Chronic pneumonia: provocative factors, classification, clinical picture, methods of diagnosis and therapy. Causes and treatment of chronic pneumonia

• Treatment of chronic pneumonia
• Prevention of chronic pneumonia
• Which Doctors Should You See If You Have Chronic Pneumonia

What is chronic pneumonia

The concept of chronic pneumonia was first introduced by Bayle (1810) to refer to a nontuberculous chronic process in the lungs. Numerous morphological studies I. V. Davydovsky (1937), A. T. Khazanov (1947), S. S. Weil (1957), and later A. I. Strukov and I. M. Kodolova (1970), I. K. Esipova (1978), based mainly on the study of lung preparations removed by surgeons for suppurative processes, showed that etiopathogenetic and clinically different diseases are characterized by common morphological features, which are an expression of the stereotypical reaction of lung tissue elements to certain damaging factors ( inflammation, carnification, pneumosclerosis, emphysema, etc.). Chronic inflammation and its consequences as a morphologically detectable phenomenon soon began to be wrongly identified with the term "chronic pneumonia", which was already given a clinical meaning, considering it the name of a special nosological form of pulmonary pathology. Soon, for obvious reasons, this form absorbed almost all chronic non-tuberculous pathology of the lungs.

Since the mid-1950s, ideas about a staged, progressive course of chronic pneumonia began to develop in the domestic literature, first put forward by pediatricians, and then by therapists and some surgeons. These ideas, reflected in the so-called "Minsk" (1964), and then "Tbilisi" (1972) versions of the classification of chronic pneumonia, adopted at the relevant plenums of the board of the All-Union Scientific Society of Therapists, consisted in the fact that chronic pneumonia is a staged ongoing pulmonary process starting with unresolved acute pneumonia, in which there is a gradual progression both in the depth and severity of local changes (progressive pneumosclerosis, the formation of foci of necrosis and abscess formation, bronchiectasis, etc.), and in the total volume of the lesion with a gradual capture of the entire bronchopulmonary tissue and the development of severe functional disorders in the form bronchial obstruction and cor pulmonale. Characteristic until recently, some exaggeration of the role of infection in the origin bronchial asthma led to the fact that this disease was associated with the concept of chronic pneumonia [Bulatov PK, 1965; Uglov F. G., 1976].

The concept of a broadly interpreted chronic pneumonia seemed tempting in theoretical terms, since it united almost all chronic non-specific lung pathology in the form of a harmonious dynamic process with a single etiology and pathogenesis, as well as convenient in practical terms, since for establishing a diagnosis of a chronic non-specific disease it was enough to exclude the presence of tuberculosis and cancer in the patient. However, this concept turned out to be purely speculative and does not correspond to firmly established facts. So, it turned out that acute transitionpneumonia, arose against the background of a previously healthy bronchial tree, in the chronic form is extremely rare, which in no way can explain the sharp increase in the incidence of chronic non-specific lung diseases observed throughout the world. In addition, long-term observations of patients could not confirm the regular transition from chronic pneumonia with the presence of only local pneumosclerosis (the result of unresolved acute pneumonia) to bronchiectasis or destruction of the lung parenchyma, as well as the transformation of a local process, which is pneumonia, into a total lesion of bronchopulmonary tissue. with the development of general bronchial obstruction, emphysema, etc. Finally, as the experience of modern pulmonology has shown, the main and most common chronic non-specific lung disease, leading to progressive disability and death of patients and often having a decisive influence on the development of acute processes in the lungs, is Chronical bronchitis not primarily associated with acute pneumonia. Although this most important nosological form in non-specific pulmonary pathology was not formally denied by the concept of chronic pneumonia in the interpretation of the Minsk and Tbilisi classifications, it was actually absorbed by it, and this certainly played a negative role in the study of lung diseases and the fight against them, since it was by no means not about different terminology, but about a different approach to the essence of chronic lung pathology, which determines not only promising directions scientific research but also a set of organizational measures for prevention and treatment.

All of the above does not mean, however, that chronic pneumonia in a more specific and narrow sense of the term does not exist at all. According to the definition, chronicpneumonia represents, as a rule, localizedprocess:

As a result of unresolved completely acute pneumonia;

The morphological substrate of which is pneumosclerosis and / or carnification of the lung tissue, as well as irreversible changes in the bronchial tree according to the type of local chronic bronchitis;

Clinically manifested in repeated outbreaks inflammatory process in the affected part of the lung.

All components of this definition seem to be fundamentally important. Thus, the localization of the process emphasizes the difference between chronic pneumonia and diffuse diseases lungs, such as chronic bronchitis, emphysema and diffuse pneumosclerosis. The obligatory connection of chronic pneumonia with acute shows the main feature of its pathogenesis and delimits it from primary chronic diseases. The indication that the substrate of the disease is pneumosclerosis draws a line between chronic pneumonia and chronic diseases, which are based on destruction, suppuration in pathological cavities resulting from the collapse of the lung parenchyma or bronchial expansion. Mention of obligatory relapses of inflammation in the affected area of ​​the lung excludes asymptomatic from the concept of chronic pneumonialocalized pneumosclerosis, which is a purely morphological or radiological phenomenon, in other words, not a disease, but a form of cure for certain forms of pneumonia, as well as destructive lesions associated with non-specific or tuberculosis infection.

Strict limitation of the concept of "chronic pneumonia" has led to the fact that the number of patients with this diagnosis was many times smaller than previously thought. If in the past it was believed that acute pneumonia ends with a transition to a chronic form with a frequency of 16 to 37% [Molchanov N. S., 1965], then at the present time, according to the data of the employees of VNIIP A. N. Gubernskova, E. A. Rakova and etc., does not exceed 1-3%. Such a sharp difference is primarily due to the fact that in the past chronic pneumonia was mistakenly attributed to acute prolonged pneumonia lasting more than two months, cases of chronic bronchitis, against which acute pneumonia developed, as well as exacerbations of chronic bronchitis without proven pneumonic infiltration. If in the 60s it was believed that patients with chronic pneumonia accounted for more than half of the contingent of patients in the pulmonology department [Zlydnikov D. M., 1969], then at present, according to the All-Russian Research Institute of Pulmonology, the number of such patients does not exceed 3–4%, and according to a number of foreign authors 1-2%,

Pathogenesis (what happens?) during Chronic pneumonia

Since, according to the above definition, chronic pneumonia is a consequence of acute infectious inflammation lung, its etiology corresponds to the etiology of acute pneumonia. The question of the pathogenesis of incomplete resolution of acute pneumonia and its transition to chronic pneumonia has not been fully studied. Most likely, in this case we are talking O irreversible loss of part of normal structures lung during the acute process. If at the same time there is a massive necrosis of a piece of lung tissue, followed by its non-sterile decay, then pneumonia is complicated abscess. If a relatively small part of the tissue elements dies, and the dead ones are less resistant to harmful effects cells alternate with viable ones (disseminated necrosis according to S. S. Girgolav, 1956), then a pneumosclerosis, which, as already mentioned, is a morphological substrate of chronic pneumonia.

A large, and perhaps the main, role in the origin of repeated outbreaks of infection in the zone of pneumonia transferred in the past is also played by those remaining after it. irreversible changes in the relevant area bronchial tree(local chronic bronchitis), leading primarily to a local violation of the cleansing function of the bronchi.

The intensity of the damaging effect of an infectious factor on the lung tissue depends both on the virulence of microorganisms and on the reactivity of the patient's body. Any factors that reduce the reactivity of the patient(senile age, intoxication, including viral, vitamin deficiencies, alcoholism, overwork, etc.) can contribute to the transition of acute pneumonia to a chronic form [Molchanov, N. S. and Stavskaya V. V., 1971, and others. ]. Since a significant role in the damaging effect of the pathogen on tissues is played not only by their pathosity, but also by the duration of exposure, significant importance in the pathogenesis of chronic pneumonia is given to untimely and inadequate treatment patients with acute pulmonary processes, leading to a protracted course of the latter.

Finally, extremely important and, perhaps, decisive in the pathogenesis of chronic pneumonia is chronic obstructive bronchitis, sharply disrupting the drainage and aeration function of the bronchi in the area acute inflammation lung. In all likelihood, it is precisely the fact that men are more likely to experience bronchitis caused by smoking and occupational hazards, explains the high frequency of chronic pneumonia in them, and according to the inscriptions of an employee L. G. Soboleva (1979), who summarized the experience of the medical unit of a large enterprise of heavy engineering, the transition of acute pneumonia to chronic was observed almost exclusively in patients who had previously suffered from obstructive bronchitis.

Irreversible changes that develop in the lung during the transition of acute pneumonia to chronic (pneumosclerosis, local bronchitis) cause respiratory dysfunction, flowing predominantly in a restrictive manner. Gn-persecretion of mucus in sections of the bronchial tree with impaired drainage function, impaired expansion and aeration of the alveoli in the zone of pneumosclerotic changes determine the fact that the affected area of ​​the lung tissue becomes the place of least resistance to further adverse effects. According to modern concepts, as etiological factor exacerbations are of greatest importance pneumococcus and Haemophilus influenzae. The reason for their activation is most often viral infection, cooling ("cold") and a number of other factors. As a result of exacerbation of the infectious process, there are repeated lofecal outbreaks of inflammation, which can be localized both in the bronchial tree and in the lung parenchyma (the so-called "bronchitis" and "parenchymal" types of exacerbation).

Local exacerbations of the infection may, in all likelihood, be complicated by diffuse changes in the bronchial tree, and secondary chronic bronchitis develops, which can cause obstructive ventilation disorders. However, such an evolution of the process in chronic pneumonia cannot be considered either frequent or typical.

PATHOLOGICALANATOMY

The affected part of the lung in chronic pneumonia is usually reduced in volume and covered with pleural adhesions. On the cut lung tissue appears to be tight. The walls of the bronchi are rigid. The lumen contains a viscous secret.

Microscopically, manifestations expressed to a greater or lesser extent are revealed pneumosclerosis: fibrosis of the interstitial tissue with signs of inflammation. In some cases, carnification predominates with obliteration of the alveoli as a result of the organization of fibrinous exudate. In some patients, carnification develops in the form of large nodes that have a spherical shape ("spherical" chronic pneumonia). Areas of interstitial sclerosis and carnification may alternate with foci of periscar emphysema. The walls of the bronchi are thickened due to fibrosis. In the mucous and submucosal layers, phenomena of chronic inflammation are noted with a characteristic restructuring of the epithelium (the predominance of goblet cells over ciliary cells).

Symptoms of chronic pneumonia

For the reasons stated above, the "Minsk" and "Tbilisi" three-stage classifications of chronic pneumonia should now be considered unacceptable.

Depending on the predominance of certain morphologicallychanges chronic pneumonia can be divided into: a) and interstitial (with a predominance of interstitial sclerosis) and b) car infecting (with a predominance of cariification of the alveoli). Both of these forms are distinguished by fairly clear clinical and radiological characteristics (see below). Depending on the prevalence should be distinguished: a) focal (often carnifying), b) segmental, c) lobar chronic pneumonia. The diagnosis should also indicate the localization of changes (by lobes and segments) and, in addition, process phase(exacerbation, remission),

First of all, the question arises about the boundary between protracted acute pneumonia and chronic pneumonia. In the past, the time elapsed since the onset of the disease was used as a criterion. So, according to the ideas of the authors of the "Tbilisi" classification (1972), such a period was considered 8 weeks. V. P. Silvestrov (1974) lengthened this period to 3 months, and other domestic and foreign authors - up to a year or even more. Long-term follow-up of patients with prolonged pneumonia, performed by V. A. Kartavova at our institute, showed that residual X-ray changes can persist for many months and then disappear without a trace. Thus, The criterion for the diagnosis of chronic pneumonia can serve not so much as the period from the onset of the diseaseniya, how much long-term dynamic observation of the patient. Only the absence, despite long-term and intensive treatment, of positive X-ray dynamics, and most importantly, repeated outbreaks of the inflammatory process in the same area of ​​the lung, allow us to speak about the transition of pneumonia to a chronic form.

IN remission phase complaints of patients with chronic pneumonia can be extremely scarce or absent altogether. Typical is an unproductive cough, mainly in the morning with a satisfactory general condition and good health. Physical data is also scarce. Sometimes in the affected area it is possible to determine the dullness of the percussion tone and mild wheezing. Large-focal carnifying pneumonia is characterized by the absence of complaints. X-ray there is a decrease in the volume of the corresponding section of the lung and an increase in the pulmonary pattern due to interstitial changes. At carnifying form intense, fairly well-defined shadows can be observed, giving rise to differential diagnosis with a peripheral tumor. Not infrequently, a high standing of the corresponding dome of the diaphragm, obliteration of the sinuses and other abnormal changes are noted. At bronchography convergence of bronchial branches in the affected area, uneven filling and uneven contours (deforming bronchitis) are revealed.

Bronchoscopy catarrhal (sometimes purulent during an exacerbation) endobronchitis is found, most pronounced in the corresponding lobe or segment.

At spirographic study find, as a rule, restrictive changes in ventilation, and in patients with simultaneously existing chronic bronchitis - also obstructive phenomena.

IN exacerbation phase the state of health of patients worsens, weakness, sweating appear, body temperature rises to subfebrile or febrile figures. The cough intensifies or appears, the amount of sputum increases, it can become purulent. Sometimes there are chest pains on the side of the lesion. Physical findings may resemble acute pneumonia (dullness, fine bubbling and crepitating rales), and radiologically in the zone of pneumosclerosis, fresh infiltration of the lung tissue appears. IN blood moderate leukocytosis, an increase in ESR, as well as biochemical criteria for exacerbation (hypoalbuminemia, an increase in fibrinogen, sialic acids, haptoglobin) are noted. When the exacerbation subsides, biochemical tests return to normal more slowly than clinical indicators.

Diagnosis of chronic pneumonia

The differential diagnosis of chronic pneumonia and lung cancer; It is well known that cancer patients are often followed up for months with an erroneous diagnosis of chronic pneumonia, with the result that treatment opportunities are lost. It should be well remembered that lung cancer occurs very often, and chronic pneumonia is much less common. Therefore, in any case of a prolonged or recurrent inflammatory process in the lung, especially in elderly men and smokers, one should first of all exclude a tumor that stenoses the bronchus and causes the phenomena of the so-called paracancer pneumonia. The same must be said with respect to those often found during an accidental x-ray examination large focal shadows in the lung, which most often turn out to be tumors, but can also be areas of carnification. In the absence of a typical clinical and radiological picture of the tumor correct diagnosis can be established on the basis of the dynamics of the x-ray picture, which appears negative in cancer. It should be emphasized, however, that the specially undertaken dynamicmonitoring of patients with suspected cancer isbig risk and is generally unacceptable. In a timely manner clarifythread diagnosis In most cases succeeded with the help ofal methods - bronchoscopy with biopsy, transbronchial or transthoracic biopsy of the pathological focus, regional lymph nodes, bronchography, etc. If it is impossible to establish an accurate diagnosis with these methods, a thoracotomy is indicated with a diagnosis clarification on the operating table and subsequent intervention of the appropriate volume.

Differential diagnosis of chronic pneumonia and chronic bronchitis is established on the basis of the absence of a direct connection between the onset of the disease and acute pneumonia in patients with bronchitis, as well as local changes type of infiltration of the lung tissue during exacerbations. Bronchitis is characterized by diffuse lesions and typical functional changes(obstructive ventilation disorders, pulmonary and pulmonary heart failure).

For bronchiectasis, in contrast to chronic pneumonia, the younger age of patients with impaired patency distally located branches, as well as typical bronchial dilatations detected by bronchography, are characteristic. It should be noted, however, that according to bronchographic data, there are no transitional forms between these two states.

Chronic lung abscess differs from chronic pneumonia in a typical clinic of acute pulmonary suppuration at the onset of the disease, as well as in the presence of a cavity against the background of pneumosclerosis, which is detected radiologically (tomography, bronchography).

Certain difficulties often arise in the differentiation of chronic pneumonia and some forms tuberkalung lung. The latter is characterized by the absence of an acute nonspecific process at the onset of the disease, predominantly upper lobe localization of lesions, petrifications in the lung tissue and hilar lymph nodes. The diagnosis of tuberculosis is confirmed by repeated examination of sputum, tuberculin skin tests, and serological methods.

Treatment of chronic pneumonia

exacerbation phase in principle, it should be the same as acute pneumonia, but still differs in some features. Due to the fact that the most common causative agents of exacerbations are pneumococcus and Haemophilus influenzae, antibacterial treatment is carried out with the help of penicillin and tetracycline drugs, as well as erythromycin in sufficient dosages. Sulfa drugs such as sulfadimethoxine may also be effective. Duration of antibiotic use depending on clinical effect ranges from 1-2 to 3-4 weeks. In case of insufficient effectiveness, the composition of antibacterial agents is corrected taking into account the results of sputum culture on special media, which is recommended to be done at the beginning of treatment, before the use of antibacterial agents.

An important element of therapy are means aimed at improvement of bronchial patency and bronchialclearance: bronchodilators, expectorants, mucolytics. Many authors recommend to use during exacerbation of chronic pneumonia endotracheal and endobronchial sanitation with thorough washing of the affected sections of the bronchial tree with a 3% solution of sodium bicarbonate and the subsequent introduction of antibacterial, bronchodilator and mucolytic drugs into them.

A certain role in the treatment of exacerbation of chronic pneumonia is played by the appointment of anti-inflammatory and desensitizing agents (aspirin, pipolfen, 10% CaCl 2 solution intravenously). Nutrition of patients should be complete and sufficiently rich in vitamins. It is advisable to use vitamin preparations orally and parenterally.

IN subsiding exacerbation phase recommended inhalation of phytoncides of onion and garlic, massage chest, breathing exercises and physiotherapeutic procedures (UHF, diathermy, inductothermy, electrophoresis of dionine and vitamin C); you can add to this electrophoresis of aloe, calcium chloride, potassium iodide, heparin, pancreatin and other medicines.

Treatment of chronic pneumonia in remission phase is a set of measures aimed at preventing exacerbation, i.e. measures of secondary prevention. The patient must constantly be registered in the pulmonology room polyclinics. He needs rational employment (elimination of sharp fluctuations in temperature, industrial air pollution, etc.). Smoking cessation is essential.

Showing courses of anti-relapse therapy in night dispensaries, specialized sanatoriums, etc. With frequent exacerbations and low efficiency or impossibility of anti-relapse therapy, the question of using surgical methods can be raised. Radical lung resection is possible in young and middle-aged individuals with a sufficiently clear localization of the process and the absence of general contraindications to intervention on the organs of the chest cavity.

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Table of contents:

Chronic pneumonia is local inflammation some part of the lung with alternating periods of remission and exacerbation. Diagnosis occurs with the help of x-rays, test results, bronchoscopy.

We know that acute pneumonia, also called pneumonia, is a complex disease with high fever, poor flow, a hard cough, and possible lethal outcome. But does it happen chronic pneumonia? It turns out that yes. And although Western scientists and pulmonologists do not like to single out this disease separately, domestic experts are sure that such a phenomenon in the environment of diseases has the right to exist.

It is possible to understand that this is chronic pneumonia by the clear localization of the inflammation process, the undulating course with periods of exacerbations and relative relief. Also, the patient must have been ill at least once. acute pneumonia.

Symptoms of chronic pneumonia

The main symptom is cough. It will torment almost all patients both during remission and during exacerbation. There are still symptoms of chronic pneumonia in adults, such as purulent and mucous allocation at coughing. Temperature will increase with exacerbations.

The physician can determine chronic pneumonia, as a shortening of the sound tone in the projection of the focus. Also, when listening to the same part of the lung, wheezing of different calibers can be heard, and this does not depend on the period of the disease. Such features when listening can persist for two to three days.

Chronic pneumonia in children

Scientists have found that true chronic pneumonia can only be in those children who have there are permanent changes tissues of the lungs and bronchi. As in adults, it is a consequence of an acute manifestation of pneumonia, when it turns into protracted stage or simply not cured.

Chronic pneumonia in newborns slightly different in its manifestations. The baby's skin is gray-pale, he has low blood pressure and difficult breathing. The baby may vomit, or in the process of feeding, he may experience intestinal spasm. More symptoms: drowsiness And lack of vitality.

Most children develop chronic pneumonia before three years of age.

Treatment of chronic pneumonia

Most often, a consequence of the work of the infection is chronic pneumonia. Treatment is selected according to what microorganism caused it. If the reason lies elsewhere, then the treatment will be chosen without involving antibacterial drugs. It happens that comes chronic pneumonia in children. Treatment in this case is very careful not to spoil the child needs microflora.

Pathogen is determined most accurately by sputum culture and laboratory examination of bronchoscopy materials. Only in this way can one truly appoint the right drug. Can't guess. How to treat chronic pneumonia can only tell certified doctor.

Phlegm has properties stagnate. She's hard to get out due to changes in the composition of cells of the bronchial mucosa. As for the lungs themselves, it is quite extensive chronic pneumonia. Round education 5 cm- not yet the limit. If the airways blocked by phlegm from which a person cannot get rid of by coughing, prescribed bronchodilators for spasms and mucolytics for trouble-free coughing.

Also important. Exercise therapy for chronic pneumonia is almost always prescribed. You need to take a long breath, while saying sounds w-w-w-o-o-o-o-o then relax for a couple of seconds and repeat. Useful for sputum removal and general general light gymnastics.

Treatment of chronic pneumonia in adults is characterized by the use of agents that are capable of minimize the process of inflammation in tissues. Prescribe and antihistamines drugs.

Causes of Chronic Pneumonia

Not cured acute pneumonia, or inflammation that has been treated incorrectly. If taken antibiotics against one kind microorganisms, and the causative agent is completely different - then it will be just an extra blow to the liver. That's why it's so important lab tests made with good quality.

Among the reasons may be lack of interest to exercise therapy and wrong mode on acute stage illness. Man cannot refuse smoking during treatment - then recovery will take place a very long time, A the effectiveness of drugs will be significantly reduced.

Chronic bronchitis and a weak immune response can contribute to chronic pneumonia.

Prevention of chronic pneumonia

Monitor the state of health, do not endure the disease "on the legs", do gymnastic exercises in the fresh air and give up smoking- here are the basic rules healthy lungs. If you are worried about coughing, you need to go to the doctor and, if necessary, do not be afraid of excessive exposure and make X-ray.

Chronic pneumonia is such exacerbations that constantly recur. Other phenomena that can affect both children and adults can be dangerous in this pathology.

Chronic pneumonia can be identified by the following unambiguous criteria:

• localization of the process - this disease differs from diffuse-type lesions in the lung area, which is why treatment is necessary;
• the presence of 1 episode associated with in the medical history;
• indispensable identification of various areas of connective tissue in the lungs;
• course of a wave-like type with repetitions and deterioration of the state.

After their identification, you should contact a specialist and not engage in self-restoration of the body.

Such treatment will cause even more harm, moreover, before you start, you should understand what are the causes of its occurrence and symptoms.

Main Factors

Chronic pneumonia in the absolute number of cases is the logical conclusion of an untreated severe process, which, moreover, is associated with complications. According to statistics from 1 to 3% acute pneumonia transformed into chronic forms.

The most important factor should be considered the degree of patency of the bronchial region within the framework of inflammation of the lungs. Destabilization of the physiological parameters of the walls of the bronchi provokes a decrease or the absolute absence of local protective reactions. The latter do not create obstacles for the periodic reproduction of pathogenic agents.

An increased degree of sensitization of the body due to various allergens has a positive effect on the formation of a chronic course of pneumonia in children. This is most pronounced in the presence of genetically acquired anomalies in the structure or formation of the cardiovascular and respiratory systems.

External factors

Chronic pneumonia in children and adults develops under the influence of the following environmental factors:

• smoking of any type - whether passive or active;
• increased degree of pollution, increased ratio of gases;
• the presence of permanent household-type allergens in the air;
• volatile components that are harmful and dangerous in production.

One of the factors that can provoke symptoms of persistent pneumonia is the presence of a foreign object in the bronchial region. It most often occurs in childhood in the first years of life.

It is not always possible to identify an obstruction at the initial visit to a specialist on a standard x-ray examination.

Exceptionally repeated foci of the same localization make it possible to suspect whether there is chronic pneumonia in children provoked by aspiration.

Pathogenetic changes

The presented changes are, in fact, massive necrotic processes that provoke aggravated consequences and the formation of an abscess in the lung region. The alternation of minor necrosis with the integral parenchyma of the respiratory area provokes the formation of pneumosclerosis.

In addition to the changes noted in the alveolar region, there is a destabilization of the internal lining in the bronchi. These processes can be small or medium in size. Symptoms of local permanent bronchitis interfere with the main cleansing and drainage work. Increased secretion of sputum and changes in the sclerotic nature on this basis form positive environment for the habitat and reproduction of microorganisms. The following factors can be the main ones:

• a decrease in the speed of the body, the treatment of which will take weeks or months;
• late and incorrect recovery in the primary process;
• presence of chronic obstructive pulmonary disease in children.

These factors are characterized by decisive importance, and therefore are perceived by experts as one of the most dangerous. In order to make a diagnosis of chronic pneumonia, one should obtain full information about the symptoms of pathology. It is on this basis that the treatment will be based.

General picture of symptoms

The most characteristic manifestation should be considered a cough. In most patients, it will form not only during remission, but also during exacerbation. According to its characteristics, the cough is wet, with an insignificant ratio of discharge. Its properties are reduced to mucous and purulent.

In the projection of the painful focus, the specialist may note a shortening of the sound tone. An important criterion should be considered the preservation of the auscultatory picture for 2-3 days or more. At the same time, the symptoms are such that moist rales of different calibers are heard in the same location, regardless of the period of the disease, the treatment of which is necessary.

Exacerbation symptoms associated with chronic pneumonia in a child will appear in inverse proportion to their age.

For example, the older the child is, the less often exacerbations will form if pneumonia has begun. In adults, at the stage of remission, signs of soreness of the lung tissues may even completely disappear.

There are 2 types of chronic inflammation:

• bronchitis, in which a new inflammation begins to capture the bronchial region, and clinical symptoms much more characteristic of the acute form of bronchitis;
• Pneumatic, implying the involvement of alveolar tissues in the algorithm, which disappears when accompanied by obvious intoxication, especially in young children.

additional information

Chronic pneumonia in children, as well as adults, can have several degrees of development. The division into stages is carried out taking into account the frequency of complications, their characteristics and nuances, the condition of the sick without deterioration, the ratio of respiratory failure and the presence or absence. In accordance with this, 3 degrees are identified: mild, moderate and severe.

In this regard, it should be clearly understood what are the differences between the chronic form of pathology and the protracted one. First of all, this is the fact that the symptoms do not go longer than 1 year from the date of accession acute phase. In addition, changes on the X-ray remain permanent, there is no positive dynamics. The latter occurs even regardless of whether treatment was carried out or not.

Repetitive outbreaks should also be taken into account. infectious processes in the same region of the lung tissue. They testify in favor of chronic and inveterate algorithms. In addition, differential diagnosis of chronic inflammation of the pulmonary region is carried out with diseases such as tuberculosis, chronic bronchitis, lung cancer, and chronic abscess.

Pneumonia with bronchiectasis

• Availability copious discharge with sputum, mainly in the morning;
• the presence in the sputum of purulent impurities with an unpleasant and sudden pungent odor;
• an increase in the severity of symptoms of respiratory failure.

The species is characterized by pallor of the epidermis, an increase in the venous network in the area, and the acquisition of a barrel-shaped sternum. In adults in additional order identify characteristic shapes of fingers and nail plates.

Permanent fatigue and reduced endurance in relation to physical loads in children can provoke mental problems. They will manifest themselves in tearfulness, frequent tantrums and reduced concentration. This form of chronic pneumonia is the most dangerous psychologically, and its treatment is the longest.

Diagnostic measures

It is possible to identify whether a disease is present through several examination methods. The first of these is an x-ray of the pulmonary region. Radiography, carried out simultaneously in 2 projections, allows you to identify changes in the size of any of the departments of the region, whether there are focal changes, as well as other pathological processes.

This is followed by bronchography, which should be taken as mandatory. diagnostic method. It allows you to identify bronchiectasis and other blackouts, establishing their origin, probable deformations.

Bronchoscopy identifies purulent exacerbations, if they are present, and it also accurately identifies a particular area of ​​​​infection.

Another method is spirography, which is an examination of the work of breathing of the external type. This technique helps to detect changes not only in pulmonary system, but also within the alveoli, as well as other organic structures. Only after a 100% correct diagnosis has been made, treatment can begin.

Recovery process

Depending on how severe the exacerbations are, treatment is carried out in a hospital or under the permanent supervision of a treating specialist at home.

Besides:

• forced antibacterial components, taking into account bacteriological samples, should be taken as the basis of etiotropic recovery;
• antihistamines, anti-inflammatory components, immune modulators and stimulants will be needed by the sick person not only at the stage of acute inflammation, but also during remission to reduce the likelihood of re-infection.

The chronic form of pneumonia with bronchiectasis is treated through the active use of bronchosanation and physiological procedures. This helps to optimize drainage functions.

In a child with modern approach to the recovery process, it turns out in most cases to achieve stabilization and prevent the subsequent development of pathological foci. Success in adults recovery process directly depends on what pathologies are accompanied and what is the integral immune status.

Additional measures

Immediately after discharge from the hospital, it is necessary to undergo recovery in a sanatorium or resort. The provision of measures for the general strengthening of the body, therapeutic exercises, as well as physiotherapy have a positive effect on patients, including children. The active use of components of traditional medicine, herbal medicine - all this finds wide application. In this regard, in a comprehensive restoration, it occupies not the last place. However, regardless of how effective these measures are, they should be agreed with a specialist.

The implementation of clinical examination is necessary twice during. For patients with diagnosed bronchiectasis, the number preventive examinations And restoration measures to eradicate relapses should be 4 times within 12 months.

Prevention

When or if pneumonia has been manifested for a long time, an equally important role should be given to preventive measures.

• maintaining a healthy lifestyle and maintaining optimal physical activity;
• permanent sanitation of the oral cavity and nasal area, if necessary;
• elimination of any provoking factors, even if they are associated with work.

It is necessary during the first year after the cure of the pathology to carry out special breathing exercises resort to massage treatments. A set of exercises can be carried out daily, while massage is shown 1-2 times a week. As symptoms improve, the number of repetitions may be reduced.

To prevent others respiratory diseases and seasonal colds, you can resort to vaccination and immunization. This is true not only for children, but also for adults. Inflammation of the lungs in this case simply will not form.

It should be noted that the chronic form is one of the most complex and difficult to treat. However, when integrated approach and correct recovery, the disease will be defeated in sufficient short time. The patient has only one task - to prevent the recurrence of pathology.

Chronic pneumonia is a non-specific progressive inflammation of the lung tissue that develops against the background of incompletely resolved acute pneumonia. The disease is characterized by an undulating course with periodic relapses. Patients complain about coughing with sputum, fever, general weakness, night sweats.

Reasons for the development of the disease

Chronic pneumonia is diagnosed in 2–4% of patients who have experienced acute, complicated pneumonia. In the damaged organ, areas of fibrosis and carnification are formed, the drainage function of the bronchi is disturbed, and secretion stagnates. Often, foci of suppuration are revealed.

Causes of chronic pneumonia:

• infectious lesions of the upper respiratory tract: sinusitis, tonsillitis, otitis, adenoid;
• frequent colds, viral diseases;
• hypovitaminosis;
• congenital sequestration of the lung;
• circulatory disorders;
• hypothermia;
• weakening of the immune system.

At risk are small children who have had measles, rubella, scarlet fever. In the elderly, smokers, chronic alcoholics, the risk of developing recurrent pneumonia increases several times.

The causative agents of the inflammatory process

Inflammation of the lungs provokes infection by pathogenic microorganisms. Most often, a mixed bacterial flora is determined, in the composition of sputum:

• pneumococci are sown;
• staphylococci;
• hemophilic and Pseudomonas aeruginosa;
• yeast, molds.

In 10% of patients, the causative agent of pneumonia is mycoplasma, legionella, viruses.

Types of chronic pneumonia

The transition of acute pneumonia to recurrent is noted in the absence of positive dynamics of the treatment for 3 or more months. If periodic outbreaks of exacerbation are observed in the same area of ​​\u200b\u200bthe lung, the preliminary diagnosis of CP is confirmed. Taking into account the morphological features, chronic inflammation of the lung tissue is divided into:

• interstitial pneumonia;
• carnifying pathology.

It differs by the predominance of sclerotic processes in the walls of the alveoli and the connective cells of the parenchyma, the defeat of the blood and lymphatic vessels. During coughing, sputum with blood clots is released, patients suffer from fever, rapid weight loss. Pneumonia ends with pneumosclerosis, can cause pulmonary bleeding.

Carnifying pathology leads to the growth of connective tissue in the lumen of the alveoli. Pathology disrupts normal gas exchange, causes respiratory failure.

Depending on the severity of the course, the disease is divided into:

• uncomplicated;
• complicated.

Chronic pneumonia can be complicated by:

• general disorders;
• pulmonary process;
• inflammatory processes in various organs.

TO general violations usually include:

• changes in the work of the central nervous system;
• development of cardiovascular syndrome;
• development of DIC;
• toxic-septic condition;
• the occurrence of toxic shock (ITS).

The course of chronic pneumonia can be complicated various processes in lungs:

• destruction;
• abscess;
• pneumothorax.

During the course of chronic pathology, the following inflammatory processes in the organs can develop:

• otitis;
• meningitis;
• sinusitis;
• pyelonephritis.

Varieties of recurrent pneumonia

Depending on the prevalence of the inflammatory process, recurrent pneumonia is classified into:

Features of diagnostics

Establishing a diagnosis can be difficult due to the fuzzy clinical picture of a chronic disease. X-ray examination in 3 projections helps to assess the condition of the respiratory tract. With large-focal carnifying pneumonia, it is noted:

• reduction of the affected lung;
• strengthening of the lung pattern;
• pleural changes, shadows with a clear contour, uneven filling and deformation of the contours of the bronchi are often observed.

In the phase of exacerbation of chronic pneumonia, X-ray of the lungs shows the formation of a fresh infiltrate in the area of ​​pneumosclerosis, a decrease in the affected lobe of the organ.

In the patient's blood, an increased level is found:

• leukocytes;
• squirrel;
• fibrinogen;
• hepatoglobin;
• increase in ESR.

Microscopic examination reveals a high titer of neutrophils, bacteriological analysis necessary to determine the causative agent of the inflammatory process and the selection of effective antibiotics.

During the physical examination, the following are heard:

• crepitus.

To determine the respiratory volumes, a respiratory volume is performed, with recurrent pneumonia, the indicators may decrease slightly, but with concomitant obstructive bronchitis, the volume of inspiration decreases, and airway patency deteriorates.

Differential diagnosis is carried out with cancer, lung abscess, tuberculosis, chronic bronchitis, bronchiectasis. In doubtful cases, do tuberculin tests, perform computed tomography(CT), MRI, thoracoscopy, biopsy.

Methods of treatment

Therapy of chronic pneumonia is carried out, to which the causative agents of inflammation are most sensitive. The most commonly used drugs are the penicillin, tetracycline class, sulfonamides,. Due to the fact that pathogenic bacteria are able to quickly develop resistance to drugs, drugs of various groups are simultaneously prescribed. Antibacterial therapy should be carried out for at least 3-4 weeks. In case of low efficiency of treatment, a correction of the dosage of drugs is required. Intravenously administered antibacterial plasma, immunoglobulin in combination with antihistamines. To restore the drainage function of the bronchi, prescribe:

• expectorant drugs (, Eufillin);
• mucolytics;
• bronchodilators.

Perform fibrobronchoscopic sanitation, install positional drainage. Improve the discharge of thick sputum aerosols of enzymes Trypsin, Chymotrypsin.

During the period of subsidence of the inflammatory process, inhalations are prescribed. Physiotherapy procedures increase the effectiveness of treatment:

• shortwave diathermy;
• UV irradiation;
• inductothermy;
• electrophoresis.

In addition, vitamin therapy is carried out, immunomodulators, homeopathic remedies are taken, the patient must eat intensively, in a balanced way. With frequent relapses of the disease, resection of the affected area of ​​the lung may be required. The operation is performed with a clearly localized inflammatory process and the absence of contraindications.

Prevention of chronic pneumonia

The main preventive measure is timely treatment acute stage of pneumonia, strict adherence to the doctor's recommendations. It is necessary to carry out rehabilitation of chronic foci of infection (sinusitis, caries, tonsillitis), to prevent hypothermia. Smokers are advised to stop bad habit, lead healthy lifestyle life, sports.

Patients with chronic pneumonia should:

• be registered with the attending physician;
• regularly undergo inspection and examination;
• must visit at least 2 times a year;
• patients with a disability group are required to consult a specialist at least 4 times within 12 months.

• breathing exercises;
• massage;
• chest electrophoresis;
• harden the body.

To improve the patency of the bronchi, a prophylactic course of mucolytics, expectorants is prescribed. Good to visit health resorts, relax by the sea.

Prognosis of chronic pneumonia

The outcome of the disease depends on the prevalence of the inflammatory process, the frequency and severity of relapses, and the rate of progression. respiratory failure and formation of cor pulmonale. About 50% of patients suffer from various complications of the pathology, these include:

• amyloidosis of internal organs;
• lung abscess;
• bronchial asthma.

The progression of pneumonia leads to disability, the development of heart and respiratory failure, which poses a direct threat to human life.

The chronic form of pneumonia develops against the background of undertreated acute inflammation. Areas of infiltration in the lungs do not completely resolve, are replaced connective tissue, lead to pneumosclerosis and frequent relapses of the disease. For effective treatment, a course of antibiotics, vitamin therapy, and immunomodulators are prescribed.

Chronic pneumonia (chronic pneumonia) is a disease in which lung tissue becomes inflamed, and the inflammatory process is localized in a specific place, affecting soft tissues lungs. Chronic pneumonia is a chronic, i.e., continuously recurring process. To prevent chronic pneumonia, you need to avoid cold infections.

The international medical community does not recognize such a disease as chronic pneumonia. That is why there is no chronic pneumonia in the international classifier of diseases. Despite this, chronic pneumonia exists.

Treatment of the lungs for chronic pneumonia should be accompanied by bed rest, proper nutrition, anti-inflammatory drugs, inhaled steroids and other medical procedures. Hospitalization may also be indicated for treatment.

Chronic obstructive pulmonary pneumonia is a severe and incurable disease. In chronic obstructive pneumonia, bronchial patency decreases and pathological changes occur in lung tissues.

Chronic nonspecific pneumonia - chronic inflammatory disease lung, characterized by periodic outbreaks of inflammation that occur on the basis of structural changes in the tissues of the lungs and bronchi.

Causes

The cause of the development of chronic pneumonia is unresolved. The development of the disease occurs in several stages: acute form the disease becomes protracted, and under adverse factors develops into a chronic form.

The causes of the development of the disease lie in pathogenetic factors. The main reason is a violation of the function of the local bronchopulmonary protection system. This can occur with a decrease in the activity of alveolar macrophages and leukocytes, a decrease in phagocytosis, a deficiency of secretory IgA, a decrease in the concentration of bacteriolysins in the bronchial contents, etc. All these factors create a favorable environment for the development of an infectious inflammatory process in a separate area of ​​the lungs, which leads to such severe diseases such as focal pneumosclerosis and local deforming bronchitis. A fairly common cause of the disease is a weakened immune system. Often the disease develops due to alcohol abuse, poor nutrition.

Kinds

According to the prevalence of inflammatory processes, chronic pneumonia is:

1. focal form;
2. segmental form;
3. share form.

According to the phase of the process, pneumonia can be:

1. aggravated;
2. in remission.

According to the clinical form, they are divided into bronchiectasis pneumonia and without the presence of bronchiectasis.

Symptoms

The chronic form of the disease is always the result of an unresolved acute form of pneumonia. There is no strict time period after which it can be argued that the acute form of the disease has developed into a chronic form.

The decisive role in the diagnosis is played by the absence of positive X-ray dynamics and the appearance of repeated exacerbations of the inflammatory process in the same area of ​​the lung.

At the time of exacerbation, the patient may experience the following symptoms:

• increased sweating;
• weakness;
• decreased appetite;
• separation of sputum with an admixture of pus during a cough;
• body temperature above normal by several degrees;
• chest pain.

Warning signs of the development of the disease:

• weight loss;
• the appearance of moist small bubbling rales.

All these symptoms are signs of acute pneumonia, therefore, in order to make an accurate diagnosis, it is necessary to undergo a complete examination. X-ray examination of the lungs, blood test, bronchography, bronchoscopy, spirography, bacteriological examination of sputum will help to detect chronic pneumonia.

Medication treatment

For the treatment of chronic pneumonia, new penicillins are used - piceracillin, azlocillin, mezlocillin. German clinics are testing roxithromycin, which is better tolerated by patients than erythromycin.

If pneumonia is caused by pneumococci, then erythromycin will be quite effective, since pneumococcal resistance to erythromycin is rare. Of course, erythromycin is inferior to penicillin in its effect on pneumococcus. But the ongoing antibiotic therapy- empirical.
Erythromycin is preferred for patients with signs of penicillin allergy and for those patients in whom primary atypical pneumonia and legionnaires' disease are suspected.

Side effects from erythromycin are relatively rare - nausea, vomiting, diarrhea. Moreover, the latter is due to increased intestinal motility, especially when more than 2 g of the drug is taken per day. In single patients there are allergic reactions, even less often - jaundice.

Chronic pneumonia in adults can develop due to weakened immunity, alcoholism. The most likely pathogens are pneumococcus, staphylococcus aureus, Haemophilus influenzae, Klebsiella. In this case, one cefamandol or mandol is used for treatment.

Chronic pneumonia, complicating chronic bronchitis - most of the pathogens are pneumococcus, Haemophilus influenzae. The drug of choice is ampicillin or a cephalosporin. Sometimes a doctor will prescribe penicillin or a cephalosporin in combination with an aminoglycoside.

The effectiveness of therapy can be determined after 2-3 days. Improvements will be indicated by a noticeable decrease in body temperature and the disappearance of signs of intoxication of the body, an improvement in the general condition of the patient. The ineffectiveness of the treatment during this time is the result of an incorrectly selected dose of an antibacterial agent and the extent of inflammatory changes in the lungs, the development of an infection that is insensitive to the selected drug.

Empiric therapy for pneumonia is continued for at least 5 days, until the body temperature is normal for 2-3 days. Usually, if penicillin, cephalosporins, or erythromycin have been prescribed, treatment rarely takes less than 10 days. Therapy of some patients lasts longer.

In the elderly and elderly, the duration of empiric therapy has not been established. But if pneumonia is not life threatening, treatment continues for at least 7-10 days. Patients who are severely ill should be given antibacterial drugs until complete resorption of the infiltrate in the lungs.

At the same time, the remaining radiological changes in the lungs (strengthening, enrichment, deformation of the lung pattern, signs of peribronchial infiltration), with the patient's well-being completely normalized, cannot serve as an indication for continuing antibiotic therapy.

The prescription of antibiotics in excessive doses is fraught with pulmonary superinfection with the appearance of constant fever in the patient. To avoid this, antibacterial agents it is expedient to appoint in the smallest effective doses. Preference should be given to one drug. Combination antibiotic therapy is justified for patients with severe course diseases that need to be treated immediately until the cause of the development of the process in the lungs is established.

Herbal preparations for treatment

Plants have been used to treat human diseases since time immemorial. Information about this can be found in all cultural monuments - Sanskrit, European, Chinese, Greek, Latin, Russian, etc. Lately interest in herbal medicine has increased in many countries around the world. It is widely used by doctors in Bulgaria, the Czech Republic and Slovakia, Poland, France, China, India, the CIS and other countries.

Along with traditional dosage forms from plants - infusions, decoctions, relatively new forms and methods are now used and applied (oxygen cocktails, aerosols, applications, herbal pastes, etc.).

IN medicinal plants found various biological active substances determining their therapeutic value in the treatment of chronic pneumonia. Also accepting funds from medicinal herbs necessary as a prevention of the development of chronic pneumonia.

Plants collected before flowering are included in many collections for the treatment of bronchial asthma. For the treatment of inflammatory chronic diseases of the lungs, bronchi and for the prevention of exacerbations, they are collected in early spring, when there is a shortage of vegetables, or the so-called spring desynchronosis, patients are prescribed plantain, fireweed, primrose, oats, borage, lungwort, oregano, marshmallow, which positively affect the surfactant system of the lungs, prevent its vulnerability. From these plants, either vegetable salads are prepared (in which young stalks of horsetail, nettle leaves, young greens of shepherd's purse, yams, wood lice, gouts, etc.) or juices (from nettles, dandelions, chicory, cow parsnip, primrose).

Aerosol therapy

The following medicines are used in aerosols: antibacterial (taking into account the drug sensitivity of the sown nonspecific microbial flora), anti-inflammatory, thinning and deodorizing sputum (mucolytics, proteolytic enzymes, menthol, herb thyme, wild rosemary, chamomile flowers, turpentine), improving the motor function of the bronchi and blood flow in their vessels (plantain and coltsfoot leaves, St. John's wort, calendula flowers, kalanchoe juice, sea buckthorn and eucalyptus oil), antispasmodics (ephedrine, eufillin, dried nettle, knotweed herb, horsetail, birch buds, juniper berries).

Usually, treatment begins with inhalation of a bronchodilator mixture in combination with furatsilin. Anti-tuberculosis drugs or antibiotics are then added to the aerosol mixture. a wide range actions.

Since the most common causative agents of acute pneumonia are pneumococci, which are usually sensitive to penicillins, along with intramuscular injection sodium salt benzylpenicillin or other antibiotics, it is advisable to additionally prescribe inhalation aerosols of sulfanilamide preparations. Phytoncides can be included in aerosols simultaneously with antibiotics and sulfanilamide preparations.

For inhalation of phytoncides, special devices are required. In particular, fruit gruel should be placed in a glass or plastic vessel, from which phytoncides are inhaled through a tube. The course of treatment is 10-15 inhalations.

Patients in whom chronic pneumonia is severe are prescribed inhaled heparin aerosols. As a result of treatment, microcirculation in the pulmonary circulation will noticeably improve, bronchospasm will be eliminated, ventilation of the lungs will improve, and hypoxia will decrease.