Acute and chronic bronchitis presentation. Acute and Chronic Bronchitis Acute Bronchitis Slides

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Definition. Chronic bronchitis - inflammation of the bronchi, characterized by three main features: 1. Diffuse (uneven) nature of the defeat of the bronchial tree; 2. Progressive chronic course with periods of exacerbations and remissions; 3. The main clinical symptoms are: cough, sputum production and shortness of breath. COPD - chronic bronchitis, COPD; - bronchial asthma; - emphysema of the lungs.

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Factors contributing to the increase in the frequency of chronic bronchitis: - growing air pollution; - an increase in smoking in some countries; - allergization of the population; - epidemics of influenza and other viral infections. The frequency of chronic bronchitis: - per 1000 visits 11 - for chronic bronchitis; - among all diseases of the bronchopulmonary apparatus, 25% are chronic bronchitis.

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ETIOLOGY. - Smoking tobacco. - Alcohol abuse. - Air pollution. - Occupational hazards (organic and inorganic dust, toxic vapors and gases). - cold, humid climate. - infections. - Endogenous factors (foci of chronic infection of the nasopharynx, immunodeficiency states, hereditary predisposition). - Hypothermia, overheating.

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Mucociliary transport system Mucous glands of the trachea and large bronchi Bronchial secretions - mucus (mucin, lipids, proteins, nucleic acids, secretory immunoglobulin). Ciliated epithelium of the bronchial tree Influence of parasympathetic researchers The influence of a sympathetic researcher

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PATHOGENESIS Pathogenic factors (smoking, dust, smoke, gases, occupational hazards). Hypertrophy of the bronchial mucous glands Violation of the rheological properties of mucus (thick, liquid). Violation of mucociliary transport of inhaled particles. Violation of defense mechanisms (decrease in the bactericidal activity of the bronchi, violation of specific and nonspecific defense). Accession of infection (viruses, mycoplasma, pneumococci, staphylococci, haemophilus influenzae, etc.). Chronic bronchial inflammation

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The morphology of chronic bronchitis: - 1.5 times increase in the thickness of the walls of the bronchi; - hypertrophy of bronchial mucous glands and goblet cells; - Areas of inflammation, sclerosis, dystrophic and atrophic changes in all bronchial walls (panbronchitis); - purulent impregnation of the bronchial wall with areas of ulceration (the possibility of bleeding). - pneumofibrosis, pulmonary emphysema. - development of bronchiectasis.

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Classification of chronic bronchitis. - primary - secondary 2. According to the clinical course: - "dry" - catarrhal - purulent 3. According to the clinical and functional characteristics: - non-obstructive - obstructive 1. By pathogenesis:

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Continuation. 4. According to the phase of the disease: - exacerbation; - remission; 5. By complications: - chronic obstructive bronchitis with emphysema (COPD); - pulmonary hypertension, cor pulmonale; - pulmonary (respiratory) and cardiac (right ventricular) failure.

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Clinical course: - cough, sputum; - hypotonic tracheobronchial dyskinesia; - shortness of breath (bronchospastic and obstructive syndrome, degree of respiratory failure). - diffuse cyanosis, acrocyanosis. - hypercapnia.

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Continuation. - Data of examination, percussion, auscultation (barrel chest, box tone, hard or weakened vesicular breathing, prolonged exhalation, dry wheezing). - Signs of obstruction (shortness of breath on exertion, unproductive cough, prolonged exhalation, wheezing on exhalation, pulmonary emphysema, decreased respiratory function).

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Pulmonary heart (cor pulmonale). Definition - a pathological condition characterized by hypertrophy and (or) dilatation of the right ventricle of the heart as a result of pulmonary hypertension caused by primary diseases of the bronchopulmonary apparatus, pulmonary vessels or thoracodiaphragmatic pathology.

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It is classified into: - acute cor pulmonale; - subacute cor pulmonale; - chronic cor pulmonale. Stages: - compensated - decompensated (pulmonary heart failure).

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Diagnosis of chronic bronchitis. - Blood (erythrocytosis, increased hematocrit and blood viscosity, during exacerbation: leukocytosis, neutrophillosis, ESR. - Sputum (neutrophilic leukocytosis, bronchial epithelial cells, erythrocytes, macrophages, impaired rheological properties). standing of the diaphragm and reducing its excursion) - Bronchography (detection of bronchiectasis) - Bronchoscopy (examination of the bronchial mucosa, biopsy production).

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Respiratory function (standards): VC: male. - 4 - 5 liters. Female - 3 - 4 liters. FEV1: husband. - 3 - 4 liters. Female - 2 - 3 liters. Tiffno's index: FEV1 / VC x 100 (70 - 85%). MVL: husband. - 100 - 125 l min. wives - 80 - 100 l min. - Scanning of the lungs (radioisotope study).

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Acute bronchitis is a disease
acutely emerging
inflammation of the mucous membrane
tracheobronchial tree. Spicy
bronchitis is one of the most common
respiratory diseases (34.5%).

Etiology
as etiological factors of acute
bronchitis, the following factors can be distinguished:
infectious (viruses, bacteria)
physical (excessively dry, hot, or
cold air)
chemical (acids, alkalis, etc.)
allergic (organic dust, pollen
plants)
V

Predisposing factors:
-
climatic factors
smoking tobacco
alcoholism
congestive changes in the lungs with cardiac
inadequacies
- influenza viruses, parainfluenza, rhinoviruses
- chlamydiae also act as pathogens,
pneumococci, hemophilic sticks,
staphylococci

Classification of acute bronchitis (A.I. Vorokhov, 1989).

1. By etiology are distinguished:
A. Bronchitis of infectious origin
(viral, bacterial)
B. Non-infectious bronchitis (due to
physical and chemical factors)
B. Mixed

2. By pathogenesis, there are:

allocate:
A. Primary bronchitis, which is independent
disease
B. Secondary bronchitis complicating other pathological
processes (measles, whooping cough, rubella, diphtheria, etc.)
3. By the level of damage to the bronchial tree:
A. Proximal bronchitis (tracheobronchitis)
B. Distal bronchitis (involvement of small bronchi and the occurrence of
bronchial obstruction)
B. Bronchiolitis

4. Flow options:
A. Acute current bronchitis (2-3 weeks)
B. Prolonged bronchitis (up to 1 month or more)
5. By the nature of the inflammatory process:
A. Catarrhal
B. Edematous
V. Purulent

The clinical picture of acute bronchitis.

Patients complain about:
dry, irritating cough
- feelings of rawness or pain behind the breastbone
- in case of damage to the smaller bronchi
there are symptoms of airway obstruction
ways (paroxysmal cough, shortness of breath).
- on the 2nd - 3rd day, a small
the amount (up to 50 ml per day) of the mucous membrane or
mucopurulent sputum, sometimes mixed with
blood.

-the majority of patients have pain in
lower chest, associated with
cough and convulsive contraction of the diaphragm
- general weakness, malaise, weakness
- back and limb pain
- sometimes sweating
-the temperature is normal or subfebrile in
in severe cases, the temperature rises to 37.5-
38 ° C.
-When percussion over the lungs is determined
clear pulmonary sound.
-With auscultation in the first days of the disease
determined by hard breathing, dry wheezing
or humming wheezing.

- after 2 - 3 days, wet
variegated wheezing that disappears after
vigorous cough.
The course of acute bronchitis is usually mild with a gradual
subsiding and complete cessation of cough.
The duration of clinical manifestations is most often 7-14
days followed by recovery.
At the same time, a prolonged course is also possible.
lasting up to 6 weeks or more. The reasons
this may be bacterial superinfection,
infection with aggressive viruses. Heavy
a protracted course is observed with distal
bronchitis. This form of acute bronchitis is often
turns into chronic bronchitis.

Complications of acute bronchitis

Bronchopneumonia
acute cor pulmonale
transition to a chronic form.

Laboratory and instrumental research.

UAC: may be moderate
neutrophilic leukocytosis and small
increased ESR.
LHC: possible appearance of C-reactive
protein, increased sialic acid content
acids.
OAM: Usually no pathology.

General analysis sputum: with purulent
bronchitis is determined by a large number
leukocytes.
X-ray changes in acute
bronchitis is often absent. However, in a number
cases can reveal increased pulmonary
pattern due to peribronchial edema, and
also expansion and indistinctness of the roots of the lungs in
due to reaction to infection.

Treatment of acute bronchitis.

Treatment is most often carried out on an outpatient basis.
The exception is patients with severe
intoxication and serious concomitant
(pulmonary, cardiovascular) pathology.
Treatment is mostly symptomatic:
1.Antipyretic, pain relievers:
- analgin
- acetylsalicylic acid
- paracetamol 0.5 g - 3 times a day, etc.)

2. Vitamins, especially C, 0.1 g - 3 times a day and A
3 mg 3 times a day.
3. It is recommended to drink plenty of warm liquid.
(tea with lemon or raspberry jam),
diaphoretic (lime blossom tea).
The condition of patients is also facilitated by mustard plasters or
pepper plaster on the sternum and steam
inhalation.
4. In case of damage to the nasopharynx, use aerosol
drugs:
- cameton
- inhalipt
These drugs are antiseptic,
anti-inflammatory and local anesthetic
action.

5.To relieve excruciating dry cough
antitussives are prescribed:
- libexin 0.1 g - 3-4 times a day
- codeine-containing preparations (codterpin).
6. If the etiological factor is
viral infection, possible use
antiviral prep-in:
- remantadine (in the first 24-78 hours of the disease
flu)
- interferon or arbidol, ergoferon, viferon, etc.
7. In the absence of effect from symptomatic
therapy, the appearance of purulent sputum is prescribed
antibacterial drugs taking into account microbial
spectrum.

1.aminopenicillins:
- amoxicillin 0.5 g 3 times a day - 7-10 days
2.macrolides:
- erythromycin
- azithromycin (sumamed 0.5) g once a day -3 days
- Rulid 150 mg - 2 times a day
3.Oral cephalosporins of the second generation
4.tetracycline-doxycycline

5. With obstructive bronchitis:
- sympathomimetics (salbutamol, berotek)
- anticholinergics (atrovent)
- theophyllines (aminophylline, teopec)
These patients also have indications for
the use of expectorants (mucoregulators):
- ambroxol
- acetyl cesteine

Prophylaxis

Prevention of acute bronchitis consists in
prevention and effective treatment of acute
respiratory viral infections. Important
elimination of various
irritants of the bronchial mucosa
(dustiness, gas pollution), fight against
smoking, alcoholism. Need a timely
remediation of foci of infection (primarily in
nasopharynx), elimination of obstructions to the nasal
breathing, general hardening.

Chronic bronchitis - chronic
inflammatory disease of the bronchi,
accompanied by persistent cough with
sputum separation for at least 3 months a year in
for 2 or more years, while the indicated
symptoms are not related to any other
diseases.
Chronic bronchitis - widespread
disease and occurs in 16% of adults
population.

Etiology

In the onset of chronic bronchitis, a significant
the role is played by polutants:
1.tobacco smoke
2.Politants of industrial production
character
Climatic factors can also cause
provocative action. Development and exacerbation
chronic bronchitis contributes to moist and cold
climate. Exacerbations usually occur in the fall,
in winter, early spring.
The infectious factor has a secondary role
in the development of chronic bronchitis. Those. infection
promotes exacerbation. These can be viruses.

Factors predisposing to the development of chronic bronchitis:

chronic tonsillitis
rhinitis
sinusitis
carious teeth
violation of nasal breathing (polyposis
nose, etc.)
alcohol abuse
chronic renal failure.

Classification of chronic bronchitis

1.The nature of the inflammatory process in the bronchi:
- simple (catarrhal) bronchitis
- purulent bronchitis
- mucopurulent bronchitis
- hemorrhagic bronchitis
- fibrinous bronchitis (with a very
viscous sputum rich in fibrin)
2. By functional characteristics:
- non-obstructive
- obstructive (COPD)

3.According to the level of damage to the bronchial tree:
- with a predominant defeat of large
bronchi (proximal bronchitis)
- with a predominant defeat of small
bronchi (distal bronchitis).
4. Downstream:
- latent
- with rare exacerbations
- with frequent exacerbations
- continuously relapsing.
5. By the phase of the process:
- aggravation
- remission

6. Complications:
- pulmonary emphysema
- hemoptysis
- respiratory failure
- chronic cor pulmonale

The clinical picture of chronic bronchitis.

- The main complaints are cough with
sputum (with non-obstructive bronchitis)
- Shortness of breath with a decrease in tolerance to
physical activity (with chronic
obstructive bronchitis).
- In smokers, a slight cough, dry or with
secretion of mucous sputum, mainly in
morning hours - "smoker's cough".
- Gradually the cough becomes more
pronounced, worse in cold and damp
weather, after hypothermia and accompanied
periodic discharge of mucopurulent or
purulent sputum.

- When small bronchi are damaged, it develops
dyspnea
(at first, shortness of breath worries with physical
load, then becomes constant).
- cyanosis
- paroxysmal unproductive cough,
increasing from warm
premises in the cold.

When examining patients, especially in the initial stages
disease, visible deviations may not be. V
advanced stages, even in remission,
there are signs of pulmonary and cardiac
insufficiency, emphysema of the lungs:
- acrocyanosis
- pasty or swelling of the legs
- swelling of the cervical veins
- change of nails by the type of "watch glasses".
Palpation: Voice tremor is unchanged, or
uniformly reduced.

Percussion: percussion sound in uncomplicated
cases not changed, with bronchial obstruction
it has a tympanic hue. About emphysema
evidenced by boxed sound, low standing
diaphragm, restriction of respiratory excursion
lungs.
With auscultation, breathing can be both increased,
and weakened. Uniform weakening of breathing
indicates pulmonary emphysema. For
chronic bronchitis is characterized by severe
breathing and dry, diffuse wheezing. When the appearance
in the bronchi, moist secretions are often heard
wet wheezing, the caliber of which depends on the level
lesions of the bronchial tree.

Distinguish between clinical options
chronic bronchitis:
- simple (catarrhal)
- purulent
- obstructive.
Diagnostics is based on the results of the interpretation of three
the main symptoms: cough, sputum and shortness of breath.
Chronic simple bronchitis is characterized by:
- dry cough or sputum production up to 20 ml per day
- shortness of breath occurs only with significant physical
load
- ventilation disorders with functional
research is not detected.

Chronic suppurative bronchitis differs from
simple:
- mild shortness of breath without obvious signs of impairment
patency of the bronchi.
- cough during an exacerbation is constant, with
secretion of mucopurulent sputum up to 100 ml in
day
- shortness of breath appears when doing the usual
physical work
- the patient's general condition worsens
insignificantly. There is no cyanosis.

Chronic obstructive bronchitis
characterized by:
- shortness of breath on exertion
- increased shortness of breath under the influence of stimuli
- hacking unproductive cough with
difficult sputum
- lengthening the expiratory phase
- dry wheezing of a high timbre in the expiratory phase
The auscultatory picture is similar to the signs
an attack of bronchial asthma. The elements are revealed
chronic cor pulmonale (increase in size
hearts to the right). With functional tests
signs of generalized bronchial
obstruction.

Laboratory and instrumental research

UAC: no significant changes. At
severe exacerbation of purulent bronchitis
possible small neutrophilic
leukocytosis and a moderate increase in ESR.
LHC: increased levels of C-reactive protein,
haptoglobin, sialic acids in serum
- the main indicators of the activity of inflammation
with bronchitis.

Sputum analysis. Sputum may be
mucous membrane (white or transparent) or
purulent (yellow or yellow-green).
Possible black color of sputum with
the content of coal particles in it
dust. Blood streaks are characteristic of
hemorrhagic bronchitis. For
fibrinous bronchitis is characteristic
the presence of bronchial casts in the sputum.

On microscopic examination, purulent
a large amount of sputum is found
neutrophilic leukocytes are often found
bronchial epithelial cells, macrophages,
bacterial cells.
Sputum bacteriological examination
reveals different kinds infectious
pathogens and their sensitivity to
antibacterial agents.
Bronchoscopy: may reveal catarrhal,
purulent, hypertrophic, atrophic
bronchitis.

Radiography of the lungs. X-ray signs
chronic bronchitis are detected only in long-term
sick, characterized by strengthening and deformation
pulmonary pattern on loop-mesh type,
increased transparency of pulmonary fields, expansion
shadows of the roots of the lungs.
Study of the function of external respiration.
Spirographic research, as well as
peak flowmetry does not reveal violations of the bronchial
patency in chronic non-obstructive
bronchitis.
With obstructive bronchitis, obstructive
variant of ventilation disorders (decrease in FEV 1,
Tif-phno test, maximum volumetric velocity), less often
mixed (obstructive-restrictive) variant.

Chronic bronchitis treatment

1 quitting smoking
2.Inpatient treatment and bed rest
shown only to certain groups of patients:
1) Severe exacerbation of chronic
bronchitis with an increase in respiratory
failure despite active
ambulatory treatment.
2) Acute pneumonia or spontaneous
pneumothorax.
3) The appearance or strengthening of the right ventricular
failure.

4) Significant intoxication and severe
deterioration of the general condition.
5) Unsatisfactory social status.
3. Patients with chronic bronchitis
a balanced diet with
sufficient content of vitamins, include in
diet of raw vegetables and fruits, juices. At
chronic bronchitis with discharge of large
the amount of sputum loss of protein occurs.
Protein-enriched is indicated for these patients
diet. With decompensated cor pulmonale
diet number 10 is prescribed with salt restriction and
liquid and high potassium content.

4. Drug therapy
1) Bronchodilator therapy:
a) the main drug atrovent (anticholinergic) 2-4
inhalation -3-4 times a day
b) in the absence of effect, beta2-agonists are prescribed:
berotec, salbutamol or
berodual (atrovent + fenoterol)
c) aminophylline, teopec
2) Antibacterial therapy:
a) semi-synthetic penicillins:
- amoxicillin 500mg-3 times a day
b) macrolides:
- erythromycin 0.1 g 4 times a day for 1-2 weeks

- Rulid (1t = 50; 100; 150mg) 150mg-2 times 15 minutes before meals
(1-2 weeks)
- Sumamed 1t 500mg
(azithromycin-1caps 250 mg and 500 mg) 500 mg 1 time
per day for 3 days
c) tetracyclines:
- doxycycline: 0.1 g once a day for 7-10 days
d) cephalosporins:
- kefzol
- claforan
3. Expectorants, mucolytics:
- ambroxol (ambrobene, ambrosal, lazolvan)
(1t = 30mg) 30 mg 2 times a day (after meals, with a drink
sufficient amount of water) or syrup 2 tsp 3 times
day - 2 weeks

-ACC (tab and granules = 200mg) 1t (200mg) 2-3 times a day
-Ascoril (bronchodilator, mucolytic) 2 hours-3 times a day
-Can recommend traditional expectorants
funds:
Potassium iodite - 3% solution, infusion and decoction of thermopsis herb,
marshmallow, "chest collection", abundant hot drink,
alkaline inhalations, alkaline mineral waters
4.Antihistamines (suprastin, cetrin, fencarol)
5.immunomodulators:
a) T-activin 100 μg s / c 1 time in 3 days
b) levomizole 100mg-150mg per day in 2-3 doses for 2-3 days
in a row with 4-5 day breaks. Total 8-12 cycles

Prevention of chronic bronchitis.

Primary prevention is based on
prevention of factors contributing to
the development of the disease. Significantly reduce
the incidence of chronic bronchitis
possible when solving environmental problems,
reducing exposure to harmful dust and
gases in production. Great importance
has anti-smoking, thorough
examination of persons employed,
associated with industrial hazards
and periodic preventive
survey of workers.

Secondary prevention primarily includes
early diagnosis of the disease. Efficiency
medical examination the higher, the more early forms
diseases are taken on dispensary registration. In all
cases require rational employment
patients, careful treatment of inflammatory
diseases of the nasopharynx, prevention of viral
respiratory diseases, patient education
measures to improve bronchial drainage and
increasing the body's resistance. V
depending on the course and complications of obstructive
bronchitis carry out continuous basic therapy
bronchodilators.

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Acute bronchitis Acute bronchitis (OB) is an inflammatory disease of the trachea and bronchi, which is characterized by an acute course and reversible diffuse lesions of the mucous membrane. OB is one of the most common respiratory diseases, which often affects children and the elderly (more often men). This disease is more susceptible to people living in areas with a cold and humid climate, working in drafts, in damp cold rooms. OB is often combined with damage to the upper respiratory tract (rhinopharyngitis, laryngitis, tracheitis), or observed in isolation.

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Etiology Causal factors: infectious (viruses, bacteria); physical (exposure to excessively hot or cold air); chemical (inhalation of acid vapors, alkalis, poisonous gases); allergic (inhalation of plant pollen, organic dust).

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Contributing factors: acute upper respiratory tract infections; focal infections of the paranasal sinuses and tonsils; violation of nasal breathing; cooling; smoking; a decrease in the reactivity of the body (after serious diseases, operations, with hypovitaminosis, poor nutrition, etc.).

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Clinic The disease begins acutely. Sometimes the symptoms of an acute respiratory illness - a runny nose, sore throat, hoarseness - precede. The clinical picture of OB consists of symptoms of general intoxication and bronchial lesions. Symptoms of general intoxication: weakness, headache, pain in the muscles of the back and legs, aches, chills. The temperature can rise to subfebrile, sometimes high, or remains normal.

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Symptoms of bronchial damage: dry, rough, painful, unproductive cough with a small amount of mucous sputum; after 1 - 3 days the cough becomes moist, mucopurulent sputum is coughing up. Sore throat and trachea decrease, temperature decreases, general condition improves; possible shortness of breath - a symptom of obstruction (obstruction) of the bronchi;

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with percussion of the chest - no changes (clear pulmonary sound); on auscultation - hard breathing and dry wheezing, during the period of sputum dilution - wet rales of various sizes.

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Additional studies: X-ray picture of the lungs - no changes, sometimes the pulmonary pattern is strengthened and the roots of the lungs are expanded; KLA - neutrophilic leukocytosis, increased ESR.

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The prognosis is usually good - recovery in 2 - 3 weeks; In the absence of proper treatment, OB can acquire a protracted course (up to 1 month or longer) or become more complicated.

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Complications of bronchopneumonia, acute pulmonary heart failure (ARF), chronic bronchitis.

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Treatment Treatment of OB is mainly symptomatic, usually outpatient, in severe cases - inpatient: bed rest at a high temperature, measures that eliminate irritation of the bronchi, facilitate breathing (airing the room, excluding smoking, cooking, using odorous substances, abundant warm drink (tea with raspberries , lemon, honey, lime blossom, milk and soda.

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When the temperature drops, the following are used: distractions for chest pains (mustard plasters, pepper plaster or warming compresses on the sternum and interscapular region, warm foot baths);

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phytotherapy expectorant action: steam inhalation of herbal decoctions (eucalyptus, St. John's wort, chamomile), essential oils(aniseed, eucalyptus, menthol); ingestion of infusions of herbs thermopsis, licorice root, marshmallow, plantain leaves, coltsfoot, thyme herb, anise fruits, eucalyptus tincture.

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Drug therapy includes: antitussive sedatives for dry, painful cough (codeine, codterpin, sinecode, libexin, levopront); bronchodilators for broncho-obstructive syndrome (salbutamol, berotek in inhalation, aminophylline in tablets, bronchodilator in the form of syrup, etc.); expectorant drugs (Coldrex broncho, Doctor Mom, bronchipret, primrose herbion syrup, marshmallow syrup, etc.); mucolytics (fluiditec, fluimucil, acetylcysteine, carbocisteine, mucodin; ambroxol, bromhexine, ambrobene, lazolvan, solvin, etc.); local antiseptics, anti-inflammatory and analgesic drugs with simultaneous damage to the nasopharynx (hexoral, strepsils, septolete, stopangin, iox, etc.); antipyretic drugs (analgin, acetylsalicylic acid, paracetamol, etc.);

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drugs with a combined effect are also used: bronchodilator and antitussive (bronchodilator), expectorant and anti-inflammatory (plantain herbion syrup), expectorant and antitussive (codelac), antitussive, anti-allergic and antipyretic (coldrex find) vitamins, immunomodulators (cough suppressants); antibacterial drugs (better taking into account the microbial spectrum) are used in the absence of the effect of symptomatic treatment, high temperature, the appearance of purulent sputum, as well as in elderly and debilitated patients. The minimum duration of treatment is 5 - 7 days. The most commonly used antibiotics are semisynthetic penicillins (ampicillin, amoxicillin), macrolides (erythromycin, rovamycin, azithromycin), cephalosporins (cefaclor, cephalexin), tetracyclines (doxycycline) and sulfonamides: biseptalene (bactrim), sulfonamides

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FAP paramedic tactics - prescribing treatment and issuing sick leave for 5 days; Health center - recommendations for treatment, issuance of a certificate of exemption for 3 days, during which, if necessary, the patient must consult a local doctor; EMS - provision of emergency care (antipyretics, bronchodilators) and a recommendation to call a local doctor.

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Prevention Hardening, ARVI prevention; Treatment of URT diseases, removal of polyps, treatment of curvature of the nasal septum; sanitary and hygienic measures - combating moisture, dust, smoke, smoking, etc.

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Chronic bronchitis Chronic bronchitis (CB) is a progressive diffuse lesion of the mucous membrane and deeper layers of the bronchi, caused by prolonged irritation of the bronchial tree by various harmful agents, manifested by cough, sputum production, shortness of breath and respiratory dysfunctions. According to the WHO recommendation, bronchitis can be considered chronic if it is accompanied by a persistent cough with sputum production for at least 3 months a year for 2 or more years. CB occurs mainly in persons over 40 years of age, in men 2-3 times more often than in women.

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Etiology In the etiology of chronic bronchitis, the long-term effect of irritating factors on the bronchial mucosa is important, among which we can conditionally distinguish: exogenous: tobacco smoke; substances of industrial and production origin; dust; climatic factors, cooling; infectious factors;

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endogenous: frequent acute respiratory viral infections, not cured acute bronchitis, prolonged bronchitis; focal infections of the upper respiratory tract; pathology of the nasopharynx, impaired breathing through the nose; hereditary disorder of enzyme systems; metabolic disease. the main role in the emergence of CB belongs to pollutants - various impurities contained in the inhaled air. The main reason for the exacerbation of the disease is infection.

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Classification of HB The nature of the inflammatory process: simple (catarrhal), purulent, mucopurulent, special forms (hemorrhagic, fibrinous). The presence or absence of bronchial obstruction: non-obstructive, obstructive. The level of damage to the bronchial tree: with a predominant lesion of the large bronchi, with the defeat of the small bronchi and bronchioles. Course: latent, with rare exacerbations, with frequent exacerbations, continuously recurrent.

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Phase: exacerbation, remission. Complications: pulmonary emphysema, diffuse pneumosclerosis, hemoptysis, respiratory failure (DN) (acute, chronic I, II, III degree), secondary pulmonary hypertension (transient, with or without circulatory failure).

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An example of a diagnosis formulation: Chronic obstructive bronchitis, continuously recurrent course, exacerbation phase, pulmonary emphysema, diffuse pneumosclerosis. DN I - II.

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Clinic In the phase of exacerbation: patients note an increase in temperature to subfebrile, weakness, sweating, and other symptoms of general intoxication; there is an increase in cough, an increase in sputum production, especially in the morning, a change in its character (purulent) - with non-obstructive bronchitis; as the disease progresses and the small bronchi are involved in the process, a pronounced violation of bronchial patency (obstructive bronchitis) occurs with the development of shortness of breath up to suffocation. Unproductive cough "barking", sputum is secreted in small quantities; patients may complain of pain in the muscles of the chest and abdomen, which are associated with frequent cough;

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on auscultation - hard breathing, variegated dry and wet wheezing; in the blood - leukocytosis, increased ESR; in sputum - leukocytes, erythrocytes, epithelium. In the remission phase: symptoms of bronchitis are absent or mild. But signs of pulmonary heart disease and emphysema (if any) persist

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Complications caused directly by infection: pneumonia; bronchiectasis; bronchospastic and asthmatic components; due to the progressive development of bronchitis: hemoptysis; emphysema of the lungs; diffuse pneumosclerosis; pulmonary (respiratory) failure, which leads to pulmonary hypertension, the formation of chronic cor pulmonale.

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Diagnostics The preliminary diagnosis of chronic bronchitis is made if the patient has: cough with sputum, possibly shortness of breath, hard breathing with prolonged expiration, scattered dry and wet rales, "cough history" (long-term smoking, nasopharyngeal pathology, occupational hazards, prolonged or recurrent course of OB and etc.). The diagnosis can be confirmed: signs of inflammatory lesions of the bronchi according to bronchoscopy, examination of sputum and bronchial contents, it is necessary to exclude other diseases with similar symptoms (pneumonia, tuberculosis, bronchiectasis, pneumoconiosis, lung cancer, etc.). In obstructive chronic bronchitis, in contrast to non-obstructive chronic bronchitis, the following are observed: signs of pulmonary emphysema on the roentgenogram; violation of bronchial patency in the study of the function of external respiration (spirography data, peak flowmetry)

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Treatment is outpatient or inpatient (depending on the severity of the patient's condition, the presence of complications, the effectiveness of previous treatment): exclusion of factors contributing to the exacerbation of the disease; a diet with a high content of vitamins and protein (restriction of salt, fluid); in the exacerbation phase: antibiotic therapy, antibiotics are prescribed as early as possible, are often administered parenterally in large doses, in severe cases - intratracheally (through a bronchoscope); expectorants, bronchodilators; distractions; in remission: FTL, exercise therapy, SKL.

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The tactics of a FAP paramedic is to refer the patient to a local therapist in case of exacerbation of chronic bronchitis. Health center - refer to a shop or district doctor to clarify the diagnosis and prescribe outpatient treatment, or to resolve the issue of hospitalization according to indications. EMS - provision of emergency aid adequate to the symptoms: at high temperature - antipyretic drugs, with hemoptysis - haemostatic, with shortness of breath - humidified oxygen, bronchodilator drugs, etc. Depending on the patient's condition: either hospitalization in the therapeutic department, or a recommendation to call a local doctor.

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Recipes Rp.:Tab. Libexini 0.1 No. 20 D.S. 1 - 2 tablets 3 - 4 times a day. Rp.:Dragee Bromhexini 0.04 # 20 D.S. 2 tablets 3 times a day, regardless of the meal. Rp.:Biseptoli 480 D.t.d. No. 20 in tabul. S. 2 tablets 2 times a day after meals. Rp.:Azithromycini 0.25 D.t.d. No. 6 in caps. S. 1 capsule 1 time per day 1 hour before meals or 2 hours after meals for 5 days.

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with percussion of the chest - no changes (clear pulmonary sound); on auscultation - hard breathing and dry wheezing, during the period of sputum dilution - wet rales of various sizes.

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Additional studies: X-ray picture of the lungs - no changes, sometimes the pulmonary pattern is strengthened and the roots of the lungs are expanded; KLA - neutrophilic leukocytosis, increased ESR.

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Complications of bronchopneumonia, acute pulmonary heart failure (ARF), chronic bronchitis.

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When the temperature drops, the following are used: distractions for chest pains (mustard plasters, pepper plaster or warming compresses on the sternum and interscapular region, warm foot baths);

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phytotherapy expectorant action: steam inhalations of herbal decoctions (eucalyptus, St. John's wort, chamomile), essential oils (aniseed, eucalyptus, menthol); ingestion of infusions of herbs thermopsis, licorice root, marshmallow, plantain leaves, coltsfoot, thyme herb, anise fruits, eucalyptus tincture.

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endogenous: frequent acute respiratory viral infections, not cured acute bronchitis, prolonged bronchitis; focal infections of the upper respiratory tract; pathology of the nasopharynx, impaired breathing through the nose; hereditary disorder of enzyme systems; metabolic disease. The main role in the emergence of CB belongs to pollutants - various impurities contained in the inhaled air. The main reason for the exacerbation of the disease is infection.

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An example of a diagnosis formulation: Chronic obstructive bronchitis, continuously recurrent course, exacerbation phase, pulmonary emphysema, diffuse pneumosclerosis. DN I - II.

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Department of Propedeutics of Internal Diseases

Doctor of Medical Sciences, Professor A.S. Adamchik

Acute bronchitis:

Acute bronchitis (OB) is an inflammatory disease of the trachea and bronchi, which is characterized by an acute course and reversible diffuse damage to the mucous membrane.

OB is one of the most common organ diseases

breathing, which is more common in children and the elderly (more often in men).

This disease is more susceptible to people living in

areas with cold and humid climates, working in drafts, in

damp cold rooms. OB is often combined with the defeat of the upper

respiratory tract (rhinopharyngitis, laryngitis, tracheitis), or is observed

Etiology:

1. Infectious (viruses, bacteria);

2. physical (exposure to excessively hot or cold air);

3. chemical (inhalation of vapors of acids, alkalis, poisonous gases);

4. allergic (inhalation of plant pollen, organic dust).

Contributing factors:

1. Acute upper respiratory tract infections;

2. focal infections of the paranasal sinuses and tonsils;

3. violation of nasal breathing;

6.decrease in the reactivity of the body (after serious illnesses, operations,

with hypovitaminosis, poor nutrition, etc.).

Clinic:

The disease begins acutely. Sometimes the symptoms of an acute respiratory illness - a runny nose, sore throat, hoarseness - precede. The clinical picture of OB consists of symptoms of general intoxication and bronchial damage.

Symptoms of general intoxication:

weakness, headache, pain in the muscles of the back and legs, aches, chills. The temperature can rise to subfebrile, sometimes high, or remains normal.

Symptoms of bronchial damage:

1. Dry, rough, painful, unproductive cough with a small amount of mucous sputum;

2.after 1 - 3 days, the cough becomes moist, muco-purulent coughs up

3.sore throat and trachea decreases, temperature decreases, general condition

improves; 4. possible shortness of breath - a symptom of obstruction (obstruction) of the bronchi;

Physical data:

1. With percussion of the chest - no changes (clear pulmonary sound);

2. with auscultation - hard breathing and dry wheezing, during the period of sputum dilution - moist rales of various sizes.

Additional research:

1. X-ray picture of the lungs - no changes, sometimes enhanced

pulmonary drawing and expanded roots of the lungs;

2. KLA - neutrophilic leukocytosis, increased ESR.

Forecast:

1. Usually favorable - recovery in 2 - 3 weeks;

2.in the absence of proper treatment, OB can acquire a protracted

course (up to 1 month and longer) or get complicated.

Treatment:

Treatment of OB is mostly symptomatic, usually on an outpatient basis, in severe

1. bed mode at high temperature;

2.measures that eliminate irritation of the bronchi, facilitate

breathing (airing the room, avoiding smoking, cooking,

use of odorous substances);

3.An abundant warm drink (tea with raspberries, lemon, honey, linden blossom,

Presentation on the topic: Bronchitis

Acute bronchitis Acute bronchitis (OB) is an inflammatory disease of the trachea and bronchi, which is characterized by an acute course and reversible diffuse lesions of the mucous membrane. OB is one of the most common respiratory diseases, which often affects children and the elderly (more often men). This disease is more susceptible to people living in areas with a cold humid climate, working in drafts, in damp cold rooms. OB is often combined with damage to the upper respiratory tract (rhinopharyngitis, laryngitis, tracheitis), or observed in isolation.

Contributing factors: acute upper respiratory tract infections; focal infections of the paranasal sinuses and tonsils; violation of nasal breathing; cooling; smoking; decreased reactivity of the body (after serious illness, surgery, hypovitaminosis, poor nutrition, etc.).

Clinic The disease begins acutely. Sometimes symptoms of acute respiratory disease precede - runny nose, sore throat, hoarseness. The clinical picture of OB consists of symptoms of general intoxication and bronchial damage. Symptoms of general intoxication: weakness, headache, pain in the muscles of the back and legs, aches, chills. The temperature can rise to subfebrile, sometimes high, or remains normal.

Symptoms of bronchial damage: dry, rough, painful, unproductive cough with a small amount of mucous sputum; after 1 - 3 days, the cough becomes moist, mucopurulent sputum is coughing up. Pain in the throat and trachea decreases, the temperature decreases, the general condition improves; possible shortness of breath - a symptom of obstruction (obstruction) of the bronchi;

with percussion of the chest - no changes (clear pulmonary sound); with auscultation - hard breathing and dry wheezing, during the period of sputum liquefaction - moist rales of various sizes.

Additional studies: X-ray picture of the lungs - no changes, sometimes the pulmonary pattern is enhanced and the roots of the lungs are expanded; KLA - neutrophilic leukocytosis, increased ESR.

The prognosis is usually favorable - recovery after 2 to 3 weeks; In the absence of proper treatment, OB can acquire a protracted course (up to 1 month or longer) or become more complicated.

Complications of bronchopneumonia, acute pulmonary heart failure (ARF), chronic bronchitis.

Treatment Treatment of OB is mainly symptomatic, usually outpatient, in severe cases - inpatient: bed rest at high temperatures, measures to eliminate irritation of the bronchi, facilitate breathing (airing the room, excluding smoking, cooking, using odorous substances, abundant warm drink (tea with raspberries, lemon, honey, lime blossom, milk with soda.

When the temperature drops, the following are used: distractions for chest pains (mustard plasters, pepper plaster or warming compresses on the sternum and interscapular region, warm foot baths);

phytotherapy expectorant action: steam inhalation of decoctions of herbs (eucalyptus, St. John's wort, chamomile), essential oils (anise, eucalyptus, menthol); ingestion of infusions of thermopsis herbs, licorice root, marshmallow, plantain leaves, coltsfoot, thyme herb, fruits , eucalyptus tincture.

Drug therapy includes: antitussive sedatives for dry, painful cough (codeine, codterpin, sinecode, libexin, levopront); bronchodilators for broncho-obstructive syndrome (salbutamol, berotek in inhalation, aminophylline in tablets, bronchodilator in the form of syrup, etc.); expectorant drugs (Coldrex broncho, Dr. Mom, bronchipret, herbion primrose syrup, marshmallow syrup, etc.); mucolytics (fluditec, fluimucil, acetylcysteine, carbocysteine, mucodin; ambroxol, bromhexine, ambrobene, lazolvan, etc.); local antiseptics, anti-inflammatory and analgesic drugs with simultaneous damage to the nasopharynx (hexoral, strepsils, septolete, stopangin, iox, etc.); antipyretic drugs (analgin, acetylsalicylic acid, paracetamol, etc.);

drugs with a combined action are also used: bronchodilator and antitussive (bronchodilator), expectorant and anti-inflammatory (plantain herbion syrup), expectorant and antitussive (codelac), antitussive, anti-allergic and antipyretic (coldrex find) vitamins, immobilizing agents (taking into account antibiotics); microbial spectrum) are used in the absence of the effect of symptomatic treatment, high temperature, the appearance of purulent sputum, as well as in elderly and debilitated patients. The minimum duration of treatment is 5 - 7 days. The most commonly used antibiotics are semisynthetic penicillins (ampicillin, amoxicillin), macrolides (erythromycin, rovamycin, azithromycin), cephalosporins (cefaclor, cephalexin), tetracyclines (doxycycline) and sulfonamides: biseptalene (bactrim), sulfonamides

FAP paramedic tactics - prescribing treatment and issuing a sick leave for 5 days; Zdravpost - recommendations for treatment, issuing a certificate of exemption for 3 days, during which, if necessary, the patient should consult a local doctor; EMS - emergency care (antipyretic, bronchodilators) and a recommendation to call a local doctor.

Prevention Hardening, prevention of ARVI; Treatment of upper respiratory tract diseases, removal of polyps, treatment of curvature of the nasal septum; sanitary and hygienic measures - the fight against moisture, dust, smoke, smoking, etc.

Chronic bronchitis Chronic bronchitis (CB) is a progressive diffuse lesion of the mucous membrane and deeper layers of the bronchi, caused by prolonged irritation of the bronchial tree by various harmful agents, manifested by cough, sputum production, shortness of breath and respiratory dysfunction. According to the WHO recommendation, bronchitis can be considered chronic if accompanied by a persistent cough with sputum production for at least 3 months a year for 2 or more years. CB occurs mainly in people over 40 years of age, in men 2 - 3 times more often than in women.

Etiology In the etiology of chronic bronchitis, long-term exposure to the bronchial mucosa of irritating factors is important, among which we can conditionally distinguish: exogenous: tobacco smoke; substances of industrial and production origin; dust; climatic factors, cooling; infectious factors;

endogenous: frequent acute respiratory viral infections, not cured acute bronchitis, protracted bronchitis; focal infections of the upper respiratory tract; pathology of the nasopharynx, impaired breathing through the nose; hereditary violation of enzyme systems; metabolic disorders. The main role in the occurrence of CB belongs to pollutants - various impurities contained in the inhaled air. The main reason for the exacerbation of the disease is infection.

Classification of CP The nature of the inflammatory process: simple (catarrhal), purulent, mucopurulent, special forms (hemorrhagic, fibrinous). The presence or absence of bronchial obstruction: non-obstructive, obstructive. The level of damage to the bronchial tree: with a predominant lesion of the large bronchi, with the defeat of the small bronchi and bronchioles. Course: latent, with rare exacerbations, with frequent exacerbations, continuously recurring.

An example of a diagnosis formulation: Chronic obstructive bronchitis, continuously recurrent course, exacerbation phase, pulmonary emphysema, diffuse pneumosclerosis. DN I - II.

Clinic In the exacerbation phase: patients note an increase in temperature to subfebrile, weakness, sweating and other symptoms of general intoxication; there is an increase in cough, an increase in sputum production, especially in the morning, a change in its character (purulent) - with non-obstructive bronchitis; as the disease progresses and the small bronchi are involved in the process, a pronounced violation of bronchial patency (obstructive bronchitis) occurs with the development of shortness of breath up to suffocation. Unproductive cough "barking", sputum is secreted in small quantities; patients may complain of pain in the muscles of the chest and abdomen, which are associated with frequent cough;

on auscultation - hard breathing, variegated dry and wet rales; in the blood - leukocytosis, increased ESR; in sputum - leukocytes, erythrocytes, epithelium. In the remission phase: symptoms of bronchitis are absent or mild. But signs of pulmonary heart disease and emphysema (if any) persist

Complications caused directly by infection: pneumonia; bronchiectasis; bronchospastic and asthmatic components; due to the progressive development of bronchitis: hemoptysis; pulmonary emphysema; diffuse pneumosclerosis; pulmonary (respiratory) insufficiency, which leads to pulmonary hypertension, the formation of chronic pulmonary heart disease.

Diagnostics The preliminary diagnosis of chronic bronchitis is made if the patient has: cough with sputum, possibly shortness of breath, hard breathing with prolonged expiration, scattered dry and wet rales, "cough history" (long-term smoking, nasopharyngeal pathology, occupational hazards, prolonged or recurrent OB and The diagnosis can be confirmed: signs of inflammatory lesions of the bronchi according to bronchoscopy, examination of sputum and bronchial contents, it is necessary to exclude other diseases with similar symptoms (pneumonia, tuberculosis, bronchiectasis, pneumoconiosis, lung cancer, etc.). non-obstructive: signs of pulmonary emphysema on the roentgenogram; impaired bronchial patency in the study of the function of external respiration (spirography data, peak flowmetry)

Treatment is outpatient or inpatient (depending on the severity of the patient's condition, the presence of complications, the effectiveness of previous treatment): exclusion of factors contributing to the exacerbation of the disease; diet with a high content of vitamins and protein, (salt, fluid restriction); in the exacerbation phase: antibiotic therapy antibiotics are prescribed as early as possible, are often administered parenterally in large doses, in severe cases - intratracheally (through a bronchoscope); expectorants, bronchodilators; distractions; in remission: FTL, exercise therapy, SKL.

Clinical examination 1. CP non-obstructive with exacerbations no more than 3 times a year without DN: examination by a therapist, CBC, sputum and sputum analysis for CD 2 times a year; examination of the ENT doctor and dentist once a year; ECG, bronchological examination according to indications; anti-relapse treatment 2 times a year: inhalation, vitamins, expectorants, FTL, exercise therapy, massage, hardening, sports, sanitation of foci of infection, SCL, smoking cessation, rational employment.

2. CB non-obstructive with frequent exacerbations without DN: examinations by a therapist, CBC, spirography 3 times a year; fluorography, biochemical blood test once a year, other studies as in the first group; anti-relapse treatment 2 - 3 times a year (as in the first group + immunocorrective therapy).

3. CB obstructive with DN: examinations of the therapist 3 - 6 times a year; other examinations as in the second group; anti-relapse treatment 3 - 4 times a year (as in the second group + bronchodilators, endobronchial sanitation)

The tactic of a FAP paramedic is to refer the patient to a local therapist in case of exacerbation of chronic bronchitis. A health center is to refer to a workshop or district doctor to clarify the diagnosis and prescribe an outpatient treatment, or to resolve the issue of hospitalization according to indications. EMC - provide emergency care adequately to the symptoms: at high temperatures, antipyretics. , with hemoptysis - hemostatic, with shortness of breath - humidified oxygen, bronchodilator drugs, etc. Depending on the patient's condition: either hospitalization in the therapeutic department, or a recommendation to call a local doctor.

Prevention of bronchitis

Prevention of bronchitis. Long chronic rhinitis should not be allowed, treated in a timely manner inflammatory diseases respiratory tract. Quitting smoking and alcohol, of course. These habits weaken the body. Hypothermia, chronic and inflammatory diseases also contribute to bronchitis. To protect the body, it is imperative to take vitamins so that bronchitis no longer bothers.

Slide 16 from presentation "Diseases and injuries of the respiratory system"... The size of the archive with the presentation is 611 KB.

Biology grade 8

"The internal environment of the body" grade 8 "- The composition of the blood. The internal environment of the body. Role internal environment in life. Clotting of blood. Immunity. Composition and function of blood. Property of the internal environment of the body. Blood plasma. Functions of the blood. Life periods of leukocytes. Human. Leukocytes. The internal environment of the body and its components. Blood groups. The structure of erythrocytes. Knowledge of students about the composition and functions of the internal environment of the body. White blood cells.

"Eyes - organs of vision" - The meaning of sight. Unique human ability. The most common visual impairment. The organ of vision. Organs of vision, diseases and damage to the eyes. Anterior part of the choroid. The eyes must be protected from contamination. Eyes. Myopia. The structure of the organ of vision. Healthy eyes. The causes of the disease. Aged people.

"Health-saving technologies in biology lessons" - Working with terms. Text of the tutorial. The problem of maintaining and strengthening health. Health and education. Health-preserving lesson. Realization of the health-preserving potential of the lesson. Public policy... The attitude of pupils to the lesson that has taken place. Health-saving potential. Skin hygiene topics. Compiled notes. Health-preserving potential of the lesson. Dominant [school] risk factors. Problems of the modern lesson.

"Biology" Human Skeleton "" - Passive part. The rib cage is expanded downward and to the sides. Organic substances give the bone elasticity, mineral hardness. Spine. Skeleton (skeletos - dried) is a collection of hard tissues. Red bone marrow is soft tissue. Skeleton bones. The human skeleton has a number of differences from the mammalian skeleton. Skeleton sections. Divisions of the body. Human skeleton. The spine has 4 curves. Skeleton functions.

"Birds of the Red Book" - Osprey. Birds. The Red Book of the Samoilovsky District does not yet exist. The owl is easily identified by its size. Large predatory bird... Toadstool. Adult birds have white plumage. Little bustard the size of a chicken. Grebes are common on all continents. Bustard. Swan. Owl. Birds from the Red Book. The number of bustards has been greatly reduced.

"Animal Amur tiger" - Elk. Threat to existence. Himalayan bears. Seoul Summer Olympics mascot. Live up to 15 years. Kingdom of Animals. Reproduction. Habitat. Flag and coat of arms of Primorsky Krai. Amur tiger weight. Amur tiger food. Protection of tigers. Roe. Length. The object of worship of nationalities. Enemies of the Amur tiger. Nutrition. Amur tiger. In China, for killing a tiger - the death penalty. Dappled deer. Quiz.