According to the level of damage, proximal and distal chronic bronchitis is distinguished. Most often with B x. there is a widespread uneven lesion of large, small bronchi and bronchioles; the bronchial wall thickens due to hyperplasia of the glands, vasodilation, edema; cell infiltration weak or moderate (lymphocytes.). Usually a catarrhal process occurs, less often – atrophic. Changes in the distal regions occur as simple distal bronchitis and bronchiolitis. The lumen of the bronchioles increases, there are no accumulations of leukocytes in the wall of the bronchi.
Clinic of chronic bronchitis
Chronic bronchitis is characterized by a gradual onset. For a long time (10-12 years), the disease does not affect the well-being and performance of the patient. Start B x. patients are often associated with colds, acute respiratory infections, flu, and acute pneumonia with a protracted course. However, according to the anamnesis, coughing in the morning against the background of smoking (“smoker’s cough”, prebronchitis) precedes obvious symptoms of chronic bronchitis. Dyspnea and signs of active inflammation in the lungs are initially absent. Gradually, the cough becomes more frequent, especially in cold weather, becomes constant, sometimes decreasing in the warm season. The amount of sputum increases, its character changes (mucopurulent, purulent). Shortness of breath occurs, first at exertion, then at rest. Patients feel worse, especially in wet, cold weather. Of the physical data, the most important for diagnosis are: hard breathing (in 80% of patients): scattered dry rales (75%); restriction of the mobility of the pulmonary region during breathing (in 54%); tympanic shade of percussion tone; cyanosis of visible mucous membranes. The clinic of chronic bronchitis depends on the level of damage to the bronchi, the phase of the course, the presence and degree of bronchial obstruction, as well as complications. With a predominant lesion of large bronchi (proximal bronchitis), a cough with mucous sputum is noted, auscultatory changes in the lungs are either absent or are manifested by rough, hard breathing with a large number of diverse dry rales of a relatively low tone; bronchial obstruction ket. The process in medium-sized bronchi is characterized by a cough with mucopurulent sputum, dry, buzzing wheezing in the lungs, and the absence of bronchial obstruction. With a predominant lesion of the small bronchi (distal bronchitis), the following are observed: dry wheezing of high timbre and bronchial obstruction, clinical symptoms of which are shortness of breath in physical. load and exit from a warm room to the cold; paroxysmal excruciating cough with the separation of a small amount of viscous sputum; dry wheezing during exhalation and lengthening of the exhalation phase, especially forced. Bronchial obstruction is always prognostically unfavorable, since its progression leads to pulmonary hypertension and hemodynamic disturbances in the pulmonary circulation. Usually, the process begins with proximal bronchitis, then in almost two thirds of patients distal joins it.
By the nature of the inflammatory process, catarrhal and purulent chronic bronchitis are distinguished. With catarrhal chronic bronchitis, a cough with mucous or mucopurulent sputum is noted , symptoms of intoxication are absent, exacerbations and remissions are pronounced, the activity of the inflammatory process is established only by biochemistry. indicators. With purulent chronic bronchitis, a cough with purulent sputum is detected, permanent symptoms of intoxication, remissions are not expressed, the activity of the inflammatory process of II, IIIII degrees.
According to clinical and functional data, obstructive and non-obstructive chronic bronchitis is distinguished. Obstructive chronic bronchitis is characterized by shortness of breath. Unobstructive shortness of breath is not accompanied, and there are no ventilation disorders for many years (“functionally stable bronchitis”). The transition state between these forms is conventionally referred to as “functionally unstable bronchitis.” In patients with such bronchitis, during multiple functional studies, lability of external respiration indices, their improvement under the influence of treatment, transient obstructive disorders during exacerbation are noted.
Exacerbation of chronic bronchitis is manifested by increased cough, increased sputum, general symptoms (fatigue, weakness); body temperature rarely rises, usually to subfebrile; chills, sweating are often observed, especially at night. Almost a third of patients have neuropsychiatric disorders of varying degrees: neurasthenia-like reactions, astheno-depressive syndrome, irritability, autonomic disorders (weakness, sweating, tremor, dizziness).
Chronic bronchitis with an initial lesion of the small bronchi is known when the disease (distal bronchitis) begins with shortness of breath (5-25% of cases). In this case, an assumption arises of a primary heart disease. In the small bronchi there are no “cough” receptors, so the lesion is characterized only by shortness of breath. Further spread of inflammation to the large bronchi causes a cough, sputum production, the disease takes on more typical features.
Complications of chronic bronchitis – emphysema, pulmonary heart, pulmonary and pulmonary heart disease. Chronic bronchitis progresses slowly. From the onset of the disease to the development of severe respiratory failure takes an average of 25-30 years. Most often, its course recurs, with almost asymptomatic intervals. Seasonal exacerbations are noted (spring, autumn). There are several stages of chronic bronchitis: prebronchitis; simple non-obstructive bronchitis with a primary lesion of the bronchi of large and medium caliber; obstructive bronchitis with a widespread lesion of the small bronchi; secondary emphysema; chronic compensated pulmonary heart; decompensated pulmonary heart. Deviations from this scheme are possible: the initial lesion of the small bronchi with severe obstructive syndrome, the formation of a pulmonary heart without emphysema.