Bronchitis with obstructive syndrome. Obstructive bronchitis is a serious obstacle to breathing

Obstructive bronchitis- an inflammatory disease that affects the bronchi and is complicated by obstruction. This pathological process is accompanied by severe edema respiratory tract, as well as a deterioration in the ventilation capacity of the lungs. Obstruction develops more rarely; doctors diagnose non-obstructive bronchitis several times more often.

This disease is the “prerogative” of young children starting from the age of 3. It is more rare in people of working age.

Causes

Obstructive bronchitis in children and adults most often begins to progress due to the penetration of infection into the body - viruses or bacteria. But in order for pathology to begin to develop, favorable conditions are also needed. The following factors contribute to the development of obstructive bronchitis in adults and children:

• decrease in the body's immune forces;
• inadequate and irrational nutrition;
• frequent diseases of the upper respiratory tract;
• stressful situations that are repeated repeatedly.

The second reason for the development and progression of the disease is an allergic reaction. If a child is prone to allergies, then the likelihood of developing chronic obstructive bronchitis increases.

Chronic obstructive bronchitis is a disease that most often begins to progress in people who smoke for a long time, work in production with various chemicals. substances and so on.

It is also worth highlighting internal factors that contribute to the development of obstructive bronchitis in adults and children:

• second blood group;
• hereditary deficiency of immunoglobulin A;
• deficiency of the enzyme alpha1-antitrypsin.

Stages

The severity of chronic obstructive bronchitis in an adult or child is assessed by FEV1, which stands for the volume of forced expiration produced in one second. There are three degrees of severity of the disease:

• Stage 1. FEV1 is more than 50% of normal values. At this stage, chronic obstructive bronchitis does not worsen the patient’s quality of life. There is also no need to constantly be registered with a pulmonologist;
• Stage 2. FEV1 is reduced to 35–49%. In this case, the pathology affects the patient’s quality of life, so he needs to be systematically monitored by a pulmonologist;
• Stage 3. FEV1 less than 34%. The symptoms of the pathology are very pronounced. Patients should undergo treatment as an inpatient or outpatient in a pulmonary department.

Symptoms

Symptoms of obstructive bronchitis in children and adults are somewhat different. They largely depend on the severity of the pathology, the functioning of the immune system, as well as on the characteristics of the patient’s body.

Symptoms of the disease in adults

It is worth noting that acute obstructive bronchitis mainly affects children under five years of age, while in adults, symptoms appear only when the acute course becomes chronic. But sometimes primary acute obstructive bronchitis can begin to progress. As a rule, this occurs against the background of acute respiratory infections.

Symptoms:

• temperature increase;
• dry cough. It usually develops in attacks, worsening in the morning or at night;
• the respiratory rate per minute increases up to 18 times. For a child this figure will be slightly higher;
• During exhalation, wheezing sounds are observed, which can be heard even at a distance.

If the above symptoms persist for three weeks, then in this case doctors say that acute obstructive bronchitis has developed. If this condition recurs more than three times in a year, we will be talking about a recurrent form of the disease. But if the symptoms do not disappear within 2 years, then clinicians talk about the development of chronic obstructive bronchitis. In this case, the main clinical picture is supplemented by the following symptoms:

• headache. Occur due to hypoxia;
• cough in morning hours. Usually during it, sputum of a mucous or purulent nature is released;
• in severe cases of chronic obstructive bronchitis, hemoptysis may be observed;
• dyspnea;
• sweating;
• changes in the appearance of fingers and nails;
• increased fatigue.

Symptoms of the disease in children

Obstructive bronchitis in children usually occurs in an acute form. Risk group: children under 5 years of age. And it is possible that obstructive bronchitis may develop in an infant. There is one peculiarity - in a child, the symptoms of acute obstructive bronchitis are difficult to distinguish from bronchiolitis, so it is very important that the doctor conducts a competent differential diagnosis.

The development of acute obstructive bronchitis in children usually occurs due to the penetration of a viral infection into the body: adenovirus, etc. The pathology in a child is much more severe and complex. At first, you can note symptoms that are more indicative of development: the child is capricious, the temperature rises, and a slight cough appears.

The following symptoms indicate that acute obstructive bronchitis has begun:

• body temperature rises again;
• the cough is not productive and manifests itself in attacks;
• wheezing is observed when exhaling;
• increased breathing rate above the age norm (it is especially important to pay attention to this symptom when obstructive bronchitis develops in an infant);
• several elements of the body take part in the act of breathing at once - intercostal spaces, wings of the nose, jugular fossa, etc.;
• drowsiness or, conversely, constant anxiety;
• weak cry;
• the child refuses to eat.

Diagnostics

Diagnosis of acute and chronic obstructive bronchitis includes physical, endoscopic, laboratory, functional and radiological techniques. The program includes:

• percussion of the lungs;
• auscultation of the lungs;
• X-ray;
• spirometry;
• pneumotachometry;
• peak flowmetry;
• bronchography;
• sputum analysis by PCR;
• immunological tests.

The doctor will be able to tell how to treat obstructive bronchitis only after he has assessed the test results and identified the cause of the development of the pathology, as well as the severity of its course.

Treatment

Treatment of obstructive bronchitis requires a very long period of time and should only be carried out in a hospital setting. Therapy for an adult and a child is somewhat different. When drawing up a treatment plan for obstructive bronchitis, everything is taken into account - the characteristics of the pathology, the degree of FEV1, the general condition of the patient’s body, and age.

Treatment in adults

In order for the treatment of obstructive bronchitis in adults to be as effective as possible, it is necessary:

• eliminate the harmful factor that contributed to the progression of the disease - this could be an unfavorable place of work or smoking;
• stick to a diet;
• During the period of exacerbation, antibacterial drugs are added to the treatment plan for obstructive bronchitis. This is especially true in the case of purulent sputum. The drugs of choice are Sumamed, Amoxil;
• take bronchodilators;
• medications are prescribed that help thin sputum and remove it;
• vibration massage is indicated.

Treatment in children

Treatment of obstructive bronchitis in a child is carried out strictly in a hospital setting. Especially when it comes to babies. The treatment plan for a child’s illness includes the following measures:

• carrying out inhalations using a nebulizer. As a rule, a saline solution with the addition of Ventolin, Berodual and other drops is used;
• It’s important to drink a drink a day sufficient quantity liquids;
• Only a doctor prescribes antibiotics to treat a child. Self-medication is unacceptable, as it can only worsen the course of the pathology;
• during the period of bronchial blockage, it is strictly forbidden to give expectorants;
• in more severe clinical situations, they resort to placing a dropper in the child with saline solution and the addition of active substances.

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Diseases with similar symptoms:

Pneumonia (officially pneumonia) is an inflammatory process in one or both respiratory organs, which is usually infectious in nature and is caused by various viruses, bacteria and fungi. In ancient times, this disease was considered one of the most dangerous, and although modern treatments make it possible to get rid of the infection quickly and without consequences, the disease has not lost its relevance. According to official data, in our country every year about a million people suffer from pneumonia in one form or another.

Obstructive bronchitis is the most common disease that affects the respiratory system. Today, bronchitis with obstruction is diagnosed in every 4 patients suffering from of 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 develops into chronic form, it will be very, very difficult to cure him. 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.

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

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

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

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

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

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

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

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 inflammation of the bronchi can only be missed by minimal amount of people.

Quiz: How susceptible are you 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; it is much easier to treat lung diseases in the initial stages than in advanced stages. 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 specialists such 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 immunity 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, natural remedies. Don't forget to make it at home wet cleaning and ventilation of the room.

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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 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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    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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    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 allow it to protect the respiratory system from dangerous bacteria, viruses and other microorganisms.

• 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.

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

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

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

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

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.

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

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 delivering discomfort 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.

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 mucus and clots of secretion. In older people, blood can be found in it.
2. Heat. 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. 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 high temperature.
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 strong cough. If obstructive bronchitis in an adult, the symptoms and treatment of which have not been fully studied by a doctor, is characterized by shortness of breath with physical exercise, this is not a chronic course of the disease. But if shortness of breath affects the patient even at rest, this indicates the development of an advanced form, which needs to be treated as the diagnosis is carried out.
5. Acrocyanosis. This is a blue discoloration of the fingers, nose and lips. If the patient still has a fever, the obstruction will only be relieved after 2-4 months of treatment. In this case, this symptom may constantly disappear and appear again.

Additional symptoms of the disease include:

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

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

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

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

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

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

• adrenergic receptors (Terbutaline, Salbutamol) - these drugs increase the bronchial lumen and also allow you to remove unpleasant symptoms illness (you need to take such medications for more than one day to achieve quick treatment results);
• 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.

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

• 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.

• 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 folk remedies– many people are interested in the question of whether it is possible to get rid of bronchitis folk ways and what consequences such treatment entails: in fact, this method of treatment is considered one of the most effective and efficient.

If it reappears, 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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• Congratulations! You are completely healthy!

  Your health is fine now. Don’t forget to take good care of your body, and you won’t be afraid of any diseases.

• There is reason to think.

  The symptoms that are bothering you are quite extensive, and are observed in a large number of diseases, but we can say with confidence that something is wrong with your health. We recommend that you consult a specialist and undergo a medical examination to avoid complications. We also recommend that you read the article on detection and treatment of bronchitis.

• You are sick with bronchitis!

  In your case there are clear symptoms bronchitis! However, there is a possibility that it could be another disease. You need to urgently contact qualified specialist, only a doctor can make an accurate diagnosis and prescribe treatment. We also recommend that you read the article on detection and treatment of acute bronchitis.

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Diseases in which breathing is impaired are the most common in pediatric practice. The leading symptom of such diseases is cough. A pronounced narrowing in the bronchi can lead to it.

What it is?

With obstructive bronchitis, severe narrowing of the bronchi occurs - obstruction. This condition is caused by numerous causes and provoking factors. As a result of obstruction, breathing is impaired. A few days after the onset of the disease, all symptoms begin to progress, which leads to a deterioration in the baby’s condition.

The bronchial tree is covered with microscopic cilia. They are found on the surface of the cells that form the bronchi. After exposure to provoking factors, the movements of the cilia are disrupted, which also contributes to impaired sputum discharge and increases obstruction.

Causes

Any bronchitis develops only after exposure to various provoking factors on the child’s body. There are quite a few of them a large number of. They are especially dangerous for newborns and infants.

The immunity of children of the first year has not yet fully formed. Any agent foreign to the child’s body can cause severe inflammation in the bronchi. This immediately leads to bronchial obstruction.

Reasons that can cause the disease include:

Viral infections. The most common culprits of the disease: influenza and parainfluenza viruses, MS virus, adenoviruses. They easily penetrate the baby's upper respiratory tract and quickly spread through the bloodstream, reaching the bronchi and lungs. Viral infections are the leading cause of bronchial obstruction in babies in the first months of life.

Bacteria. Streptococci, staphylococci and moraxella are the most common reasons, which can cause bacterial forms of the disease. These microorganisms contribute to the development of severe inflammation, which leads to a pronounced narrowing of the lumen of the bronchi. The disease caused by bacterial flora has a more severe course and requires intensive care.

Allergies. When an allergen enters the body, the immune system is activated. This contributes to a large release of various biologically active substances into the blood, which strongly spasm the bronchi. Against the background of allergies, breathing is significantly impaired and shortness of breath increases.

Inhalation of polluted air. Living near large industrial enterprises or factories, the baby has a higher risk of bronchial obstruction. This occurs as a result of constant exposure to tiny particles toxic substances into the small bronchi. Industrial emissions quickly lead to the development of breathing problems.

Prematurity. In the third trimester of pregnancy, the final formation of the respiratory organs of the unborn baby occurs. This process occurs almost until the days of birth. If for some reason the child is born earlier, then the risk of underdevelopment of the respiratory organs increases several times. Such an anatomical defect often leads to impaired respiratory function.

Quick cessation of breastfeeding. Children who have been breastfed for a very short time have a higher risk of developing bronchitis. To fight various infections you need good level immunity. During breastfeeding, babies receive large amounts of immunoglobulin G. These protective antibodies help them not to get sick during seasonal colds and protect them from the development of diseases of the bronchopulmonary system.

How does it arise?

The influencing provoking factor leads to the development of severe inflammation. Most viruses and bacteria enter the body through the upper respiratory tract. Settling on the epithelial cells lining the respiratory organs, they begin to have a strong toxic effect.

The incubation period varies and depends on the characteristics of the specific microorganism that causes the disease. On average, it is 7-10 days. At this time, the child does not make any complaints. There are no specific signs of the disease during the incubation period. Only weakened children may feel a little tired and drowsy.

After the end of the incubation period, the first specific symptoms characteristic of this disease appear. An active inflammatory process occurring in the bronchial tree contributes to disruption of the discharge of mucus and sputum.

In children who have anatomical defects in the structure of the bronchi, very narrow clearance bronchi. Bronchial obstruction in such children develops much more often and is much more severe.

Kinds

The course of diseases accompanied by bronchial obstruction may be different. This depends on the initial state of the baby’s immunity, the features of the anatomical structure of the respiratory system, as well as the cause that caused the disease.

According to the frequency of occurrence, all obstructive bronchitis can be divided:

Spicy. These variants of the disease are appearing for the first time. They last, on average, 1-2 weeks. After the therapy, the baby is completely cured.

Chronic. May be recurrent. They occur with periods of exacerbations and remissions. If the treatment is not of sufficient quality or the baby has concomitant diseases acute forms become chronic.

By severity:

Lungs. Occurs with minimally expressed symptoms. They are treated well. After the therapy, the babies fully recover. There are no long-term consequences of the disease.

Average. The cough is more severe, annoying. Body temperature with moderately severe obstructive bronchitis rises to 38 degrees. Shortness of breath may increase. The child's general condition suffers greatly. In some cases, hospitalization and more intensive therapy are required.

Heavy. Leaks from pronounced violation general condition and well-being of the baby. Body temperature rises to 38.5-39.5 degrees, severe shortness of breath, accompanied by signs of respiratory failure. Treatment is carried out only in a children's hospital, and if cardiopulmonary failure develops, in the intensive care unit.

Symptoms

Narrowing of the bronchial lumen and impaired sputum discharge lead to the child developing specific signs of the disease:

Cough. Appears 2-3 days after the end of the incubation period. A hacking cough bothers the baby more during the daytime. May be paroxysmal.

Dyspnea. Occurs in moderate to severe disease. With shortness of breath, the number of respiratory movements per minute increases. Babies breathe more often. This symptom can be seen from the outside, paying attention to the movements of the chest during breathing.

Pain in the chest when coughing up. With bronchial obstruction, the sputum becomes very dense and thick. All attempts at coughing lead to increased pain in the chest area.

Increased body temperature. It increases to 37-39.5 degrees. Bacterial forms of the disease are accompanied by a higher temperature.

Blue discoloration of the nasolabial triangle. The skin in this area of ​​the face is very thin and sensitive. A pronounced decrease in the level of oxygen in the blood leads to the development of acrocyanosis (blue discoloration) of this area. Against the background of a pale face, the nasolabial triangle contrasts strongly.

Poor nasal breathing and redness of the pharynx. These secondary signs occur with viral and bacterial infections and often appear in a child with obstructive bronchitis.

Severe drowsiness and poor health. Sick children refuse to eat and begin to act up. Little children are more willing to be held. Prolonged coughing attacks lead to the baby starting to cry.

Thirst. It appears during severe intoxication of the body. The more severe the disease, the more clearly this symptom manifests itself in the baby.

Active movements of the ribs during breathing. Breathing movements have a large amplitude and become visible from the side.

Loud breathing. During breathing movements, bubbling sounds are heard. They arise as a result of the passage of air through tightly closed bronchi.

Diagnostics

At the first appearance of signs of bronchial obstruction, the child should be shown to a pediatrician. The doctor will conduct a clinical examination and recommend additional examinations. Such tests are needed to determine the severity and cause of the disease.

To diagnose obstructive bronchitis, use:

General blood analysis. An increase in the number of leukocytes and an accelerated ESR indicate the presence of an inflammatory process. Changes and shifts in the leukocyte formula make it possible to clarify the viral or bacterial nature of the disease.

Biochemistry of blood. Allows you to identify the presence of complications that develop with respiratory pathology. Also used for differential diagnosis.

X-ray of the chest organs. This method is used in children older than one year. This study allows you to determine the degree of narrowing of the bronchi, as well as identify concomitant lung diseases.

Spirometry. Helps assess functional impairment. Indications of forced inhalation and exhalation allow doctors to draw a conclusion about the presence and severity of bronchial obstruction.

Specific laboratory tests to identify allergens. Necessary to establish the cause of bronchial obstruction in children with an allergic form of the disease.

Differential diagnosis

Narrowing of the lumen of the bronchi occurs not only with obstructive bronchitis. Bronchial obstruction syndrome may occur with various diseases. In order to correctly establish a diagnosis, differential diagnosis is required.

Most often, obstructive bronchitis can be confused with:

Stenosing laryngotracheitis. Most often caused by viruses. It usually occurs 3-4 days after the onset of a viral infection. Characterized by the appearance barking cough and severe shortness of breath.

Obliterating alveolitis. With this disease, the inner epithelial layer of the bronchi grows, which leads to the appearance and accumulation of foamy sputum. Usually the cough is paroxysmal. Often the disease leads to various complications.

Acute bronchitis. The symptoms are similar. Only spirometry can accurately establish the correct diagnosis.

Cystic fibrosis. This disease is congenital. Typically, children develop poorly and lag behind their peers in physical development. During an exacerbation, a severe cough appears with difficult to clear and very viscous sputum. The course of the disease is quite severe. The disease requires systemic treatment.

Consequences and complications

Frequent obstructive bronchitis can lead to the development of persistent breathing problems in children. With reduced immunity, the baby experiences new exacerbations over a relatively short period of time.

Poorly performed treatment or untimely diagnosis of the disease contribute to the development of complications in the future. Persistent bronchial obstruction can lead to the development of bronchial asthma, especially if the narrowing of the bronchial lumen is caused by allergies.

Prolonged and persistent cough contributes to the formation of bronchiectasis. With this pathology, the distal sections of the bronchi expand with the formation of additional cavities. Bronchiectasis contributes to the appearance of shortness of breath with increasing respiratory failure. Surgery is performed to eliminate this condition.

During an exacerbation of obstructive bronchitis caused by bacterial infection, the inflammatory process may spread to the lungs.

In this case, pneumonia or abscesses appear. They, in turn, lead to a deterioration in the baby’s well-being. Intensive antibiotic therapy is required to eliminate purulent formations.

Treatment

To eliminate the unfavorable symptoms of the disease, various methods of therapy are used. After examining the child and establishing a diagnosis, the pediatrician will recommend a specific treatment regimen, which is provided for in clinical guidelines. These medical developments contain the necessary algorithm for doctors’ actions when identifying a specific pathology.

Obstructive bronchitis should be treated from the first days after the onset of symptoms. Early prescription of medications helps to cope with all the adverse manifestations of the disease and prevent chronicity. Medicines that eliminate bronchial obstruction and promote better mucus discharge are prescribed by the attending physician.

For the treatment of obstructive bronchitis use:

• Agents with mucolytic effects. They help thin thick mucus and facilitate its easier passage through the bronchopulmonary tree. Preparations based on ambroxol are widely used in pediatric practice. "Ambrobene", "Lazolvan", "Flavamed" help eliminate even a severe cough. Prescribed according to age, 2-3 times a day for 7-10 days.
• Antipyretic. Prescribed when the temperature rises above 38 degrees. Used in children various means based on paracetamol. Not prescribed for long-term use. May cause allergic reactions and side effects.
• Bronchodilators. P Designed to eliminate blockage in the bronchi and improve breathing. They are usually prescribed in the form of aerosols or inhalations. The effect is achieved in 10-15 minutes. Short-acting bronchodilators based on salbutamol act within 5 minutes.
• Combined drugs containing bronchodilators and anticholinergic drugs. To improve bronchial conduction in children, “Berodual” is used. Prescribed by inhalation. The dosage and frequency of inhalations is carried out taking into account the age of the child. Usually the drug is prescribed 3-4 times a day.
• Antihistamines. Helps cope with adverse symptoms of allergic forms of the disease. In children, drugs based on loratadine, Claritin, and Suprastin are used. Prescribed 1-2 times a day, usually in the first half of the day. Discharged for 7-10 days. For more severe cases - for 2-3 weeks.
• Vitamin complexes enriched with selenium. These substances are needed to combat intoxication. The biologically active components that are present in the vitamin complex help the baby fight infection and improve the functioning of the immune system. Selenium is needed for the active functioning of the immune system.
• Glucocorticosteroids. Used for severe and long term diseases. Pulmicort inhalations are usually prescribed. The drug is prescribed for long-term use. Apply 1-2 times a day until stable good result. May cause side effects with long-term use.
• Leukotriene receptor blockers. Helps quickly eliminate bronchospasm. They have a lasting effect. The drug "Singulair" begins to have an effect within 2 hours after administration. Apply once a day.

Treatment at home

You can help your child cope with the disease not only with the help of medicines and pills. The use of medicines prepared at home also helps to eliminate a persistent cough and improve the child’s well-being.

Methods that are safe and effective for self-use include:

Warm, plenty of drink. Alkaline mineral waters heated to a temperature of 40-45 degrees are perfect. They are prescribed 20 minutes before or an hour after meals, 3-4 times a day. The course of treatment is 7-10 days. You can use “Essentuki” or “Borjomi”.

Liquorice root. This wonderful remedy improves mucus discharge and promotes better expectoration. It should be used with caution, keeping in mind possible allergic reactions. Works great even with a strong cough.

Breast fees. The composition of such pharmaceutical preparations includes several medicinal plants that have expectorant and anti-inflammatory effects. Licorice, coltsfoot, and sage help relieve coughs and improve bronchial conduction.

Radish juice. To prepare such a homemade medicine, ordinary black radish is suitable. To prepare 250 ml of drink, you only need 1 teaspoon of juice. Before use, add honey to taste.

Breathing exercises

It is used after the acute process has subsided. Typically, such gymnastics is carried out 5-6 days after the onset of the disease. The correct sequence of breathing movements helps normalize the functioning of the respiratory system and cope with adverse symptoms.

In order to improve the outflow of mucus, when performing breathing exercises, a sharp and short breath is taken. Exhale – quite slow and smooth. While exhaling, you should count to 5. Each set of exercises consists of 3-4 repetitions. It is recommended to practice every day. Even during remission, breathing exercises will be very useful.

How to conduct breathing exercises see more details in the video below.

Nutrition

The diet of a baby suffering from bronchial obstruction must be complete and contain all the necessary nutrients and vitamins.

Breastfeeding in acute period the disease should not be canceled. Together with mother's milk, the baby receives all the necessary protective antibodies that help him fight the infection that causes bronchitis.

Older children should eat small meals, at least 5-6 times a day. A child's diet should include a variety of protein products. It is better that your baby receives some source of protein with each meal. Veal, rabbit, chicken or fish are perfect.

Try to choose leaner varieties. Fatty foods take longer to be absorbed by a weakened child's body. You can supplement proteins with cereals and vegetables. Fresh ones also work well as protein dishes. dairy products. They make a great afternoon snack or second dinner.

All dishes are best steamed, baked or stewed. They should have a more liquid consistency. For babies younger age Fruit and vegetable purees are perfect. It is not necessary to give your child foods from jars. Good choice There will be mashed cauliflower or potatoes, prepared at home.

The baby must drink enough liquid. As drinks you can use compotes, various fruit drinks and juices made from fruits and berries. Frozen fruits are also suitable for preparing healthy decoctions. Try to give your child more boiled water. This will help eliminate the adverse symptoms of intoxication.

Strengthen your immune system. Active walks in the fresh air, good nutrition and proper daily routine contribute to normal operation immune system.

Treat inflammatory diseases of the upper respiratory tract in a timely manner. Children suffering from chronic otitis media or sinusitis are more likely to develop obstructive bronchitis in the future. To prevent this, regularly visit an otolaryngologist with your child.

Use special room humidifiers. Too dry air contributes to breathing problems. Room humidifiers help create a comfortable and physiologically favorable microclimate in any room.

Diseases of the bronchopulmonary system are more often diagnosed in children in age group from 8 months to 6 years. Important role plays a role in the development of this pathology hereditary factor, the child’s exposure to helminthic infestations, bacterial and viral infections. With a disappointing diagnosis of chronic obstructive bronchitis, children still have a chance to avoid serious consequences. Effective treatment consists of eliminating the inflammatory reaction in the bronchi, restoring their normal patency, and using bronchodilators and expectorants.

Infants are characterized by poor development of the upper respiratory tract, bronchi and lungs. The glandular tissue of the inner walls of the bronchial tree is delicate, susceptible to irritation and damage. Often, with diseases, the viscosity of mucus increases, and the cilia cannot evacuate thick mucus. All this should be taken into account before treating obstructive bronchitis in a child with medications and home remedies. It must be remembered that the severity of the disease in babies is influenced by the intrauterine infections they have suffered, ARVI in infancy, underweight, allergies.

The most important causes of bronchitis with obstruction in children:

• viruses - respiratory syncytial, adenovirus, parainfluenza, cytomegalovirus;
• ascariasis and other helminthiasis, migration of helminths in the body;
• structural anomalies of the nasal cavity, pharynx and esophagus, reflux esophagitis;
• microorganisms - chlamydia, mycoplasma;
• weak local immunity;
• aspiration.

The inflammatory process in obstructive bronchitis causes swelling of the mucous membrane, resulting in the accumulation of thick sputum. Against this background, the lumen of the bronchi narrows, and a spasm develops.

Viral infection has the greatest influence on the occurrence of obstructive bronchitis in children of all ages. Environmental factors and climatic anomalies also play a negative role. The development of obstructive bronchitis in infants can occur against the background of early refusal of breast milk, transition to mixed or artificial feeding. Bronchial spasms occur in infants even when drops and pieces of food frequently enter the respiratory tract. Migrations of helminths can cause bronchial obstruction in children over 1 year of age.

Among the reasons for the deterioration of the bronchial mucosa, doctors name bad environmental situation in places where children live, parents smoking. Inhaling smoke disrupts the natural process of cleansing the bronchi from mucus and foreign particles. Resins, hydrocarbons and other smoke components increase the viscosity of sputum and destroy the epithelial cells of the respiratory tract. Problems with the functioning of the bronchial mucosa are also observed in children whose parents suffer from alcohol addiction.

Obstructive bronchitis - symptoms in children

The bronchial tree of a healthy person is covered from the inside with mucus, which is removed along with foreign particles under the influence of miniature outgrowths of epithelial cells (cilia). Typical obstructive bronchitis begins with attacks of dry cough, for acute form Characterized by the formation of thick, difficult to separate sputum. Then shortness of breath occurs due to the fact that the inflamed mucous membrane thickens in the inflamed bronchi. As a result, the lumen of the bronchial tubes narrows and obstruction occurs.

Manifestations of bronchial obstruction syndrome in children:

• first, catarrhal processes develop - the throat becomes red, painful, and rhinitis occurs;
• when breathing, the intercostal spaces, the area under the sternum, are drawn in;
• it is difficult to breathe, shortness of breath, noisy, rapid, wheezing occurs;
• suffers from a dry cough that does not turn into a productive (wet) cough;
• low-grade fever persists (up to 38°C);
• attacks of suffocation periodically develop.

Wheezing and whistling in the lungs of a child with obstructive bronchitis can be heard even from a distance. The frequency of breaths is up to 80 per minute (for comparison, the average rate in 6–12 months is 60–50, from 1 year to 5 years – 40 breaths/minute). Differences in the course of this type of bronchitis are explained by the age of young patients, metabolic characteristics, and the presence of hypo- and avitaminosis. The serious condition in weakened babies can last up to 10 days.

With a recurrent course of the disease, repeated exacerbation of symptoms is possible. Against the background of ARVI, the mucous layer is irritated, the cilia are damaged, and the patency of the bronchi is impaired. If we are talking about an adult, then doctors talk about chronic bronchitis with obstruction. When young children and preschoolers get sick again, experts cautiously declare the recurrent nature of the disease.

Bronchial obstruction occurs not only with bronchitis

The main symptoms and treatment of obstructive bronchitis in children differ from those of other respiratory diseases. Externally, the symptoms resemble bronchial asthma, bronchiolitis, cystic fibrosis. With ARVI, children sometimes develop stenosing laryngotracheitis, when the sick baby has difficulty speaking, coughs violently, and breathes heavily. It is especially difficult for him to take a breath; even at rest, shortness of breath occurs, and the skin triangle around the lips turns pale.

When roundworm larvae migrate into the lungs, a child develops a condition resembling symptoms of bronchial obstruction.

Attacks of suffocation in a completely healthy child can be caused by reflux of stomach contents into the esophagus or aspiration of a foreign body. The first is associated with reflux, and the second is associated with hard pieces of food, small parts of toys, and other foreign bodies that have entered the respiratory tract. During aspiration, changing the position of the baby’s body helps him reduce attacks of suffocation. The main thing in such cases is to remove the foreign object from the respiratory tract as quickly as possible.

The causes of bronchiolitis and obstructive bronchitis are largely similar. Bronchiolitis in children is more severe, the bronchial epithelium grows and produces a large volume of sputum. Bronchiolitis obliterans often takes a chronic course, accompanied by bacterial complications, pneumonia, emphysema. Bronchopulmonary form Cystic fibrosis is manifested by the formation of viscous sputum, whooping cough, and suffocation.

Bronchial asthma occurs if inflammatory processes in the bronchi develop under the influence of allergic components.

The main difference between bronchial asthma and chronic bronchitis with obstruction is that attacks occur under the influence of non-infectious factors. These include various allergens, stress, and strong emotions. In asthma, bronchial obstruction persists day and night. It is also true that over time, chronic bronchitis can develop into bronchial asthma.

Unfortunately, the chronic form of the disease in children is often detected only in an advanced stage. The airways are so narrow at this point that it is almost impossible to completely cure bronchial obstruction. All that remains is to restrain inflammation and alleviate the discomfort that occurs in young patients. Used for this purpose antimicrobials, glucocorticosteroids, expectorants and mucolytics.

Massage and feasible exercises increase the vital capacity of the lungs, help slow down the development of the disease, and improve the overall well-being of the sick child.

1. Do inhalations with saline solution, alkaline mineral water, bronchodilators through a steam inhaler or use a nebulizer.
2. Select expectorant medications with the help of a doctor and pharmacist.
3. Give herbal tea and other warm drinks more often.
4. Provide your child with a hypoallergenic diet.

When treating acute obstructive bronchitis in children, it is necessary to take into account that therapy is not always carried out only on an outpatient basis. If there is no effectiveness, children with bronchospasm are hospitalized. Often in young children, acute obstructive bronchitis is accompanied by vomiting, weakness, poor appetite or lack thereof. Also, indications for hospitalization are age under 2 years and an increased risk of complications. Parents better not give up inpatient treatment if the child’s respiratory failure progresses despite treatment at home.

Features of drug therapy

Relief of attacks in sick children is carried out using several types of bronchodilators. Use drugs "Salbutamol", "Ventolin", "Salbuvent" based on the same active ingredient (salbutamol). The drugs "Berodual" and "Berotec" are also bronchodilators. They differ from salbutamol in their combined composition and duration of action.

Bronchodilators can be found in pharmacies in the form of syrups and tablets for oral administration, powders for the preparation of inhalation solution, and aerosols in cans.

Decide on the choice of medications, decide what to do with them during the period outpatient treatment, consultations with a doctor and pharmacist will help. For bronchial obstruction caused by ARVI, anticholinergic drugs are effective. The drug Atrovent from this group received the most positive reviews from specialists and parents. The product is used for inhalation through a nebulizer up to 4 times a day. The age-appropriate dosage for the child should be discussed with the pediatrician. The bronchodilator effect of the drug appears after 20 minutes.

Features of the drug "Atrovent":

• exhibits pronounced bronchodilator properties;
• acts effectively on large bronchi;
• causes a minimum of adverse reactions;
• remains effective during long-term treatment.

Antihistamines for obstructive bronchitis are prescribed only to children with atopic dermatitis and other associated allergic manifestations. Drops of Zyrtec and its analogues are used in infants; Claritin is used to treat children after 2 years of age. Severe forms bronchial obstruction is relieved with the inhaled drug "Pulmicort", a glucocorticoid. If the fever persists for more than three days and the inflammation does not subside, then systemic antibiotics are used - cephalosporins, macrolides and penicillins (amoxicillin).

Means and methods for improving sputum discharge

A variety of cough medications for childhood bronchitis are also used. From the rich arsenal of expectorants and mucolytics, preparations with ambroxol deserve attention - "Lazolvan", "Flavamed", "Ambrobene". Doses for single and course doses are determined depending on the age or body weight of the child. The most suitable dosage form is also selected - inhalation, syrup, tablets. Active ingredient It has a faster anti-inflammatory, expectorant and mucolytic effect when inhaled.

It is forbidden to take antitussive syrups and drops (cough reflex blockers) for obstructive bronchitis.

For obstructive bronchitis, various combinations of drugs are used, for example, 2-3 expectorants. First, they give medications that thin the mucus, in particular with acetylcysteine ​​or carbocysteine. Then inhalations with solutions that stimulate coughing - sodium bicarbonate and its mixtures with other substances. The improvement in the child’s condition becomes more noticeable after a week, and the full duration of the therapeutic course can be up to 3 months.

Breathing exercises and special massage are used to facilitate the discharge of sputum. For the same purpose, a procedure is performed to promote the outflow of sputum: the child is laid on his stomach so that his legs are slightly higher than his head. Then the adult folds his palms into a “boat” and taps them on the baby’s back. The main thing in this drainage procedure is that the movements of the hands are not strong, but rhythmic.

Do you know that…

1. The genetic basis of lung diseases has been proven through scientific research.
2. Among the risk factors for bronchopulmonary diseases, in addition to genetics, are abnormalities in the development of the respiratory system and heart failure.
3. In the mechanism of development of respiratory diseases, the sensitivity of the mucous membrane to certain substances plays an important role.
4. Children who are prone to allergic reactions or already suffer from allergies are more susceptible to recurrent forms of chronic respiratory diseases.
5. Experts from the USA have discovered the effect on the lungs of microbes that cause dental caries.
6. To identify lung diseases, radiography, computed tomography, and biopsy methods are used.
7. To modern alternative methods Treatment of respiratory diseases includes oxygen therapy - treatment with oxygen and ozone.
8. Of the patients who have undergone lung transplantation, 5% are minors.
9. Reduced body weight often accompanies the progression of lung diseases, so care must be taken to increase the calorie content of the diet of frequently ill children.
10. Frequent obstructive bronchitis - up to 3 times a year - increases the risk of bronchospasm without exposure to infection, which indicates the initial signs of bronchial asthma.

Preventive measures

The diet and lifestyle of the mother during pregnancy affects the health of the baby. It is recommended to follow a healthy diet, not smoke, and avoid second-hand smoke. It is very important for a pregnant or nursing woman and her baby to stay away from harmful chemical substances, causing allergies and toxicosis.

Negative factors that increase the chances of developing obstructive bronchitis:

• harmful effects of air pollutants - dust, gases, fumes;
• various viral and bacterial infections;
• genetic predisposition;
• hypothermia.

Continuing breastfeeding helps prevent obstructive bronchitis in children under one year of age. It is necessary to regularly clean, ventilate and humidify the air in the room where the child is. It is recommended to devote the health season in the summer to hardening procedures and relaxation by the sea. All these measures will help protect children and adult family members from bronchitis with obstruction.

Particular attention should be paid to the prevention of acute respiratory viral infections and allergies, as the most important causes of the development of chronic bronchitis in children.

It is more difficult to protect children attending children's institutions from various infections and helminthic infestations. Recommended with early years Constantly develop the child’s hygiene skills, monitor compliance with the daily routine and diet. During seasonal infections, it is advisable to avoid visiting crowded places where new viruses quickly attack the child’s body. As a result, illnesses - ARVI, sore throat - are becoming more frequent. The mucous membrane of the upper respiratory tract and bronchi does not have time to recover, which provokes the development of bronchitis and its complications.

Signs of obstructive bronchitis in children, treatment, risk factors updated: March 21, 2016 by: admin

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

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

Treatment of chronic obstructive bronchitis includes:

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

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

Indications for hospitalization are:

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

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

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

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

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

Chronic obstructive bronchitis - treatment with non-drug methods

Complex of non-drug therapeutic measures in 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 and so on.). Great importance 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.

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

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

In case of respiratory failure and acid-base disorders, a hypocaloric diet and intake restriction are advisable. simple carbohydrates, 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 a decrease in 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, systematic use of bronchodilators is the basis basic therapy 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 due to the formation of emphysema in them. At the same time, it should be taken into account that some modern bronchodilator drugs have a fairly wide spectrum of action. They help reduce swelling of the bronchial mucosa, normalize mucociliary transport, reduce the production of bronchial secretions and inflammatory mediators.

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

Inhalation administration of bronchodilators

It is preferable to use inhaled forms of bronchodilators, since this route of drug administration facilitates faster penetration of drugs into the mucous membrane of the respiratory tract and long-term maintenance of a sufficiently high local concentration of drugs. The latter effect is ensured, in particular, by the repeated entry into the lungs of medicinal substances absorbed through the bronchial mucosa into the blood and entering 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, clasp the mouthpiece of the inhaler tightly with your lips and begin to inhale slowly and deeply, press the canister once and continue deep breath. 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 patients old age For those who find it difficult to fully master the skills of using a metered dose inhaler, it is convenient to use so-called spacers, in which the medicine in the form of an aerosol is sprayed into a special plastic flask by pressing the canister immediately before inhalation. In this case, the patient takes a deep breath, holds his breath, exhales into the mouthpiece of the spacer, after which he takes a deep breath again without pressing the canister.

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

The advantages of inhaling drugs through nebulizers are:

• the depth of penetration of medicinal fine aerosol into the respiratory tract, including medium and even small bronchi;
• simplicity and convenience of inhalation;
• no need to coordinate inspiration with inhalation;
• the possibility of administering high doses of drugs, which allows the use of nebulizers to relieve the most severe clinical symptoms(severe shortness of breath, 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 vagus nerve. Therefore, their effect is manifested both when using the drug before the onset of irritating factors and when the process has already developed.

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

Remember:

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

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

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

Side effects

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

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

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

Contraindications

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

Selective beta2-agonists

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

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

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

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

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

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

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

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

Currently widely used selective beta2-adrenergic agonists 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. However, it should be borne in mind that the selectivity of various beta2-adrenergic agonists is relative and does not completely exclude beta1 activity.

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

Short-acting drugs 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 the relief of attacks of acute bronchial obstruction (for example, in patients with bronchial asthma) and treatment chronic obstructive bronchitis. Their action begins 5-10 minutes after inhalation (in some cases earlier), the maximum effect appears after 20-40 minutes, the duration of action is 4-6 hours.

The most common drug in this group is salbutamol (Ventolin), which is considered one of the safest beta-agonists. The drugs are most 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 undesirable systemic reactions in the form of tremor, palpitations, headache, etc. This is explained by most of the drug settles in upper sections respiratory tract, is swallowed by the patient and absorbed into the blood in the gastrointestinal tract, causing the described systemic reactions. The latter, in turn, are associated with the presence of minimal reactivity in the drug.

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

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

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

In contrast to 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 bronchodilatory effect exceeds the effects of salbutamol and fenoterol. A distinctive feature of the drug is its very high selectivity, which is more than 60 times higher than that of salbutamol, which ensures a minimal risk of developing side systemic effects.

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

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

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

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

Several important practical conclusions follow from the above.

1. Considering the high effectiveness of beta2-adrenergic agonists in relieving acute episodes of bronchial obstruction, their use in patients with COPD is indicated primarily at the time of exacerbations of the disease.
2. It is advisable to use modern, long-acting, highly selective sympathomimetics, for example, salmeterol (Serevent), although this does not at all exclude the possibility of sporadic (not regular) use of short-acting beta2-adrenergic agonists (such as salbutamol).
3. Long-term regular use of beta2-agonists as monotherapy for patients with COPD, especially elderly and senile patients, cannot be recommended as permanent basic therapy.
4. If 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 both for the relief of acute attacks of asthma and for the treatment of chronic obstructive bronchitis. Usual dose is 1-2 doses of aerosol 3 times a day. The onset of action of the drug is after 30 s, maximum effect- after 2 hours, 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 low dose sympathomimetic. These advantages of combined drugs allow us to recommend them for long-term basic bronchodilator therapy in patients with COPD when monotherapy with Atrovent is insufficiently effective.

Methylxanthine derivatives

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

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

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

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

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

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

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

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 longer duration action, which is important for the treatment of nocturnal symptoms of the disease that persist despite treatment of chronic obstructive bronchitis with anti-inflammatory drugs.

Long-acting theophylline preparations are divided into 2 groups:

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

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

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

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

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

Mucolytic and mucoregulatory agents

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

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 the penetration of antibiotics into bronchial secretions and the bronchial mucosa, increasing the effectiveness of antibacterial therapy and reducing its duration.
8. Carbocisteine ​​normalizes the quantitative ratio of acidic and neutral sialomucins in bronchial secretions, reducing the viscosity of sputum. Promotes regeneration of the mucous membrane, reducing the number of goblet cells, especially in the terminal bronchi.
9. Bromhexine is a mucolytic and mucoregulator. Stimulates the production of surfactant.

Anti-inflammatory treatment of chronic obstructive bronchitis

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

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

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

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

To resolve the issue of the advisability of long-term continuous use of corticosteroids in patients with COPD, it is proposed to carry out trial therapy: 20-30 mg/day. at the rate of 0.4-0.6 mg/kg (prednisolone) for 3 weeks (oral corticosteroids). The criterion for the positive effect of corticosteroids on bronchial patency is an increase in the response to bronchodilators in a bronchodilation test by 10% of the required FEV1 values ​​or an increase in FEV1 by at least pa 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 a safe and very well tolerated drug. In case of exacerbation of the disease, the drug is prescribed at a dose of 80 mg 2 times a day for 2-3 weeks. In case of stable COPD (stage of relative remission), the drug is prescribed in the same dosage for 3-6 months. There are reports of good tolerability and high effectiveness of fenspiride with continuous treatment for at least 1 year.

Correction of respiratory failure

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

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

• decrease in arterial blood PaO2
• decrease in SaO2
• decrease in PaO2 to 56-60 mm Hg. Art. in the presence of additional conditions(edema due to right ventricular failure, signs of cor pulmonale, the 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 not shown. 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. New macrolides, in particular azithromycin, which can be taken only once a day, are highly effective for respiratory infections in patients with chronic bronchitis. A three-day course of azithromycin is prescribed at a dose of 500 mg per day. New macrolides affect pneumococci, Haemophilus influenzae, moraxella, as well as intracellular pathogens.

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

Treatment tactics for chronic obstructive bronchitis

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

In the stage of remission (outside exacerbation of COPD), special importance is attached to bronchodilator therapy, emphasizing the need individual choice bronchodilators. 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 changes, the importance of infectious factors increases, which often determines the need for antibacterial agents ah, respiratory failure increases, decompensation of the pulmonary heart is possible. The basic principles of treatment of exacerbation of COPD are the intensification of bronchodilator therapy and the prescription of antibacterial agents according to indications. Intensification of bronchodilator therapy is achieved by both increasing doses and modifying methods of drug delivery, using spacers, nebulizers, and in case of severe obstruction, intravenous administration of drugs. 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 methods for correcting increased blood viscosity - hemodilution - is often required. Treatment of decompressed cor pulmonale is carried out.

Chronic obstructive bronchitis - treatment with traditional methods

Treatment with some folk remedies helps relieve chronic obstructive bronchitis. Thyme, the most effective herb to combat bronchopulmonary diseases. It can be consumed as tea, decoction or infusion. Prepare medicinal herb You can grow it at home 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.

Give preference it's better that way 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. 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 at finished form 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 to medicinal effect herbs could 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 a complete recovery. In addition, you should not write off a healthy lifestyle, alternating work and rest, as well as taking vitamin complexes and high-calorie foods.