Bronchitis : Causes, symptoms, diagnosis , treatment, prevention
Pulmonology / / April 24, 2016
Alternative names: chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema
Bronchitis and its types
Brief anatomy of the respiratory system
risk factors for bronchitis
Occupational risk factors of bronchitis
Symptoms of bronchitis
diseases with similar symptoms
Treatment of bronchitis
approach to the treatment of uncomplicated chronic bronchitis
Treatment of chronic bronchitis in the elderly
Treatment of acute exacerbations of chronic bronchitis
Oxygen therapy (oxygen therapy)
bronchitis, or chronic obstructive pulmonary disease (COPD) is a condition characterized by reduced airflow in the lungs.The disease develops and gets worse over time.Bronchitis is an irreversible disease, but the therapy can slow pathological processes in the airways.
Although patients can breathe normally, changes in the small airways, bronchoconstriction difficult
following respiratory symptoms characteristic of COPD:
- The deterioration of pulmonary function during exercise, the appearance of shortness of breath;
- Chronic cough;
- Discharge of mucus (phlegm) when you cough;
- Shortness of expiration over time.
two major diseases of the respiratory system - is emphysema and chronic bronchitis.Another, less common disease is obstructive bronchitis, inflammatory disease of the small airways.Asthma has the same symptoms, but it is quite another disease.Patients can have both asthma and COPD.
Smoking is a common cause as emphysema and chronic bronchitis.These diseases often develop together.When chronic bronchitis occurs with emphysema, often to the doctor it can be difficult to differentiate these two diseases:
- Emphysema . Emphysema is a disease in which the alveoli, the air sacs at the end of the small airways (bronchioles) are destroyed.
This process usually proceeds as follows:
walls of the alveoli become inflamed and damaged.Over time, they lose their ability to stretch and contract, lose their elasticity.
Normal lung function is disturbed, there is a narrowing of the airways, making breathing out becomes more difficult to interfere with the normal performance levels of oxygen and carbon dioxide.
Emphysema is usually accompanied by bronchial obstruction.The bronchi and lungs is an increase in connective tissue, lung tissue replacement and prolonged bronchoconstriction occurs regardless of inflammation.
- Chronic bronchitis . Chronic bronchitis is characterized by cough and excess mucus formation, which can persist for 3 months, for at least two years.
Chronic bronchitis has the following characteristics:
- inflammation of the bronchi (smoking and air pollution) causes the production of mucus that clogs the airways and makes breathing difficult.
- Mucus is cleared by coughing.The presence of persistent cough and inflammation can cause damage to the bronchial tubes.Thus they swell and thicken, leaving less space for airflow.
Brief anatomy of the respiratory system
Light. Light - two spongy body, surrounded by thin, moist membranes called pleura.Each lung is composed of smooth, shiny lobes.The right lung has three lobes and the left has two.About 90% of the lung is filled with air and only 10% - hard tissue.
When inhaling the air passes through the windpipe (trachea) into the lungs by means of flexible airways called bronchi.Like tree branches, the bronchi are divided into more than one million small branches called bronchioles.The bronchioles end in microscopic sacs - alveoli.
Each lung contains millions of these tiny alveoli.A thin membrane of alveolar gas exchange contributes to the implementation.
capillaries lining the outside of the alveolar walls, - it is the smallest of blood vessels that carry blood throughout the body.Red blood cells carry oxygen throughout the body and return the carbon dioxide to the lungs.
Causes of chronic bronchitis
Cigarette smoking is the most common cause of COPD.Cigarette smoke contains irritants that contribute to airway inflammation, initiating processes that damage cells in the lungs, increasing the risk of COPD and lung cancer.
But smoking is not the only cause of COPD.Most smoking studies account for about 80% of cases.Other reasons include - genetic syndromes (alpha-1-antitrypsin), exposure to contaminants, such as dust, vapors and various stimuli, asthma. consider them in detail.
- pathological process. key process leading to emphysema is not fully understood.Inflammatory cells (T-lymphocytes, neutrophils and alveolar macrophages) emit chemicals called enzymes, which act on the fabric at the deepest part of the lung where gas exchange is performed.As a result of airway narrowing, exhalation difficult, damaged alveoli and ultimately destroyed.
- Smoking. typical patient with COPD - a practitioner or a former smoker, over the age of 50, has a habit of more than 20 years.Lung function with age is deteriorating.The longer a person smokes, the higher the risk of developing emphysema.Most patients are smokers with 20 years experience.Once the smoker quits smoking, his lungs begin to function the same as in healthy people, but most of the damage in the lungs, which arose at the time of smoking, not restored.
Passive smoking by inhaling tobacco smoke can also increase the risk of developing COPD, as stimuli from cigarette smoke into the lungs.
Different effects of smoking can lead to emphysema or chronic bronchitis.Pulmonary emphysema due to smoking, most often occurs in the upper lobes of the lungs.
In chronic bronchitis, smoking causes inflammation, resulting in damage to the respiratory tract.Damage
mucociliary outputting mucus, bacteria and foreign particles from the lungs promote that foreign substances accumulate in the lungs and can lead to infection and chronic bronchitis.
- Environmental factors. Tobacco smoking is the main risk factor for COPD, but 25 - 45% of patients with COPD have never smoked in developing countries.In areas exposed to industrial pollutants and poor ventilation, as well as cooking with wood and charcoal are at high risk of developing COPD.
Researchers have concluded that exposure to smoke from burning biomass may actually pose the greatest risk of COPD worldwide.Other factors that increase the risk of COPD include:
- Air pollution;
- Genetics. Alpha-1 antitrypsin (A1AD) is the only known genetic risk factor for emphysema.About 1% of people with COPD have a genetic disorder that prevents the creation of sufficient AAT protective enzymes.AAT deficiency when the injury occurs in both walls of the alveoli and airways, leading to them.
toxins associated with smoking deactivate any amounts of AAT, so smokers with AAT deficiency have almost no chance of avoiding emphysema.
Screening tests are now available for the detection of a genetic defect that causes A1AD.
People with AAT over 30 years old, younger patients who have symptoms of respiratory diseases, as well as non-smokers and persons with severe and rapidly progressive disease should be screened every year for COPD.
- Bacteria and viruses . Some bacteria, such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhal, affect the lower respiratory tract in almost half of patients with chronic bronchitis.
However, the role of bacteria, viruses and other microorganisms in the occurrence of symptoms and chronic inflammation is unclear.Some experts believe that even a low level of infection in the lungs can cause an inflammatory reaction, which continues to provoke acute attacks.Viruses can exacerbate COPD.
risk factors for chronic bronchitis
main risk factors for COPD are:
- Cigarette smoke;
- Age over 40 years;
- Exposure to industrial dusts and chemicals;
- Exposure to smoke from burning wood or other biomass;
- Exposure to indoor air pollution;
Occupational risk factors of bronchitis
Workers who are exposed to toxic chemicals (such as silica or cadmium), industrial smoke, dust and other air pollutants for longtime are at increased risk of developing COPD. These include:
- Furnace workers;
- farmers engaged in grain crops;
- Women who are prepared over an open fire;
- Railway workers (from exposure to diesel exhaust);
- Allergy and asthma.
- Abnormal lung development in the womb may increase the risk of developing COPD later in life.The researchers found that infants with poor airway function, more likely to have breathing problems in the future.Preventative measures for these children may be needed as early as infancy.
- Studies also show that eating bacon, sausage may decrease lung function and increase the risk of developing COPD.Canned meat with a high content of nitrates, acts much like tobacco smoke, and contributes to lung damage.
Symptoms of chronic bronchitis
hallmark symptom of COPD is shortness of breath, progressive over time.It is often accompanied by a cough that produces phlegm, and wheeze.Symptoms may vary.Many patients have symptoms such as chronic bronchitis and emphysema.
- Symptoms of emphysema . Typically, the first symptoms of emphysema found in heavy smokers by 50 years.
- The main early symptom is shortness of breath that occurs during mild exertion.Cough is usually insignificant, producing little phlegm (mucus).
- later develop severe symptoms, including rapid, difficult breathing and a feeling of lack of air (oxygen starvation), which persist even at rest or with minimal physical activity.
- Patients are often underweight, pinkish skin and tend to breathe through pursed lips.
- Unintended weight loss and muscle mass may indicate a poor prognosis.
symptoms of alpha-1 antitrypsin-related emphysema usually appear between the ages of 30 to 40 years.Typically, they include:
- Shortness of breath on exertion;
- symptoms of chronic bronchitis. Chronic bronchitis usually causes the following symptoms:
- Chronic cough is the hallmark symptom of chronic bronchitis, even in its early stages.
- cough with phlegm for at least 3 months a year for 2 consecutive years.The cough often starts to shortness of breath.
- Shortness of breath occurs, but it may not be as strong during the holidays, as it is in people with emphysema.
- night worsen symptoms in patients with chronic bronchitis and heart failure.
- At the end of the severe stage of the disease, lack of oxygen leads to a bluish color of the skin (cyanosis).
- body can swell under the influence of heart failure.
diseases with similar symptoms
Some diseases have similar symptoms and may occur in conjunction with COPD:
- Acute bronchitis. Viruses and bacteria can cause acute bronchitis.In most cases, it requires no treatment.Cough usually lasts for 7 - 10 days.Approximately half of the patients, but the cough can last up to 3 weeks, and 25% of patients continue to cough for more than 1 month.Patients with severe symptoms may need antibiotics.
- Asthma. Classic symptoms of an asthma attack are coughing, wheezing, and shortness of breath (dyspnea).Patients with asthma tend to have trouble breathing and may wheeze when you exhale.Users may experience irritation in the lining of the nose and throat, thirst and the need to urinate before the asthma attack.About 75% of patients who have chest pain.The pain can be very serious, even if the asthma attack itself is not heavy.At the end of the attack, usually appears cough that produces a viscous, sticky mucus.
- Lung cancer. Lung cancer usually shows no symptoms until the disease starts to progress.Frequent bouts of pneumonia or lung infection that does not clear up, may be the first signs of lung cancer.
Symptoms of lung cancer may include:
- Bloody sputum;
- Chest pain;
- Shortness of breath;
- Weight loss.
- Bronchiectasis. is irreversible lung disease in which airways in the lungs expanded wall and ultimately destroyed.In patients with this disease may occur chronic infection or inflammation of the sinuses (sinusitis), chronic cough, phlegm, in severe cases, with the content of the blood.
People with this disease usually have severe, frequent respiratory infections, since childhood.
Other factors associated with bronchiectasis are:
- Cystic fibrosis;
- The problem with the immune system (immunodeficiency);
- Rheumatic diseases;
Diagnosis of chronic bronchitis
Experts recommend that every adult smoker who complains of cough every day, be screened for COPD.In one study, nearly half of patients over 60 years old who smoke regularly, have been diagnosed with COPD.All those who have a chronic cough, increased sputum or shortness of breath, worsening over time should be checked for the presence of disease.
- Medical examination. Physical examination begins with the appearance of the patient.Usually, the appearance does not change in people with mild to moderate COPD.
In COPD patients with emphysema may experience severe thinness in the normal skin color.In chronic bronchitis can be observed bluish color of the lips and fingers, overweight body, swelling in the legs.Breathing may be rapid and shallow, occurring through pursed lips while exhaling may be more protracted.The patient will be asked to cough and get rid of mucus, if possible.
- Survey chest. doctor will perform a simple examination of the chest with a stethoscope for listening.The nature sounds doctor can judge the pathological processes in the respiratory organs and their localization.
- Pulmonary function tests (spirometry).