Chronic obstructive bronchitis treatment

Chronic obstructive bronchitis - Treatment

With such a disease as chronic obstructive bronchitis treatment is meant long-term and symptomatic. Due to the fact that chronic obstruction of the lungs is inherent in smokers with many years of experience, as well as people engaged in harmful production with an increased content of dust in the inspired air, the main task of treatment is to stop the negative impact on lungs.

Chronic obstructive bronchitis: treatment with modern means

Treatment of chronic obstructive bronchitis in most cases is an extremely difficult task. First of all, this is explained by the main regularity of the development of the disease - the steady progression of bronchial obstruction and respiratory failure due to inflammatory process and hyperreactivity of the bronchi and the development of persistent irreversible violations of bronchial patency caused by the formation of obstructive emphysema lungs. In addition, the low efficiency of treatment of chronic obstructive bronchitis is due to their late when there are already signs of respiratory failure and irreversible changes in lungs.

Nevertheless, modern adequate complex treatment of chronic obstructive bronchitis in many cases allows to achieve a decrease in the rate of progression of the disease leading to the growth of bronchial obstruction and respiratory failure to reduce the frequency and duration of exacerbations, increase efficiency and tolerance to physical load.

Treatment of chronic obstructive bronchitis includes:

• non-pharmacological treatment of chronic obstructive bronchitis;
• use of bronchodilators;
• the appointment of mukoregulatory therapy;
• correction of respiratory failure;
• anti-infective therapy (with exacerbations of the disease);
• anti-inflammatory therapy.

Most patients with COPD should be treated on an outpatient basis, according to an individual program developed by the attending physician.

Indications for hospitalization are:

1. Exacerbation of COPD, not controlled on an outpatient basis, despite the course (preservation of fever, cough, purulent sputum, signs of intoxication, increasing respiratory failure and etc.).
2. Acute respiratory failure.
3. Increased arterial hypoxemia and hypercapnia in patients with chronic respiratory failure.
4. The development of pneumonia in COPD.
5. The appearance or progression of signs of heart failure in patients with chronic pulmonary heart disease.
6. The need for relatively complex diagnostic manipulations (for example, bronchoscopy).
7. The need for surgical interventions with the use of anesthesia.

The main role in recovery belongs undoubtedly to the patient himself. First and foremost, it is necessary to abandon the pernicious habit of cigarettes. The irritating effect that nicotine exerts on lung tissue will nullify all attempts to "unlock" the work bronchi, improve blood supply in the respiratory system and their tissues, remove the coughing spells and bring the breath into a normal state.

Modern medicine suggests combining two treatment options - basic and symptomatic. The basis of basic treatment of chronic obstructive bronchitis are such drugs that remove irritation and stagnation in the lungs, facilitate the passage of sputum, expand the lumen of the bronchi and improve in them circulation. This includes xanthine series preparations, corticosteroids.

At the stage of symptomatic treatment, mucolytics are used, as the main means for fighting cough and antibiotics, in order to exclude the attachment of secondary infection and the development of complications.

Periodic physiotherapy and therapeutic exercises for the chest area are shown, which greatly facilitates the outflow of viscous sputum and ventilation of the lungs.

Chronic obstructive bronchitis - treatment with non-pharmacological methods

The complex of non-medicinal treatment measures in patients with COPD includes unconditional cessation of smoking and, if possible, elimination other external causes of the disease (including exposure to household and industrial pollutants, repeated respiratory viral infections, and etc.). Of great importance are sanation of foci of infection, primarily in the oral cavity, and the restoration of nasal breathing, etc. In most cases, a few months after the termination smoking decreases clinical manifestations of chronic obstructive bronchitis (cough, sputum and dyspnea) and there is a slowdown in the rate of decline in FEV1 and other indicators of the function of the external respiration.

The diet of patients with chronic bronchitis should be balanced and contain a sufficient amount of protein, vitamins and minerals. Particular importance is attached to the additional intake of antioxidants, for example tocopherol (vitamin E) and ascorbic acid (vitamin C).

Nutrition in patients with chronic obstructive bronchitis should also include an increased amount of polyunsaturated fatty acids (eicosapentaenoic and docosahexaenoic) contained in marine products and possessing a peculiar anti-inflammatory effect due to a decrease in metabolism arachidonic acid.

With respiratory failure and violations of the acid-base state, a hypocaloric diet and a restriction of the intake of simple carbohydrates, increasing as a result of their accelerated metabolism, the formation of carbon dioxide, and, accordingly, reducing sensitivity respiratory center. According to some data, the use of a hypocaloric diet in severe COPD patients with signs of respiratory failure and chronic hypercapnia in terms of effectiveness is comparable to the results of the use of long-term low-flow oxygen therapy.

Medication for chronic obstructive bronchitis

Bronchodilators

The tone of the smooth musculature of the bronchi is regulated by several neurohumoral mechanisms. In particular, the dilatation of the bronchi develops with stimulation:

1. beta2-adrenoceptors with epinephrine and
2. VIP receptors of the NASH (non-adrenergic, noncholinergic nervous system) vasoactive intestinal polypeptide (VIP).

Conversely, the narrowing of the lumen of the bronchi arises with stimulation:

1. M-cholinergic receptors with acetylcholine,
2. receptors to P-substance (NANH-system)
3. alpha-adrenergic receptors.

In addition, numerous biologically active substances, including inflammatory mediators (histamine, bradykinin, leukotrienes, prostaglandins, activation factor platelets - FAT, serotonin, adenosine, etc.) also have a pronounced effect on the tone of the smooth muscles of the bronchi, contributing mainly to a decrease in the lumen bronchi.

Thus, the bronchodilation effect can be achieved in several ways, in which at present the most widely used blockade of M-cholinergic receptors and stimulation of beta2-adrenergic receptors bronchi. In accordance with this, M-holinolytics and beta2-agonists (sympathomimetics) are used in the treatment of chronic obstructive bronchitis. The third group of bronchodilator drugs that are used in patients with COPD include methylxanthine derivatives, the mechanism of their action on the smooth muscles of the bronchi is more complicated

According to modern ideas, the systematic use of bronchodilators is the basis of basic therapy in patients with chronic obstructive bronchitis and COPD. Such treatment of chronic obstructive bronchitis is the more effective the more. the reversible component of bronchial obstruction is expressed. True, the use of bronchodilators in COPD patients for obvious reasons has a significantly lower positive effect than in patients with bronchial asthma asthma, since the most important pathogenetic mechanism of COPD is the progressive irreversible airway obstruction caused by the formation of emphysema in them. At the same time, it should be borne in mind that some of the modern bronchodilator preparations have a fairly wide range of action. They contribute to reducing the edema of the bronchial mucosa, the normalization of mucociliary transport, reducing the production of bronchial secretions and inflammatory mediators.

It should be emphasized that often in patients with COPD described above functional tests with bronchodilators are negative, because the increase in FEV1 after a single application of M-holinolitikov and even beta2-sympathomimetics is less than 15% of the due values. However, this is not meant, then it is necessary to refuse from the treatment of chronic obstructive bronchitis with bronchodilators, since the positive effect of their systematic use usually comes not earlier than 2-3 months from the beginning treatment.

Inhalation of bronchodilators

It is more preferable to use inhalation forms of bronchodilators, because this way of administration of drugs contributes to a faster penetration of drugs into the mucous membrane of the respiratory tract and long-term preservation of a sufficiently high local concentration preparations. The latter effect is provided, in particular, by repeated entry into the lungs of medicinal substances absorbed through the mucous membrane the membrane of the bronchi in the blood and falling on the bronchial veins and lymph vessels in the right heart, and from there again in the lungs

An important advantage of the inhalation route of bronchodilator administration is the selective effect on the bronchi and a significant limitation of the risk of developing side effects of the system.

Inhalational administration of bronchodilators is provided by the use of powder inhalers, spacers, nebulizers, etc. When using a metered-dose inhaler, the patient needs certain skills in order to ensure a more complete ingestion of the drug into the airways. For this, after a smooth calm exhalation, the mouthpiece of the inhaler is tightly wrapped around the lips and starts to inhale slowly and deeply, press the can and then take a deep breath. After that they hold their breath for 10 seconds. If two doses (inhalations) of the inhaler are prescribed, you should wait at least 30-60 seconds, then repeat the procedure.

In patients of senile age, who find it difficult to master fully the habits of using a dosed inhaler, it is convenient to use so called spacers in which a drug in the form of an aerosol by pressing the can is sprayed in a special plastic flask directly before inhaling. In this case, the patient takes a deep breath, holds his breath, exhales into the mouthpiece of the spacer, then again takes a deep breath, no longer pressing the can.

The most effective is the use of compressor and ultrasonic nebulizers (from lat.: nebula - fog), in which Sputtering of liquid medicinal substances in the form of fine aerosols, in which the drug is contained in the form of particles ranging in size from 1 to 5 m. This allows to significantly reduce the loss of drug aerosol that does not enter the respiratory tract, and also provide a significant penetration depth aerosol into the lungs, including medium and even small bronchi, whereas with conventional inhalers such penetration is limited to the proximal bronchi and trachea.

The advantages of inhalation of drugs through nebulizers are:

• the penetration depth of the medicinal fine aerosol into the respiratory tract, including medium and even small bronchi;
• simplicity and convenience of inhalation;
• lack of coordination of inspiration with inhalation;
• the possibility of introducing high doses of medicines, which makes it possible to use nebulizers for relief of the most severe clinical symptoms (pronounced dyspnea, attack of suffocation, etc.);
• the possibility of incorporating nebulizers into the ventilator circuit and oxygen therapy systems.

In this regard, the introduction of drugs through nebulizers is used primarily in patients with severe obstructive syndrome, progressive respiratory deficiency, in elderly and senile people and so-called. Through nebulizers, it is possible to inject into the respiratory tract not only bronchodilators, but also mucolytic agents.

Anticholinergic drugs (M-cholinolytics)

Currently, M-cholinolytics are regarded as first-choice drugs in patients with COPD, since the leading pathogenetic mechanism of the reversible component of bronchial obstruction in this disease is cholinergic bronchoconstruction. It is shown that in patients with COPD holinolitiki on the strength of bronchodilator action are not inferior to beta2-adrenomimetics and exceed theophylline.

The effect of these bronchodilators is associated with competitive inhibition of acetylcholine on the receptors of postsynaptic membranes of the smooth muscles of the bronchi, mucous glands and mast cells. As you know, excessive stimulation of cholinergic receptors leads not only to an increase in the tone of smooth muscles and increased secretion of bronchial mucus, but also to degranulation of mast cells leading to the release of a large number of inflammatory mediators, which ultimately enhances the inflammatory process and hyperreactivity bronchi. Thus, cholinolytics inhibit the reflex response of smooth muscles and mucous glands, caused by activation of the vagus nerve. Therefore, their effect manifests itself both with the use of the drug before the onset of the action of the irritating factors and with the already developed process.

It should also be remembered that the positive effect of cholinolytics is primarily manifested at the level trachea and major bronchi, since it is here that there is a maximum density of cholinergic receptors.

Remember:

1. Cholinolytics serve as first-choice drugs in the treatment of chronic obstructive bronchitis, because the parasympathetic tone in this disease is the only reversible component of the bronchial obstruction.
2. The positive effect of M-cholinolytics is:
   1. in reducing the tone of the smooth muscles of the bronchi,
   2. decrease the secretion of bronchial mucus and
   3. reducing the degranulation of mast cells and limiting the release of inflammatory mediators.
3. The positive effect of anticholinergics is primarily manifested at the level of the trachea and large bronchi

In COPD patients, inhalation forms of anticholinergics are usually used - so-called quaternary ammonium compounds, which penetrate poorly through the mucous membrane of the respiratory tract and practically do not cause systemic side effects effects. The most common of these are ipratropium bromide (atrovent), oxytropium bromide, ipratropium iodide, tiotropium bromide, which is used primarily in metered aerosols.

The bronchodilating effect begins 5-10 minutes after inhalation, reaching a maximum in about 1-2 hours. Duration of Ipratropium iodide - 5-6 h, ipratropium bromide (Atrovent) - 6-8 hours, 8-10 hours, oxitropium bromide and tiotropium bromide - 10-12 hours.

Side effects

Among the undesirable side effects of M-holinoblokatorov include dry mouth, sore throat, cough. Systemic side effects of blockade of M-cholinergic receptors, including cardiotoxic effects on the cardiovascular system, are practically absent.

Ipratropium bromide (atrovent) is available in the form of a dosed aerosol. Assign 2 inhalations (40 mcg) 3-4 times a day. Inhalation of atrovent even by short courses significantly improves bronchial patency. Especially effective in COPD is the long-term use of atrovent, which reliably reduces the number of exacerbations chronic bronchitis, significantly improves oxygen saturation (SaO2) in arterial blood, normalizes sleep in patients with COPD.

In COPD of mild severity, the course appointment of inhalations of atrovent or other M-holinolitikon, usually during periods of exacerbation of the disease, the duration of the course should not be less than 3 weeks. With COPD of moderate to severe severity, anticholinergics are used continuously. It is important that with prolonged therapy, the patient does not experience tolerance to taking the drug and tachyphylaxis.

Contraindications

M-holinoblokatory are contraindicated in glaucoma. Care should be taken when they are prescribed for patients with prostate adenoma

Selective beta2-adrenomimetics

Beta-2 adrenomimetics are rightfully considered to be the most effective bronchodilators, which are now widely used for the treatment of chronic obstructive bronchitis. We are talking about selective sympathomimetics, which selectively exert a stimulating effect on beta2-adrenoreceptors bronchus and almost do not act on beta 1-adrenergic receptors and alpha-receptors, only in a small amount represented in bronchi.

Alpha-adrenergic receptors are mainly determined in the smooth muscles of blood vessels, in the myocardium, CNS, spleen, platelets, liver and adipose tissue. In the lungs, a comparatively small number of them is located mainly in the distal parts of the respiratory tract. Stimulation of alpha-adrenergic receptors, in addition to pronounced reactions from the cardiovascular system, the central nervous system and thrombocytes, leads to an increase in the tone of the smooth muscles of the bronchi, increased secretion of mucus in the bronchi and the release of histamine fat cells.

Beta-1 adrenergic receptors are widely represented in the myocardium of the atria and ventricles of the heart, in the conducting system of the heart, in the liver, muscle and adipose tissue, in the blood vessels and are almost absent in bronchi. Stimulation of these receptors leads to a pronounced reaction from the cardiovascular system in the form of a positive inotropic, chronotropic and dromotropic effects in the absence of any local response from respiratory ways.

Finally, beta2-adrenergic receptors are found in the smooth muscles of blood vessels, uterus, adipose tissue, as well as in the trachea and bronchi. It should be emphasized that the density of beta2-adrenergic receptors in the bronchial tree significantly exceeds the density of all distal adrenoreceptors. Stimulation of beta2-adrenergic receptors with catecholamines is accompanied by:

• relaxation of the smooth muscles of the bronchi;
• a decrease in histamine release by mast cells;
• activation of mucociliary transport;
• stimulation of epithelial cell production of bronchial relaxation factors.

Depending on the ability to stimulate alpha beta-1 and / and beta-2-adrenergic receptors, all sympathomimetics are divided into:

• universal sympathomimetics, affecting both alpha and beta-adrenoreceptors: adrenaline, ephedrine;
• non-selective sympathomimetics stimulate both beta1 and beta2-adrenoceptors: isoprenaline (novodrin, izadrin) orciprenaline (alupept, astmopent) geksaprenalin (ipradol);
• selective sympathomimetic, selectively acting on beta2-adrenergic receptors: salbutamol (Ventolin), fenoterol (berotek), terbutaline (brikanil) and some prolonged form.

At present, for the treatment of chronic obstructive bronchitis, universal and nonselective sympathomimetics are practically are not used because of the large number of side effects and complications due to their pronounced alpha- and / or beta1 activity

The currently widely used selective beta2-adrenomimetics almost do not cause serious complications from the cardiovascular system and CNS (tremor, headache, tachycardia, rhythm disturbances, arterial hypertension, etc.), peculiar to non-selective and, all the more so, universal It should nevertheless be borne in mind that the selectivity of various beta2-adrenomimetics is relative and does not completely exclude beta1 activity.

All selective beta2-adrenomimetics are divided into short and long-acting drugs.

Short-acting medicines include salbutamol (ventolin, fenoterol (berotek), terbutaline (bricanil), etc. Preparations of this group are administered by inhalation and are considered a means of choice mainly for relief of attacks acute the emergence of bronchial obstruction (for example, in patients with bronchial asthma) and the treatment of chronic obstructive bronchitis. Their action begins 5-10 minutes after inhalation (in some cases before), the maximum effect is manifested in 20-40 minutes, the duration of the action is 4-6 hours.

The most common drug of this group is salbutamol (ventolin), which is considered one of the safest beta-adrenomimetics. Drugs are more often used by inhalation, for example, using a spinner, in a dose of 200 mm no more than 4 times a day. Despite its selectivity, even with the inhalation application of salbutamol, some patients (about 30%) experience undesirable systemic reactions in the form of tremors, palpitations, headaches, and the like. This is because most of the drug is deposited in upper parts of the respiratory tract, swallowed by the patient and absorbed into the blood in the gastrointestinal tract, causing the described systemic reaction. The latter, in turn, are related to the presence of minimal reactivity in the preparation.

Fenoterol (berotek) has a somewhat greater activity compared with salbutamol and a longer half-life. However, its selectivity is about 10 times lower than salbutamol, which explains the poor tolerability of this drug. Fenoterol is administered in the form of metered-dose inhalations of 200-400 μg (1-2 breaths) 2-3 times a day.

Side effects are observed with prolonged use of beta2-adrenomimetics. These include tachycardia, extrasystole, increased episodes of angina in patients with IHD, elevation of systemic arterial pressure, and others caused by incomplete selectivity of drugs. Long-term use of these drugs leads to a decrease in the sensitivity of beta2-adrenergic receptors and the development of their functional blockade, which can lead to an exacerbation of the disease and a sharp decrease in the effectiveness of previously conducted treatment of chronic obstructive bronchitis. Therefore, COPD patients are recommended, if possible, only sporadic (non-regular) use of drugs of this group.

Long-acting beta2-adrenomimetics include formoterol, salmeterol (sulfur), saltos (delayed-release salbutamol), and others. The prolonged effect of these drugs (up to 12 hours after inhalation or oral administration) is due to their accumulation in the lungs.

In contrast to the short-acting beta2-agonists, the listed long-acting drugs appear to be slow, so they are used predominantly for long-term permanent (or course) bronchodilator therapy with the aim of preventing the progression of bronchial obstruction and exacerbations of the Po disease According to some researchers, beta2-adrenomimetics of prolonged action also have an anti-inflammatory effect, since they reduce permeability vessels, prevent the activation of neutrophils, lymphocytes, macrophage inhibiting the release of histamine, leukotrienes and prostaglandins from mast cells and eosinophils. A combination of long-acting beta2-adrenomimetics with inhaled glucocorticoids or other anti-inflammatory drugs is recommended.

Formoterol has a significant duration of bronchodilator action (up to 8-10 hours), including with inhalation. The drug is administered by inhalation in a dose of 12-24 μg 2 times a day or in tableted form at 20, 40 and 80 μg.

Volmax (salbutamol SR) is a prolonged preparation of salbutamol intended for reception per os. The drug is prescribed 1 tablet (8 mg) 3 times a day. The duration of action after a single dose of 9 hours.

Salmeterol (sulfur) also refers to relatively new prolonged beta2-sympathomimetics with a duration of 12 hours. The strength of bronchodilating effect exceeds the effects of salbutamol and fenoterol. Distinctive features of the drug is a very high selectivity, which is more than 60 times exceeds that of salbutamol, which provides a minimal risk of developing secondary systemic effects.

Salmeterol is prescribed in a dose of 50 mcg 2 times a day. In severe bronchial obstructive syndrome, the dose can be increased 2-fold. There is evidence that prolonged therapy with salmeterol leads to a significant decrease in the occurrence of exacerbations of COPD.

Tactics of the use of selective beta2-adrenomimetics in patients with COPD

Considering the expediency of the use of selective beta2-adrenomimetics for the treatment of chronic obstructive bronchitis, several important circumstances should be emphasized. Despite the fact that the bronchodilators of this group are now widely prescribed in the treatment of COPD patients and are regarded as preparations of basic therapy, patients must die, that in real clinical practice their use encounters significant, sometimes insurmountable, difficulties, connected, first of all, with the presence of most of them expressed by-products phenomena. In addition to cardiovascular disorders (tachycardia, arrhythmias, tendency to elevation of systemic arterial pressure, tremor, headaches, etc.), these drugs with prolonged application can aggravate arterial hypoxemia, as they promote perfusion of poorly ventilated parts of the lungs and further impair ventilation-perfusion relations. Long-term use of beta2-adrenomimetics is also accompanied by hypocapnia due to redistribution of potassium inside and outside the cell, which is accompanied by an increase in the weakness of the respiratory muscles and deterioration of ventilation.

However, the main disadvantage of prolonged use of beta2-addressymmetrics in patients with bronchial obstructive syndrome is the regular formation of tachyphylaxis - a decrease in strength and the duration of the bronchodilator effect, which in time can lead to ricochet bronchoconstriction and a significant decrease in the functional parameters characterizing the patency airways. In addition, beta2-adrenomimetics increase the hyperactivity of the bronchial tubes to histamine and methacholine (acetylcholine), thus causing an exacerbation of parasympathetic bronchoconstrictor influences.

From what has been said, several important conclusions in practical terms follow.

1. Given the high efficacy of beta2-adrenomimetics in the management of acute episodes bronchial obstruction, their use in patients with COPD is shown, especially at the time of exacerbations disease.
2. It is advisable to use modern prolonged highly selective sympathomimetics, for example, salmeterol (sulfur), although this does not exclude the possibility of sporadic (non-regular) administration of short-acting beta2-adrenomimetics (type salbutamol).
3. Prolonged regular use of beta2-agonists as monotherapy in patients with COPD, especially elderly and senile, can not be recommended as a permanent basic therapy.
4. If patients with COPD continue to need to reduce the reversible component of bronchial obstruction, and monotherapy with traditional M-anticholinergics is not it is advisable to switch to the use of modern combined bronchodilators, including M-cholinergic inhibitors in combination with beta2-adrenomimetics.

Combined bronchodilators

In recent years, combined bronchodilators have become increasingly used in clinical practice, including long-term therapy for COPD patients. The bronchodilator effect of these drugs is provided by stimulation of beta2-adrenergic receptors of peripheral bronchi and inhibition of cholinergic receptors of large and medium bronchi.

Berodual is the most common combined aerosol preparation containing anticholinergic ipratropium bromide (atrovent) and beta2-adrenostimulator fenoterol (berotek). Each dose of berodual contains 50 μg of fenoterol and 20 μg of atrovent. This combination allows you to get a bronchodilator effect with a minimal dose of fenoterol. The drug is used both for relief of acute attacks of suffocation, and for the treatment of chronic obstructive bronchitis. The usual dose is 1-2 doses of aerosol 3 times a day. The beginning of the drug - after 30 seconds, the maximum effect - after 2 hours, the duration of the action does not exceed 6 hours.

Combinent is the second combined aerosol preparation containing 20 μg. cholinolytics of ipratropium bromide (atrovent) and 100 μg of salbutamol. Combine used for 1-2 doses of the drug 3 times a day.

In recent years, the positive experience of combined use of anticholinergics with beta2-agonists of prolonged action (for example, atrovent with salmeterol) began to accumulate.

This combination of bronchodilators of the two described groups is very common, since combined preparations have a more potent and persistent bronchodilator effect than both components in isolation.

Combined preparations containing M-cholinergic inhibitors in combination with beta2-adrenomimetics, are characterized by a minimal risk of side effects due to a relatively small dose of sympathomimetics. These advantages of combined drugs allow us to recommend them for long-term basic bronchodilator therapy of COPD patients with insufficient effectiveness of monotherapy with atrovent.

Derivatives of methylxanthines

If the reception of holiolytic or combined bronchodilators is not effective, to treatment chronic obstructive bronchitis can be supplemented with methylxanthine-type drugs (theophylline and other). These drugs have been used successfully for many decades as effective medicines for the treatment of patients with bronchial obstructive syndrome. Theophylline derivatives have a very wide spectrum of action, which goes far beyond the bronchodilator effect alone.

Theophylline inhibits phosphodiesterase, resulting in the accumulation of cAMP in smooth muscle cells of the bronchi. This facilitates the transport of calcium ions from myofibrils to the sarcoplasmic reticulum, which is accompanied by relaxation of smooth muscles. Theophylline also blocks the purine receptors of the bronchi, eliminating the bronchoconstrictive effect of adenosine.

In addition, theophylline inhibits the degranulation of mast cells and the isolation of inflammatory mediators from them. It also improves renal and cerebral blood flow, increases diuresis, increases strength and frequency cuts the heart, lowers pressure in a small circle of blood circulation, improves the function of the respiratory muscles and aperture.

Short-acting drugs from the theophylline group have a pronounced bronchodilator effect, they are used to arrest acute episodes bronchial obstruction, for example, in patients with bronchial asthma, as well as for prolonged therapy of patients with chronic bronchial obstructive syndrome.

Euphyllin (compound theophyllip and ethylenediamine) is released in ampoules of 10 ml,% solution. Euphyllin is administered intravenously in 10-20 ml of isotonic sodium chloride solution for 5 minutes. With rapid administration, it is possible to drop blood pressure, dizziness, nausea, tinnitus, palpitations, redness of the face and a feeling of heat. Introduced intravenously, euphyllin acts for about 4 hours. With intravenous drip introduction, a longer duration of action (6-8 hours) can be achieved.

The theophyllines of prolonged action in recent years are widely used for the treatment of chronic obstructive bronchitis and bronchial asthma. They have significant advantages over short-range theophyllines:

• decreases the frequency of medication;
• the accuracy of dosing of drugs increases;
• provides a more stable therapeutic effect;
• prevention of asthma attacks in response to physical stress;
• drugs can be successfully used to prevent night and morning attacks of suffocation.

Prolonged theophyllines have a bronchodilator and anti-inflammatory effect. They largely suppress both the early and late phases of the asthmatic reaction that occur after the inhalation of the allergen, and also have an anti-inflammatory effect. Long-term treatment of chronic obstructive bronchitis with prolonged theophyllines effectively controls the symptoms of bronchial obstruction and improves lung function. Since the drug is released gradually, it has a longer duration of action, which is important for treatment nocturnal symptoms of the disease that persist despite treatment of chronic obstructive bronchitis with anti-inflammatory drugs preparations.

Prolonged theophylline preparations are divided into 2 groups:

1. Preparations of the 1st generation are active for 12 hours; they are prescribed 2 times a day. These include: theodore, theotard, theopek, durofillin, ventax, theogard, teobid, slobid, euphyllin SR, and others.
2. Preparations of the second generation last about 24 hours; they are prescribed once a day. These include: theodur-24, uniphil, dilatran, euphylong, phylocontin, and others.

Unfortunately, theophyllines act in a very narrow range of therapeutic concentrations of 15 μg / ml. With increasing doses, a large number of side effects occur, especially in elderly patients:

• gastrointestinal disorders (nausea, vomiting, anorexia, diarrhea, etc.);
• cardiovascular disorders (tachycardia, rhythm disturbances, up to ventricular fibrillation);
• disorders of the central nervous system (tremor of hands, insomnia, agitation, convulsions, etc.);
• metabolic disorders (hyperglycemia, hypokalemia, metabolic acidosis, etc.).

Therefore, when using methylxanthines (short and prolonged action), it is recommended to determine the level theophylline in the blood at the beginning of the treatment of chronic obstructive bronchitis, every 6-12 months and after the change of doses and preparations.

The most rational sequence of bronchodilators in COPD patients is as follows:

Sequence and volume of bronchodilator treatment of chronic obstructive bronchitis

• With slightly expressed and inconsistent symptoms of bronchial obstruction syndrome:
  • inhalation M-holinolitiki (atrovent), mainly in the phase of exacerbation of the disease;
  • if necessary, inhaled selective beta2-adrenomimetics (sporadically - during exacerbations).
• With more consistent symptoms (mild and moderate severity):
  • inhalation M-holinolitiki (atrovent) constantly;
  • with insufficient effectiveness - combined bronchodilators (fermented, combinent) constantly;
  • with insufficient effectiveness - addition of methylxanthine.
• At low efficiency of treatment and progression of bronchial obstruction:
  • to consider the replacement of berodual or a combination with the use of a highly selective beta2-adrenomimetic of prolonged action (salmeterol) and combination with M-cholinolytics;
  • Modify the methods of drug delivery (spencers, nebulayers),
  • continue taking methylxanthines, theophylline parenterally.

Mucolytic and mucoregulatory agents

Improvement of bronchial drainage is the most important task of treating chronic obstructive bronchitis. To this end, any possible effects on the body, including non-drug treatments, should be considered.

1. A plentiful warm drink helps to reduce the viscosity of sputum and increase the sol-layer of bronchial mucus, which facilitates the functioning of the ciliated epithelium.
2. Vibratory massage of the chest 2 times a day.
3. Positional drainage of bronchi.
4. Expectorants with an emetic-reflex action mechanism (herb of thermopsis, terpinhydrate, root ipekakuany, etc.), stimulate the bronchial gland and increase the amount of bronchial secret.
5. Bronchodilators, improving the drainage of bronchi.
6. Acetylcysteine ​​(flumucin), viscosity of sputum due to rupture of disulfide bonds of mucopolysaccharides of sputum. It has antioxidant properties. Increases the synthesis of glutathione, which takes part in detoxification processes.
7. Ambroxol (lazolvan) stimulates the formation of a tracheobronchial secretion of reduced viscosity due to depolymerization of acid mucopolysaccharides of bronchial mucus and production of neutral mucopolysaccharides goblet cells. It increases the synthesis and secretion of the surfactant and blocks the disintegration of the latter under the influence of unfavorable factors. Strengthens the penetration of antibiotics into the bronchial secretion and bronchial mucosa, increasing the effectiveness of antibiotic therapy and shortening its duration.
8. Carbocysteine ​​normalizes the quantitative ratio of acidic and neutral sialomucines to bronchial secretions, reducing the viscosity of sputum. Promotes regeneration of the mucous membrane, reducing the number of goblet cells, especially in terminal bronchi.
9. Bromhexine is a mucolytic and a mucoregulant. Stimulates the production of surfactant.

Anti-inflammatory treatment of chronic obstructive bronchitis

Since the formation and progression of chronic bronchitis is based on the local inflammatory response of the bronchi, the success of treatment patients, including patients with COPD, is primarily determined by the possibility of inhibition of the inflammatory process in respiratory ways.

Unfortunately, traditional non-steroidal anti-inflammatory drugs (NSAIDs) are not effective in patients COPD and can not stop the progression of clinical manifestations of the disease and a steady decline FEV1. It is suggested that this is due to the very limited, one-sided effect of NSAIDs on metabolism arachidonic acid, which is the source of the most important inflammatory mediators - prostaglandins and leukotrienes. As is known, all NSAIDs, by inhibiting cyclooxygenase, reduce the synthesis of prostaglandins and thromboxanes. At the same time, activation of the cyclooxygenase pathway of arachidonic acid metabolism increases the synthesis of leukotrienes, which is probably the most important cause of ineffectiveness of NSAIDs in COPD.

Another mechanism is the anti-inflammatory effect of glucocorticoids, which stimulate the synthesis of protein that inhibits the activity of phospholipase A2. This leads to a restriction of the production of the source of prostaglandins and leukotrienes, arachidonic acid, which explains high anti-inflammatory activity of glucocorticoids in various inflammatory processes in the body, including COPD.

Currently, glucocorticoids are recommended for the treatment of chronic obstructive bronchitis, in which the use of other methods of treatment has proved ineffective. Nevertheless, only 20-30% of patients with COPD manage to improve bronchial patency with these drugs. More often we have to abandon the systematic use of glucocorticoids due to their numerous side effects.

To solve the question of the advisability of prolonged continuous use of corticosteroids in patients with COPD, it is suggested to perform a trial therapy: 20-30 mg / day. at the rate of, mg / kg (according to prednisolone) for 3 weeks (oral corticosteroid intake). The criterion for the positive effect of corticosteroids on bronchial patency is the increase in response to bronchodilators in the bronchodilation test at 10% of the proper values ​​of OPB1 or an increase in FEV1 at least in pa 200 ml. These indicators can be the basis for long-term use of these drugs. At the same time, it should be emphasized that at present there is no generally accepted point of view on the tactics of using systemic and inhaled corticosteroids in COPD.

In recent years, for the treatment of chronic obstructive bronchitis and certain inflammatory diseases of the upper and lower respiratory tract with success a new anti-inflammatory drug fenspiride (erespal), effectively acting on the mucous membrane of respiratory ways. The drug has the ability to suppress the release of histamine from mast cells, reduce leukocyte infiltration, reduce exudation and release of thromboxanes, as well as permeability of blood vessels. Like glucocorticoids, fepspiride inhibits the activity of phospholipase A2 by blocking the transport of calcium ions necessary for the activation of this enzyme.

Thus, fepspiride reduces the production of many mediators of inflammation (prostaglandins, leukotrienes, thromboxanes, cytokines, etc.), having a pronounced anti-inflammatory effect.

Fenspiride is recommended to be used both for exacerbation and for long term treatment chronic obstructive bronchitis, being safe and very well tolerated means. When the disease worsens, the drug is prescribed in a dose of 80 mg twice a day for 2-3 weeks. With a stable course of COPD (the stage of relative remission), the drug is prescribed in the same dosage for 3-6 months. There are reports of good tolerability and high efficacy of fenspiride for continuous treatment for at least 1 year.

Correction of respiratory failure

Correction of respiratory failure is achieved through the use of oxygen therapy and training of the respiratory musculature.

Indications for long-term (up to 15-18 hours per day) low-flux (2-5 liters per minute) of oxygen therapy both in hospital and at home are:

• decrease in PaO2 arterial blood <55 mm Hg. p.
• reduction of SaO2 <88% at rest or <85% with a standard sample with 6-minute walking;
• a decrease in PaO2 to 56-60 mm Hg. Art. in the presence of additional conditions (edema due to right ventricular failure, signs of the pulmonary heart, the presence of P-pulmonale on the ECG or erythrocytosis with a hematocrit above 56%)

For the purpose of training respiratory muscles in COPD patients, various schemes of individually selected respiratory gymnastics are prescribed.

Intubation and ventilation is indicated in patients with severe progressive respiratory failure, increasing arterial hypoxemia, respiratory acidosis or signs of hypoxic damage to the brain the brain.

Antibacterial treatment of chronic obstructive bronchitis

In the period of stable course of COPD antibiotic therapy is not indicated. Antibiotics are prescribed only during the exacerbation of chronic bronchitis in the presence of clinical and laboratory signs of purulent endobronchitis, accompanied by an increase in body temperature, leukocytosis, symptoms of intoxication, an increase in the amount of sputum and the appearance in it of purulent elements. In other cases, even the period of exacerbation of the disease and exacerbation of bronchial obstructive syndrome, the use of antibiotics in patients with chronic bronchitis has not been proven.

It has already been mentioned above that the most frequent exacerbations of chronic bronchitis are caused by Streptococcus pneumonia, Haemophilus influenzae, Moraxella catanalis, or the association of Pseudomonas aeruginosa with morocell (y smokers). In elderly, weakened patients with a severe course of COPD, staphylococci, Pseudomonas aeruginosa and Klebsiella may predominate in bronchial contents. On the contrary, in patients of a younger age, intracellular (atypical) pathogens: chlamydia, legionella, or mycoplasma, often become the causative agent of the inflammatory process in the bronchi.

Treatment of chronic obstructive bronchitis usually begins with the empirical administration of antibiotics, taking into account the spectrum of the most frequent pathogens of exacerbations of bronchitis. Selection of an antibiotic based on the sensitivity of flora in vitro is carried out only if the empirical antibiotic therapy is ineffective.

For first-line drugs with exacerbation of chronic bronchitis include aminopenicillins (ampicillin, amoxicillin), active against hemophilic rods, pneumococci and mora seksely. It is advisable to combine these antibiotics with inhibitors of ß-lactamases, (for example, with clavulonic acid or sulbactam) that provides a high activity of these drugs to lactamase-producing strains of the hemophilic rod and moraxelles. Recall that aminopenicillins are not effective against intracellular pathogens (chlamydia, mycoplasmas and rickettsia).

Cephalosporins of II-III generation belong to broad-spectrum antibiotics. They are active against not only gram-positive, but also gram-negative bacteria, including haemophilic rod strains producing ß-lactamase. In most cases, the drug is administered parenterally, although with mild to moderate severity of exacerbation, oral cephalosporins of the second generation (for example, cefuroxime) may be used.

Macrolides. High efficacy for respiratory infections in patients with chronic bronchitis have new macrolides, in particular azithromycin, which can be taken only once a day. Assign a three-day course of azithromycin at a dose of 500 mg per day. New macrolides act on pneumococci, haemophilus rod, moraxella, and intracellular pathogens.

Fluoroquinolones are highly effective against gram-negative and gram-positive microorganisms, especially "respiratory" fluoroquinolones (levofloxacin, cykloxacin, etc.) - drugs with increased activity against pneumococci, chlamydia, mycoplasma.

Tactics of treatment of chronic obstructive bronchitis

According to the recommendations of the National Federal Program "Chronic Obstructive Lung Disease 2 treatment regimens for chronic obstructive bronchitis: treatment of exacerbation (maintenance therapy) and treatment of exacerbation COPD.

In the stage of remission (without exacerbation of COPD), bronchodilator therapy is of particular importance, emphasizing the need for an individual choice of bronchodilators. In this case, in the first stage of COPD (mild severity), the systematic use of bronchodilators is not is provided, and only high-speed M-anticholinergics or beta2-agonists are recommended needs. Systematic use of bronchodilators is recommended starting with the second stage of the disease, with preference given to long-acting drugs. Annual anti-influenza vaccination is recommended at all stages of the disease, the effectiveness of which is high enough (80-90%). Attitude to expectorants outside the exacerbation - restrained.

Currently, there is no medication that can affect but the main significant feature of COPD: the gradual loss of pulmonary functions. Medications in COPD (in particular, bronchodilators) only alleviate the symptoms and / or reduce the incidence of complications. In severe cases, a special role is played by rehabilitation measures and prolonged low-intensity oxygen therapy, while a prolonged the use of systemic glucocorticosteroids should be avoided, if possible, by replacing them with inhaled glucocorticoids or by taking fenspiride

With exacerbation of COPD, regardless of its cause, the significance of various pathogenetic mechanisms in the formation of the symptom-complex of the disease increases the importance of infectious factors, which often determines the need for antibacterial agents, increases respiratory insufficiency, possible decompensation pulmonary heart. The main principles of treatment for exacerbation of COPD are the intensification of bronchodilating therapy and the appointment of antibacterial drugs according to indications. Intensification of bronchodilator therapy is achieved by both increasing the dose and modifying the delivery methods drugs, the use of spacers, nebulizers, and with severe obstruction - intravenous administration preparations. Expanded indications for the appointment of corticosteroids, it becomes preferable to their systemic appointment (oral or intravenous) in short courses. In severe and moderate exacerbations, it is often necessary to use methods for correcting high blood viscosity - hemodilution. Treatment of decompressed pulmonary heart is performed.

Chronic obstructive bronchitis - treatment with folk methods

It helps to relieve chronic obstructive bronchitis treatment with some folk remedies. Thyme, the most effective herb for fighting bronchopulmonary diseases. It can be used in the form of tea, decoction or infusion. To prepare medicinal herbs can be at home, growing it on the beds of your garden or, in order to save time, buy a finished product in the pharmacy. How to brew, insist or boil the thyme - indicated on the chemist's packaging.

Tea from thyme

If there is no such instruction, then you can use the simplest recipe - to make tea from thyme. To do this, take 1 tablespoon chopped herb thyme, put in a porcelain teapot and pour boiling water. Drink 100 ml of this tea 3 times a day, after a meal.

Decoction of pine buds

Perfectly removes stagnation in the bronchi, reduces the number of wheezing in the lungs by the fifth day of use. Prepare such a decoction is not difficult. Pine kidneys do not need to be collected by themselves, they are available in any pharmacy.

It is better to give preference to the manufacturer who took care to indicate on the packaging the recipe of preparation, and also all the positive and negative actions that can occur in people taking decoction of pine kidney. Pay attention that pine buds should not be taken to people with blood diseases.

Magical root of licorice

Medicinal potions can be presented in the form of an elixir or breast-feeding. Both are purchased in ready-made form in the pharmacy. Elixir is taken by drops, 20-40 per hour before meals 3-4 times a day.

Breast collection is prepared in the form of infusion and is taken half a glass 2-3 times a day. Take infusion should be before eating, so that the medicinal action of the herbs could enter into force and have time to "get" to the problem organs with the blood flow.

Will allow to defeat chronic obstructive bronchitis treatment with drugs and modern and traditional medicine in the compartment with perseverance and belief in complete recovery. In addition, you should not write off a healthy lifestyle, alternation of work and rest, as well as the intake of vitamin complexes and high-calorie food.

ilive.com.ua

Chronic obstructive bronchitis - causes, symptoms and treatment

Bronchitis is the most common disease. It occurs in both adults and children. Chronic obstructive bronchitis is not only an inflammatory disease of the bronchi, but also the presence of damage to the bronchial mucosa. As a result, the process of proper ventilation of the bronchi is disrupted.

In this case, spasms and an obstruction to sputum are observed. It develops as an independent disease, and occurs as complications after other diseases such as influenza, acute respiratory infections, acute respiratory infections, inflammation of the nasopharynx, as the result of the influence of harmful substances in the production (work with cement, cadmium, silicon, in coal mines, metallurgy) as well as bad habits (smoking) and genetic inclinations.

Symptoms of obstructive bronchitis:

- A strong cough is the most common symptom of any type of bronchitis. Usually cough with bronchitis delivers a strong discomfort to the patient and makes him immediately consult a doctor.

- Cough oscillations in intensity, fluctuations in body temperature.

Tachycardia and pallor.

- A long, wheezy exhalation, wheezing.

- Shortness of breath, which occurs as a symptom of bronchitis even at the lowest physical exertion.

- Severe fatigue. This symptom occurs sharply with the onset of the development of the disease. At the same time the patient's fatigue exists at the slightest physical exertion.

In the case of obstructive chronic bronchitis, participation in the act of respiration of additional musculature is observed.

- The raised temperature characterizes an acute period of disease. When the disease goes to a chronic stage, the immunity falls so much that the body does not react to the inflammation process and the temperature does not increase.

Key mechanisms of the disease:

- Inflammation of not only medium and large bronchi, but also small ones, including the alveoli.

- Development of broncho-obstructive syndrome.

- Occurrence of diffuse secondary emphysema of the lungs.

- Hypoxemia and hypercapnia, as a consequence of the violation of gas exchange and ventilation.

- Pulmonary arterial hypertension.

Diagnosis of obstructive bronchitis

To diagnose this disease, the following studies are prescribed:

- Urine and blood tests.

- LHC, which determines the presence of a common protein and protein derivatives (fibrin, creatinine, haptoglobin, etc.).

- IAK for determination of blood content and functionality of T-B-lymphocytes, immune complexes.

- X-rays of light.

- Spirography.

- Echocardiography.

- Analysis of total and bacteriological sputum.

Treatment of obstructive bronchitis

Like any other serious illness, obstructive bronchitis requires proper targeted treatment. If the patient refuses treatment, the disease can go into a chronic form and give an inflammation to the lungs, promote the development of asthma.

For correct treatment, a clear and adequate correctly diagnosed diagnosis is necessary. Modern methods of diagnosis help the doctor accurately and in the shortest possible time to diagnose the disease, namely, the absence or presence of an obstructive form of bronchitis.

The beginning of treatment is characterized by bed rest and complete rest. As the patient's condition improves, walks and ordinary household duties are allowed.

Special conditions for proper treatment:

- Elimination of a variety of aggressively influencing factors, such as cosmetics, household chemicals and polluted air.

- To give up smoking. Among smokers, about 80% of patients suffer from obstructive bronchitis.

- The correct diet, diet, which will promote a speedy recovery. You should give up fried foods, spicy, oily and salty. Best suited are sour-milk products, cereals and broths. Such products will provide the body with the right amount of calories and do not overload it.

Medications for treatment

Drugs and procedures prescribed by a doctor are aimed at alleviating the symptoms of the disease and an obligatory hindrance to its development. Usually doctors prescribe such medicines:

- Adenoreceptors (terbutaline or salbutamol). These drugs contribute to the expansion of bronchial alveoli.

- Expectorants and mucolytics, such as Ambroxol or ATSTS. Very good effect has drugs based on herbs, in particular, thyme.

- Preparations are antibacterial. The most effective macrolide preparations are Erythromycin, Azithromycin, as well as drugs from the penicillin group, such as Amoxicillin. Such drugs are prescribed in the form of tablets, very rarely in the form of injections or inhalations in order to avoid complications.

- Inhalations with medicinal herbs (peppermint, chamomile, thyme) and essential oils are a great way to treat obstructive bronchitis.

- Antibiotics are used in case of severe forms of the disease, or when there are no positive results from treatment by other methods.

Traditional methods of treatment

The main methods used in non-traditional medicine are the reception of phytopreparations and the use of various compresses. For example, apply a compress of butter and honey. In equal proportions, the heated above ingredients are applied to the chest and back in the form of a normal compress. The course of treatment is one month.

Therapeutic exercise is also used in connection with the fact that in adults it is difficult to get rid of sputum. Thanks to physical exercises, recovery is faster. Also used breathing exercises, which improve the process of ventilation.

These methods are effective, but more moderate, compared with medicines, but have the right to exist. In any case, one should be cautious and do not resort to self-medication, since to diagnose the correct diagnosis it is necessary a specialist with special knowledge and able to choose the only correct treatment of one or another disease.

medportal.su

Obstructive bronchitis in adults

Obstructive bronchitis in adults - diffuse bronchial damage caused by prolonged irritation and inflammation, at which there is a narrowing of the bronchi, accompanied by difficulty in getting out the accumulated mucus, phlegm. With bronchospasm, which are inherent in this disease, there is difficulty breathing, shortness of breath, wheezing, not associated with the defeat of other systems and organs. Progressive inflammatory process leads to impaired ventilation of the lungs.

The causes of bronchial obstruction

Factors affecting the development of obstructive bronchitis:

Medical factors:

• Infectious and inflammatory diseases of the respiratory system and violation of nasal breathing, foci of infection in the upper respiratory tract - bronchitis, pneumonia
• Recurrent viral infections and nasopharyngeal diseases
• Tumors of the trachea and bronchi
• Hyperreactivity of the respiratory tract
• Genetic predisposition
• Propensity to allergic reactions
• Injuries and burns
• Poisoning

Socio-economic factors:

• Smoking, second-hand smoke (see video from what do cigarettes)
• Alcohol abuse
• Unfavorable living conditions
• Elderly age

Environmental factors:

• Long-term effects on the bronchial mucosa of physical stimuli in the external environment are allergens, such as pollen of some plants, house dust, animal hair, etc.
• The presence of chemical stimuli in the air at work or at home - inorganic and organic dust, acid fumes, ozone, chlorine, ammonia, silicon, cadmium, sulfur dioxide, etc. (cm. influence of household chemicals on health).

Types of obstructive bronchitis

Acute obstructive bronchitis- An acute form of bronchial obstruction for adults is not typical, as most often acute obstructive bronchitis occurs in children under 4 years old. However, in adults primary obstructive bronchitis is observed - due to the addition of several risk factors described above, an inflammatory process develops. On the background of acute respiratory viral infection, influenza, pneumonia, with inadequate treatment and other provoking factors, the onset of obstruction may begin. In acute obstructive bronchitis, the main symptoms in patients are as follows:

• First observed catarrh of the upper respiratory tract
• Severe dry cough, with hard-to-recover sputum
• Coughing attacks especially worse at night
• Difficulty breathing, with exhaled breath
• The temperature is subfebrile, no higher than 3, this distinguishes acute obstructive bronchitis from simple acute bronchitis, which is usually a high temperature.

Acute bronchial obstruction is curable, but if it acquires a chronic form, it can become a progressive, irreversible disease.

Chronic obstructive bronchitisis a progressive obstruction of the bronchi in response to various stimuli. Violation of bronchial patency is conditionally divided into: reversible and irreversible. Symptoms with which patients usually consult a doctor:

• Strong cough, with a discharge in the morning of sparse phlegm mucus
• Shortness of breath, first appears only with physical exertion
• Wheezing, shortness of breath
• Sputum can become purulent in the period of addition of other infections and viruses and is regarded as a relapse of obstructive bronchitis.

Over time, with an irreversible chronic process, the disease progresses, and the intervals between relapses become shorter. In chronic course,

How to treat obstructive bronchitis

Treatment of obstructive bronchitis should be with the active participation of the patient in the treatment process. If possible, it is necessary to eliminate the negative factors provoking the progression of the disease - this is primarily a refusal to smoke, the desire to lead a maximally healthy lifestyle, if the main cause of the development of bronchial obstruction is industrial hazards - is desirable change of work.

Bronchodilating therapy.It consists of three groups of medicines:

• Anticholinergic drugs. The most effective and known of them Ipratropium bromide in metered aerosols is Atrovent. The effect of inhalation drugs is slow for about an hour and lasts 4-8 hours. Daily dosage 2-4 inhalations 3-4 times.
• Beta is a 2-agonist. These medications are recommended to be used 3-4 times a day. If the patient does not have a clear manifestation of the symptoms of the disease, then they can be used only as a prophylaxis immediately before physical exertion. The most famous drugs: Berotek, salbutamol.
• Methylxanthines. Widespread use of prolonged theophylline, they are used 1 -2 times a day. The most famous of these drugs is Teopek. A solution of euphyllin is administered only in hospitals according to indications. Caution is necessary when treating methylxanthines in patients with heart failure.

Mukoregulatory drugs.To improve sputum discharge, in cases of violation of its secretion, use Acetylcysteine, Ambroxol or Lazolvan (see. list of all expectorants for cough).

Antibacterial therapy.In cases of bacterial infection, in the presence of purulent sputum and signs of general intoxication, antibiotics are prescribed for bronchitis of a wide spectrum of action for 7-14 days. In inhalations, antibiotics are not used. If the patient has chronic obstructive bronchitis, antibiotic treatment prophylactically, in order to avoid exacerbations, do not.

Corticosteroids. Their use is limited, and systemic corticosteroids are prescribed only with severe respiratory failure. Perhaps the use of inhaled hormones, because the side effects in this application are significantly reduced.

Therapeutic breathing exercises.The training of the respiratory muscles is indicated to all patients with chronic obstructive bronchitis. This gymnastics exercises in Strelnikova, and breathing Buteyko, and the use of Frolov's breathing apparatus.

Indications for inpatient treatment

• Exacerbation of chronic obstructive bronchitis, which does not stop with outpatient treatment (persistent cough with purulent sputum, shortness of breath, signs of respiratory failure increase)
• Respiratory failure, which developed sharply.
• Attachment of pneumonia.
• Signs of heart failure with the development of the pulmonary heart.
• Need for bronchoscopy.

Advantages of nebulizers for the administration of medicines for COPD

Medicinal products for the treatment of obstructive bronchitis should be used in the form of inhalations. Most often in the home for this purpose use nebulizers. Their advantages are as follows.

• The drug is sprayed in the form of fine particles in the composition of the aerosol, due to which the depth of penetration of the substance in the respiratory tract increases.
• Ease of use in children and the elderly (do not coordinate inhalation with inhalation, which is difficult to teach a small child or elderly).
• The nebulizer allows you to inject high doses of the drug and can be used to stop attacks of suffocation.

zdravotvet.ru

Chronic obstructive bronchitis and COPD

Chronic obstructive bronchitis is a diffuse inflammatory disease of the bronchi characterized by an early lesion respiratory structures of the lung and leading to the formation of bronchial obstructive syndrome, diffuse lung emphysema and progressive disruption pulmonary ventilation and gas exchange, which are manifested by cough, dyspnoea and sputum, not associated with other diseases of the lungs, heart, system of blood, etc.

Thus, unlike chronic non-obstructive bronchitis, the key mechanisms that determine the characteristics of the course of chronic non-obstructive bronchitis are:

1. Involvement in the inflammatory process is not only large and medium, but also small bronchi, as well as alveolar tissue.
2. The development as a result of this bronchoobstructive syndrome, consisting of irreversible and reversible components.
3. Formation of secondary diffuse emphysema of the lungs.
4. Progressive violation of ventilation and gas exchange, leading to hypoxemia and hypercapnia.
5. Formation of pulmonary arterial hypertension and chronic pulmonary heart (CHS).

If at the initial stage of the formation of chronic obstructive bronchitis the mechanisms of damage to bronchial mucosa resemble those in chronic non-obstructive bronchitis (violation of mucociliary transport, hypersecretion of mucus, seeding of mucous pathogenic microorganisms and initiation of humoral and cellular factors inflammation), then the further development of the pathological process with chronic obstructive bronchitis and chronic non-obstructive bronchitis is fundamentally different from friend. The central link in the formation of progressive respiratory and pulmonary heart failure, characteristic of chronic obstructive bronchitis, is centroacinar pulmonary emphysema that occurs as a result of early damage to the respiratory parts of the lungs and an increasing bronchial obstruction.

Recently, to denote such a pathogenetically conditioned combination of chronic obstructive bronchitis and emphysema with progressive respiratory failure, the term "chronic obstructive pulmonary disease (COPD)" is recommended, which, according to the latest version of the international classification of diseases (ICD-X), it is recommended to use in clinical practice instead of the term "chronic obstructive bronchitis". According to many researchers, this term largely reflects the essence of the pathological process in the lungs with chronic obstructive bronchitis in the late stages of the disease.

Chronic obstructive pulmonary disease (COPD) is a collective concept that combines chronic inflammatory diseases of the respiratory system with a predominant lesion of the distal sections of the respiratory tract with irreversible or partially reversible bronchial obstruction, which are characterized by a constant progression and an increasing chronic respiratory insufficiency.. The most common causes of COPD include chronic obstructive bronchitis (in 90% of cases), bronchial asthma of severe course (about 10%), emphysema, developed as a result of deficiency of alpha1-antitrypsin (about 1%).

The main sign on which the COPD group is formed is the steady progression of the disease with the loss of the reversible component of bronchial obstruction and the growing phenomena of respiratory failure, the formation of centroacinar pulmonary emphysema, pulmonary arterial hypertension and pulmonary heart. At this stage of COPD development, the nosological affiliation of the disease is indeed leveled.

In the United States and Great Britain, the term "Chronic obstructive pulmonary disease" (COPD - chronic obstructive pulmonary disease; in the Russian transcription of COPD) also includes cystic fibrosis, obliterans bronchiolitis and bronchiectasis disease. Thus, at present, there is a clear inconsistency in the definition of COPD in the world literature.

Nevertheless, despite the similarity of the clinical picture of these diseases at the final stage of the disease development, at the early stages of the formation of these diseases it is advisable to preserve their nosological independence, since the treatment of these diseases has its own specific characteristics (especially cystic fibrosis, bronchial asthma, bronchiolitis, etc.).

There are still no reliable and accurate epidemiological data on the prevalence of this disease and the mortality of COPD patients. This is mainly due to the uncertainty of the term "COPD" that existed for many years. It is known that at present in the United States the prevalence of COPD among people over 55 is almost 10%. From 1982 to 1995 the number of patients with COPD increased by 4%. In 1992, the death rate from COPD in the United States was 1 per 10, 00 population and was the fourth leading cause of death in that country. In European countries, COPD mortality ranges from, (Greece) to 4, (Hungary) per 100 000 population. In the UK, approximately 6% of men's deaths and 4% of women's deaths are due to COPD. In France, 1, 00 deaths per year are also associated with COPD, accounting for a% of all deaths in this country.

In Russia, the prevalence of COPD in 1990-1998, according to official statistics, reached an average of 16 per 1000 population. Mortality from COPD in the same years was from 1 to 2, per 100 000 population. According to some data, COPD reduces the natural life expectancy by an average of 8 years. COPD leads to a relatively early loss of work capacity of patients, and most of them disability occurs approximately 10 years after the diagnosis of COPD.

ICD-10 code J44.8 Other specified chronic obstructive pulmonary disease J44.9 Chronic obstructive pulmonary disease, unspecified

Risk factors for chronic obstructive bronchitis

The main risk factor for COPD in 80-90% of cases is tobacco smoking. Among "smokers" chronic obstructive pulmonary disease develops 3-9 times more often than in non-smokers. The mortality from COPD determines the age at which smoking was started, the number of cigarettes smoked and the duration of smoking. It should be noted that the problem of smoking is especially relevant for Ukraine, where the prevalence of this harmful habit is 60-70% among men and 17-25% among women.

Chronic obstructive bronchitis - Causes and pathogenesis

Symptoms of chronic obstructive bronchitis

The clinical picture of COPD consists of a different combination of several interrelated pathological syndromes.

COPD is characterized by a slow gradual progression of the disease, which is why most patients turn to the doctor late, at the age of 40-50 years, when there is already enough expressed clinical signs of chronic inflammation of bronchi and bronchial obstructive syndrome in the form of cough, shortness of breath and reduced tolerance to daily physical load.

Chronic obstructive bronchitis - Symptoms

What's bothering you?

Coughing in the lungs Shortness of breath

Diagnosis of chronic obstructive bronchitis

At the initial stages of the development of the disease, careful examination of the patient, evaluation of anamnestic data and possible risk factors During this period, the results of objective clinical research, as well as data from laboratory and instrumental methods, are few informative. Over time, when the first signs of bronchial obstructive syndrome and respiratory failure appear, objective clinical and laboratory and instrumental data become increasingly diagnostic value. Moreover, an objective assessment of the stage of the development of the disease, the severity of the course of COPD, the effectiveness of the therapy is possible only with the use of modern research methods.

Chronic obstructive bronchitis - Diagnosis

What it is necessary to survey?

Bronchi Lungs

How to inspect?

Bronchoscopy Examination of bronchi and trachea X-ray of lungs Examination of respiratory (lung) organs Computed tomography of thorax

What tests are needed?

Sputum examination

Who to contact?

Pulmonologist

Treatment of chronic obstructive bronchitis

Treatment of COPD patients in most cases is an extremely difficult task. First of all, this is explained by the main regularity of the development of the disease - the steady progression of bronchial obstruction and respiratory failure due to inflammatory process and hyperreactivity of the bronchi and the development of persistent irreversible violations of bronchial patency caused by the formation of obstructive emphysema lungs. In addition, the low efficiency of treatment for many COPD patients is due to their late referral to the doctor, when there are already signs of respiratory failure and irreversible changes in the lungs.

Nevertheless, modern adequate complex treatment of patients with COPD in many cases allows to achieve a decrease in the rate of progression of the disease leading to increasing bronchial obstruction and respiratory failure to reduce the frequency and duration of exacerbations, improve efficiency and tolerance to physical activity.

Chronic obstructive bronchitis - Treatment

In addition to treatment

Treatment of bronchitis Physiotherapy with bronchitis Obstructive bronchitis: treatment with folk remedies Treatment of obstructive bronchitis in adults Antibiotics for bronchitis Antibiotics for bronchitis in adults: when appointed, the names What to treat? Tavanik Daksas

ilive.com.ua

COPD: characteristic symptoms and treatment with folk remedies

In chronic obstructive pulmonary disease, COPD, symptoms and treatment with folk remedies may be of interest to many people. One of the main manifestations of COPD can be attributed to the progressive dysfunction of the lungs themselves, as well as respiratory tract - the organs of gas exchange of man. The risk group for this disease is middle-aged and older people, starting from 37-45 years.

The main factors provoking the disease are:

• addiction;
• tobacco smoking;
• dust intoxication with salts of silicon or cadmium;
• pathogenic effects of certain microorganisms;
• hereditary predisposition to manifestations of the disease.

The presence of intense provoking effects can significantly reduce the age threshold of the disease.

Characteristic symptoms of obstructive disease

Symptoms of COPD:

1. Irregularly showing moist or dry cough.
2. Mucus or pus, accumulating in the upper respiratory tract and secreted by breathing or coughing.
3. Functional disturbances of gas exchange in the body.
4. Difficulty breathing or shortness of breath with increased motor activity.

The progressive nature of the course of chronic obstructive pulmonary disease is determined by:

• general weakness of the body;
• hypoxia;
• functional degeneration of lung tissue;
• weakening and violation of the shape of the diaphragm;
• degradation of the respiratory musculature.

The most acute hypoxia in COPD patients is manifested during periods of intense physical exertion, for example, when running or fast walking, overcoming obstacles, climbing stairs, wearing weights etc.Exacerbations or particularly severe forms of chronic obstructive pulmonary disease can lead to the inability to move independently without the help of relatives or hospital staff. Anamnesis of COPD often includes drug addiction or smoking, acute respiratory diseases, seasonal pulmonary inflammation, industrial intoxication or exposure to the patient's body of harmful gases or dust particles. As a rule, almost all parts of the lungs are affected, as well as blood vessels that penetrate the lung tissue.

Therapy of chronic lung disease

Chronic obstructive pulmonary disease is very successfully treated with folk medicine. For such treatment are used:

• infusions;
• decoctions;
• herbal tea;
• compresses;
• Food.

Treatment of folk remedies for COPD: herbs

Most often folk medicine resorts to herbal treatment of COPD. This helps to eliminate many symptoms of the disease and significantly improve the overall condition of the patient. Medicines made from medicinal plants can be taken together or separately. The main thing is to observe the rules of preparation, dosage and the regimen for taking decoctions and infusions.

One of the most effective folk remedies for the treatment of obstructive illness is infusion, cooked on the basis of herbal collection. In its composition:

• 200 g of mallow;
• 200 g of chamomile;
• 100 g of sage.

A mixture of these ingredients must be ground with a blender or mixer to a powdery state. For the preparation of the present, 1 tbsp. Spoon this mixture with 1 cup boiling water. Insist should be in a warm place for 60 minutes. After this, the infusion should be filtered and boiled water added to it to the original volume. To obtain a noticeable effect, take the infusion for 60 days (daily) 2 times a day. The next infusion is prepared in the same way and in the same proportions as the previous one. It includes:

• 100 g of flaxseed;
• 200 g of lime color;
• 200 g of chamomile;
• 200 g of eucalyptus.

The duration and mode of reception are similar. The next collection includes ingredients that promote the excretion of sputum from the lungs and general improvement of the body. It includes:

• althea root;
• anise berries;
• clover;
• forest mallow;
• chamomile;
• liquorice root.

The indicated components (100 g each) must be mixed, add flaxseed (300 g) and boil with boiling water. Proportion art. Spoon the mixture on, liter of boiling water. The infusion time is 30 minutes. The filtered infusion is accepted, as in the previous cases.

To withdraw phlegm, remove inflammation and eliminate cough, syrup from the root of nettle, mashed and mixed with sugar (in the proportions:) helps. After a 6-hour infusion in a warm place, the syrup is filtered and taken 3 times daily.

Decoction of wild-leaf, or, as it is often called, mother-and-stepmother, is often used to treat diseases of the respiratory system. For patients with chronic obstructive pulmonary disease, it is prepared by pouring the herb with steep boiling water (10 g per 200 ml) and insisting in a warm place before cooling down. Take the infusion you need for 2 or 3 tablespoons. spoons during the day every 2 hours.

Use of food for COPD treatment

For the treatment of COPD at home, traditional medicine offers the use of certain foods. For example, a black radish, which, as is known, is often used in the treatment of diseases of the upper respiratory tract.

From the black radish and beets, taken in the same amount (in kg), the infusion is prepared. Vegetables should be grated on a fine grater and mixed with cooled boiled water (1 liter). Infuse 3 hours. Reception mode - 3 times a day for 4 tablespoons. spoons for 30 days. After the completion of the course, a break of 7-10 days is necessary. After this, if necessary, treatment can be repeated.

For treatment, milk is used in a warm form and with various additives. Several options for treatment of COPD milk:

1. 1 hour a spoon of badger fat or interior fat for 250 ml of hot milk.
2. 1 hour A spoon of Iceland moss is brewed with 200 ml of hot milk. It is taken three times a day for a glass.
3. 1 cup of milk with honey, butter and a few drops of an ammonium anise mixture is taken before going to bed in a hot state.
4. 500 ml of milk with the addition of 1 clove garlic, passed through the press, brought to a boil. Then the milk with garlic is infused, and honey is added to it. It is taken in preheated form several times during the day.

Inhalations and compresses

For the treatment of COPD, inhalations are actively used. For example, inhalations are made using sea salt (3 tbsp. tablespoons per 1 liter). You can use for inhalation broth from such herbs as:

• ledum;
• oregano;
• calendula;
• mint;
• chamomile.

Cooking decoction for inhalation can be from one herb or mixture. You can breathe in pairs saturated with essential oil of chamomile, eucalyptus or pine. For one inhalation, 3-5 drops of oil, added to a pot of boiling water, is sufficient. Instead of oils you can use baking soda (5 g per 200 ml of water).

The phytoncides on the onions should be inhaled through the mouth. This can be done through a glass, pressed to the mouth, filled with freshly cut onions. Exhale through the nose.

The remaining raw material after the preparation of the above-described infusion from the dandruff (mother-and-stepmother) can be applied for a compress. While the cake is not cold, it is evenly distributed over the chest and covered with a soft dense tissue (for example, flannel). After this, the patient needs to lie down a little while the compress does not cool.

All methods of treatment are time-tested. But, applying the people's means, all the same, one should not give up medical care.

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The specialist will be able to carry out the necessary diagnostics, determine the stage of the disease, advise which folk medicine will be most effective for a particular patient.

respiratoria.ru

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