obstructive bronchitis - a disease characterized by symptoms: chronic diffuse non-allergic inflammation of the bronchi, manifested cough with phlegm and shortness of breath not related to the involvement of other organs and systems.Obstructive bronchitis is defined by a progressive disruption of the pulmonary ventilation and gas exchange for the obstructive type.In accordance with the definition of WHO experts to patients with symptoms of obstructive bronchitis include people who have a cough for at least 3 months per year for 2 years, to the exclusion of other diseases of the upper airways, the bronchi and the lungs that can cause these symptoms.In this article we will discuss the symptoms of obstructive bronchitis and the main features of obstructive bronchitis in humans.We also tell you about how to identify obstructive bronchitis.
obstructive bronchitis -
symptoms Symptoms of obstructive bronchitis develops gradually, its progression depends on the frequency of exacerbations.For several years, th
Complaints symptoms of obstructive bronchitis
This symptom is cough usually occurs in the morning, during the transition from rest to motion activity, at the exit from a warm room into the cold.Outside bacterial exacerbation of obstructive bronchitis sputum slimy, superinfection with a mucopurulent or purulent symptoms.With the combination of symptoms of obstructive bronchitis with symptoms of systemic arterial hypertension or symptoms of severe emphysema can occur hemoptysis.
Such symptoms as shortness of breath during exercise increases gradually.This symptom of obstructive bronchitis increases with infectious exacerbation of obstructive bronchitis.Gradually, the patient noted expiratory difficulty first symptoms after considerable physical exertion or forced expiratory later under normal loads and even at rest.There are signs of obstructive bronchitis: audible or tangible at applying the palm to the chest distant dry wheezing or whistling.Fluctuations in the degree of dyspnea during the day require the elimination of asthma.
Subfebrile body temperature, fatigue, sweating, and pain in different groups of muscles associated with their overexertion when coughing - symptoms that occur during the infectious exacerbation of obstructive bronchitis.
reasons for the appearance of symptoms of obstructive bronchitis
obstructive bronchitis - polyetiology disease.The leading cause signs of obstructive bronchitis - inhalation of irritants for a long time (tobacco smoke, professional, industrial and domestic air pollutants).By the development of symptoms of obstructive bronchitis predisposes also genetically determined deficiency QI-antitrypsin (is also important for the development of emphysema).Secondary infection (staphylococcus, streptococcus, Haemophilus influenzae, pneumococci, at least - Pseudomonas aeruginosa, Klebsiella, Haemophilus influenzae, influenza viruses, parainfluenza, respiratory syncytial virus, rhinoviruses and mycoplasmas) often causes aggravation and contributes to the progression of obstructive bronchitis.The main factors contributing to the appearance of symptoms of obstructive bronchitis and its progression, also include heart failure, pulmonary embolism, spontaneous pneumothorax, uncontrolled oxygen therapy, long-term use psychosedative means surgery, metabolic disorders (diabetes, electrolyte imbalance, malnutrition), aspiration.
obstructive bronchitis - signs
For obstructive bronchitis is characterized by signs of progressive course.The pathogenesis associated with impaired mucociliary clearance and delayed sputum in the lumen of the bronchi with symptoms of obstructive bronchitis, reduction of local humoral and cellular protection, the development of bronchial obstruction and superinfection.
Violation of mucociliary clearance at the signs of obstructive bronchitis
When symptoms of obstructive bronchitis goblet cell hyperplasia occurs in the composition of mucosal airway epithelium and hypertrophy of mucous glands, which leads to increased formation of mucus.It increases the number of goblet cells in the terminal portion of the respiratory tree, where normally they are very few.Bronchial secretion with symptoms of obstructive bronchitis becomes more viscous and viscous (gel fraction increases).At the same time violated synchronous and undulation of the cilia located on the surface of epithelial cells, which normally provides the removal of mucus from the airways.The viscous glassy secret with symptoms of obstructive bronchitis can completely block the small bronchi.Violation move mucus out of the respiratory tract contributes to its penetration of the surface of alveolar cells, which disrupts the diffusion of gases.Reflex cough symptomatic arises partly improves the patency of the bronchi with obstructive bronchitis, but the increase in sputum capacity for adhesion (sticking) impedes its movement with air shocks (for coughs).Due to the blockade mechanisms mucociliary clearance and destruction of airway epithelium develop local inflammatory reaction in the bronchi and adjacent tissues (development syndrome "bald bronchus", when the mechanism of mucus evacuation practically not functioning).The children of the first years of life with obstructive bronchitis occur overproduction and increasing the viscosity of mucus in combination with edema bronchial mucosa that violates the second and promotes mucociliary clearance of airway obstruction.In older children in the pathogenesis of obstructive syndrome in addition to these factors are important and dyskinesia bronchospasm bronchus with symptoms of obstructive bronchitis.
Violation of local protective reactions of the bronchial mucosa in obstructive bronchitis
Along with slizeobrazovaniem and mucociliary clearance mechanisms to protect also include humoral immunity - Ig, lysozyme, lactoferrin, antiprotease, complement, interferon;cellular link - alveolar macrophages, neutrophils, lymphocytes and lymphoid tissues, with accompanying symptoms of bronchial obstructive bronchitis.Against the background of violations of one or more components of the protective reactions a significant role is played by the infection.Defective functioning of phagocytes in the inflammation in chronic obstructive bronchitis combined with an increase in the number of internally located and extracellular microorganisms.
bronchial obstruction with signs of obstructive bronchitis
bronchial obstruction (bronchial obstruction) - violation of bronchial patency (as opposed to the restriction, which is characterized by decrease in lung volumes).Obstruction of the symptoms of obstructive bronchitis has a reversible and irreversible components.The reversible component due to the contraction of smooth muscles of the bronchi, hypersecretion of bronchial glands and swelling of the bronchial mucosa.The irreversible component of obstruction is associated with the destruction of elastic collagen bases bronchial and peribronchial fibrosis, changes in the shape and obliteration of the bronchioles.Reducing the peak expiratory flow (PEF) with symptoms of obstructive bronchitis account for the loss of elastic recoil ( "return") light, resulting in a drop in pressure in the airways during forced expiration at high intrathoracic pressure.Inflammatory restructuring and reduction of airway smooth muscle increases the resistance to air flow.Violation of the mechanical properties of the respiratory tract increases their ability to collapse as you exhale.The development of this syndrome on the basis of feedback enhances mucociliary disorders, reduces local protection.The circle closes.The disease becomes incurable.
Infectious factor for symptoms of obstructive bronchitis
viral and bacterial infections is secondary in determining obstructive bronchitis.The accumulation of the increased viscosity of the mucus, reducing the body's defenses, bronchial obstruction promote the downward spread of infection of the upper respiratory tract and exacerbation of the disease.
How to identify obstructive bronchitis
Definition obstructive bronchitis - patomorfologija
Since the early symptoms of obstructive bronchitis in small airways is formed metaplasia goblet cells, reducing the number of ciliated cells and impaired function of the cilia, there are exposure of the wall of the bronchus (syndrome "bald bronchus"), inflammation of the respiratory bronchioles, wall edema, hypertrophy of smooth muscle and peribronchial fibrosis.Restructuring airway wall with symptoms of obstructive bronchitis is a consequence of the increase of the submucosa and adventitia (edema, deposition of proteoglycans, collagen), hyperplasia of the secretory cells.
How to identify obstructive bronchitis - differential diagnosis
Diagnostics signs of obstructive bronchitis carried out on the basis of exclusion of other diseases.It is necessary to carry out bacteriological examination of sputum for the exclusion of pulmonary tuberculosis with symptoms of obstructive bronchitis.Bronchial obstruction in the determination of obstructive bronchitis usually develops at an obstructive bronchitis and bronchial asthma.In bronchial asthma, especially when the initial symptoms in between attacks during the parameters of external respiration is usually not modified or changes are largely reversible inhaled beta2-Adrenomimeticalkie funds.When obstructive bronchitis symptoms of bronchial obstruction are constantly during the exacerbation of the disease they are amplified (but not in the form of acute attacks), and after treatment gradually weaken (in a few weeks or months), but rarely disappear.
During an exacerbation chronic obstructive bronchitis differentiate from pneumonia, bronchiectasis, left ventricular failure, lung cancer, pulmonary embolism.
definition of chronic obstructive bronchitis
On examination, the patient with suspected obstructive bronchitis a long time do not show any symptoms and features.Only with the development of emphysema reveal a barrel chest, participation in the breath auxiliary muscles, cyanosis, jugular vein, changing the form of nails ( "hour glass").
physical signs of obstructive bronchitis are increasing as the disease progresses.Voice tremor symmetrical, with the development of emphysema is weakened.Percussion of the lungs in the early stages of obstructive bronchitis detects lung sounds.With the progression of obstructive bronchitis gradually boxed percussion sound occurs, which corresponds to the development of emphysema.Percussion border of light moved down, it decreases the mobility of the lower edges of the lungs.Auscultation of the lungs reveals a sign of how rigid breathing in the early stages of chronic obstructive bronchitis.With the increase of bronchial obstruction appear wheezing, especially clearly audible during forced expiration and after exercise.Severe obstruction is accompanied by a characteristic symptom of lengthening the duration of exhalation.Crackles with obstructive bronchitis reflect the accumulation of mucus in the airways.When coughing patient tone or the number of wheezing usually changes.Auscultation of the heart when srednetyazhёlom and heavy course of chronic obstructive bronchitis can identify the accent and sometimes splitting II tone of the pulmonary artery.
Using questionnaires in determining obstructive bronchitis
basis of early diagnosis of obstructive bronchitis is the use of questionnaires in the prophylactic examination of the population.In the presence of a productive cough for at least 3 months per year for 2 consecutive years in the absence of other diseases that can cause these symptoms, it is necessary to identify the patient examination or eliminate chronic obstructive bronchitis.
ERF study in determining obstructive bronchitis
necessary criteria for determining the signs of obstructive bronchitis - an objective documentation of the obstruction of the respiratory flow in the functional study of the lungs.Definitive diagnosis of obstructive bronchitis necessary tools proven to reduce Tiffno index up to 70% or below.Under normal values of pulmonary ventilation parameters exclude the diagnosis of chronic obstructive bronchitis (in the presence of other clinical signs of bronchitis should be diagnosed simple or obstructive chronic bronchitis).
Normal values of lung ventilation parameters during the second examination exclude the diagnosis of obstructive bronchitis.Parameter estimation by forced expiratory "flow-volume" curve to determine the prevalence of obstruction of large or small bronchi, the presence of generalized obstruction or functional signs of emphysema when the symptoms of obstructive bronchitis.Fluctuations parameters bronchial obstruction during the day more than 20% are not typical symptoms of obstructive bronchitis and more typical of asthma.
If any broncho-obstructive syndrome is recommended by acute inhalation test with bronchodilator, used to determine the reversibility of obstruction (usually up to 15%).With the dramatic growth and PSV OFVg after inhalation of one of these drugs should be suspected asthma.The study of acid-base balance and blood gas with symptoms of obstructive bronchitis allows you to objectively diagnose the degree of respiratory failure.
chest X-ray to determine obstructive bronchitis
This study obstructive bronchitis is carried out in the first place to avoid local or disseminated lesions of the lung, identify comorbidities.When symptoms of uncomplicated obstructive bronchitis on plain film changes in the lungs are not available.As the process progresses, usually after 2-3 years, there is a growing pulmonary pattern, the deformation of the lung roots, thickening of the bronchial walls, signs of emphysema.
Bronchography for symptoms of obstructive bronchitis
This study is the determination of obstructive bronchitis carried out only if you suspect the presence of bronchiectasis.When signs of obstructive bronchitis on bronchograms can be cylindrical bronchiectasis on inspiration, their spadenie forced expiratory and enlarged ducts of the mucous glands.Before bronchography advisable to conduct therapeutic and diagnostic bronchoscopy, and if necessary - transbronchial rate readjustment of the bronchial tree (therapeutic bronchoscopy).
high-resolution CT (non-invasive procedure) has become an alternative bronhografii in recent years.
of chronic obstructive bronchitis
There are two options for the development of obstructive bronchitis - for blackleg and bronhiticheskomu type.
Emphysematous type (type A, "odyshechny type") - signs
Patients with this type of symptoms of obstructive bronchitis called "pink pyhtelki" (so named because in the background of severe shortness of breath does not develop cyanosis).The clinical picture is dominated by symptoms of emphysema.Symptoms appear in the older age groups (usually after 60 years): progressive shortness of breath with exertion, loss of body weight, slight cough and sputum (may be absent).When you extend the functionality of the study reveal a sharp increase in the residual volume of the lungs.Radiological signs of emphysema is determined at obstruitivnom bronchitis.Hypoxemia, pulmonary hypertension and right ventricular failure developed only in the late stages.Characteristically slowly progressive course.