Obstructive chronic bronchitis must be distinguished from asthma of bronchial infectious-allergic, obstructive chronic bronchitis with predastma, chronic pneumonia, bronchiectasis, lung cancer. Among the large contingent of patients with chronic bronchitis, there are certain groups that require a particularly thorough examination: patients with recurring purulent bronchitis; patients with a combination of sinusitis, otitis media and recurrent bronchitis; patients with chronic bronchitis with intestinal malabsorption syndrome. In the differential diagnosis of these conditions, it is necessary to keep in mind immunodeficiency diseases (antibody deficiencies). Although recurrent infections (otitis media, sinusitis, persistent bronchitis) are characteristic in childhood, symptoms can first appear only at a young age. A deficiency of serum protease inhibitors should also be borne in mind.
Chronic bronchitis treatment
One of the principles is the earliest possible treatment. The types and methods of therapy are determined by the form of chronic bronchitis and the presence of complications. At the stage of exacerbation, complex therapy is carried out: anti-inflammatory, desensitizing, improving bronchial patency, secretolytic. Anti-inflammatory and antibacterial agents include sustained-release sulfonamides, chemo-drugs, bactrim, biseptol, poteseptil, antibiotics. The appropriate choice of antibiotics is facilitated by a microbiological examination of sputum. Against the background of antibiotic therapy (the appointment of a second antibiotic after a long course of the first), an exacerbation of the disease may occur, which is often the result of the activation of another pathogen resistant to the drug used. Penicillin group drugs activate the growth of Escherichia coli, broad-spectrum antibiotics – Proteus, Pseudomonas aeruginosa, Levomycetin – pneumococcus (with an abundant amount of hemophilic bacillus). The latter is especially important, since the etiology of chronic bronchitis is most often associated with pneumococcus and hemophilic bacillus, in which there are antagonistic relationships. An exacerbation is accompanied by liquefaction of sputum and an increase in the number of microbes in it. Sputum thickening is an indirect sign of successful antibacterial treatment, however, in this case, cough, shortness of breath may intensify and there will be a need for bronchodilator and secretolytic drugs.
In view of the pronounced immunological disorders in the treatment of chronic bronchitis, agents that affect immunity, immunocorrective therapy (diutsifon. Decaris, prodigiosan, sodium nucleinate) are used, which are being studied and should be based on a comprehensive assessment of systemic and local immunities. In the period of exacerbation, u-globulin preparations are used, in particular anti-staphylococcal y-globulin (5 ml twice a week, four injections), with a prolonged course, staphylococcal toxoid (0.05-0.1 ml subcutaneously, followed by an increase of 0.1 -0.2 ml in the range of 1.5-2 ml). A positive effect of the transfer factor on the course of the disease was noted. Prodigiosan has been shown to be effective (the polysaccharide complex from the Bacillus prodigiosae culture stimulates mainly B lymphocytes, phagocytosis, and increases resistance to viruses), which is recommended for violations of antibody production. With phagocytosis dysfunction, preparations with a phagocytosis-stimulating effect (methyluracil, pentoxyl) are advisable; in case of insufficiency of the T-system, decaris is used.
Of great importance in the complex treatment of chronic bronchitis are methods of endobronchial debridement, various types of therapeutic bronchoscopy, except for lavage, which rarely gives good results. In severe respiratory distress, one of the rational and effective methods of treatment is assisted ventilation of the lungs in combination with drug therapy and oxygen aerosol therapy in a specialized department.
In the presence of insufficiency of antitryptic activity of serum, proteolytic enzymes are not recommended. With the development of chronic pulmonary heart disease with a concomitant decrease in the level of androgens and fibrinolytic activity of the blood, anabolic steroids, heparin and drugs that lower the pressure in the pulmonary artery are used. Treatment and preventive measures include: eliminating the harmful effects of irritating factors and smoking; suppression of the activity of the infectious and inflammatory process; improving pulmonary ventilation and bronchial drainage with expectorants; elimination of hypoxemia; sanitation of foci of infection; restoration of nasal breathing; physiotherapy courses two to three times a year; tempering procedures; Exercise therapy – “respiratory”, “drainage”.