Chronic bronchitis is a permanent or recurring diffuse lesion of the bronchial mucosa with subsequent involvement of the deeper layers of their wall, accompanied by hypersecretion of mucus, impaired cleansing and protective functions of the bronchi, manifested by constant or periodic cough with sputum and shortness of breath, not associated with other bronchopulmonary processes and pathology of other organs and systems. According to the epidemiological criteria of the World Health Organization, bronchitis is considered chronic if cough with sputum lasts three months or more a year and at least two consecutive years. According to the All-Union Scientific Research Institute of Pulmonology (VNIIIP) of the Ministry of Health in the general group of patients with chronic non-specific lung diseases, chronic bronchitis is 68.5%. More often, men are sick (the ratio between men and women is 7: 1), representatives of physical labor associated with frequent cooling and changing temperature conditions.
Classification of chronic bronchitis
Chronic bronchitis according to the classification of VNIIP MZ refers to chronic diseases with a primary lesion of a diffuse bronchial tree.
The following types of chronic bronchitis are subdivided: simple uncomplicated, proceeding with the release of sputum mucosa but without ventilation disorders; purulent, manifested by the release of purulent sputum constantly or in the exacerbation phase; obstructive, accompanied by persistent obstructive ventilation disorders; purulent-obstructive, in which purulent inflammation is combined with ventilation disorders of the obstructive type. The question of the appropriateness of the allocation of allergic bronchitis as an independent nosological form is discussed. In the domestic literature, especially concerning pediatrics, the terms “asthmatic bronchitis”, “allergic bronchitis”, “asthmatoid bronchitis” are found. Foreign researchers, although they do not distinguish asthmatic bronchitis (synonyms: asthmatoid bronchitis, pseudo-asthma, capillary bronchitis) as a separate nosological unit, often use this term in pediatric practice. The domestic literature describes allergic bronchitis, which is characterized by the features of obstructive syndrome (prevalence of bronchospasm), a peculiar endoscopic picture (vasomotor reaction of the bronchial mucosa), and bronchial contents (a large number of eosinophils), which is not typical of other forms of bronchitis. At present, it has been recognized in domestic medicine that it is advisable to designate this form of bronchitis (as well as other forms of chronic obstructive and nonobstructive bronchitis when combined with extrapulmonary manifestations of allergies and bronchospastic syndrome) as predastma.
Etiology of chronic bronchitis
The etiology of chronic bronchitis is not yet fully established, it includes many factors. The main cause of chronic bronchitis is considered a toxic chemical. effects: smoking and inhalation of toxic substances, air pollution, irritating effects of industrial dust, fumes, gases. An infection plays an important role in the progression of chronic bronchitis, but its importance as a direct and primary cause remains controversial. The most common opinion about the secondary nature of the chronic infectious and inflammatory process that develops in the altered mucous membrane of the bronchi. In the etiology of the inflammatory process, the leading role of pneumococcus (Streptococcus pneumonie) and hemophilic bacillus (Haemophylis influenze) is generally recognized . Activation of the inflammatory process is caused mainly by pneumococcus. In some cases, chronic bronchitis is a consequence of untreated acute bronchitis of an infectious (most often viral) nature – a secondary chronic process. It is possible that chronic bronchitis in adults can be associated with childhood chronic respiratory diseases, which may be the onset of chronic bronchitis, which occurs latently with progression in adulthood. Most foreign scientists deny the existence of chronic bronchitis in childhood and adolescence. Further study of this issue is needed.