is to reduce the rate of disease progression.

For simple (catarrhal) chronic obstructive bronchitis, the main method of treatment is the use of expectorants aimed at normalizing mucociliary clearance and preventing the addition of purulent inflammation. As expectorants, you can use drugs of reflex action - thermopsis and epicuan, marshmallow, wild rosemary or resistive action - potassium iodide, bromhexine; or mucolytics and mucoregulators - ambroxol, acetylcysteine, carbocysteine, which destroy mucopolysaccharides and disrupt the synthesis of sputum sialumucins.

In case of exacerbation of chronic obstructive bronchitis, 1-2 weeks antibacterial therapy taking into account antibiograms. Preference is given to new generation macrolide drugs, amoxicillin + clavulanic acid, clindamycin in combination with mucolytics. In case of exacerbations of the disease, antibacterial therapy is prescribed (spiramycin 3,000,000 units x 2 times, 5-7 days, amoxiclav 625 mg x 2 times, 7 days, clarithromycin 250 mg x 2 times, 5-7 days, ceftriaxone 1.0 x 1 time, 5 days). For hyperthermia, paracetamol is prescribed.

After receiving the results bacteriological research Depending on the clinical effect and the isolated microflora, adjustments are made to the treatment (cephalosporins, fluoroquinolones, etc.).

An important place in the treatment of chronic asthma belongs to the methods of therapeutic breathing exercises aimed at improving the drainage function of the bronchial tree and training the respiratory muscles. Physiotherapeutic methods of treatment and therapeutic massage respiratory muscles.

For the treatment and prevention of mycosis during long-term massive antibiotic therapy, itraconazole oral solution 200 mg 2 times a day is used for 10 days.

The basis for the symptomatic treatment of chronic bronchitis is bronchodilators, preferably inhaled - a fixed combination of fenoterol and iprotropium bromide.

The first and most effective method for this is to stop smoking. Any consultations about the dangers of smoking are effective and should be used at every appointment.

It is necessary to exclude risk factors, annual vaccination with influenza vaccine and short-acting bronchodilators as needed.

List of essential medications:

• Ipratropium bromide aerosol 100 doses
• Ipratropium bromide 21 mcg + Fenoterol hydrobromide 50 mcg
• Salbutamol aerosol 100 mcg/dose; tablet 2 mg, 4 mg; nebulizer solution 20 ml
• Theophylline tablet 200 mg, 300 mg tablet retard 350 mg
• Fenoterol aerosol 200 doses
• Salmeterol aerosol for inhalation 250 mcg/dose
• Ambroxol syrup 15 mg/5 ml; 30mg/5 ml; solution 7.5 mg/ml
• Amoxicillin oral suspension 250 mg/5 ml
• Amoxicillin + clavulanic acid 625 mg
• Paracetamol syrup 2.4% in a bottle; suspension; suppositories 80 mg
• Azithromycin 500 mg
• Itraconazole oral solution 150 ml – 10 mg/ml
• Metronidazole 250 mg, tab.

List of additional medications:

• Aminophylline solution for injection 2.4% in ampoule 5 ml, 10 ml
• Beclamethasone aerosol 200 doses
• Fluticasone aerosol 120 doses
• Clarithromycin 500 mg, tablet.
• Spiramycin 3 million units, tab.

Criteria for transfer to the next stage:

• low-grade fever for more than 3 days and purulent sputum;
• increasing respiratory failure and signs of heart failure.

Complications and dangers of obstructive bronchitis:

If treatment for acute obstructive bronchitis is not started in time, the disease can become chronic and cause complications, such as:

• pneumonia;
• acute respiratory failure;
• bronchial asthma;
• formation of chronic pulmonary heart;
• emphysema;
• tuberculosis;
• lung cancer

Possible death.

The risk group includes:

• people susceptible to allergic reactions;
• people with a history of atopic dermatitis;
• people who spend a lot of time in places with polluted air (miners, builders, railway workers);
• smoking people.

Prevention of obstructive bronchitis:

To prevent obstructive bronchitis, patients are recommended to:

• promptly treat diseases of the ENT organs;
• do special breathing exercises;
• strengthen immunity;
• do not smoke in the presence of children;
• ventilate regularly workroom and an apartment.

Unfortunately, many people now suffer from a disease such as bronchitis. We are all sure that it occurs only as a complication after ARVI. However, those who are faced with chronic form, imagine getting rid of this problem in a completely different way. Treatment and symptoms of chronic obstructive bronchitis are slightly different from the acute form. With this degree of the disease, severe obstruction of the respiratory tract is observed. In this form of the disease, treatment has two components: irreversible and reversible.

If treatment measures are not taken thoroughly, then the reversible degree will gradually turn into irreversible over time. COB should not be perceived as a mild disease. In fact, this is a very serious problem that can be accompanied by severe complications. As it progresses, not only inflammation occurs, the disease can also affect the bronchial mucosa. At the same time, their correct ventilation is also disrupted; this complication does not allow sputum to pass away, and often causes attacks of suffocation.

The “Live Healthy” program perfectly describes the features of chronic obstructive bronchitis:

Poor ecology directly affects the development of bronchitis in both adults and children. However, there are many other factors that can cause chronic obstructive bronchitis. Doctors conditionally divide them into several groups:

External provocateurs

• bad habits are one of the most common causes of the development of chronic obstructive bronchitis. It accounts for approximately 95% of cases;
• professional – people who work in organizations with a large number dust and toxic substances. They have a bad effect on the condition of a person’s lungs. Cadmium and silicon are especially harmful. These toxic substances are commonly found in chemical and metallurgical plants;
• constant colds - flu, ARVI, etc.;
• adenoviral infection;
• mononucleosis;
• vitamin C deficiency.

Internal provocateurs

• Hereditary predisposition comes first;
• birth premature - the lungs are able to fully function only at 39 weeks of pregnancy;
• human immunodeficiency virus;
• bronchial asthma;
• bronchial hyperactivity.

Signs of illness

The symptoms of chronic obstructive bronchitis are slightly different from the acute form. The main difference is that the cough does not stop even during remission.

1. After severe bouts of coughing, which is also accompanied by heavy sweating, and suffocation produces only a small amount of sputum.
2. Sometimes blood streaks also appear in the mucus.
3. When bronchitis worsens and coughing attacks become more frequent and intensified, pus is observed in the mucus.
4. In this case, the patient is accompanied by constant shortness of breath, which initially occurs only during physical exertion, and over time even during moments of rest.
5. Breathing in COPD is quite difficult, with characteristic whistling and wheezing.
6. The inhalation becomes much longer than the exhalation. And all because the muscles of the neck, back and even the abs contribute to the expansion of the chest.
7. In severe cases, there is even an enlargement of the veins in the neck, the wings of the nose swell when inhaling, and areas on the chest become sunken.
8. When the body gets tired of fighting the disease, symptoms of respiratory and heart failure begin to accompany the person. A characteristic blue discoloration appears on the nails, in the area of ​​the nasolabial triangle and on the skin. In some patients, swelling of the lower extremities can also be seen.
9. The patient begins to complain of constant fatigue, lack of energy and desire to be active.
10. Some patients even have symptoms of intoxication.

The nature of chronic bronchitis in children

Often, children are affected by an acute form of bronchitis, which can be easily cured with timely treatment. However, it is worth paying special attention to the exacerbation of obstructive bronchitis in children, who are often exposed to acute respiratory viral infections and allergy attacks. And all because there is a risk of developing allergic form diseases and bronchial asthma. The appearance of these diseases provokes frequent relapses.

This is important: It is necessary to closely monitor the child’s well-being, and if a high low-grade fever occurs, attacks of suffocation, or persistent coughing without mucus discharge, you should urgently call a doctor. The best way out is treatment of chronic obstructive bronchitis in the acute stage in an inpatient setting, in a hospital.

Diagnostics

As soon as the first signs of bronchitis appear, you should urgently seek professional medical help. At the first examination, the doctor will be able to accurately diagnose. Since this disease is accompanied by a pronounced clinical picture. Symptoms in adults too , and in children they are always pronounced.

The diagnosis is confirmed by listening to the lungs, in which there are wheezes, their frequency constantly changing when the person clears his throat. In order to rule out pneumonia, tuberculosis or cancer, the doctor recommends undergoing a chest x-ray. The results will show that COPD is characterized by tightening breathing with whistling and wheezing during rapid exhalation. And the number of pulmonary edges becomes smaller, and a boxy sound is observed during percussion. A particularly symptom of emerging heart failure of pulmonary origin is a strong accent of the second sound of the pulmonary artery when listening.

However, many doctors argue that in order to establish an accurate diagnosis of chronic bronchitis, one audition and an x-ray are not enough. To do this, it is necessary to undergo an endoscopic examination, which will accurately indicate the depth and level of reversibility of the inflammatory process.

Types of endoscopic examinations

• spirometry;
• pneumotachometry;
• peak flowmetry;
• bronchoscopy;
• bronchography.

It is also important that the results of other laboratory research, which include:

• blood and urine test (general);
• blood biochemistry;
• immunoassays;
• blood gas composition;
• sputum examination.

You also need to know how to distinguish COB from asthma:

Treatment of chronic obstructive bronchitis

The main thing in the treatment of obstructive bronchitis is to reduce the progress of the disease. This means that it is first necessary to remove the very cause of the disease, which led to a relapse.

Those who smoke should quit this habit. And if you have a harmful profession, then it is advisable to choose another, more suitable one. In order to remove the main signs of the disease, a the whole complex treatment. This includes:

• bronchodilators - it is best to carry out inhalations, and when cases are advanced, the medicine is administered intravenously. To relieve spasm, the doctor will prescribe Eufillin, Berotek, etc.;
• Mucolytic medications are prescribed to reduce the viscosity of mucus and its quantity. To improve the output, you can take ACC or Lazolvan, etc.;
• anti-inflammatory drugs will quickly remove inflammation. And in some cases, even Prednisolone is prescribed.
• Antibacterial drugs are prescribed only when the cause of bronchitis is bacteria.

The course of therapy can last from one week to two. And when chronic obstructive bronchitis subsides, some medications still have to be taken, they facilitate expectoration. You can also do special breathing exercises. It is best to take a course of vitamin therapy.

Forecasts

If chronic obstructive bronchitis has been adequately treated with modern means , then the prognosis is quite favorable. Attacks can be prevented and reduced, and complications avoided. But this is only provided that the treatment regimen was correct and timely. Unfortunately, in old age and when there are many other chronic diseases, the fight against chronic bronchitis becomes more difficult. However, this is not a death sentence, and you still need to be careful and take care of yourself.

Prevention

No matter how strange it may sound, chronic bronchitis can be easily dealt with. To do this, you need to follow a few simple rules:

1. The main prevention of diseases is maintaining a healthy lifestyle.
2. Quitting bad habits (smoking, drinking alcohol).
3. Proper and rational nutrition.
4. Constant walks in the fresh air.

It is also necessary to carry out timely treatment of acute respiratory diseases. And when allergic reactions occur, it is necessary to undergo antihistamine therapy.

This is important: Pay attention to the environment and living conditions accommodation. You need to ventilate the room every day and do wet cleaning at least three to four times a week. It is best to install air humidifiers, since the humidity in the room should not be less than 60%. If COB appears as a result of toxic substances in the environment, it is recommended to change your place of residence or profession.

In conclusion, I would like to say that any disease can be defeated only with proper treatment. And, most importantly, never self-medicate! Coordinate all your actions with your doctor!