Department faculty and hospital therapy of medical faculty and department internal diseases of medical prophylactic faculty. Acute bronchitis Chronic bronchitis

Acute bronchitis acute inflammation of the bronchial mucosa, which is characterized by cough and sputum, and in lesions of the small bronchi - dyspnea

Prevalence: According to the referral - 14% With temporary disability is %

Aetiology Predisposing factors:Causing factors: - climate and weather - smoking - focal infection - alcohol abuse - respiratory failure through the nose - pulmonary congestion -bacteria, mycoplasma and other combinations) - chemical exposure - physical effects (dust, dry, hot, cold air) - allergic effects (organic dust, pollen, etc.)

PATHOGENESIS · Nasopharyngeal lesion · Virus is introduced into the cells of the epithelium · Cell death · 2-3 days penetrates deep into the tissue bacterial (mainly coccal flora - pneumococci, staphylococci, bacillus influenza) Changes in blood vessels (microcirculation disturbance, microthrombosis) and nerve cells (trophic disturbance) · inflammation

PATHOMORPFOLOGY loss of ciliated epithelium increase the number of goblet cells and strain in the presence of deep lesions there is degeneration of the submucosal epithelium submucosa infiltration by neutrophils and lymphocytes

CLINIC · For viral infections - the general intoxication syndrome (malaise, weakness, T) · MANIFESTATIONS ARI - runny nose, sore throat, FEELING Soreness behind the breastbone and between the shoulder blades · Dry, then cough Auscultation: In case of defeat the large bronchi - None known · HARD WIND, DRY AND SCATTERED WHEEZES

COMPLICATIONS · SHALLOW CENTRAL PNEUMONIA · ASTHMATIC BRONCHITIS · BRONCHIOLITIS

DIAGNOSTICS · Common blood - ↑, ESR ↑, CRP + · PAINTING smear Ziehl-Neelsen (cough with sputum> 2 WEEKS) · FER · Radiography (SCOPE), of lungs · Bronchoscopy (if indicated)

Classification of acute bronchitis (by Kokosov A.N., 1993) I. Aetiology: 1. Infective origin - a) virus; b) bacterial; b) viral-bacterial 2. Due to the physical and chemical hazards 3. Mixed 4. Unspecified aetiology II. By Pathogenesis: primary (independent) secondary

Classification of acute bronchitis (by Kokosov A.N., 1993) (continuation) III. BY LEVEL OF LESION: · Tracheobronchitis (proximal bronchitis) · Bronchitis (medium bronchitis) · Bronchiolitis (distal bronchitis) IV. By the nature of inflammation.(by sputum): ● dry ● catarrhal ● purulent

Classification of acute bronchitis (by Kokosov A.N., 1993) (continuation) V. on functional features: 1) non-obstructive 2) obstructive 3) Asthma VI. Adrift: 1. sharp current (no more than 2 weeks); 2. protracted (1 month or more) 3. recurrent (recurrence within a year and 3 times more)

DIFFERENTIAL DIAGNOSTICS · Bronchopneumonia · Chronic bronchitis · Bronchial asthma · TUBERCULOSIS · Lungs tumour

TREATMENT · Antiviral drugs · Antibiotics · Expectorants drugs · Antitussive drugs · Anti-inflammatory and antipyretic drugs · Bronchodilatatory drugs · Prednisolone · Antisensitizers

FORECAST In the rational therapy presence, as a rule favourable. Complete recovery usually occurs within 2-4 weeks. In the late diagnosis and untimely treatment CRF may develop.

Chronic bronchitis - a disease characterized by chronic diffuse non-allergic bronchial inflammation, manifested a cough with sputum, dyspnea. By the WHO - patients with chronic bronchitis including persons who have a cough with sputum for at least 3 months per year for 2 years.

Prevalence: 80% of all accidents of AML 50% of all disabilities in AML

AETIOLOGY I. Exogenous factors: · Tobacco smoke · Air pollution · Climatic factors · Infection II. Endogenous factors · Nasopharynx pathology · Nasal respiratory disturbance Frequent ARI, ON · Genetic predisposition · Obesity

PATHOGENESIS Change the structural and functional properties of mucous tunic The development of inflammation Obstructions and drainage function of bronchi

CLINIC - triad complex · Cough with sputum · Apnea (expiratory) · Low-grade fever SIGNS OF OBSTRUCTION 1) lengthening the exhalation phase 2) wheezes on expiration and in the lying position 3) obstructive pulmonary emphysema

THE COURSE OF CHRONIC BRONCHITIS I variant - emphysematous type (type A, "dyspnea " type) · Pink “puffers" (no cyanosis) · Predominant emphysema · Symptoms appear after 60 years · Characterized by slowly progressive course

Variant II - bronhitichesky type (type B, "coughing" type) · Blue "puffy" · Productive cough · Weak dyspnea · Symptoms at a young age · Remote wheezes · ERF - dramatically impaired · Characterized by rapid progression

COMPLICATIONS · Associated with infection (pneumonia, BE, BA (nealler) and asthmatic) · Related to the evolution of the CB (EL, diffuse pneumosclerosis, LN, drugs with the development of right ventricular failure)

EXAMINATION PROGRAM General clinical research Analysis of sputum FER (FEV, or PEF 79% and below) Chest X-ray Bronchography (with suspected BE) RCT

CLASSIFICATION HB (Kokosov A.N., Gerasin V.A., 1994) I. By the nature of inflammation: · catarrhal · purulent II. By the functional characteristics: · obstructive · non-obstructive

TREATMENT I. Aetiotropic (including antibiotics) II. Pathogenic: · Improvement of pulmonary ventilation (O2 therapy, physical therapy) · Restoration of bronchial patency: a) improved drainage (expectorants, mucolytic drugs) b) elimination of the bronchial spasm (bronchodilatory drugs): M- anticholinergic drug - ipratropium bromide,

·  2 - adrenergic agonist - Berodual; - selective  2 - adrenergic agonists- Fenoterol, Salbutamol, Terbutamol (long-acting form - Saltos, Volmax) - xanthines - theophylline, teopen, teotard, retofil) · GCS III. Others - in a painful cough - erespal, heparin - for the improvement of microcirculation.