Long-term inflammation of the bronchi, accompanied by a cough, is called chronic bronchitis. The disease most often develops in adults. The choice of drug treatment and the prescription of the necessary medications depend on the correct assessment of the symptoms of bronchitis. Unfortunately, it is impossible to permanently cure chronic bronchitis at a late stage. But in the absence of therapy, the disease progresses and leads to the development of COPD, emphysema, bronchiectasis, cor pulmonale and other severe complications.

Chronic bronchitis: definition, mechanism of development and prevalence

The bronchi conduct air from the upper respiratory tract to the pulmonary alveoli. Their walls contain glands that secrete mucus, muscle cells that can contract and narrow the lumen of the bronchi, and connective tissue. The surface of the bronchi is lined with epithelium, which cleans it and removes mucus with particles of dust and other contaminants. This process is carried out using microscopic oscillating cilia.

Development of cough with bronchitis

Factors that cause chronic bronchitis damage the ciliated epithelium of large and medium bronchi. His cells begin to break down. In response, the body’s defense reactions develop:

• inflammation, necessary for the delivery of immune cells to the lesion, cleansing it and restoring the integrity of the bronchial wall;
• excessive production of mucus by the bronchial glands to remove products of the inflammatory reaction;
• cough caused by constant irritation of sensitive nerve endings in the wall of the bronchi and necessary to remove the resulting mucus (phlegm).

Long-term inflammation causes depletion of defenses, a deficiency of macrophage cells that absorb dirt and microorganisms occurs, and the cough reflex weakens. The local production of immunoglobulins A and G is inhibited, which is accompanied by mucociliary insufficiency (impaired functioning of the epithelial cilia). Pathogenic microorganisms, for example, pneumococcus, Haemophilus influenzae, and moraxella, multiply on the surface of the bronchi.

The damaged wall of the bronchi is replaced by connective tissue and thickens, which leads to a narrowing of their lumen (bronchial obstruction). Disruption of normal air flow leads to the appearance of emphysema. Damage to all layers of the bronchial wall is accompanied by their local expansion and the formation of bronchiectasis - “sacs” in which purulent sputum stagnates.

The blood supply to the alveoli is disrupted. To ensure normal oxygen levels in the blood, the pressure in the pulmonary vessels increases, and pulmonary hypertension develops. The right parts of the heart gradually cease to cope with the increased load, and their contractility decreases. Cor pulmonale is formed, accompanied by impaired pumping function and blood stagnation. Symptoms such as swelling, enlarged liver, and dilation of large veins appear.

Impaired oxygen supply to the alveoli causes respiratory failure.

Initially, the disease is not accompanied by obstruction. This is a simple form of the disease. Depending on the nature of the inflammation and the sputum produced, it can be catarrhal (the mildest) or mucopurulent. With the appearance of bronchial obstruction, obstructive bronchitis develops, which refers to chronic obstructive pulmonary disease. This group also includes chronic bronchitis with an asthmatic component or broncho-obstructive syndrome.

At the stage of simple inflammation (catarrhal chronic bronchitis), the course of the disease is reversible, that is, a cure is possible. If obstruction has formed and a persistent infection has occurred (mucopurulent bronchitis), recovery is no longer possible, and treatment is aimed only at eliminating the symptoms of the pathology and preventing complications.

The main sign that allows you to identify the disease is a cough with sputum. This symptom should bother the patient on most days of one month for at least 3 months a year for two or more years. The disease occurs with alternating exacerbations and remissions, when the patient feels better. When episodes of shortness of breath, paroxysmal cough, and suffocation appear at least three times during the year, we can talk about the transformation of simple chronic bronchitis into COPD.

When the process worsens, when the cough intensifies, the patient releases pathogenic microorganisms into the external environment. They usually do not harm others with healthy immune systems. Chronic bronchitis itself is not contagious, it is not transmitted by sharing utensils, kissing, etc., but it is still dangerous for children, the weak and elderly people around the patient.

Every year, about 400 people out of 100 thousand adults get sick. Most often affected are middle-aged and older men, who usually experience “smoker's bronchitis.”

Manifestation of the disease

In acute bronchitis in adults, viral etiology is most often noted. Acute bronchitis in this situation in adults begins like any acute viral respiratory disease, with manifestations of intoxication processes.

By the end of the first day, or a little later, a cough appears, a characteristic sign of bronchitis. The following symptoms can be identified for acute bronchitis in adults:

• acute onset;
• increased body temperature;
• dry cough in the early stages;
• pain when coughing in the chest;
• pain in the muscles;
• headache;
• increased fatigue.

Viral bronchitis is characterized by the presence not only of its symptoms, but also of other manifestations of a viral infection of the upper respiratory tract:

• runny nose;
• sore throat;
• hoarseness of voice.

The viral process can be complicated by bacterial infections, or immediately develop from a combination of two infections.

Viral acute bronchitis is characterized by the appearance after a few days of illness of a productive cough with mucous sputum.

And with the addition of bacterial inflammation, or with bacterial bronchitis in adults, a purulent cough can be detected.

In the further course of the disease, all concomitant manifestations of viral infections disappear, and only manifestations of bronchitis in the form of cough remain.

We can talk about additional obstruction if, in addition to coughing, shortness of breath occurs in adult patients with bronchitis. It is manifested by difficulty in exhaling and wheezing in the lungs, rapid breathing.

The development of chronic forms requires a longer period of time; they develop gradually and do not have a pronounced onset.

Important to know: What are the complications of bronchitis?

It is precisely because of the absence of an acute onset that patients do not begin treatment for the disease for a long time.

Patients do not pay attention to a cough that is insignificant at first for a long time. But later it becomes permanent, pronounced, and this forces adults to begin treating the disease.

In the absence of exacerbations, the cough is productive only after waking up, and the rest of the time it is dry. With severe obstruction, there may be prolonged coughing attacks, while it is dry.

As an exacerbation develops, the dry cough changes to a wet one, and the amount of mucus released when coughing increases. Its character also changes to purulent.

During exacerbations, symptoms of shortness of breath intensify in patients. Often [obstructive chronic bronchitis] occurs in people who smoke or work in hazardous industries.

They experience shortness of breath during physical activity for a long time, but do not pay due attention to it.

Over time, changes in the mucous membranes of the bronchi only progress if treatment is not started or the harmful effects are not eliminated.

In advanced cases of the disease, they experience shortness of breath and with simple actions, difficulties arise with self-care.

[In chronic bronchitis], treatment of cough and shortness of breath is more labor-intensive; continuous treatment with any medications may be prescribed to ensure normal life activities.

Regardless of the form of the disease, acute or chronic, in the presence of obstruction, patients require mandatory medical care. Since its presence causes symptoms of respiratory failure. If chronic bronchitis and cough symptoms are not treated, severe irreversible complications develop.

Causes of chronic bronchitis

Chronic bronchitis is a non-infectious disease. He is called:

• smoking;
• contact with occupational hazards: dust, hydrocarbon combustion products, nitrogen dioxide, sulfur oxides, ozone;
• pollution of the surrounding air with harmful gases and dust;
• frequent colds.

Risk factors for the development of chronic bronchial inflammation:

• disadvantaged social status, poverty;
• elderly age;
• poor nutrition, lack of proteins, vitamins;
• alcoholism.

Symptoms of bronchitis in adults

The main symptom of simple chronic bronchitis is cough. It appears in the morning and is accompanied by coughing up a small amount of light, yellow or greenish sputum. This condition can persist for years. Chest pain is not typical for chronic bronchitis.

With the development of obstructive bronchial lesions, the following signs of bronchitis appear in adults:

• constant cough with thick sputum, worse in cold weather;
• shortness of breath, limiting physical activity (first when climbing stairs, then when fast, and subsequently when walking normally and even with minimal household activity);
• cyanosis of the skin, lips, swelling of the legs;
• headache;
• prolongation of exhalation, during which wheezing may be heard.

If too much sputum is produced, there is a high probability of infection of the lower respiratory tract with the development of symptoms of pneumonia.

How does chronic bronchitis manifest itself during examination: when listening, the doctor detects hard breathing, numerous dry wheezing, and in the lower sections, wet wheezing may appear, disappearing after clearing the throat.

Symptoms that require immediate medical consultation:

• duration of cough more than 3 weeks;
• sleep disturbance;
• fever above 38˚C;
• admixture of blood to sputum;
• shortness of breath or suffocation;
• chest pain when breathing or coughing.

Complications of chronic bronchitis develop gradually, with a long course of the disease, but lead to adverse consequences:

• emphysema;
• atelectasis (areas of collapsed dense tissue in the lungs);
• pneumosclerosis (proliferation of connective tissue replacing normal lung cells);
• bronchiectasis;
• expiratory tracheal stenosis (collapse of its walls during exhalation with the development of paroxysmal barking cough);
• respiratory failure;
• chronic pulmonary heart disease, heart failure.

Reasons for the development of bronchitis

The most common etiology of the disease is various infectious diseases, the most common are the following:

• [viral diseases];
• [bacterial diseases];
• [fungal diseases].

Among viral diseases, the most common are adenovirus, rhinovirus, enterovirus, and parainfluenza.

And among bacterial ones, the main role belongs to staphylococcal, streptococcal, pneumococcal infectious agents.

In rare cases, a disease may develop when exposed to atypical bacteria, such as mycoplasma, chlamydia.

Fungal infections develop only in the presence of reduced body defenses - immunodeficiency states.

The infectious nature of bronchitis is typical for acute forms of the disease, or for [exacerbations of chronic forms].

There are also mixed causes of the development of the disease in bronchitis in adults, that is, there may be a combination of [viral and bacterial infections].

Factors contributing to the development of a chronic process or predisposing to the development of an acute process are:

• often sick people;
• age of patients over 60 years;
• smoking;
• alcohol abuse;
• poor nutrition;
• labor activity at industrial enterprises with exposure to harmful air factors;
• constant overwork;
• decreased physical activity;
• inhaling cold air through the mouth in winter;
• living in regions with a humid climate;
• pronounced daily temperature fluctuations;
• the presence of hazardous industries near residential areas;
• congestive heart failure with congestion in the lungs;
• chronic diseases of the nasopharynx - rhinitis, sinusitis, pharyngitis, tonsillitis;
• various chest injuries.

Chronic changes in the walls of the bronchi occur with prolonged exposure to these factors.

Chronicity of the inflammatory process can also be caused by untreated acute bronchitis, or if its treatment was illiterate. The disease can take several forms:

• [spicy];
• [chronic];
• simple;
• [obstructive].

Important to know: Symptoms of dust bronchitis - how to recognize the disease?
The disease is said to be acute when it lasts less than three months in two years, and if its course is longer, then it is already a chronic form.

A simple form of bronchitis is said to exist if there are no signs of an obstructive component, and if there are signs, then this is an obstructive form of the process.

The obstructive form is characterized by the presence of narrowed lumens in the bronchi, and there is also an acute and chronic course.

Only the chronic course of this form is characterized by the development of irreversible changes in the walls of the bronchi.

Treatment of chronic bronchitis

Therapy for simple chronic inflammation of the bronchi is carried out on an outpatient basis. Smoking cessation plays a critical role in treatment. Quitting this bad habit can lead to a reduction in symptoms or recovery even without treatment.

In addition, it is necessary to exclude other causes of the disease - dust, contact with harmful gases, and so on.

It is recommended to drink more fluid. It is useful to eat more lemons, honey, almonds, garlic, and also use bay leaves for cooking. To improve sputum discharge, you can use semi-alcohol compresses on the interscapular area, but only at normal temperature.

The diet for chronic bronchitis is normal; table No. 10, enriched with protein and fermented milk products, is recommended.

It is recommended to use a humidifier at home.

You can read about the symptoms and treatment of acute bronchitis here.

Drug treatment of bronchitis in adults: drugs

How to treat chronic bronchitis in adults during an exacerbation? When the cough intensifies, expectorants and mucoregulators are added to treatment, in particular ambroxol, acetylcysteine, bromhexine. Ascoril is used - a drug with a bronchodilator and coughing effect, as well as Erespal - an anti-inflammatory drug. In some cases, the doctor prescribes treatment for bronchitis with antibiotics such as amoxiclav, levofloxacin, azithromycin, as well as glucocorticoids in inhalations or tablets.

You can read about the use of nebulizers and other inhalers for chronic bronchitis here.

Treatment of chronic bronchitis

If COPD develops, its treatment is carried out according to generally accepted regimens. Bronchodilator drugs used:

• M-anticholinergics (ipratropium bromide);
• beta-agonists (fenoterol).

Theophylline preparations (Theotard) may be prescribed, but they do not play a leading role in treatment.

Surgery

Surgery is possible if complications develop. For example, with bullous pulmonary emphysema, the affected areas are removed. If symptoms of severe respiratory failure occur, indications for long-term oxygen therapy or lung transplantation arise.

Rehabilitation

To improve the health of patients with chronic bronchitis, methods of physiotherapy, breathing exercises, and physical therapy are used.

Physiotherapy for chronic bronchitis: UHF currents, microwaves, inductothermy, electrophoresis of calcium chloride, heparin, potassium iodide, aminophylline are used. During the period of remission, mud treatments, pine baths, stays at sea resorts, and visits to special salt caves are recommended.

In case of exacerbation, inhalation of mucolytic and bronchodilator drugs, for example, salbutamol and lazolvan, is used in treatment. They can be carried out using a nebulizer. A general practitioner should prescribe medications and determine the dosage.

In chronic bronchitis, large and medium-sized bronchi are affected, so regular steam inhalations with soda or alkaline mineral water will also be effective. They can be done twice a day for 5 – 7 days.

Among the methods of physical therapy for patients with simple chronic bronchitis, Nordic walking is best suited. In addition, swimming and yoga are beneficial for them. Classes should be held at least three times a week for half an hour. For purulent bronchitis, exercises that improve bronchial drainage and vibration massage of the chest are indicated.

A few simple exercise therapy exercises for the treatment of chronic bronchitis at home:

• body turns with arms spread to the sides;
• tilting the body forward while sitting on a chair;
• circular rotations with arms bent at the elbows;
• tilting the head forward as you exhale, while inhaling – straightening the chest;
• various turns and bends with a gymnastic stick held with outstretched arms;
• breathing with inhalation through the nose and slow exhalation through half-closed lips.

This set of exercises for bronchitis can be repeated daily 1 – 2 times a day.

What can cause the development of chronic bronchitis?

Pollutants, which are unique impurities in the air, play a major role in the occurrence of the disease. They have completely different nature and chemical structure. Pollutants have a very harmful effect on the bronchi. The worst thing for lung health is inhaling tobacco smoke. Scientists have already proven that the incidence of bronchitis in people who are heavy smokers is approximately 5 times higher. It should be remembered that tobacco smoke tends to significantly reduce the resistance of the bronchi to the adverse environmental factors that exist today.

In second place among the most common factors influencing the development of the disease are pollutants, which have a so-called industrial production nature. These can be products of incomplete combustion of oil, gas or coal. All of the above pollutants have a fairly strong irritant effect on healthy bronchi.

Viral infections that are common today play a significant role in the development of severe chronic bronchitis. They can develop secondarily due to disruption of natural defense mechanisms. Exacerbation of the disease is caused by respiratory syncytial viruses, pneumonia, and influenza viruses. They tend to have a detrimental effect on the ciliated cells of the bronchi, which causes a fairly serious disruption of the structure of the epithelium. This helps a large number of bacteria gradually penetrate the mucous membrane. That is why treatment of chronic bronchitis in adults should be carried out in a timely manner.

Prognosis and prevention

Simple (non-obstructive) chronic bronchitis has a relatively favorable prognosis. It rarely causes severe complications. They develop after a long course of the disease. Quitting smoking significantly increases the likelihood of restoration of damaged bronchial mucosa. Half of former smokers stop coughing within a month.

The prognosis for obstructive bronchitis depends on the degree of bronchial obstruction and its reversibility. If, under the influence of drugs that dilate the bronchi, their lumen increases, the likelihood of severe complications is low, especially with constant treatment. If lung function is significantly and/or irreversibly impaired, the prognosis is poor. Why is chronic bronchitis dangerous: the disease leads to disability, severe pulmonary heart failure and death.

Measures to prevent chronic bronchitis:

• to give up smoking;
• respiratory protection during contact with occupational hazards;
• strengthening the immune system, if necessary, surgical treatment of sinusitis, tonsillitis and other foci of chronic infection;
• regular preventive examinations of persons of certain professions with a mandatory study of respiratory function for early detection of impaired bronchial obstruction;
• annual flu vaccination.

How to treat dry cough?

It, as a rule, begins with the prescription of mucolytic drugs - they transform coughing from unproductive to productive, in other words, they transfer the disease from dry to wet.

Thus, sputum, abundantly accumulated in the bronchi due to inflammation, begins to leave the body along with a cough.

As a rule, such drugs relieve chest pain within a day, and after a week the symptoms of bronchitis begin to disappear.

There are many medications that have worked well at this stage of treatment for a relatively long time.

This group of drugs includes: Ambroxol, Flavamed, Lazolvan, Abrol . As a rule, they are available in the form of syrup, drops, or tablets and are taken 3 times a day.

You should know! The already well-known Acetylcysteine ​​(ACC, Fluimucil) is taken after meals in the form of a powder, soluble in water, or tablets 2 - 4 times a day.

The effect of this drug begins faster than those listed above; this group of drugs appeared relatively recently and is highly effective.

Antitussive drugs are also prescribed . They do not have direct medicinal properties, but act on the cough center in the medulla oblongata, reducing its conductivity.

The coughing reflex decreases, gagging and chest pain stop. Most often, this is Codeine - the medicine is taken twice a day, 1 tablet.

Drugs in this group should not be taken for a long time (more than 1 week).

In case of severe pain in the chest area during illness, is useful . Many doctors pay attention to the diet at this time; food should not contain anything spicy or salty.

If the cough remains after illness

Note! Sometimes it happens that bronchitis has already passed, but the cough remains after the illness. In this case, it is usually called protracted.

It is recommended to treat it with herbal mixtures of sage, licorice, plantain and chamomile . Based on these herbs (there are other recipes), a decoction is made and 150 ml is taken before meals.

Natural milk with honey and butter helps a lot.

It is useful to carry out inhalations using aromatic oils from pine, spruce, eucalyptus, fir or juniper.