Bronchitis symptoms

Bronchitis is an inflammatory disease of the bronchi with a predominant lesion of their mucous membrane. The process is developing as a result of a viral or bacterial infection - influenza, measles, pertussis, etc.

The frequency of occurrence ranks first among other respiratory diseases. Bronchitis mainly affects children and the elderly. Men are sick more often, which is due to occupational hazards and smoking. Bronchitis is more common in people living in areas and countries with a cold and humid climate, in damp stone rooms or working in drafts. How to treat this ailment with folk remedies, look here.

Bronchitis as a whole is divided into primary and secondary. The primary bronchitis is attributed to those in which the clinical picture is due to an isolated primary lesion of the bronchi or a combined lesion of the nasopharynx, larynx and trachea. Secondary bronchitis is a complication of other diseases - influenza, pertussis, measles, tuberculosis, chronic nonspecific lung diseases, heart diseases and others. Inflammation primarily can be localized only in the trachea and major bronchi - tracheobronchitis, bronchus of the middle and small caliber - bronchitis, bronchioles - bronchiolitis, which occurs mainly in infants and young children. However, this isolated local inflammation of the bronchi is observed only at the beginning of the development of the pathological process. Then, as a rule, the inflammatory process from one area of ​​the bronchial tree spreads rapidly to neighboring areas.

There are acute and chronic forms of bronchitis.

Acute form of is characterized by inflammation of the bronchial mucosa. It is most common in young children and the elderly. The disease is accompanied by a dry and sharp cough that intensifies at night. After a few days, the cough usually softens and is accompanied by a sputum discharge.

Acute bronchitis usually occurs as a result of infection and occurs against the background of rhinitis, laryngitis, pharyngitis, tracheitis, influenza, catarrh, pneumonia and allergies. Provoke the emergence of bronchitis can weaken the body due to other diseases, addiction to alcohol and smoking, hypothermia, prolonged exposure to dampness, high humidity.

The harbingers of acute bronchitis are a runny nose, a sore throat, hoarseness and sometimes a temporary loss of voice, a dry, painful cough. The temperature may rise, chills, body aches and general weakness.

Acute inflammation of the bronchi can occur under the influence of many factors - infectious, chemical, physical or allergic. Especially often they fall ill in the spring and autumn, because at this time, hypothermia, colds and other diseases reduce the body's resistance.

Acute bronchitis develops when an irritant or infection causes inflammation and swelling of the lining bronchioles, resulting in narrowing of air passages. When the cells lining the air passages are irritated to a certain degree, the cilia( sensitive hairs) that usually catch and throw out foreign objects cease to work. Then, an excessive amount of mucus is produced, which clogs the air passages and causes a strong cough characteristic of bronchitis. Acute bronchitis is common, and usually the symptoms go away in a few days.

Acute bronchitis can be either primary or secondary. It occurs mainly in the catarrh of the upper respiratory tract and the flu, when the inflammatory process from the nasopharynx, larynx and trachea extends to the bronchi. Acute bronchitis often occurs in people who have foci of chronic inflammation in the nasopharynx - chronic tonsillitis, sinusitis, rhinitis, sinusitis, which are a source of permanent sensitization of the body, changing its immunological responses.

• The most common cause of acute bronchitis are viral infections( including common cold and flu).Bacterial infections can also lead to the development of bronchitis.

• Irritants such as chemical vaporization, dust, smoke and other air pollutants can cause an attack of bronchitis.

• The risk of severe bronchitis attacks increases smoking, asthma, poor nutrition, cold weather, congestive heart failure and chronic lung diseases.

In general, acute bronchitis can develop:

• with the activation of microbes-saprophytes, constantly located in the upper respiratory tract( for example, Frenkel pneumococci, Friedlander pneumobacillus, streptococcus, staphylococcus and others);

• for acute infectious diseases - influenza, pertussis, diphtheria and other infections;

• due to hypothermia, sudden onset of sudden changes in body temperature or inhalation of cold, moist air through the mouth;

• When inhaling vapors of chemical toxic substances - acids, formalin, xylene, etc.

Most often acute diffuse bronchitis develops under the influence of provoking factors: organism cooling, acute infectious diseases of the upper respiratory tract, exposure to exogenous allergens( allergic bronchitis).Reduction of protective reactions of the body also occurs with fatigue and general exhaustion, especially after the transferred mental trauma and the background of serious diseases.

At the onset of development of acute bronchitis, hyperemia occurs( reddening, indicating a sharply increased blood supply) and swelling of bronchial mucosa with pronounced hypersecretion of mucus containing leukocytes and, more rarely, red blood cells. Then, in more severe cases, the defeat of the bronchial epithelium and the formation of erosions and ulcers, and in some places - the spread of inflammation to the submucosal and muscular layer of the bronchial wall and the interstitial tissue( which surrounds the bronchi).

Those who suffer from such diseases as rhinitis, tonsillitis, sinusitis, sinusitis, the probability of getting acute bronchitis is higher. Often, bronchitis occurs with acute infectious diseases( influenza, measles, whooping cough, typhoid fever).When hypersensitivity to protein substance, acute bronchitis can develop by inhaling dust from animals or plants.

Since the first day of the disease, antibiotics and sulfonamides are prescribed. For the removal of bronchospasm apply eufillin, ephedrine, isadrine and other bronchodilators. A good effect, especially in the early days of the disease, is given by cans, mustard plasters, hot foot baths. Soften cough alkaline inhalation, inhalation of steam, frequent drinking of hot tea, hot milk with Borjomi or soda.

With a dry, painful cough, you should use Stoptussin, coterpine, tusuprex, glaucine( the drugs are used according to the doctor's prescription).If sputum coughs hard, give expectorants: bromhexine, potassium iodide, Doctor MOM, etc.

For the treatment of acute bronchitis mustard must be used, hot foot baths with mustard, copious drinking, rubbing of the chest, inhalation. It is useful to drink syrup from the root of the althaea and infusion of licorice root. Effective is lime tea( sold in pharmacies).

In chronic bronchitis , changes are observed in all structural elements of the bronchial wall, and lung tissue is also involved in the inflammatory process. The first symptom of chronic bronchitis is a persistent cough with which much mucus is released, especially in the mornings. As the disease progresses, it becomes more difficult to breathe, especially under physical stress. Due to the low level of oxygen in the blood, the skin becomes bluish. If acute bronchitis lasts from several days to several weeks, the chronic bronchitis lasts for months and years. If acute bronchitis is not treated, it can lead to complications - cardiac and respiratory failure, emphysema.

Chronic bronchitis can develop as a complication after acute or frequent repetition of acute bronchitis. In chronic bronchitis, not only the mucous membrane inflames, but also the bronchial walls themselves, together with the surrounding lung tissue. Therefore, chronic bronchitis is often accompanied by pneumosclerosis and emphysema of the lungs. The main symptom of chronic bronchitis is dry coughing, which often occurs in the morning after a night's sleep, and also in damp and cold weather. When you cough expectoration purulent sputum greenish shade. Over time, the patient with chronic bronchitis appears shortness of breath, pale skin. Heart failure may develop.

A frequent cause of chronic bronchitis is a prolonged, repeated inhalation of irritating dust and gases. The causes of chronic bronchitis can also be diseases of the nose, chronic inflammatory processes in the paranasal sinuses. Accession of this infection worsens the course of chronic bronchitis, causing the transition of the inflammatory process from the mucous membrane of the nose and sinuses to the walls of the bronchi and peribronchial tissue. Chronic bronchitis can be a consequence of acute bronchitis.

At the onset of the disease, the main symptom of chronic bronchitis is a cough that is worse in cold and wet weather. In most patients, a cough is accompanied by a sputum discharge. It occurs only in the mornings in the morning or worries the patient all day and even at night.

Among the symptoms of bronchitis are also increased fatigue, pain in the muscles of the chest and abdomen( caused by frequent coughs).Body temperature, usually normal, during periods of exacerbation may increase. Hypersensitivity to microflora and protein decay products in patients with chronic bronchitis can lead to the occurrence of bronchial asthma.

In the treatment of chronic bronchitis, especially in the early period, it is important to eliminate all irritating mucous membranes of bronchial factors: to prohibit smoking, to change the profession associated with the inhalation of dust, gases or vapors. It is necessary to carefully examine the nose, paranasal sinuses, tonsils, teeth, etc., in which there may be foci of infection, and conduct appropriate treatment. It is important to provide the patient free breathing through the nose.

Antibiotics are prescribed during periods of exacerbation of the disease after determining the sensitivity to them of sputum-derived microbes. The duration of antibiotic treatment varies from 1 to 3-4 weeks.

An important place in treatment is occupied by sulfonamides, especially in cases of intolerance to antibiotics or the development of fungal diseases.

For the treatment of cough syndrome in chronic bronchitis the following groups of drugs are used: - mucolytics( promote liquefaction of sputum) - acetylcysteine, ambroxol, bromhexine, etc.;

- mukokinetics( contribute to the sputum) - thermopsis, potassium iodide, Doctor MOM;

- mukoregulyatory( have the properties of mukokinetics and mucolytics) - eryspal, fluvi-fort;

- drugs that suppress the cough reflex. To treat bronchitis is necessary under the supervision of a doctor, but drugs with mustard can promote a speedy recovery.

Treatment of the disease is done only by a doctor. In addition to basic therapy, compresses, rubbing, teas for better mucus separation and inhalation, especially those prepared on the basis of medicinal plants, are useful.

By the degree of inflammation of the bronchi distinguish bronchitis catarrhal, mucopurulent, purulent, fibrous and hemorrhagic;on the prevalence of inflammation - focal and diffuse.

• Deep persistent cough with discharge of gray, yellowish or green sputum.

• Shortness of breath or shortness of breath.

• Fever.

• Chest pain, worse when coughing.

Clinical picture. Patients at the beginning of the disease note sagging in the throat and behind the sternum, hoarseness of the voice, cough, pain in the muscles of the back, limbs, weakness, sweating. Coughing first is dry or with a scanty amount of viscous, hard to separate sputum, it can be coarse, sonorous, often "barking" and appears in the form of seizures painful to the patient. During coughing attacks, a small amount of viscous mucous sputum, often "vitreous," is hardly visible.

On the second-third day of the illness, during coughing attacks, there is pain behind the sternum and at the points where the diaphragm is attached to the chest, sputum begins to appear more abundantly, initially mucopurulent, sometimes with an admixture of veins of scarlet blood, and then - purely purulent. In the future, the cough gradually decreases, becomes softer, so that the patient feels a noticeable relief.

Body temperature with mild bronchitis is normal or sometimes elevated within a few days, but insignificantly( subfebrile condition).In severe bronchitis, the temperature rises to 38.0-39.5 ° C and can remain so for several days. The frequency of breathing is usually not increased, but in the presence of fever is increased slightly. Only with diffuse lesions of small bronchi and bronchioles does severe dyspnoea occur: the number of breaths can increase to 30, and sometimes up to 40 per minute, with frequent increases in cardiac contractions( tachycardia).

When percussion( percussion) of the thorax, percussion sound is usually not changed, and only with diffuse inflammation of small bronchi and bronchioles does it acquire a boxy tint. At listening, hard breathing and dry buzzing and / or wheezing are determined, which can change( increase or decrease) after coughing.

During the "resolution"( subsidence) of the inflammatory process in the bronchi and liquefaction under the influence of proteolytic enzymes of viscous sputum along with dry rales can be listened to and moist non-sound wheezing. X-ray examination does not reveal any significant changes;Only sometimes there is an increase in pulmonary pattern in the basal zone of the lungs.

Blood can detect leukocytosis( up to 9000-11 000 in 1 μl) and accelerate ESR.

In most cases, by the end of the first week, the clinical signs of the disease disappear, and in two weeks a full recovery occurs. In physically weakened individuals, the disease can last up to 3-4 weeks, and in some cases - with systematic exposure to harmful physical factors( smoking, cooling and other) - or lack of timely and competent treatment - to take a long, chronic course. The most unfavorable variant consists in development of such complication, as bronchopneumonia.

• A medical history and physical examination are required.

• Chest x-ray, sputum and blood tests can be performed to identify other lung diseases.

• Take aspirin or ibuprofen to lower fever and reduce pain.

• Take a cough suppressant if you have a persistent dry cough. However, if you have coughing up phlegm, suppressing a cough can lead to a buildup of mucus in the lungs and lead to severe complications.

• Stay in a warm room. Breathe over steam, use an air humidifier, often take a hot shower to soften the mucus.

• Drink at least eight glasses of water a day to make the mucus less dense and easily removed.

• If a doctor suspects a bacterial infection, he may prescribe antibiotics.

• Smokers should give up cigarettes.

• Consult a doctor if symptoms persist after 36 or 48 hours or if attacks of acute bronchitis recur.

• Consult your doctor if you have a lung disease or congestive heart failure and experience symptoms of acute bronchitis.

• Consult a doctor if you have a coughing up of blood during a bout of bronchitis, you have shortness of breath or fever.

• Do not smoke and try to avoid passive smoking.

• People with a predisposition to illness should avoid being where the air contains irritating particles, such as dust, and avoid physical activity on days when the weather conditions are bad.

As we already know, acute bronchitis is one of the manifestations of a viral infection with the localization of the process in the bronchi. Due to the fact that acute bronchitis usually does not occur in isolation but is combined with the damage of other parts of the respiratory system, the disease is essentially "dissolved" in the diagnosis of acute respiratory viral infection or pneumonia. Very roughly the proportion of acute bronchitis is 50% of all respiratory diseases in children, especially the first years of life.

The main pathological factor in the development of acute bronchitis can be almost equally viral, as well as bacterial, as well as mixed infections. However, the viruses are of the greatest importance, and in the first place - parainfluenza, respiratory syncytial and adenoviruses. Rhinoviruses, mycoplasmas and influenza viruses are relatively rare in this respect. It should also be noted that acute bronchitis in children is quite naturally observed in measles and whooping cough, but with rhino-or enterovirus infection - extremely rare.

Bacteria play the smallest role. Staphylococcus, streptococcus and pneumococci are more common. It should be borne in mind that the bacterial flora is activated again against the background of a previous viral infection. In addition to

, bacterial bronchitis is observed when the integrity of the mucous membrane of airways( for example, a foreign body) is compromised. It must also be taken into account that the virus disease of the respiratory tract in the first days acquires the character of the viral-bacterial.

Features of the development of the disease in childhood, in fact, are inextricably linked with anatomophysiological features of the upper respiratory tract of the child. To them, first of all, are: much more abundant, in comparison with adults, blood supply to the mucosa, as well as age looseness under the mucous structures. Against the background of the infection, these features provide for the rapid spread of the exudative-proliferative reaction along the continuation of the respiratory tract into the depth - the nasopharynx, the pharynx, the larynx, the trachea, and the bronchi.

As a result of exposure to virus toxins, the motor activity of the ciliated epithelium is suppressed. Infiltration and edema of the mucous membrane, increased secretion of viscous mucus further slow down the "flickering" of the cilia, thus turning off the main mechanism of bronchial cleansing. The consequence of viral intoxication, on the one hand, and inflammatory reaction, on the other hand, is a sharp decrease in the drainage function of the bronchi - a difficulty in the outflow of sputum from the lower parts of the respiratory tract. What, ultimately, contributes to the further spread of infection, while creating conditions for bacterial embolism in bronchi of a smaller diameter.

From what has been said above it is clear that acute bronchitis in childhood is characterized by a significant extent and depth of involvement of the bronchial wall, as well as a pronounced character of the inflammatory reaction.

It is known that the following forms of bronchitis are distinguished in length:

• Limited - the process does not go beyond the segment or lobe of the lung;

• common - changes are observed in segments of two or more lobes of the lung from one or both sides;

• diffuse - bilateral defeat of airways.

According to the nature of the inflammatory reaction, the following are distinguished:

• catarrhal;

• purulent;

• fibrinous;

• necrotic;

• ulcerative;

• hemorrhagic;

• Mixed bronchitis.

In childhood, most often there are catarrhal, catarrhal-purulent and purulent forms of acute bronchitis. Like any inflammatory process, it is composed of three phases: alterative, exudative and proliferative. A special place among diseases of the respiratory tract is bronchiolitis( capillary bronchitis) - a bilateral common inflammation of the terminal parts of the bronchial tree. By the nature of inflammation bronchiolitis is divided in the same way as bronchitis. In the most common catarrhal bronchiolitis, edema and inflammatory infiltration of the bronchiolar walls are combined with complete or partial obstruction of the lumen by a mucous or mucoid-purulent discharge.

Clinical picture. For different variants of infection, the disease pattern can have its own specific features. So, for example, parainfluenza typically develops epithelial growth of small bronchi, and adenoviral bronchitis is characterized by an abundance of mucous overlays, loosening of the epithelium, and cell rejection into the bronchus lumen.

Here it should be stressed once again that the decisive role in the development of airway narrowing in children belongs not to spasm of the bronchi, but to increased secretion of mucus and swelling of the bronchial mucosa. And it should be noted that, despite the wide prevalence of the disease and its well-known clinic, doctors often have serious doubts about the diagnosis in connection with the variety of symptoms, as well as the often present component of respiratory failure. The latter circumstance can play a decisive role in treating the process as pneumonia, which later turns out to be incorrect.

Acute bronchitis is a disease manifested in the course of an acute respiratory-viral infection. Therefore, it is characterized by:

• communication with the infectious process;

• evolution of the general state according to the evolution of the infectious process;

• catarrhal phenomena in the nasopharynx and throat, preceding the appearance of bronchitis.

The temperature response is usually due to the underlying infectious process. Its expression varies in each specific case, depending on individual characteristics, and the duration varies from one day to a week( an average of 2-3 days).In this case, it should always be remembered that in children the absence of fever does not exclude the presence of an infectious process.

Cough, dry and wet,: - the main symptom of bronchitis. In the initial period it is dry, painful. Its duration is different. Usually at the end of the first week or at the beginning of the second the cough becomes wet, with the separation of sputum and then gradually disappears. In young children, cough often persists for more than 14 days, although the total duration rarely exceeds three weeks. A prolonged dry cough, often accompanied by a feeling of pressure or pain behind the sternum, indicates the involvement of trachea( tracheitis, tracheobronchitis) in the process.

The "barking" tone of the cough speaks of a larynx lesion( laryngitis, laryngotracheitis, laryngotraheobronchitis).

In physical examination percutaneously, either a clear pulmonary sound or a pulmonary sound with a boxed tone is determined, which is determined by the presence or absence of constriction of the bronchi and its degree. At auscultation, all variants of wheezing, dry and wet, including small-bubbles, are listened to. It should be borne in mind that finely bubbly moist wheezing testifies only to the defeat of the smallest bronchi. The origin of these wheezing, as well as dry, large and medium-bubbly moist, exclusively bronchial.

Radiographic changes manifest themselves as an intensification of the pattern of the lungs, small shadows are visible - most often in the lower and basal zones, symmetrically on both sides. The inflammatory process in the mucosa of the respiratory tract is accompanied by vascular hyperemia and increased lymph production. As a result, there is an increase in the pattern along the course of the bronchoconstrictive structures, which makes it more abundant, the shadows become wider, the sharpness of the contours worsens. The increased outflow of lymph, directed towards the regional lymph nodes, creates a picture of the radical enhancement of the figure, in which blood vessels also participate. The roots of the lungs become more intense, moderately deteriorating their structure, that is, the clarity of the elements from which the root pattern is composed. The smaller the bronchial branches involved in the process, the more abundant and indistinct the heavier figure looks.

Reactive increase in lung pattern lasts longer than clinical manifestations of bronchitis( an average of 7-14 days).Infiltrative changes in the lungs, which cover or muffle the small elements of the pulmonary pattern, are absent in bronchitis.

Changes in blood in a child's bronchitis are determined by the nature of the infection - mostly viral or bacterial.

Acute simple bronchitis is one of the manifestations of a respiratory-viral infection that occurs successively in a downward direction with a lesion of the nasopharynx, larynx, and trachea, and proceeds in the absence of clinical signs of airway obstruction.

The main complaints about temperature, runny nose, cough, often pain in the throat when swallowing. Characteristic of the evolution of cough accompanied sometimes( with tracheobronchitis) by a feeling of pressure or even by pain behind the sternum. Dry, obtrusive at the beginning of the disease, such cough in the second week becomes wet and gradually disappears. Its survival for more than two weeks is observed in young children with some types of acute respiratory viral infection, often caused by adenoviruses. Longer persistence of cough should be alarming and cause an in-depth examination of the patient, search for possible aggravating factors( it should be remembered that the cough for 4-6 weeks( without signs of bronchitis or other pathology) is observed after the tracheitis. Bronchitis is a disease characterized by clinically pronounced signs of airway obstruction: noisy breathing with prolonged exhalation, wheezing, audible at a distance, wheezing and stubborn("dry" or "wet") The terms "spasmodic bronchitis" or "asthmatic syndrome," which are sometimes used to refer to this form, are narrower because they link the development of narrowing of the bronchi only with their spasm, which is not always observed, however.

The obstructive bronchitis clinic occupies an intermediate position between simple and bronchiolitis. The complaints are basically the same. Objectively, with external examination, attention is drawn to the phenomenon of mild respiratory failure( dyspnea, cyanosis, participation in the act of respiration of the auxiliary musculature), the degree of which is usually low. The general condition of the child, as a rule, does not suffer.

Percutally a boxed tone of sound;at auscultation, an elongated exhalation, exhalation noises, dry, large and medium-bubbly wet wheezing, mainly also on exhalation, are heard. There are also all the phenomena determined by the course of the viral infection.

Acute bronchiolitis is a type of disease of the terminal bronchi in children of early age, accompanied by clinically pronounced signs of airway obstruction.

Symptoms of respiratory illness are usually the first to appear: serous runny nose, sneezing. Deterioration of the condition can develop gradually, but in many cases occurs suddenly. In this case, as a rule, there is a cough, which is sometimes paroxysmal. The general condition is broken, sleep and appetite worsen, the child becomes irritable. The picture develops more often at slightly elevated or even normal temperature, but it is accompanied by tachycardia and dyspnea.

Upon examination, the child makes the impression of a seriously ill patient with bright signs of respiratory failure. Inflating the wings of the nose with breathing is determined, participation in the act of respiration of the auxiliary muscles is manifested by the retraction of the intercostal spaces of the thorax. With pronounced degrees of obstruction, the anteroposterior diameter of the thorax is clearly seen.

Percutally determined box tone over the lungs, reducing zones of blunting over the liver, heart, mediastinum. The liver and spleen are usually probed a few centimeters below the costal arch, which is a sign not so much of their increase as displacement as a result of bloating. Tachycardia, sometimes reaching a high degree, is expressed. In both lungs, multiple small bubbling rales are heard on the entire surface both on inspiration( at the end of it) and on exhalation( at the very beginning).

This picture of the "wet lung" can be supplemented with medium- or large-bubbly damp, as well as dry, sometimes wheezing, which change or disappear when coughing.

To the so-called etiotropic( ie directly affecting the pathogenic agent, for example, bacterial) in bronchitis are the following groups of drugs:

• antibiotics;

• antiseptics( sulfonamides, nitrofurans);

• biological nonspecific defense factors( interferon).

As mentioned earlier, the expediency of using antibiotics for bronchitis therapy, and in particular for children, is now challenged by many authors, but we will not raise this issue here: it is quite specific, and therefore there is no point in discussing it in this book. Nevertheless, there are well-defined indications for prescribing the above funds for bronchitis in children, which are reduced to three main points, namely:

• the possibility or direct threat of the development of pneumonia;

• prolonged temperature reaction or high fever in the child;

• Development of general toxicosis,

• Finally, the lack of a satisfactory effect on all the therapies conducted earlier.

Consider the features of antibiotic therapy in childhood, as the child's organism reacts to certain medications differently than the adult, fully formed. Therefore, adequate( in other words, necessary and sufficient) treatment in terms of dosages is particularly important so as not to cause harm and avoid certain complications that may occur with irrational therapy with the drugs of the above pharmacological groups.

Drugs of penicillin group

• Benzylpenicillin potassium and sodium salts: children under two years old - 50 000-100 000-200 000( maximum, according to special indications) ED / kg body weight per day;from two to five years - 500 000 units, from five to ten years - 750 000 units, and finally from 10 to 14 years - 1000 000 units per day. Multiplicity of administration at least 4 times and not more than 8, respectively, after 3-4-6 hours. It must be remembered that if there are indications for intravenous administration, only the sodium salt of benzylpenicillin can be injected into the vein.

• Methicillin sodium salt - for children up to three months -50 mg / kg body weight per day, from three months to two years -100 mg / kg per day, over 12 years - adult dose( 4 to 6 g per day).It is administered intramuscularly and intravenously. Multiplicity of administration is at least two and not more than four times, respectively, after 6-8-12 hours.

• Oxacillin sodium salt - children up to a month - 20-40 mg / kg body weight per day, from one to three months - 60-80 mg / kg, from three months to two years -1 g per day, from two to sixyears - 2 g, over six years - 3 g. It is administered intramuscularly and intravenously. Multiplicity of administration at least twice a day and not more than four, respectively, after 6-8-12 hours. Inside is given 4-6 times a day for 1 hour before meals or 2-3 hours after meals in the following doses: up to five years - 100 mg / kg per day, over five years - 2 grams per day.

• Ampicillin sodium salt - up to 1 month of life - 100 mg / kg body weight per day, up to 1 year - 75 mg / kg body weight per day, from year to four years - 50-75 mg / kg, over four years -50 mg / kg. It is administered intramuscularly and intravenously. Multiplicity of administration at least two times and no more than four times a day, respectively, after 6-8 or 12 hours.

• Ampiox - up to one year - 200 mg / kg of body weight per day, from year to six years - 100 mg / kg, from 7 to 14 years - 50 mg / kg. It is administered intramuscularly and intravenously. Multiplicity of administration is at least two and no more than four times a day, respectively, after 6-8-12 hours.

• Dicloxacillin sodium salt - up to 12 years - from 12.5 to 25 mg / kg body weight per day in four divided doses, orally, 1 hour before meals or 1-1.5 hours after meals.

Preparations of macrolide group

• Erythromycin( up to two years) - 0.005-0.008 g( 5-8 mg) per kilogram of body weight, from three to four years - 0.125 g, from five to six years - 0.15 g, from seven to nine - 0.2 g, ten to fourteen - 0.25 g. It is administered orally four times a day for 1-1.5 hours before meals.

• Erythromycin ascorbate and phosphate are prescribed at a rate of 20 mg / kg of body weight per day. Enter intravenously slowly after 8-12 hours, respectively, 2 or 3 times.

• Oleandomycin phosphate - up to three years - 0.02 g / kg body weight per day, from three to six years - 0.25-0.5 g, from six to fourteen years - 0.5-1.0 g,over 14 years -1.0-1.5 grams per day. It is taken orally, 4-6 times a day. Intramuscular and intravenous can be administered to children under three years of age - 0,03-0,05 g / kg body weight per day, from three to six years - 0,25-0,5 g, from six to ten years - 0,5-0,75 g, from ten to fourteen years - 0,75-1,0 g per day. It is introduced 3-4 times accordingly in 6-8 hours.

Preparations of the amipoglycoside group

• Gentamicin sulfate - 0.6-2.0 mg / kg body weight per day. It is administered intramuscularly and intravenously 2-3 times a day, respectively, after 8-12 hours.

• Levomycetin - levomycetin sodium succinate - a daily dose for children up to one year is 25-30 mg / kg body weight, over the year - 50 mg / kg body weight. It is administered intramuscularly and intravenously twice a day, respectively, after 12 hours. Contraindicated for children with the phenomena of oppression of hematopoiesis and at the age of up to one year.

Cephalosporins

• Cephaloridine( synonym for chains), kefzol - a newborn dose of 30 mg / kg body weight per day, after one month of life - an average of 75 mg / kg body weight( 50 to 100 mg / kg).It is administered intramuscularly and intravenously 2-3 times a day, respectively, after 8-12 hours.

Antibiotics of other groups of

• Lincomycin hydrochloride -15-30-50 mg / kg body weight per day. It is administered intramuscularly and intravenously twice a day after 12 hours.

• Fuzidin sodium: is prescribed orally in doses: up to 1 year, 60-80 mg / kg of body weight per day, from one to three years -40-60 mg / kg, from four to fourteen years - 20-40 mg /kg.

The average course of antibiotic therapy in children with bronchitis is 5-7 days. For gentamycin, levomycetin - no more than 7 days, and only on special indications - up to 10-14 days.

In addition, in some cases it may be appropriate to use combinations of two or three antibiotics( to determine their intercompensability and chemical compatibility, there are specially designed tables).This expediency is determined by the condition of the patient, often severe.

Most commonly used: biseptol-120( bactrim), sulfadimethoxin, sulfadimezin, norsulfazole.

• Biseptol-120, containing 20 mg of trimethoprim and 100 mg of sulfamethoxazole, is prescribed for children up to two years at a rate of 6 mg of the first and 30 mg of the second of these drugs per 1 kg of body weight per day. From two to five years - two tablets in the morning and in the evening, from five to twelve years - four. Bactrim, which is an analog of biseptol, is recounted taking into account that one teaspoon of it corresponds to two tablets of biseptol No. 120.

• Sulfadimethoxin is prescribed to children up to four years of age: on the first day - 0.025 mg / kg of body weight, in the following days - 0, 0125 g / kg. Children over the age of four: on the first day - 1.0 g, in the following days - 0.5 g daily. Take 1 time a day.

• Sulfadimezin and norsulfazole. Children under two years of age - 0.1 g / kg of body weight per day, then 0.025 g / kg 3-4 times in 6-8 hours. Children older than two years - 0.5 g 3-4 times a day.

• Nifftrofurans( furadonin, furazolidone) are used much less often. The daily dose of the drug is 5-8 mg / kg of body weight to children under two years. Reception 3-4 times a day.

The overall course of sulfonamide or nitrofuran therapy is on average 5-7 days and in rare cases can be extended to 10.

Chronic bronchitis is one of several lung diseases that together are called chronic obstructive diseases. Chronic bronchitis is defined as the presence of a cough with mucus that lasts at least three months, two years in a row. Such a cough is observed when the tissues lining the bronchi( the branches of the trachea through which air is inhaled and exhaled air passes) are irritated and inflamed. Although the disease begins gradually, as it develops, relapses become more frequent, and as a result, coughing can become permanent. Prolonged chronic bronchitis leads to the fact that air passages of the lungs become irreversibly narrow, which greatly complicates breathing. Chronic bronchitis can not be completely cured, but nevertheless, treatment alleviates symptoms and prevents complications.

Chronic bronchitis is a long-lasting inflammatory disease of the bronchial mucosa and bronchioles.

Infection plays an important role in the development and progress of the disease. Chronic bronchitis can develop on the ground of acute bronchitis or pneumonia. An important role in its development and maintenance is also the long-term irritation of the bronchial mucosa by various chemical substances and dust particles inhaled with air, especially in cities with a moist climate and sharp weather changes, in industries with considerable dust or increased air saturation with chemical vapor. In the maintenance of chronic bronchitis, a certain role is played by autoimmune allergic reactions, which occur on the soil of absorption of protein decay products formed in the inflammatory foci.

No less important in the development of chronic bronchitis is smoking: the number of people suffering from bronchitis among smokers is 50-80%, and among non-smokers - only 7-19%.

• Smoking is the main cause of chronic bronchitis. About 90 percent of patients smoked. Passive smoking also affects the development of chronic bronchitis.

• Substances that irritate the lungs( gas emissions from industrial or chemical plants) can damage the respiratory tract. Other substances that pollute the air also contribute to the development of the disease.

• Recurrent lung infections can damage the lungs and aggravate the disease.

• Persistent cough with mucus, especially in the morning.

• Shortness of breath.

• Chryps.

• Frequent pulmonary infections.

• For patients with chronic bronchitis, vaccination against influenza and the most common form of bacterial pneumonia( pneumococcal pneumonia) is recommended.

Clinical picture. At the very beginning of the disease, the bronchial mucosa is full, sometimes hypertrophied, the mucous glands are in a state of hyperplasia. In the future, the inflammation spreads to the submucosal and muscular layers, where the scar tissue is formed;the mucosal and cartilaginous plates atrophy. In places of thinning of the walls of the bronchi, their lumen is gradually enlarged - bronchiectasises are formed.

Peribronchial tissue may also be involved in the process, with further development of interstitial pneumonia. Gradually atrophy interalveolar septa and develops emphysema of the lungs.

The clinical picture as a whole is quite typical and well studied, nevertheless, all manifestations of chronic bronchitis strongly depend on the extent of inflammation in the bronchi, as well as on the depth of the bronchial wall. The main symptoms of chronic bronchitis are cough and shortness of breath.

Cough can be of a different nature and vary depending on the season, atmospheric pressure and weather. In summer, especially dry, cough is negligible or completely absent. With increased humidity and rainy weather, cough is often intensified, and in the autumn-winter period it becomes strong, persistent with the separation of viscous mucopurulent or purulent sputum. More often a cough occurs in the morning, when the patient begins to wash or dress. In some cases, sputum is so thick that it stands out in the form of fibrous cords resembling bronchial lumen casts.

Shortness of breath for chronic bronchitis is due not only to the violation of the drainage function of the bronchi, but also to the secondary development of emphysema of the lungs. It often has a mixed character. At the beginning of the disease, breathing difficulties are noted only with physical activity, climbing the stairs or uphill. In the future, with the development of emphysema and pneumosclerosis, dyspnea becomes more pronounced. With diffuse inflammation of the small bronchi, shortness of breath takes on the character of an expiratory( predominant difficulty on exhalation).

General symptoms of the disease are observed - malaise, fatigue, sweating, body temperature rarely increases. In uncomplicated cases, palpation and percussion of the chest do not reveal any changes. When auscultation is determined vesicular or hard breathing, against which dry humming and whistling sounds are heard, as well as silent damp rales. In far-reaching cases, the examination, palpation, percussion and auscultation of the chest determine the changes characteristic of emphysema of the lungs and pneumosclerosis, and signs of respiratory insufficiency appear.

Blood changes occur only with exacerbations of the disease: the number of leukocytes increases, the ESR accelerates.

X-ray examination with uncomplicated bronchitis of pathological changes usually does not reveal. With the development of pneumosclerosis or pulmonary emphysema, there are corresponding radiographic signs. Bronchoscopy reveals a picture of atrophic or hypertrophic bronchitis( ie, with thinning or swelling of bronchial mucosa).

The obstructive nature of chronic bronchitis is confirmed by data from functional research( in particular, spirography).

Improvement of lung ventilation and respiratory mechanics with the use of bronchodilators indicates bronchospasm and reversibility of bronchial obstruction.

Differential diagnosis of chronic bronchitis is primarily carried out with chronic pneumonia, bronchial asthma, tuberculosis, lung cancer and pneumoconiosis.

Treatment of patients with chronic bronchitis should begin at the earliest possible stage. It is important to eliminate all factors that cause irritation of the bronchial mucosa. It is necessary to sanitize any chronic foci of infection, to ensure free breathing through the nose. Treatment of patients with exacerbation of bronchitis is often more appropriate in a hospital.

Further course and complications. One of the most unfavorable manifestations of chronic bronchitis, which largely determines its prognosis, is the development of obstructive disorders in the bronchial tree. The causes of this type of pathology are changes in the mucosa and submucosa of the bronchi, which develops due to a fairly long inflammatory reaction with the infiltration of the walls and spasms of not only the large bronchi but also the smallest bronchi and bronchioles, narrowing the lumen of the entire bronchial tree with a large amount of secreted secretion and sputum. The described violations in the bronchial tree lead, in turn, to disturbances in the ventilation processes. With an unfavorable variant of the development of the process, hypertension of the small circle of blood circulation further develops and a picture of the so-called "chronic pulmonary heart" is formed.

Bronchospastic syndrome can be noted in any form of chronic bronchitis and is characterized by the development of expiratory dyspnea, while if bronchospasm is the main place in the overall clinical picture of the disease, chronic bronchitis is defined as asthmatic.

Symptoms and clinics depend on the caliber of affected bronchi. The first symptoms of chronic bronchitis: a cough with or without phlegm, more characteristic for the defeat of large bronchi, progressive dyspnea is more common with lesions of small bronchi. Cough can occur paroxysmal only in the morning, and can disturb the patient all day and then at night. More often the inflammatory process first affects the large bronchi, and then spreads to the smaller ones. Chronic bronchitis begins gradually, and for many years, except for a recurrent cough, the patient does not bother. Over the years, cough becomes permanent, the amount of sputum is increased, it becomes purulent. As the disease progresses, more and more small bronchi are involved in the pathological process, which leads to pronounced violations of pulmonary and bronchial ventilation. During periods of exacerbation of chronic bronchitis( mainly during cold and wet seasons) cough, dyspnea, fatigue, weakness increase, sputum increases, body temperature rises, often slightly, chilliness and sweating appear, especially at night, pains in various muscle groups caused byfrequent coughing. Exacerbation of obstructive bronchitis is manifested by the increase of dyspnea( especially with physical exertion and transition from heat to cold), the separation of a small amount of sputum after a paroxysmal painful cough, an elongated phase of the exit, and the onset of wheezing dry wheezes on exhalation.

The presence of obstruction and determines the prognosis of the disease, as it leads to the progression of chronic bronchitis, to pulmonary emphysema, the development of the pulmonary heart, the appearance of atelectasis( compaction sites in the lung tissue), and, as a consequence, to pneumonia. In the future, the clinical picture is already determined by the developing changes in the lungs and heart. Thus, in case of complication of the disease with a chronic pulmonary heart during an exacerbation, the phenomena of heart failure increase, emphysema appears, and respiratory failure occurs.

At this stage, the development and progression of bronchiectasis is possible, with coughing a large amount of purulent sputum, possibly hemoptysis. Part of patients with asthmatic bronchitis may develop bronchial asthma.

In the phase of exacerbation, both weakened vesicular and hard breathing can be heard, often the number of dry wheezing and wet wheezing over the whole surface of the lungs increases. Outside exacerbation, they may not be. In the blood, even during the exacerbation of the disease, changes may be absent. Sometimes a moderate leukocytosis, a shift of the leukocyte formula to the left, a slight increase in ESR are determined. Of great importance is the macroscopic, cytological and biochemical examination of sputum. In severe exacerbation of chronic bronchitis, sputum purulent sputum, in it are found mostly leukocytes, DNA fibers, etc.;with asthmatic bronchitis in sputum may be noted eosinophils, Courshmann spirals, Charcot-Leiden crystals, characteristic for bronchial asthma.

In this case, radiographic symptoms in most patients for a long time are not detected. In some patients, the x-ray patterns show uneven reinforcement and deformation, as well as changes in the contours of the pulmonary pattern, with emphysema - an increase in the transparency of the pulmonary fields.

During the course of chronic bronchitis, there is a significant diversity in different patients. Sometimes bronchitis suffers for many years, but functional and morphological disorders are little pronounced. In another group of patients, the disease gradually progresses. It exacerbates under the influence of cooling, most often in the cold season, in connection with epidemics of influenza, in the presence of unfavorable occupational factors, etc. Repeated exacerbations of bronchitis lead to the development of bronchiectasis, emphysema, pneumosclerosis, signs of respiratory symptoms, and then- pulmonary heart failure.

Chronic bronchopulmonary respiratory failure is termed "chronic pulmonary insufficiency" and is distinguished by three of its degrees, depending on the severity of clinical manifestations.

For patients with severe pulmonary insufficiency, there is a cough with separation of a significant amount of sputum, persistent shortness of breath, signs of heart failure: cyanosis, enlargement of the liver( on average, usually 2-3 cm), sometimes swelling of the lower extremities. With chest x-rays, all patients have significant emphysema, and the nature of ventilation disorders is of a mixed type.

• Diagnosis of chronic bronchitis is helped by a medical history and physical examination.

• To confirm the weakened function of the lungs, the patient is checked for lung function( measurement of the volume of the air to be taken).

• X-rays can detect lung damage and help identify other diseases, such as lung cancer.

• To determine the oxygen and carbon dioxide in the blood, the arterial blood is analyzed.

The general condition of simple bronchitis is due to the response to infection( in the absence of toxicosis - satisfactory or moderate), and in obstructive bronchitis it is caused, in addition, and the degree of obstruction, and, consequently, the severity of respiratory failure.

Cough with simple bronchitis is usually dry;it becomes damp at the end of the first and beginning of the second week of the disease. In obstructive bronchitis cough - dry, stubborn, painful in the first week, and deep, moist, rich in overtones - on the second. Cough with bronchiolitis - frequent, painful, deep, increasing with the resolution.

Respiratory failure: absent from simple bronchitis;when obstructive, respiratory insufficiency of the first, rarely the second degree, is possible, and with bronchiolitis it is expressed, and it happens more often than the second-third degree.

Character of dyspnea: absent with simple bronchitis, expiratory - with obstruction.

Percussion: pulmonary sound with simple bronchitis, box tone - with obstruction.

Auscultation: breathing is hard or vesicular with simple bronchitis with the usual ratio of the phases of inspiration and expiration. With obstructive bronchitis, bronchiolitis, exhalation is difficult and elongated. Chrypses with simple bronchitis scattered, a few dry and mostly large bubbles - moist, disappearing almost completely after a cough. In obstructive bronchitis - in a large number of dry and wet rales( both small and medium-pemphigus), numerous, heard throughout the lungs are symmetrical. The quantitative dynamics of their coughing is almost independent.

To distinguish a heavy bronchiolitis from an easier obstructive bronchitis, as a rule, does not represent a significant complication: with bronchitis there are no signs of severe respiratory failure. At the same time, there is an adjacent zone where it is difficult to differentiate these two forms. In these cases, one should be guided by the presence of abundant finely bubbling rales, which are typical for bronchiolitis. This is important for differentiation with pneumonia, whereas in patients with obstructive bronchitis without wet wheezing, the main diagnostic problem is the exclusion of bronchial asthma.

• The development of the disease may slow down as a result of smoking cessation. It is also recommended to avoid passive smoking and other lung irritants.

• Moderate occupations in the air can help prevent the development of the disease and generally increase the possibility of physical activity.

• It is recommended that measures be taken to prevent pulmonary infections, including frequent hand washing and vaccination.

• Drink plenty of fluids and breathe in moist air( for example, use an air humidifier), which will help make the mucus secret less dense. Cold dry air should be avoided.

• A bronchodilator may be prescribed to facilitate breathing, which expands the bronchi.

• If a bronchodilator does not work, a steroidal medication for oral or inhalation may be prescribed. Patients taking steroids should be under the supervision of a doctor who will determine if breathing improves. If there is no reaction to the drug, steroid therapy may be interrupted.

• Additional oxygen intake helps patients with low oxygen in the blood;for them it can help prolong life.

• Antibiotics are prescribed for the treatment of newly emerging infectious diseases, which helps to prevent the increase in symptoms of the disease. Continuous antibiotic treatment is not recommended.

• Some exercises can help remove mucus from the lungs and improve breathing. The doctor can give instructions for doing the exercises.

• For patients with chronic bronchitis, the use of cough suppressants and expectorants is not recommended.

• Consult your doctor if you have a persistent cough with mucus and the amount of mucus discharged increases, its color darkens, or you notice blood in the mucus.

• Consult a doctor if you have a persistent cough in the morning.

• Consult a doctor if you experience shortness of breath or other kinds of difficulty breathing.

• Seek medical attention immediately if the skin on your face becomes bluish or purple.

Treatment of bronchitis should be based on the etiology, pathogenesis and clinical signs of the disease. Depending on the severity of the clinical picture, a more or less severe rest is prescribed, with a high temperature bed rest. It is necessary to strictly forbid the patient to smoke and moisten the dry air in the room. Food should be easily assimilated and rich in vitamins. Simultaneously, a plentiful drink is recommended, sweatshops( lime blossom, raspberry, black elderberry and others) are desirable. Useful mustard plasters or cans for the night, especially at the initial stages of the disease.

Interferon is prescribed in the first 2 days( not later) 1-2 drops in both nostrils 4-6 times a day, up to 5 days.

With a painful cough for 3-4 days prescribe antitussives. A good preparation is glaucine hydrochloride;prescribe also an infusion of the root ipecacuanas( drugstore form) for 1 tablespoon every 3-4 hours, for three days.

bronchodilators are also used for bronchodilators: teofedrin is effective( 1/2, 1 tablet 3 times a day), eufillin( 0.15 g 3 times a day).

In general, it can be said that pathogenetic therapy for bronchitis should focus on:

• restoration of drainage function of the bronchi,

• in the presence of obstruction - to restore their patency.

With this in mind, medication treatment for bronchitis mainly consists of the appointment:

• expectorating and thinning medications( mucolytics);

• bronchodilators;

• means for increasing oxygenation( supplying the body with oxygen).

Expectorants and thinned sputum preparations are administered orally or by inhalation method. Inhaling therapy of bronchitis in this book is devoted to a separate chapter, here we will only focus on a group of enzyme preparations.

Trypsin is a proteolytic enzyme, 2-5 mg of which is dissolved in 2-4 ml of isotonic sodium chloride solution and used as an aerosol once a day;the rate is from 7 to 10 days. Chymotrypsin is more stable than trypsin, and is slower inactivated. Indications for use, method, dose are the same as for trypsin crystalline. Another enzyme preparation is ribonuclease.10-25 mg of the drug are dissolved in 3-4 mg isotonic sodium chloride solution or 0.5% novocaine. Course 7-8 days. Deoxyribonuclease - 2 mg per 1 ml of isotonic sodium chloride solution, 1-3 ml per inhalation for 10-15 minutes 3 times a day. Course 7-8 days.

Experimental and clinical observations have shown that enzyme preparations help reduce the viscosity of the tracheobronchial secretion, cleanse the airways of purulent exudate, mucus, necrotic masses, regeneration and epithelialization of the mucosa of the respiratory tract.

At home, steam inhalations of 2% sodium hydrogen carbonate solution or essential oils are effective. In addition, anise oil is taken as an expectorant for 2-3 drops in a spoonful of warm water at the reception( up to six times a day).

In terms of internal remedies, mucolytics use well-known prescriptions for complex expectorant medicines based on the root of the althaea or the herb of thermopsis( 3.0 at 100.0 ml or 6.0 at 180.0 ml, 0.6 at 180.0ml or 1.0 to 200.0 ml).In the prescription containing the althea or thermopsis add sodium hydrogencarbonate to 3-5 g, ammonia anise drops and sodium benzoate for 2-3 g, syrup to 20 g. The medicine is prescribed one teaspoonful, a dessert or a tablespoon depending on the age.

Nursing fees No. 1 and No. 2( standard dosage forms, available in the retail pharmacy chain) are well proven. Gathering No. 1 contains 4 parts of the root of the marshmallow, 4 parts of the leaves of the mother-and-stepmother and 2 parts of the oregano grass, and No. 2 - leaves of the mother-and-stepmother, 4 parts, leaves of the plantain large - 3 parts, and licorice roots - 3 parts. The infusion is prepared from the calculation: one tablespoon of the mixture for a glass of boiling water.

If sputum is difficult to separate( especially in case of tracheobronchitis), expectorants are prescribed, including mucaltin - in tablets of 0.05, glacin hydrochloride in 0.1 tablets. Dosage varies depending on the age of the patient and the degree of clinical manifestations. Mucolytik ATSTS( M-acetyl-1 cysteine ​​(more often in soluble tablets or powders) is also widely used.) The drug has the property of destroying the disulfide bonds of sputum mucoproteins and thus reduces their viscosity

A range of expectorants is characterized by bronchodilator, antispastic, anti-inflammatory and sedative effect. Expectorant therapy is evaluated by the dynamics of the change in the amount of sputum per day or allocated in the first hour after awakening.

Whereas an inflammatory conditionThe process can promote the development of bronchospasm( secondary), it is necessary to use bronchodilators in a number of cases. Eufillin is preferred, mainly due to its mild and multifaceted action( improvement of pulmonary, coronary and cerebral circulation, diuretic effect).on an isotonic solution of sodium chloride, a 2.4% solution of 10.0 ml( or 2-5 mg / kg per reception).For intramuscular injection, 12% and 24% solutions are used.

Oxygenotherapy is carried out by moistened oxygen through a mask for 10-15 minutes every 2-3 hours with initial manifestations of respiratory failure, and through the nasal catheters every 1-2 hours for 10-15 minutes as the phenomena of respiratory failure increase.

However, it should be remembered that oxygenation with positive exhalation pressure( according to Martin Bouyer or Gregory) with any form of obstructive bronchitis is categorically contraindicated( possible acute emphysema).

Symptomatic therapy of acute bronchitis is determined by the clinic of the main disease - an acute respiratory-viral infection and includes the appointment of antipyretic and sedative drugs. In children with toxicosis, multidisciplinary infusion therapy is used, but this issue is already quite special, and here we will not consider it in detail.

The complex of therapeutic measures for chronic bronchitis is determined by its stage. General therapeutic measures for all forms of chronic bronchitis: the absolute prohibition of smoking, the elimination of substances that constantly irritate the mucous membrane of the respiratory tract( at home and at work), lifestyle regulation, sanitation of the upper respiratory tract, increased resistance of the body, therapeutic physical training, physiotherapy, inhalation, expectorants.

With viscous sputum, enzymatic preparations( trypsin, chymopsin) are endobronchially, modern mucolytic agents( acetylcysteine, bromhexine) are endobronchial and oral.

Sputum for sputum is also promoted by well-known expectorants of plant origin with their rational choice and reception.

Expectorant drugs facilitate expectoration, dilute sputum, or reduce secretion. They are prescribed:

• with delayed secretion or with very abundant secretion of secretion, threatening pulmonary edema;in this case it is necessary to cause a cough;

• when coughing, severely disturbing the patient;

• with a dry cough and with no sputum;when coughing up phlegm, the cough should become soft and moist;

• with malodorous sputum resulting from decomposition processes in the lungs and bronchi for disinfection, deodorization and secretion reduction.

It should be noted that for the appointment of expectorants in chronic bronchitis there are quite certain contraindications:

• hemoptysis;

• when dryness of the airway should not use drugs that reduce secretion;

• with threatening pulmonary edema, do not prescribe medications that depress cough or increase and dilute secretion;

• caution is also necessary when prescribing expectorants to pregnant women.

Drugs of the next group have the property of excreted bronchial tubes, cause liquefaction of bronchial secretion, increase it and facilitate expectoration, and also enhance the resorptive capacity of the lungs. Apply often at the same time with emollients or with light secretion drugs.

Ammonia and its salts. Admissible salts of ammonia are allocated mostly mucous bronchi in the form of carbonates, which have the property to strengthen and dilute bronchial secretion( mucin).The use of these salts is most indicated in the presence of acute and subacute inflammatory processes of the respiratory tract and bronchitis. With the existing abundant and liquid bronchial secretion( in chronic cases), their reception becomes useless. The action of ammonia preparations is short, therefore it is necessary to consume them every 2-3 hours.

Ammonium chloride. Excreted as part of the bronchial mucosa in the form of ammonium carbonate, which acts as a base, enhancing the secretion of the mucous glands and diluting sputum, which facilitates the movement of the secret to the outside. It is prescribed primarily for bronchitis with a poor secretion inwards - adults 0.2-0.5 grams, children 0.1-0.25 g per reception 2-3 hours( 3-5 times a day) in a 0.5-2.5% solution, or as a powder in capsules. The drug should be taken after meals. In large doses, the reflex excitation of the vomiting center, which comes from the stomach mucosa, sometimes accompanied by a feeling of nausea, can join the local action.

Ambulatory anise drops .Ingredients: anise oil 2.81 g, ammonia solution 15 ml, alcohol up to 100 ml.(1 g of the drug = 54 drops).Transparent, colorless or slightly yellowish liquid with a strong anise or ammonia odor.1 g of the preparation with 10 ml of water forms a milky-muddy liquid of alkaline reaction. Applied as an expectorant, especially with bronchitis. Assign 10-15 drops every 2-3 hours 5-6 times a day alone( diluted in water, milk, tea);often added to expectorant medicines: ipecacuan, thermopsis, primrose, seneg. Children 1 drop per year of life at the reception 4-6 times a day( every 2-3 hours).Incompatible with codeine salts and with other alkaloids, With acidic fruit syrups, iodine salts.

Alkalis and sodium chloride. The main indication for the use of alkaline-saline mineral waters is the catarrh of the pharyngeal mucosa and respiratory tract. The use of alkalis is based on their ability to dissolve mucin.

Sodium bicarbonate. Resorbable even in small amounts, sodium hydrogen carbonate increases the alkaline reserve of blood;the secret of the bronchial mucosa also acquires an alkaline character, which leads to the dilution of phlegm. Assign inside 0.5-2 grams several times a day in powders, solution or more often together with sodium chloride( table salt), in proportion as with some mineral waters. Sodium bicarbonate lowers the excitability of the respiratory center when the alkaline reserve of blood increases. The drug is contraindicated with abundant liquid phlegm.

Iodine salts. Salts of iodine, exuding mucus of the respiratory tract, cause hyperemia and increased sputum secretion. In the form of an expectorant, potassium iodide is used;it is less than other iodine preparations that irritates the gastric mucosa. The advantage of potassium iodide over other expectorants is a longer-lasting effect, a disadvantage is its irritating effect on other pathways of excretion( nasal mucosa, lacrimal glands).Iodine salts often have a beneficial effect on chronic bronchitis in the elderly. Assign for prolonged chronic bronchitis with a viscous, difficult to expectorate sputum, in addition, with dry bronchitis, with catarrh with those suffering from emphysema and especially with simultaneous asthmatic complaints. There are contraindications: acute inflammatory processes of the lungs and respiratory tract, early stages of pneumonia.

In many cases, emollients are effective, for example, althaea root preparations.

When bronchitis with the separation of large amounts of serous sputum, terpinhydrate is used in a daily dose of up to 1.5 g. When putrefactive sputum, terpinhydrate is used in a dose of 0.2 g 3-4 times a day, often together with antibiotics.

With increased cough reflex and bronchial obstruction, it is advisable to prescribe medicinal forms from the herb of thyme, which contains a mixture of essential oils, some of them have a sedative effect. The combination of a central soothing effect with expectorant and some bactericidal activity makes thyme an effective drug in the obstructive form of bronchitis.

Among the preventive measures for chronic bronchitis for increasing the resistance of the body, along with the holding of respiratory therapeutic gymnastics, the hardening procedures are of great importance of a general toning agent. Adaptation properties are pantocrine, eleutherococcus, magnolia vine, vitamins. The effect on allergological reactivity and mechanisms of immunobiological protection is promising.

Pantocrin is prescribed for 30-40 drops 30 minutes before meals for 2-3 weeks. Eleutherococcus extract is recommended for 20-40 drops 3 times a day for 30 minutes before meals with courses of 25-30 days. Tincture of Chinese magnolia vine takes 20-30 drops per reception 2-3 times a day on an empty stomach for 2-3 weeks. Therapy with saparal is also shown on 0,05 g 2-3 times a day, for 15-25 days.

With purulent bronchitis, antibacterial therapy is additionally prescribed, and in case of obstructive bronchitis - spasmolytics and, in some cases, strictly according to indications - glucocorticoids.

Long-acting sulfanilamide preparations are also used: sulfapiridazine at 12 g / day, sulfadimethoxin at 1 g / day. Bactrim is effective( 2 tablets 2 times a day).Of the derivatives of quinoxaline, quinoxidine is administered 0.15 g three times a day. As anti-inflammatory agents are prescribed acetylsalicylic acid, calcium chloride and other drugs.

In general, for the effective treatment of chronic bronchitis, the identification and treatment of rhinitis, tonsillitis, inflammation of the paranasal nasal cavity is essential.

It is also necessary to prescribe vitamins: ascorbic acid at 300-600 mg / day, vitamin A at 3 mg or 9900 IU per day, vitamins B( thiamine, riboflavin, pyridoxine) - 0,03 g per day throughout the course of treatment. Showing vitamin infusions - from the fruit of dog rose, black currant, mountain ash, etc.

The expediency of using antibiotics is disputed by many authors. However, positively solving the question of the indications for their appointment in bronchitis, it is necessary to be guided by the following general rules: the possibility of pneumonia, the long-term temperature increase or its high digits, toxicosis, and the absence of the effect of previous therapy.

The average course of antibiotic therapy for bronchitis is 5-7 days. For gentamycin, levomycetin is a week, according to the indications - 10 days, in severe cases up to two weeks.

In some cases, guided by the patient's condition, it is advisable to use combinations of two or even three antibiotics, which is determined by the existing compatibility tables of this group of drugs.

Sometimes, antibiotic therapy may be chosen in favor of sulfonamides or preparations of the group of nitrofurans. The general course of sulfanilamide therapy on average lasts, as a rule, from five days to a week, less often can be extended to ten.

• The best way to prevent chronic bronchitis is to quit or not to start smoking.

• Avoid contact with substances that irritate the lungs and places with contaminated air.

Traditional medicine recommends for the treatment of bronchitis:

• drink tea with raspberries, as a diaphoretic;

• Drink infusion of leaves of mother-and-stepmother( tablespoon leaves into a glass of boiling water, drink on the throat during the day), or a mixture of mother-and-stepmother with Ledum and nettle in equal shares;

• drink infusion of pine buds( a teaspoon into a glass of water, boil for 5 minutes, insist 1,5-2 hours and drink 3 meals after eating);

• Drink onion juice and radish juice as a potent expectorant;

• with the same purpose to drink milk, boiled with soda and honey.

The risk of bronchitis can be minimized by regular hardening of the body and frequent cleaning of the house to prevent the accumulation of household dust. It is useful to stay in the air for a long time in dry weather. Treatment of chronic bronchitis is particularly successful at the seashore, as well as in dry mountainous terrain( for example, in the resorts of Kislovodsk).