What causes chronic pneumonia? Features of chronic pneumonia in adults and children

Symptoms of chronic pneumonia are not specific. Chronic pneumonia is a low-grade inflammation. The occurrence of disease occurs as a result of avoiding acute condition, the inflammatory process immediately becomes chronic.

Chronic pneumonia - symptoms and treatment

Main symptoms of the disease

The disease is characterized by its instability, it is very similar to other lung diseases, but everything flows in waves. There are attacks and moments when a relapse occurs.

The symptoms are similar to any bronchial type disease, cough with sputum, shortness of breath, low-grade fever, chest pain, etc. Symptoms may vary depending on the location.

With the wrong approach or lack of treatment, the disease begins to progress, it is important to diagnose it correctly, because clinical manifestations She's very blurry.

Chronic inflammation requires integrated approach, incomplete treatment may cause resistance to future therapy.

Treatment of chronic pneumonia

The disease needs medical supervision treatment.

First you need to achieve long-term remission.

Struggle during a period of exacerbation

During exacerbation, use antibacterial agents wide range, after achieving remission, anti-inflammatory substances, immunostimulants, and immunomodulators are used.

If a complication appears in the form of bronchiectasis, then bronchosanitation and physiotherapy are used. The success of all treatment of chronic pneumonia depends on the current immune condition, even using modern medicines Without proper immunity, it is impossible to achieve recovery.

After achieving the result, careful monitoring and medical examination are required 2 times a year. Fluorography and blood sampling for analysis are required.

Treatment includes compliance special regime, you need to consume enough nutrients. Avoid colds, prevent the appearance of even the simplest inflammations.

Do inhalation procedures both with folk and pharmaceutical products. A sanatorium with natural clean air helps a lot; it is better to go there during remission.

Drugs used for exacerbation of the disease

There are cases when the disease initially subsided, but it returns with renewed vigor. This happens especially often if a person mistakenly assumed that he was completely cured and began to lead an incorrect lifestyle.

Exists detailed list drugs that can be used for treatment, but they can only be used after prescription and consultation with a doctor. From without prescription drugs Various syrups can be used to increase bronchial patency.

The usual list prescribed by the attending physician:

• one of the modern antibiotics: amoxicillin or clavulanate;
• trypsin;
• inhalation of monomycin;
• ultraviolet irradiation.

For each type and type, its own medications, only a doctor can correctly prescribe them after a detailed diagnosis. Many drugs are used in the form of inhalations or intramuscular, intravenous injections, this is how they gain maximum effectiveness.

Physiotherapy, medical procedures

An important part of all therapy is physiotherapy and physical effects on the disease. There are now a lot of inpatient procedures offered, from inhalation to electrophoresis. All of them are effective and, together with medications, can help in treatment.

Many procedures have anti-inflammatory, stimulating, renewing effects. Now there are special devices for ultrasonic inhalation. This gives the drugs the opportunity to reach the site to begin therapy.

The electrophoresis procedure helps administer various drugs. The device is used with the help of two electrodes, which are placed on the back and chest, and medications penetrate along with electrical impulses.

Simple massage treatments can also have a positive effect. With its help, the expectoration process begins. But for this action to have a drainage effect, it must be performed by a physiotherapist.

It is necessary to show common physical activity, study walking, especially where there is clean air. Balanced rest can greatly help in healing. At mild flow Performing special breathing exercises will help.

The most important thing is that all procedures should be performed only during the period of remission; with active inflammation they are strictly contraindicated.

They also have other contraindications, a detailed list:

1. Various tumor neoplasms.
2. Serious disruption of the cardiovascular system.
3. Atherosclerosis.
4. Insufficient blood clotting.
5. Neurotoxicosis.
6. Other concomitant disease V active form.

More detailed information you can obtain from your doctor. Some procedures can also be used for the active form, for example, inhalation, but there are cases of individual intolerance.

Causes of the disease in adults

Instead of specific infections, the cause may be bad habits, autoimmune diseases and other health problems. There may be several different pathogens present at once, and this, in turn, will indicate low immunity. Acute inflammation can become sluggish after improper treatment.


If we talk about infections that most often cause disease, then in the first place will be various cocci (pneumococci, staphylococci, etc.). There are known cases when the process was started after severe flu or ARVI.

Chronic pneumonia in adults can occur due to neglect of one's nervous system, constant overwork, which contributes to a decrease in immunity, and this leads to various lesions. In addition to a decrease in general immunity, a favorable environment for infections is reduced local immunity, including bronchopulmonary protection.

Long-term favorable conditions for a person, lack of rest can be a serious reason that will cause many health problems.

A very common cause is prolonged hypothermia. During the cold season, the number of sick people increases significantly, so there is special disease prevention, which includes: taking vitamins, maintaining immunity and, of course, warm clothes that cover all parts of the body.

Classification of chronic form

This disease is quite complex; it is classified into several types and subtypes. But all these types are not generally accepted, but were invented for a simpler perception of the disease.

So, the first way it differs is its prevalence in the lungs, there are the following types:

• focal;
• segmental;
• shared

During the course, a stage is distinguished when an exacerbation occurs and a stage when remission occurs. There may be acquired causes that caused the lesion, and congenital ones due to genetics.

Different localization requires its own approach, but in treatment there are general recommendations that are suitable for any type of disease. At a minimum, with the help of only the right measures, it is possible to keep the disease in remission for a long time.

The pathogens include bacterial, viral, and even fungal pneumonia. All of them require the right approach to treatment and diagnosis.

To find out the exact details, you will need full examination, which will include x-ray examination, blood tests (general, biochemical). All this will help doctors determine the diagnosis more accurately.

Due to the fact that all pneumonias differ in pathogen, it is necessary to take sputum cultures for various infections. Every year a person manages to learn more about this disease, but the disease itself changes.

Features of different types of disease

All types of disease manifest themselves differently, so primary pneumonia is an independent disease that resolves due to changes and deformation of certain areas of the bronchi. The term bronchosclerosis is often used for this type; it is difficult to treat.


It can occur in both a simple and severe form, especially if bilateral changes have occurred with damage to the lower part of the lobe. With the right approach, you can stop the progression of the disease; in the future it will not affect human health in any way.

Secondary damage often develops against the background of other diseases, for example, against the background of chronic bronchitis. If the disease is not advanced, then eliminating the original cause will help eliminate the manifestations of pneumonia.

Congenital problems and lung diseases can lead to secondary inflammation. Treatment should be aimed at stopping or eliminating primary disease, the symptoms of pneumonia must also be eliminated.

There is no specific damage to the lungs; periodic inflammation occurs here due to changes in the tissue of the bronchi and lungs. There can be a whole chain of diseases that push the development of pneumonia, from tonsillitis to bronchitis.

This type can be asymptomatic for a long time, so it is most often diagnosed during an exacerbation. If the course of the disease is not specific, you need to take a closer look at your general condition, try to healthy image life and eat healthy food.

A progressive, indolent disease is called interstitial. Its peculiarity is that over time it spreads to the adjacent walls of the alveoli and other connective tissues.

This inflammation is usually of unknown etiology, and it is very difficult to establish the cause. People with low immunity, smokers and people working in hazardous industries are susceptible to damage.

Video

Diagnosis of this pathology

The most important thing is to correctly diagnose the disease; for this there are many old methods and some modern ones. In addition to conventional x-ray examination, examination using computed tomography. This method allows you to study the chest area in more detail.

All studies are carried out by a pulmonologist; usually a therapist refers you to him, but you can make an appointment with him right away. The doctor’s main task is to find an area in the resulting images that, under the influence of the disease, has become deformed and reduced in size; this may appear as a darkening.

Based on the study obtained, the diagnosis is determined, but to increase accuracy, bronchography is used. It allows you to identify the convergence of the bronchial branches, which will confirm the diagnosis.

But in addition to procedures that take time, there are quick ways to check. These are the so-called auscultations or, speaking in simple language, normal lung auditions.

They allow you to detect noise in the lungs. This diagnostic method is able to detect the disease in the early stages, in the absence of other means.

Along with examining the site of the immediate lesion, the entire body is also examined. Conducted lab tests blood, which determine the current level of leukocytes, so you can determine the acute or chronic course, immunodeficiency.

Sputum tests are taken to determine the infectious agent; this procedure can be repeated several times. If the disease is specific, other research methods may be prescribed, but in the standard course of the disease, only these tests and procedures are prescribed.

Possible complications of the disease

If you do not seek help, then over time the disease can spread, even become acute form. One of the most dangerous complications chronic pneumonia is necrosis of soft tissues with further connection of an abscess. This condition is life-threatening and occurs with a long, sluggish illness.

Against the background of the disease, other lung pathologies can develop well, especially if the immune system is suppressed. But with timely consultation with a specialist, all serious side effects can be avoided.

During treatment of most types of chronic pneumonia, it is possible to achieve at least remission for an indefinite period. Compliance with long-term treatment and all the doctor’s advice will help you defeat the disease forever. Genetic changes and resulting inflammation are highly treatable.

During remission, a person’s actions should be aimed at maintaining his condition. It is impossible to give an accurate prognosis in the treatment of pneumonia, we can only say that some types are very difficult to treat. But in such people, signs of the disease appear from childhood. It is possible to live with the disease; all you need to do is get examined twice a year.

To avoid getting sick again, it is very important to adhere to simple rules that will help you maintain your health.


From the very beginning you need to take simple steps:

• stop smoking;
• observe temperature standards (avoid overheating and hypothermia);
• stop overeating;
• get rid of other diseases.

The prevention of many diseases is the same, so you can use a template that has been developed over time.

The disease called “chronic pneumonia” is one of the most undesirable, because many consider it difficult to cure, but by contacting a doctor in time, observing preventive measures, the disease can be avoided or quickly cured.

In the early stages, treatment of the disease occurs much faster, and complete recovery is almost always achieved. The most important thing is not to self-medicate and follow the doctor’s prescriptions.

Chronic pneumonia

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.

Chronic pneumonia in children and adults manifests itself as recurrent exacerbations leading to replacement functional fabric connecting. This includes staged nonspecific lung diseases. In this case, exacerbations are replaced by remissions.

The danger is the constant development of pathological metamorphoses in the lung tissues. With each subsequent inflammation, more and more areas are involved.

For diffuse lesions lung tissue This pathology differs in that the process is localized. Must be detected in the lungs various areas connective tissue.

A history of an episode of acute pneumonia plays a vital role in making a diagnosis. Chronic pneumonia in adults and children occurs as a result of an untreated acute process, which was accompanied by complications. Approximately 1-3% of acute pneumonia takes a chronic course.

Violations of the physiological properties of the bronchial wall cause a decrease or complete absence of local defensive reactions. This creates conditions favorable for the periodic reproduction of various pathogenic flora.

Chronization of the process in childhood promotes increased sensitization to various allergens. This phenomenon is most typical for children with congenital anomalies of the structure or development of the cardiovascular or respiratory system.

A hyperreactive reaction also leads to relapses of pneumonia immune system, manifested by a pronounced increase in internal bronchopulmonary lymph nodes. Among external factors that contribute to the occurrence of the pathology in question should be highlighted:

• high pollution or gas contamination of the place of residence;
• smoking;
• constant presence of household allergens in the air;
• harmful volatile substances during the production process.

Symptoms of chronic pneumonia can occur when there is presence in the bronchi foreign body. This phenomenon is mainly characteristic of young children. Conventional X-ray examination does not always detect obstruction in the primary process. If lesions recur in the same location, one should suspect that a chronic inflammatory process has developed due to aspiration.

During an acute process, severe local changes. Irreversible consequences are possible. Small necrosis alternates with relatively preserved parenchyma, which leads to pneumosclerosis.

Changes also affect the internal lining of the bronchi. The cleansing and drainage functions are difficult due to local chronic bronchitis. Hypersecretion of sputum and changes in sclerotic nature create favorable conditions for the development of microorganisms.

Repeated relapses are caused by mixed flora. Pneumonia is caused by bacteria, viruses and protozoa. Due to this diversity, diagnosis and treatment are accompanied by certain difficulties.

Signs of chronic pneumonia

The most characteristic symptom of this disease is cough. In most patients it manifests itself both in remission and during periods of exacerbation. It is usually moist, with little discharge. In most cases it is mucopurulent in nature.

With such a phenomenon as chronic pneumonia, the symptoms of exacerbations appear less frequently the older the child gets. There are two types of repeated inflammations - bronchitis and pneumo- tic.

bronchitis.
In the first case, the inflammatory process is predominantly concentrated in the bronchi. In this case, a clinic appears that is close to acute bronchitis.

With the pneumotic type of inflammation, alveolar tissue is involved in the process. In this case, severe intoxication occurs, especially in young children.

As for X-ray studies, the presence of infiltrates against the background of sclerotic changes is a sign of a new outbreak pathological process. The changes are mainly focal and segmental in nature; they rarely cover the entire lobe.

With a phenomenon such as chronic pneumonia, symptoms of exacerbations occur with different frequencies; in addition, patients have different conditions during periods of remission, as well as the level of respiratory failure. Depending on these factors, mild, moderate and severe degree pathology.

Chronic pneumonia must be distinguished from prolonged pneumonia. The following factors are taken into account:

bronchitis
Also, chronic pneumonia requires differential diagnosis with some other diseases. These include chronic bronchitis, tuberculosis, chronic abscess, and lung cancer.

Chronic pneumonia with bronchiectasis

Emptying bronchiectasis manifests itself copious discharge sputum, especially in the morning. The discharge is purulent, with pungent odor.

Externally, this pathology is manifested by pale skin, dilated veins in the neck, as well as a barrel-shaped chest. Chronic fatigue And poor tolerance Physical activity in children causes mental disorders. This is manifested by decreased attention, tearfulness, and a tendency to hysterics.

The disease is treated either in a hospital or at home. In the latter case, constant monitoring is required visiting doctor.

The basis of treatment is powerful antibacterial drugs. When choosing them, you need to take into account the results of bacteriological tests. If there is chronic pneumonia with bronchiectasis, then bronchosanitation and physiotherapy are needed to improve drainage function.

Both in the acute phase and in remission are needed antihistamines, immunomodulators, anti-inflammatory drugs. In most cases, stabilization is achieved in children. As for adult patients, the success of treatment is influenced by concomitant pathologies. General immune status is also important.

It is advisable to undergo Spa treatment. Physiotherapy and therapeutic exercises have a good effect. The judicious use of traditional medicine can also significantly help in this situation. Only the attending physician can prescribe them to a patient, taking into account many factors, including the patient’s individual tolerance of certain components.

• Treatment of Chronic Pneumonia
• Prevention of Chronic Pneumonia
• Which doctors should you contact if you have chronic pneumonia?

What is Chronic pneumonia

The concept of chronic pneumonia was first introduced by Bayle (1810) to designate a non-tuberculosis chronic process in the lungs. Numerous morphological studies I. V. Davydovsky (1937), A. T. Khazanov (1947), S. S. Vaill (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 due to suppurative processes, showed that diseases that are different in etiopathogenetic and clinical terms are characterized by common morphological features, which are an expression of the stereotypical reaction of elements of the lung tissue to certain damaging factors ( inflammation, carnification, pneumosclerosis, emphysema, etc.). Chronic inflammation and its consequences as a morphologically detectable phenomenon soon began to be wrongfully 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 lung pathology.

Since the mid-50s, ideas about the 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 corresponding plenums of the board of the All-Union Scientific Society of Therapists, were that chronic pneumonia is a staged pulmonary process beginning 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 abscessation, bronchiectasis, etc.), and in the total volume of the lesion with the gradual capture of all bronchopulmonary tissue and the development of severe functional disorders in the form of bronchial obstruction and pulmonary heart. 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 P.K., 1965; Uglov F.G., 1976].

The concept of a broadly interpreted chronic pneumonia seemed tempting in theoretical terms, since it united almost all chronic nonspecific pathology of the lungs in the form of a harmonious dynamic process with a single etiology and pathogenesis, and also convenient in practical terms, since for establishing a diagnosis of a chronic nonspecific 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 not consistent with firmly established facts. So, it turned out that transition of acutepneumonia, arose against the background of a previously healthy bronchial tree, V chronic form happens extremely rarely which in no way can explain the sharp increase in the incidence of chronic nonspecific lung diseases observed throughout the world. In addition, long-term observations of patients could not confirm the natural transition from chronic pneumonia with the presence of only local pneumosclerosis (the result of unresolved acute pneumonia) to bronchiectasis or destruction of the pulmonary parenchyma, as well as the transformation of a local process, which is pneumonia, into total defeat 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 chronic bronchitis, not primarily associated with acute pneumonia. This most important nosological form in non-specific pulmonary pathology, although not formally denied by the concept of chronic pneumonia in the interpretation of the Minsk and Tbilisi classifications, was actually absorbed by it, and this, of course, played a negative role in the study of lung diseases and the fight against them, since this was not the case here. not about different terminology, but about a different approach to the essence chronic pathology lungs, 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 usually represents localizedprocess:

Resulting from acute pneumonia that has not fully resolved;

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

Clinically manifested by 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 between chronic pneumonia and acute pneumonia shows the main feature of its pathogenesis and distinguishes 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 pulmonary parenchyma or dilation of the bronchi. 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 some forms of pneumonia, as well as destructive lesions associated with nonspecific or tuberculosis infection.

The strict limitation of the concept of “chronic pneumonia” has led to the fact that the number of patients with this diagnosis turned out to be many times smaller than previously thought. If in the past it was believed that acute pneumonia ends in a transition to a chronic form with a frequency of 16 to 37% [Molchanov N. S., 1965], then at present, according to VNIIP employees A. N. Gubernskova, E. A. Rakova and etc., does not exceed 1-3%. Such a sharp difference is explained primarily by the fact that in the past, acute protracted 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, were mistakenly classified as chronic pneumonia. If in the 60s it was believed that patients with chronic pneumonia made up 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, in accordance with the above definition, chronic pneumonia is a consequence of acute infectious pneumonia, 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. In all likelihood, in this case we are talking about irreversible loss of part of normal structures lung during the acute process. If in this case massive necrosis of a section of lung tissue occurs followed by its non-sterile disintegration, 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 the lung develops pneumosclerosis, which, as already mentioned, is the morphological substrate of chronic pneumonia.

A large, and perhaps the main, role in the occurrence of repeated outbreaks of infection in the area of ​​pneumonia suffered in the past is also played by the remaining after it irreversible changes in the appropriate area bronchial tree(local chronic bronchitis), leading primarily to local disruption of the cleansing function of the bronchi.

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

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

Irreversible changes that develop in the lung during the transition from acute to chronic pneumonia (pneumosclerosis, local bronchitis) cause respiratory dysfunction, occurring 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 area of ​​pneumosclerotic changes determine the fact that the affected area of ​​the lung tissue becomes the place of least resistance to further adverse effects. By modern ideas, as etiological factor exacerbations are of greatest importance pneumococcus and hemophilus 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, repeated lofecal outbreaks of inflammation, which can be localized both in the bronchial tree and in the pulmonary parenchyma (the so-called “bronchitis” and “parenchymatous” types of exacerbation).

Local exacerbations of infection are likely to 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 section, the lung tissue appears compacted. The walls of the bronchi are rigid. The lumen contains a viscous secretion.

Microscopically, more or less pronounced manifestations are revealed pneumosclerosis: fibrosis of 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 peri-scar emphysema. The walls of the bronchi are thickened due to fibrosis. In the mucous and submucosal layers, phenomena of chronic inflammation with characteristic restructuring of the epithelium (predominance of goblet cells over ciliated cells) are observed.

Symptoms of Chronic Pneumonia

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

Depending on the predominance of certain morphologicallysky changes Chronic pneumonia can be divided into: a) interstitial (with a predominance of interstitial sclerosis) and b) carinfecting (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 one should distinguish between: a) focal (usually carnifying), b) segmental, c) lobar chronic pneumonia. The diagnosis should also indicate the localization of changes (by lobes and segments) and, in addition, phase of the process(exacerbation, remission),

First of all, the question arises about the boundary between prolonged acute pneumonia and chronic pneumonia. In the past, the time elapsed since the onset of the disease was used as a criterion. Thus, according to the authors of the “Tbilisi” classification (1972), 8 weeks were considered such a period. V.P. Silvestrov (1974) extended this period to 3 months, and other domestic and foreign authors - up to a year or even more. Long-term observations of patients who suffered from prolonged pneumonia, carried out by V. A. Kartavova at our institute, showed that residual radiological changes can persist for many months and then disappear without a trace. Thus, the criterion for the diagnosis of chronic pneumonia may not be so much the period from the onset of the diseaseunderstanding how long-term dynamic observation of the patient is. 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, allows us to talk about the transition of pneumonia to a chronic form.

IN remission phase complaints from patients with chronic pneumonia can be extremely scanty or absent altogether. A typical unproductive cough is predominantly in the morning with satisfactory general condition and good health. Physical data are also scarce. Sometimes in the affected area it is possible to detect dullness of percussion tone and mild wheezing. Large focal carnificating pneumonia is characterized by the absence of complaints. X-ray There is a decrease in the volume of the corresponding part of the lung and an increase in the pulmonary pattern due to interstitial changes. At carnifying form Intense, fairly clearly defined shadows may be observed, giving rise to differential diagnosis with a peripheral tumor. High standing of the corresponding dome of the diaphragm, obliteration of the sinuses and other prenatal changes are often observed. At bronchography the convergence of the bronchial branches in the affected area, the unevenness of their filling and uneven contours (deforming bronchitis) are revealed.

Bronchoscopically Catarrhal (sometimes purulent during exacerbation) endobronchitis is detected, most pronounced in the corresponding lobe or segment.

At spirographic study As a rule, restrictive changes in ventilation are found, and in patients with simultaneously existing chronic bronchitis- also the phenomena of obstruction.

IN exacerbation phase The patient’s well-being worsens, weakness and sweating appear, and body temperature rises to subfebrile or febrile levels. The cough intensifies or appears, the amount of sputum increases, and it may become purulent. Sometimes chest pain occurs on the affected side. Physical findings may resemble acute pneumonia (dullness, fine bubbling and crepitating rales), and radiographically in the area of ​​pneumosclerosis, fresh infiltration of 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 normalize more slowly than clinical indicators,

Diagnosis of Chronic pneumonia

Greatest practical significance It has differential diagnosis chronic pneumonia and lung cancer; It is well known that cancer patients are often observed for months with an erroneous diagnosis of chronic pneumonia, resulting in missed treatment opportunities. It should be well remembered that lung cancer is very common, and chronic pneumonia is much less common. Therefore, in any cases of 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 phenomenon of so-called paracancrotic pneumonia. The same must be said regarding those often discovered during random X-ray examination. large focal shadows in the lung, which most often turn out to be tumors, but can also represent areas of carnification. In the absence of a typical clinical and radiological picture of the tumor, the correct diagnosis can be established based on the dynamics of the radiological picture, which appears negative in case of cancer. It should be emphasized, however, that special efforts dynamicmonitoring a patient with suspected cancer isbig risk and is generally unacceptable. In a timely manner clarifythread diagnosis In most cases succeeds with the help of specialal methods - bronchoscopy with biopsy, transbronchial or transthoracic biopsy of the pathological focus, regional lymph nodes, bronchography, etc. If it is impossible to establish accurate diagnosis These methods indicate thoracotomy with clarification of the diagnosis on the operating table and subsequent implementation of an intervention of the appropriate volume.

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

For bronchiectasis, in contrast to chronic pneumonia, a younger age of patients with obstruction of the patency of distal branches is characteristic, as well as typical dilatations of the bronchi detected by bronchography. It should be noted, however, that according to bronchographic data, there are transitional forms between these two states.

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

Certain difficulties often arise when differentiating chronic pneumonia and some forms tuberkalung forest. The latter is characterized by the absence of an acute nonspecific process at the onset of the disease, predominantly upper lobe localization of lesions, petrification in the lung tissue and hilar lymph nodes. The diagnosis of tuberculosis is confirmed by repeated sputum examination, skin tests tuberculin tests, as well as 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 hemophilus influenzae, Antibacterial treatment is carried out using penicillin and tetracyclic drugs, as well as erythromycin in sufficient dosages. Sulfa drugs, such as sulfadimethoxine, may also be effective. Duration of use of antibacterial drugs depending on clinical effect ranges from 1-2 to 3-4 weeks. In case of insufficient effectiveness, the composition of antibacterial agents is adjusted taking into account the results of sputum culture on special media, which is recommended to be done at the beginning of treatment, before using antibacterial agents.

An important element of therapy are means aimed at improvement of bronchial obstruction and bronchialground clearance: bronchodilators, expectorants, mucolytics. Many authors recommend using endotracheal and endobronchial sanitation with thorough washing of the affected parts of the bronchial tree with a 3% sodium bicarbonate solution and 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 administration of anti-inflammatory and desensitizing drugs (aspirin, pipolfen, 10% CaCl 2 solution intravenously). The diet of patients should be complete and sufficiently rich in vitamins. It is advisable to use vitamin preparations orally and parenterally.

IN phase of subsiding exacerbation inhalation of onion and garlic phytoncides, chest massage, 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 medications.

Treatment of chronic pneumonia in remission phase is a set of measures aimed at preventing exacerbation, i.e. measures secondary prevention. The patient must constantly be registered in a pulmonology office clinics. He needs rational employment (excluding sudden temperature fluctuations, industrial air pollution, etc.). Quitting smoking is urgently needed.

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

Chronic pneumonia is recurrent exacerbations, the outcome of which is the restructuring and replacement of functional tissue with connective tissue, as well as deformation of the bronchial tree.

These include nonspecific lung diseases that occur in stages: a period of exacerbation is followed by a period of remission. Constant progression is dangerous pathological changes in the lung tissue itself. On the one hand, changes in the lung tissue gradually increase in one focus with the development of pneumosclerosis, necrosis, and bronchiectasis. On the other hand, with each new inflammation, new areas of unchanged tissue are involved in the process. There is qualitative and quantitative dissemination.

Chronic pneumonia has the following characteristics:

1. Localized process - how the pathology differs from diffuse lesions of the lung tissue;
2. History of at least one episode of acute pneumonia;
3. Mandatory identification of various areas of connective tissue in the lungs;
4. Undulating course with relapses and remissions.

Chronic pneumonia is always the outcome of an untreated severe acute process with complications. According to statistics, 1-3% of acute pneumonia become chronic.

The most significant factor is the patency of the bronchi at the time of pneumonia. Violation of the physiological properties of the bronchial wall leads to a decrease or complete absence local protective reactions that do not prevent the periodic reproduction of pathogenic flora.

Increased sensitization of the body by various allergens contributes to the formation of chronic pneumonia in children, especially in the presence congenital anomalies structure or development of the cardiovascular and respiratory systems.

Hyperreactive immune response in the form of a massive increase in internal bronchopulmonary lymph nodes also leads to constant relapses of pneumonia.

External factors that contribute to the development of chronic pneumonia in children and adults:

• Active or passive smoking;
• High pollution, gas contamination of the place of residence;
• The presence of constant household allergens in the air;
• Harmful and dangerous volatile substances in production.

One of the reasons that can give symptoms of chronic pneumonia is the presence of a foreign body in the bronchi. This most often occurs in children in the first years of life. Conventional x-ray examination may not always reveal obstruction in the primary process. And only repeated lesions in the same place allow us to suspect chronic pneumonia in children caused by aspiration.

Pathogenetic changes in lung tissue

The basis is severe local changes in the alveoli and bronchi at the time of acute pneumonia. Massive necrotic changes cause irreversible consequences, and a lung abscess develops. The alternation of small necrosis with relatively intact lung parenchyma leads to pneumosclerosis.

In addition to changes in the alveoli, there is a disruption of the internal lining in small and medium-sized bronchi. Manifestations of local chronic bronchitis interfere with the main cleansing and drainage function. Hypersecretion of sputum and sclerotic changes against this background create a favorable environment for the proliferation of microorganisms.

What factors can serve as a basis:

• decreased body reactivity;
• untimely and inadequate treatment of the primary process;
• the presence of chronic obstructive pulmonary disease.

Infectious agents that cause repeated relapses are represented by mixed flora. Viruses, bacteria and protozoa with varying degrees of activity can support pneumonia. The variety of pathogenic microorganisms involved in the etiology of chronic pneumonia causes great difficulties in diagnosis and selection of treatment.

Most characteristic symptom is a cough. In most patients it manifests itself in both remission and exacerbation. According to its characteristics, it is moist, with a small amount of discharge, and its properties are usually mucopurulent.

Percussion data are motley, in the projection of the inflammation focus there is a shortening of the sound. What is important is the constancy of the auscultatory pattern, in which moist rales of different sizes are heard in the same place, regardless of the period of the disease.

Symptoms of exacerbation of chronic pneumonia in children appear inversely proportional to age. That is, than older child, the less often there are exacerbations. In adults, during the period of remission, symptoms of pulmonary tissue involvement may even completely disappear.

There are two types of repeated inflammation:

1. Bronchitic type - when new inflammation primarily affects the bronchi. Clinical symptoms are more typical for acute bronchitis.
2. Pneumatic type – involvement of alveolar tissue in the process. Accompanied by severe intoxication, especially in young children.

X-rays and computed tomography scans show a slight decrease in the affected part of the lungs. Infiltrates against the background of sclerotic changes indicate a new outbreak of the infectious process. In terms of scale, the changes can be focal or segmental in nature, rarely affecting the entire lobe. On the side of the bronchi, thickening of the walls and deformation are detected.

Taking into account the frequency of complications, their nature, the condition of patients without exacerbations, the level of respiratory failure and the presence of complications, mild, moderate and severe degrees of chronic pneumonia are distinguished.

What is the difference between chronic pneumonia and protracted pneumonia:

• manifestations do not subside more than a year from the beginning of the acute phase;
• X-ray changes remain constant, there is no positive dynamics, regardless of the treatment;
• repeated outbreaks of infection in the same area of ​​the lung speak in favor of a chronic, inveterate process.

Also, the differential diagnosis of chronic pneumonia is carried out with tuberculosis, chronic bronchitis, lung cancer, chronic abscess.

Features of the course with bronchiectasis

A distinctive feature is the periodic emptying of bronchiectasis. This is manifested by copious sputum secretion, mainly in the morning. The discharge is purulent in nature with an unpleasant, pungent odor. Manifestations of respiratory failure are more pronounced.

The general appearance is pale skin, dilated veins in the neck, barrel-shaped chest. In adults, typical shapes of fingers and nails are additionally identified. Constant fatigue and low tolerance to physical activity in children it can cause mental disorders, which manifest themselves in tearfulness, hysterics and decreased attention.

Comprehensive treatment of prolonged pneumonia

Depending on the severity of the exacerbation, treatment is carried out in a hospital or under the constant supervision of a visiting physician at home.

Massive antibacterial agents taking into account bacteriological tests are the basis of etiotropic therapy. Antihistamines, anti-inflammatory substances, immunomodulators and stimulants are necessary not only in the acute phase, but also during periods of remission to reduce the likelihood of relapse.

Chronic pneumonia with bronchiectasis is treated with the active use of bronchosanitation and physiotherapy to improve drainage function.

In children, with modern approaches to treatment, in most cases it is possible to achieve stabilization and prevent progression of the pathological focus. In adults, the success of treatment directly depends on concomitant pathologies and general immune status.

Immediately after discharge from the hospital, if possible, it is necessary to undergo sanatorium treatment. Providing general strengthening measures, therapeutic exercises, and physiotherapy has a beneficial effect on patients. Active use of traditional medicine, herbal medicine is found wide application and in complex treatment are not in last place.

Medical examination is mandatory 2 times a year. For patients with bronchiectasis, the number of preventive examinations and treatment measures to prevent relapses should be four times a year.