Bronchitis abstract

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

Bronchitis in children: acute, obstructive bronchitis, symptoms, treatment

Bronchitis in children most often occurs in the form of complications against the background of acute respiratory viral infection, influenza or a severe cold, hypothermia. The provoking factors of bronchitis are seasonal sharp temperature changes, especially periods of rain with high humidity, so this disease usually occurs in the fall or spring.

In form, all bronchitis in children are divided into: Acute, Prolonged and Recurrent.

For reasons of occurrence, depends on the pathogen of inflammation and is divided into:

• Viral - influenza, adenoviruses, parainfluenza
• Bacterial - can be acute and obstructive (the causative agent is streptococcus, staphylococcus, moraxelly, hemophilic rod, as well as mycoplasma and chlamydia)
• Allergic, obstructive, asthmatic - arises from irritating chemical or physical factors, such as household chemicals, house dust (read about the symptoms of allergy to dust), animal hair, plant pollen and others.

Bronchitis in a child up to a year - symptoms and treatment

Children who are breastfed and who do not have contact with sick children and adults should not have any respiratory illnesses. However, if the child was born prematurely, has congenital malformations of the respiratory organs and other diseases, as well as in the family there are preschool children attending kindergartens and often ill - the development of bronchitis in a child up to a year is possible by the following reasons:

• narrower than the adult, bronchi, a more dry and vulnerable mucosa of the respiratory tract
• existing congenital malformations
• after a viral or bacterial infection
• the presence of individual sensitivity to chemical and physical stimuli - an allergy to anything.

The most basic symptoms of developing bronchitis are a severe dry cough, paroxysmal, accompanied by difficulty breathing, shortness of breath. Gradually, the cough becomes moist, but mucus, sputum during bronchitis in a child up to a year of significant hinders breathing, normal lung function is disrupted, since the airway in infancy narrow. Bronchitis in children up to a year and even up to 3-4 years is most often the following:

• Acute bronchitis simple
• Obstructive bronchitis
• Bronchiolitis

On acute and obstructive bronchitis, we will dwell in more detail below. And now consider the most common in children under one year oldbronchiolitis.

Bronchitis in children under one year of age - bronchiolitis

This bronchitis affects both small bronchi and bronchioles, develops more often against the background of acute respiratory viral infections, influenza viruses with the subsequent reproduction of pneumococci (and so on. streptococci). In case of inhalation of icy air or sharp concentrations of various gases, bronchiolitis can develop as an independent disease. The danger of such bronchitis is a pronounced bronchoobstructive syndrome with the development of sometimes even acute respiratory failure:

• Characterized by dry cough attacks, pronounced dyspnea mixed or expiratory form with syndromes of swelling of the wings nose, with the involvement of ancillary muscles, the entrainment of the intercostal spaces of the chest, the pallor of the skin, cyanosis.
• The child has dry mouth, no tears when crying.
• The child eats less and drinks than usual, respectively, and his urination is more rare.
• Increased body temperature, but unlike pneumonia, it is less pronounced (see. whether it is necessary to bring down the temperature).
• Shortness of breath to 60-80 breaths per minute, while breathing is grunting, superficial.
• On both sides are heard diffuse wet ringing finely bubbling and crepitating rales.
• Symptoms of intoxication in bronchiolitis in children are not expressed.
• X-ray is determined by the sharp transparency of the lung tissue, the variegation of the pattern, the horizontal standing of the ribs, the absence of infiltrative changes in the lungs.
• If at first there was a simple bronchitis, then the attachment of bronchiolitis after a while is manifested by a sharp deterioration of the general condition of the child, cough becomes more painful and intense, with scanty phlegm.
• Children are usually very restless, moody, excited.
• The blood test can be slightly changed, a slight leukocytosis and an increase in ESR are possible.
• Usually, bronchiolitis in children up to one year has a prolonged course until 1 months.
• The causes of acute bronchiolitis in children are similar to the causes of development of obstructive bronchitis in children older than 2-4 years. The local immune system of the respiratory tract in children under 2 years is weak, protection against viruses is not enough, so they easily penetrate deep into bronchioles and small bronchi.

Treatment of bronchiolitis in children

At home, you can not cure bronchiolitis. When a bronchiolitis occurs, the infant is usually shown hospitalization, so that the child is under the supervision of doctors. In the hospital pediatricians, pulmonologists will establish an accurate diagnosis and prescribe appropriate treatment. What should my mom do before the ambulance arrives?

You can only alleviate the symptoms of colds - create optimally comfortable air in the room, turn on the humidifier, air purifier.

If there is no high temperature in the child, you can ease breathing with warming creams and ointments, spread them legs, calves. Only with this you need to be cautious if the child has not had any allergic manifestations before, then it helps a lot if a child allergic, warming ointments should be excluded.

To cough softer, you can do steam inhalation-above a boiling pot with a weak saline solution, hold the baby in her arms. Or sit him down at the table and cover with a towel over a cup of hot medical solution.

Try to force the baby to drink more to avoid dehydration, if the child refuses the breast or mixture, give the child just pure water.

In the hospital to relieve the signs of respiratory failure, the baby is given inhalations with bronchodilators and allowed to breathe oxygen. Also at the doctor's discretion, an antibiotic is selected - Sumamed, Macroben, Augmentin, Amoxiclav. It is possible to use various drugs with interferon. Necessarily prescribe antihistamines for the removal of edema at the site of inflammation and a possible allergic reaction to treatment. If symptoms of dehydration are observed, then the necessary rehydration therapy is performed.

Acute bronchitis in children - symptoms

Bronchitis in children is the most common form of respiratory tract disease. Acute bronchitis is an acute inflammation of the bronchial mucosa without symptoms of inflammation of the lung tissue. Simple bronchitis in children in 20% of a self-contained bacterial disease, 80% - either in a program of viruses (Coxsackie virus, adenovirus, influenza, parainfluenza) or as a bacterial complication after these viral infections.

Clinical symptoms of bronchitis in children are as follows:

First, the child has general weakness, malaise, headache, lack of appetite, then there is a dry cough or cough with sputum, the intensity of which is rapidly increasing, while listening to determine the dry diffuse or variously moist wheezing. Sometimes there may be a barking cough in a child whose treatment is slightly different.

In the first 2 days, the temperature rises to 38 ° C, but with a mild form, the temperature can be 37-3,.

After 6-7 days, the dry cough becomes wet, the sputum discharge facilitates the child's condition and is a good sign that the body is coping with the infection and the virus.

On average, the duration of acute bronchitis in children is 7-21 days, but the nature of the disease, the severity of the inflammatory process depend on the child's age, the strength of his immune system, the presence of concomitant chronic and systemic diseases. In case of inadequate or untimely treatment, acute bronchitis can lead to addition - bronchiolitis, pneumonia.

Sometimes after the flu, for some time, the child's condition improves, and then a sharp deterioration, a rise in temperature, a rise in the cough - this is due to the weakening of the immune system in the fight against the virus and the attachment of a bacterial infection, in this case it is shown antibiotic.

With mycoplasmal or adenoviral acute bronchitis in children, the symptoms of intoxication, such as high fever, headaches, chills, lack of appetite, can be about a week. Usually acute bronchitis is bilateral, however, with mycoplasma bronchitis it is most often one-sided, sometimes combined with conjunctivitis.

Acute bronchitis in children - treatment

Most often, the duration of acute bronchitis in children, whose treatment is correct and carried out on time, should not be more than 14 days, however, in infants, cough can persist for up to a month, as well as in older children with atypical-mycoplasmic bronchitis. If suddenly the bronchitis in the child is delayed, it is necessary to exclude a number of diseases:

• aspiration of food
• pneumonia
• cystic fibrosis
• foreign body in bronchi
• tuberculosis infection

A pediatrician prescribes a full treatment package. In addition to implementing all the recommendations of the doctor, you should provide the child with special nutrition and quality care. It is desirable to create in the room the optimum humidity and purity, for this purpose it is convenient to use a humidifier and air purifier, often ventilate the room and conduct daily wet cleaning in the room in which child. And:

• Abundant drink

Ensure abundant reception of fluids in a warm form. To soften the cough, warm milk with butter or Borjomi mineral water helps, can be replaced with honey.

• Heat

With fever, the temperature just above 38C should take antipyretics - paracetamol in syrup.

• Antibiotics

Antibiotics for bronchitis in children, if recommended by a doctor, should be given strictly by the hour. If taking antibacterial drugs is necessary 3 times a day, this does not mean that you must drink from breakfast, lunch and dinner, and this means that their reception should be 24/3 = 8, every 8 hours, if 1 time per day, then give it only at the same time, for example at 9 o'clock morning. 11 rules - how to take antibiotics correctly.

• Cough medicine

With a dry cough, the child can be given antitussive medicines as prescribed by the doctor, and when it becomes wet to go on expectorants. With a dry cough, the means can be combined (Sinekod). If the cough is wet, then expectorants are shown - Mucaltin, Bromhexin, Gedelix, Alpine syrup, Thermopsis herb infusion or its dry extract, Bronchicum, Evcabal, Prospan, breastfeeds.

• Inhalation

Inhalation in bronchitis in children, the symptoms of which are very pronounced, are well assisted by inhalation with conventional baking soda, called over hot pots, inhalation of sodium bicarbonate using a nebulizer, inhaler.

• For babies

For small and infants who do not know how to clear themselves, doctors advise turning the child more often from one side to the other. In this case, sputum is shifted downward, irritating the bronchial wall, this leads to reflex cough.

• Distractions

For older children, cans, mustards, hot foot baths, they still help, and if the child has strong immunity, such procedures will help to avoid taking antibiotics. You can soar your baby's legs after 1 year, and also rub them with warming agents - turpentine ointments, Barsukor, Pulmax baby, etc., but only in the case when there is no high temperature, after rubbing, you should warm your feet and wrap child. However, in case of an allergic bronchitis in a child, neither the mustard nor the warming ointments can be used, since the composition of ointments and mustard can worsen the child's condition.

• Compresses

When bronchitis in children, the treatment is helped by compresses from warm oil. Warm sunflower oil to 40 ° C and moisten them with gauze folded several times. This compress should be imposed only on the right side and back of the baby, from above put a plastic bag and a layer of cotton wool, bandage the child around several times. Dress warm clothes, do this procedure for the night, if there is no temperature in the child.

• Folk remedies

Old folk way - radish juice with honey, cabbage juice, turnip juice - any of these juices should be given 1 teaspoon 4 times a day. You can give and cranberry juice, mixing it with honey in a ratio of 3/1, a tablespoon 3 times a day.

• Massage

The first week is well helped by chest massage, older children would be good at performing breathing exercises.

Physiotherapy with bronchitis

In children, these procedures are prescribed and conducted only at the physician's discretion, these are physiotherapy methods that contribute to faster recovery, because they have an anti-inflammatory effect, however, they can not be performed more often 2 once a year:

• Ultraviolet irradiation of the chest
• Mud, paraffin applications on the chest and between the shoulder blades
• Inductometry on the same areas
• Electrophoresis with calcium
• SOLLUX ON THE BREAST
• Aeronisation by the hydroionizer of the respiratory tract with solutions of chamomile, antibiotics.

Prevention of acute bronchitis in children:

Do not allow a prolonged runny nose in a child, timely treatment of any cold and infectious diseases will be the best preventative against penetration of the infection into the lower respiratory tract. ways.

Walking in the fresh air in the park, playing at the cottage, physical exercise in nature, tempering, daily intake of natural vitamins in fruits and vegetables, and not in tablets - the way to the health of your child.

Obstructive bronchitis in children - symptoms

In young children, usually up to 3-4 years of acute bronchitis may be accompanied by an obstructive syndrome - this is an acute obstructive bronchitis. In children, the symptoms of such bronchitis begin more often after viral infections or allergic manifestations on the stimulus.

The main symptoms of obstructive bronchitis:

• Harsh, audible long breath with whistling
• Coughing with attacks, before vomiting, debilitating
• During inhalation, the intercostal spaces are drawn in and chest is swollen with breathing

In obstructive allergic bronchitis, children do not have a temperature, it starts because of an allergic reaction to the strongest irritant for the child, and parents can often remember that they recently bought something for the child - a down pillow or a blanket made of camel or sheep wool, at home breathed in color from repair or went to visit, where there is cat.

In obstructive bronchitis in children, symptoms can begin on the 3rd-4th day of the flu or ARVI, and may also be caused by other bacteria, which is manifested in the appearance of expiratory dyspnea - an increase in the respiratory rate to 60 per minute, it is also noted difficulties when inhaled.

The child begins wheezing, noisy breathing, especially a prolonged wheezing exhale, which is heard by persons near the baby. The thorax is as if swollen, that is, the ribs are horizontally arranged. Cough is dry, obtrusive, bouts, arises suddenly, it does not bring relief and intensifies at night.

If this disease develops not after ARI, then the temperature in the early days is not increased.
Headache, weakness and nausea, are very rare.

When listening there are dry wheezing in the lungs.

X-ray revealed increased transparency, increased pulmonary pattern, in the absence of infiltrative changes in the lungs.

The analysis of blood as a viral infection - lymphocytosis, leukopenia. accelerated ESR, if allergic bronchitis in a child, then eosinophilia.

Almost always obstructive bronchitis is associated with a virus or mycoplasmal infection, relapses of obstructive bronchitis in children most often spontaneously stop by 4 years.
If the bronchioles and small bronchi are affected, then this is an acute bronchiolitis.

Obstructive bronchitis in children differs from asthma attacks, in that obstruction develops slowly, and with asthma the child abruptly begins to suffocate. Although the first attacks of bronchial asthma in children also begin during ARVI. If the obstruction occurs several times a year, it is a signal that the child is at risk for developing bronchial asthma in the future.

Obstructive bronchitis in a child can be due to passive smoking, it can be distinguished by a strong cough with a whistle in the morning, while the child's condition is quite satisfactory. Obstruction with allergies occurs when contact with an allergen and recently it becomes very frequent manifestation in children prone to allergies, such bronchitis are recurrent and threatened with development bronchial asthma.

Allergic and obstructive bronchitis in children - treatment

Hospitalization

In obstructive bronchitis in children up to a year or 2 years, treatment should be performed in a hospital under the supervision of a pediatrician, in other cases at the discretion of the doctor and parents. Treatment is best done in a hospital if:

• In addition to obstruction in the child, the symptoms of intoxication are decreased appetite, fever, nausea, general weakness.
• Signs of respiratory failure. This is shortness of breath, when the frequency of breathing increases by 10% of the age norm, counting is better done at night, and not during games or crying. In children under 6 months, the respiration rate should not exceed 60 per minute, 6-12 months - 50 breaths, 1-5 years, 40 breaths. Acrocyanosis is a sign of respiratory failure, manifested by cyanotic nasolabial triangle, nails, that is, the body experiences oxygen deficiency.
• It is not uncommon for obstructive bronchitis in children to mask pneumonia, so if the doctor suspects pneumonia from hospitalization can not be denied.

Bronchodilators

Bronchiolithics extend the bronchi, so they are designed to relieve obstruction. To date, they are presented in various forms in the pharma industry:

• In the form of syrups (Salmeterol, Clenbuterol, Ascoril), which are convenient for young children, their disadvantage is the development of tremors and palpitations.
• In the form of solutions for inhalation (see. Berodual for inhalation) - this is the most convenient way for young children, breeding a medicinal solution with a physical solution, inhalation 2-3 times a day, after improvement, it is possible to use only at night. The multiplicity and dosage, as well as the course of treatment is determined only by the pediatrician.
• Inhalers-aerosols can be used only for older children (Berodual, Salbutamol).
• Such tableted forms of bronchodilators, like theophylline (Teopec, Euphyllin), are not indicated for the therapy of children with obstructive bronchitis, they have more pronounced side effects, are more toxic than local inhalation forms.

Spasmolytics

Can be used to reduce bronchial spasms. This is papaverine or Drotaverin, No-shpa. Their reception can be carried out with the help of an inhaler, orally in the form of tablets or intravenously in a hospital.

Means for coughing

To sputum better departed, various mucoregulatory drugs are used, they help dilute sputum and accelerate its excretion:

• These are preparations with active substance ambroksol (Lazolvan, Ambrobene). These drugs can not be taken for more than 10 days, it is most convenient to use them in the form of inhalations, as well as carbocisteine ​​preparations (Fluiditek, Bronhobos, Mukosol).
• After the cough became wet, the seizures became less intense, the sputum liquefied, but it departs badly, the ambroxol should be changed to expectorants for cough for children, which should be given no more than 5-10 days, they include Gedelix, Bronchicum, Prospan, Bronhosan, Herbion (cf. Herbion from a dry and wet cough), Tussin, Bronchipret, breastfeeding, .
• Codeine-containing drugs for children should not be taken if the child has a seizure-like obsessive cough, the appointment of a doctor can be used Sinekod, Stopusin Fito, Libexin (with caution in childhood), Bronhicum, Broncholitin.
• Erespal - promotes both removal of obstruction, and reduction of sputum production, and also it possesses anti-inflammatory activity, is applied from the first days of the disease, reduces the risks of complications, contraindicated in children under 2 years.

Draining massage

To facilitate the departure of sputum, parents can themselves do their child massage the collar zone, chest, back. Especially strong massage should be done for the muscles of the back along the spine. Useful for obstructive bronchitis in children postural massage - that is, efflorescence of the baby's back in the morning, should to hang the child from the bed upside down (padding the pillow under his tummy) and tapping the palms folded in the boat 10-15 minutes. For older children, with a massage, ask the child to take a deep breath, and on an exhalation, tap. Useful and additional exercises such as inflating balloons, blowing out candles.

Antihistamines

Antihistamines are prescribed to children in the presence of allergic reactions. Such medicines for allergies like Eryus in syrup can be taken to children from 1 year, with the half a year it is possible to use Claritin and Zirtek, from 2 years in syrups and drops Cetrin, Zodak, Parlazin (cf. list of medicines for allergies). Such antihistamines of the 1st generation as Suprastin and Tavegil are used less often, only for drying with abundant liquid sputum.

Allergy or virus

If the obstruction is caused by an allergy or a virus - antibiotics can not be used, and even dangerous (see. antibiotics for colds and orgs). The appointment of antibiotics is possible only with the proven infectious origin of bronchitis in children.

When antibiotics are indicated

Treatment of bronchial obstruction with antibiotics is not indicated, only if the child has a fever over 4 days, or there was a second temperature jump to 39C after 4-5 days after the onset of the disease, accompanied by severe intoxication, severe coughing if with adequate treatment, the child suddenly becomes apathetic, sluggish, refuses to eat, has weakness, nausea, headaches and even vomiting. In such cases, the use of antibiotics is justified. They are prescribed only by a pediatrician on the basis of a clinical picture, the presence of purulent sputum (indicating bacterial bronchitis), inflammatory changes in the analysis of blood, as well as other signs of bacterial bronchitis or pneumonia (wheezing, x-ray signs).

Antiviral drugs

Most doctors recommend that for ARVI and flu, take antiviral drugs, for babies candles Genferon, Viferon, and also in the form of drops Gripferon, Interferon, take Orvire syrups (remantadine), and after three years of age tableted forms such as Kagocel and Arbidol, Cytovir 3. But it is worth remembering that if in a family history (close relatives) there are any autoimmune diseases (Sjogren's syndrome, rheumatoid arthritis, systemic red lupus, diffuse toxic goiter, vitiligo, multiple sclerosis, pernicious anemia, insulin-dependent diabetes mellitus, myasthenia gravis, uveitis, Addison's disease, primary biliary cirrhosis, autoimmune hepatitis, scleroderma) it is impossible to take immunostimulants (Kagocel, Cytovir, Amiksin), it can cause a debut of an autoimmune disease in a child, possibly not now, and later (see. more antiviral drugs for orvi).

Hormonal therapy

Hormonal drugs, such as Pulcicort, are indicated only in severe or moderate leaks obstructive bronchitis (usually with the help of a nebulizer) they quickly stop obstruction and inflammation, their appoint only a doctor.

What not to do

In obstructive bronchitis in children - treatment by rubbing and spreading the body of the child with various heating oils (Dr. Mohm ointment, ointments with medicinal plants, essential oils), the use of mustard plasters is unacceptable, since they cause an even more allergic reaction and bronchospasm, especially in toddlers up to 3 years. Also categorically it is impossible to carry out inhalations with bronchitis with various medicinal herbs and essential oils. It is only possible to use such folk remedies for warming up - heat compresses with potatoes, salt, buckwheat.

Physiotherapy

Physiotherapeutic procedures in the acute period are contraindicated, when the obstruction is already stopped, it is possible to perform UHF, electrophoresis or laser.

Hypoallergenic diet and plentiful drink

Any natural drinks - mineral water with milk, tea, broth of a dogrose, it is necessary to drink to the child as often as possible. The diet should be hypoallergenic, but at the same time maximally vitaminized, high in protein and fat content. Exclude from the diet of the child anything that can cause an allergic reaction:

• citrus, red and orange fruit
• purchased spices, sweets, milk cheeses, yoghurts, carbonated drinks, sausages and sausages - everything that contains dyes, flavors, preservatives and flavor enhancers
• honey and other beekeeping products
• fish, grown on fish farms, broiler chickens, as they are stuffed with hormones and antibiotics, which causes allergies.

When caring for a child, you should daily aerate, moisten the room where the child is. It's hot in the apartment should not be, it's better to have a cool, fresh, clean air. After the recovery of the child should be put on a dispensary record with an allergist.

zdravotvet.ru

Treatment of obstructive bronchitis in adults: a list of the best drugs

Bronchitis is an inflammatory process, localized in the respiratory tract. Inflammation can affect not only the upper, but also the lower respiratory tract.Obstructive bronchitis is the onset of reflex spasms that prevent mucus from coming out.Obstruction can be periodic, especially in chronic form. The peculiarity of such bronchitis is that it is capable of proceeding latently.

Causes and predispositions

Most often, obstructive bronchitis does not show the usual symptoms of bronchitis. Even cough, a prerequisite for the disease, looks innocuous: coughing during the day with exacerbation in the morning. Outwardly, this is similar to the usual cleansing of the airways by the body itself. Several times podkashlyat or in the morning to clear a throat after a dream, this is quite healthy rate. It is difficult to guess that this is an obstructive bronchitis. Therefore, it quickly passes into a chronic form and only then becomes apparent with exacerbations.

Another feature is that it does not always require special treatment.For example, the patient works in a dusty room. His cough is not a consequence of the disease, but the consequences of harmful work. It is enough to change jobs or change the conditions to more acceptable ones, like bronchitis disappears. This happens when the only cause of the disease is external factors.

Many experts claim that the main cause of bronchial obstruction is viral. And they call the main culprit the transferred cold, flu, ARI. However, recent observations conducted in Russia have shown the inconsistency of the statement.In fact, bronchitis is most common in those who smoke a lot or work in harmful work.This is explained by the sensitivity of the bronchi to foreign substances and particles. Here, immunity and protective barriers are powerless: dust, tar enter the body and settle on the mucous membranes immediately in the bronchi, as they come in with inhalation.

Building a logical sequence of causes, you can get such a list (from the most frequent to the lowest

enee):

• Smoking.Whether you smoke or near you is unprincipled for starting a disease;
• The impact of external factors: dust, flour, toxins, heavy metals;
• A virus or a bacterium.Lesion of the bronchi is a secondary disease;
• Allergy.An enemy agent provokes a disease.

Predisposition to respiratory disease is essential. Propensity to laryngitis, sinusitis, colds often provoke various bronchitis. This group of people is more likely than others to have pneumonia.

First signs

Symptoms depend on the type of bronchitis itself and the provocateur of the disease.If it is a latent form or chronicle, then the cough will be insignificant within a day.Cough, sometimes dry cough, sometimes with phlegm. Do not always immediately pester and brings inconvenience. It can become aggravated in the mornings or closer to the morning. Here, the cough becomes intrusive, deaf, hysterical, to the "scratch" in the throat. In addition, there are several "recognizable" signs, symptoms of obstructive bronchitis:

1. temperature jump;
2. appearance of a purulent admixture in the mucus;
3. severe shortness of breath outside of the load;
4. dry cough;
5. sweating and weakness;
6. headache;
7. loss of appetite and sleep.

Symptoms of obstructive bronchitis can manifest all at once, but can show only one or two. Symptomatology can change: today there is a cough without phlegm, tomorrow it is wet. That is, the appearance of all signs is optional.

Diagnostics

The patient is assigned an X-ray after examination, listening to the bronchi and lungs

A blood test is almost useless in diagnosing bronchial obstruction.Exception: allergic nature. In other cases, the blood clinic will show a certain number of white blood cells, which will only tell about the presence of a foci of inflammation. Therefore, the patient is assigned an X-ray after examination, listening to the bronchi and lungs.

What to do when the throat hurts from the left side when swallowing is indicated in this article.

Pain in the ear and throat on the one hand, what to do about it, is indicated in this article.

What to do when the throat hurts and painfully swallow, you can learn from this article here: http://prolor.ru/n/lechenie-n/bolit-gorlo-bolno-glotat.html

If necessary, the x-ray is done in several projections. The study is necessary to assess the condition of the bronchi and lungs, identify inflammation foci. If necessary, spirometry and ECG can be prescribed.

How to treat at home and in the hospital

Medically

TO

The ultimate goal of treatment is the elimination of spasm, the withdrawal of sputum and the complete elimination of obstruction.For this purpose algorithms of treatment schemes are used, where modern means are combined - antispasmodics and bronchodilators. Obstructive bronchitis does not pass quickly, you will need patience for complete healing.

For enlarging the lumens in the bronchi, cholinergic blockers are prescribed: Beradual or Bromide (by tolerability). To stop the process, hormones are added, often Prednizalon. It is important in the treatment to increase dilution, so the scheme necessarily includes preparations expectorant: Bromhexine, Ambroxol.

If infection is connected, antibiotics of a wide spectrum are added, the doctor can also prescribe antibiotics for a nebulizer with bronchitis.With allergic obstruction, antihistamines. Be sure to follow the general recommendations:

1. bed rest;
2. humid air in the room;
3. abundant drinking;
4. adherence to a mild diet.

Be sure to eat sour milk, a lot of vegetables and low-fat meat and fish. Try not to overload the stomach, eat a little, but full. But all this will be pointless, if a person does not eliminate the root cause: change the harmful work, stop smoking.

Folk remedies

Melissa and mint infusion - one of the effective folk remedies for the treatment of obstructive bronchitis

Treatment of bronchitis with herbs should be done carefully and correctly. For a quick recovery the patient must drink plenty of fluids. Therefore, it will be ideal if a person will drink to the maximum: herbal teas, decoctions of chamomile and sage.Be sure to include in the diet of cranberries, broth of wild rose. These berries stabilize the immune system, kill the infection, and have a mild diuretic effect.

What to do when the throat hurts without fever and a cold, can be understood from the content of the article.

How does the throat look like in angina in children, can be seen from this article.
How does the red throat look like white with a touch without temperature, is indicated here: http://prolor.ru/g/simptomy-g/belyj-nalet-v-gorle-u-vzroslogo.html

If coughing attacks severely tear the throat, especially if on this background the pain in the bronchi, make a tincture based on honey and propolis: 1/2 milk and a pinch of propolis. Drink 12 drops before the onset of the cough.

Excellent, if you combine the entire treatment with frequent inhalations. Inhalations can be home or with the help of a nebulizer. The composition of inhalation is very different:

1. decoction of mother-and-stepmother with chamomile;
2. infusion of mint and lemon balm;
3. a couple of boiled potatoes;
4. inhalation of menthol vapor.

Inhalation well helps to thin phlegm, cough it up and reduces the activity of coughing attacks. Plus, the high temperature of steam penetrating the body, kills germs.

Complications

When complications of obstructive bronchitis may appear pulmonary insufficiency

When obstruction develops, the necessary amount of air ceases to flow into the lungs. The breaths become heavy, the diaphragm does not fully open. In addition, we inhale more than breathe out afterwards. Some part remains in the lungs and provokes pulmonary emphysema.In severe and chronic forms, pulmonary insufficiency may appear, and this is the reason for the lethality.Untreated bronchitis almost always ends with pneumonia, which is much more difficult to treat.

Video

What can not be done in the treatment of obstructive bronchitis - find out from this video:

Obstructive bronchitis can be dangerous for its complications. Having a tendency to stealth, he and so creates a risk to our health. But with the usual course it is important not to postpone the trip to the lung specialist. Do not forget that obstruction can lead to chronic form when healing is impossible.

ProLor.ru

What is obstructive bronchitis?

The most common complication that develops due to a cold is obstructive bronchitis. The process of breathing is a powerful system. The lungs, which are the fundamental link in this chain, represent a complex structure with many different functions and features. Structural changes that occur in them under the influence of external or internal factors, give a momentary failure of the system. If the respiratory system is exposed to a permanent negative effect, this leads to a decrease in the degree of protection of the bronchi. Their mucous membrane, getting dirty, makes it difficult to clean the inhaled air, thereby causing the development of bronchitis.

There are several signs of developing obstructive bronchitis. As a rule, the disease begins with a protracted cough. Cough in this case is the protection of the body from the influences of the external environment. It should be noted that the development of the disease occurs slowly enough, so often coughing remains one sign of the disease. The result of coughing is the sputum secretion, which is at first dry, and later begins to cough up a mucus of a yellowish-green hue. Later, breathing is added to it, accompanied by noise and whistling, the cause of which is the difficulty of exhalation due to narrowing of bronchioles. As a rule, obstructive bronchitis is characterized by a heavy and prolonged exhalation.

Physicians distinguish several types of bronchitis: obstructive and non-obstructive, acute or chronic.

Obstructive bronchitis is characterized by the fact that the inflammation is accompanied by obstruction (complication), in which the respiratory system becomes swollen and mucus accumulates. As a result, vascular ventilation is difficult.

If obstructive bronchitis affects children, they are treated with inhalations and a set of procedures that purify the bronchi. This stabilizes blood circulation and relieves spasms. A sign of improvement is the decrease or complete disappearance of whistling and the severity of breathing.

Acute obstructive bronchitis lasts, on average, from several days to several weeks. Inflammatory process in this case is caused by infection or external factors. In children, this disease can occur due to birth trauma.

If acute obstructive bronchitis is treated timely and correctly, the patient recovers without any consequences. An incorrect approach to treatment can lead to the development of chronic obstructive bronchitis of the lungs. This disease is much more difficult to treat, especially since it entails the occurrence of a number of concomitant diseases.

The acute form of the disease is characterized by an increase in temperature and a general weakness. Signs of chronic form is hard breathing and shortness of breath.

The main causes of obstructive bronchitis in children are viral infections, as well as severe hypothermia. Adults also acquire a chronic form of the disease due to prolonged smoking.

One of the forms of obstructive bronchitis is recurrent obstructive bronchitis. This form of the disease occurs when during the year more than three times the patient was diagnosed with "obstructive bronchitis." As a rule, with incorrect and untimely treatment this disease often develops into a chronic one.

Obstructive bronchitis is treated in a complex way: first it is necessary to eliminate the cause of the disease (so became meaningless), destroy the infection, then cleanse the lungs and carry out several preventive procedures. However, it should be done only in medical conditions with the help of a specialist. Remember that self-medication is very dangerous for your health!

fb.ru

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. To do this, after a smooth calm exhalation mouthpiece inhaler tightly wrapped lips and begin to slowly and deeply inhale, once press the can and continue to 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. The duration of the action of ipratropium iodide is 5-6 h, ipratropium bromide (atrovent) 6-8 h, oxytropium bromide 8-10 h and tiotropium bromide 10-12 h.

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;
• nonselective sympathomimetics, stimulating both beta1 and beta2-adrenergic receptors: isoprenaline (Novorin, isadrin), orciprenaline (alupeptin, astomopent) hexaprenaline (ipradol);
• selective sympathomimetics, selectively acting on beta2-adrenoreceptors: salbutamol (ventolin), fenoterol (berotek), terbutaline (bricanil), and some prolonged forms.

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

How to treat obstructive bronchitis in children?

Bronchitis, this ailment in acute form, obstructive bronchitis in children is the most frequent illness in a child in the first years of life. Diseases of the respiratory tract - a common and requiring a serious treatment phenomenon, it is important to remember and preventive measures. In adults, these diseases are less common, but preschool children and babies are very susceptible to various forms of bronchitis. This is due to the mechanism of child development, so the course of the disease, its diagnosis and treatment methods have their own characteristics inherent in this age category.

Bronchitis is an inflammation of the bronchial mucosa that can affect the membranes of the organs of the upper respiratory tract. Inflammatory processes begin in the nose and throat after the virus enters them, and later spread to the respiratory tract. The peculiarity of bronchitis is that the disease develops in the presence of certain factors and does not extend to other organs of the respiratory system.

Causes of bronchitis and its types

The causes of obstructive bronchitis in children can be different. Most often it is:

• viruses and bacteria;
• significant hypothermia of the body;
• ecology;
• communication with a sick child.

The first place among the provokers of bronchitis is occupied by viruses that weaken the immune system of the body and contribute to the penetration of harmful microbes into the respiratory tract. The next factor is the gas content and dustiness of the air that the child breathes. Since bronchitis is transmitted by airborne droplets, the risk of contracting them when dealing with a sick person is also very high.

Most cases of bronchitis occur during the autumn-winter season, when the air temperature drops, viruses become more active, and the body's immune system weakens. Boys and girls get sick the same way. Children have their own developmental features that contribute to the development of bronchitis to a certain extent.

Obstructive bronchitis in infants and toddlers of the first 3 years of life is due to the anatomical features of the bronchi and their components. At this age, the internal organs of children continue to form actively, which becomes a favorable factor for their defeat by harmful microorganisms. Bronchial structures at this age are quite long, but the lumens are small. The mucociliary apparatus, responsible for the production of sputum, is not yet sufficiently developed and does not work in full force. He is responsible for protecting the bronchi from getting into them viruses and bacteria. Underdevelopment of the smooth muscles of the bronchi promotes the appearance of spasms even with a slight irritation.

The muscles of the chest in infants are weak, which prevents complete and proper ventilation of the lungs.Factors that favor the increase in cases of diseases include unformed immunity and the presence of allergies.

In the international classification, three types of bronchitis are indicated in children:

• acute bronchitis;
• bronchitis obstructive;
• acute bronchiolitis.

Bronchitis - exclusively viral diseases, they can only be infected by airborne droplets. Bronchitis in infants is very rare, and it develops in cases when the baby was born prematurely or has congenital malformations of the respiratory system, and even in contact with sick children of the elder age. If a breastbone passes into acute bronchiolitis, severe complications in the form of acute respiratory failure are possible.

Obstructive bronchitis in children

Bronchitis in a child develops gradually. First there is a common cold and dry cough that intensifies in the evening and night hours. The kid can complain of chest pain, weakness, becomes capricious, restless, nervous. Often, the body temperature rises above 38 ° C, there are problems with breathing: wheezing in the lungs, shortness of breath.

The acute form of bronchitis lasts no more than a week, it can be cured within 5-6 days. If the sputum becomes transparent, this indicates an acute stage of bronchitis, but pus is a sign of the chronic form of the disease. If treatment is not started on time or goes wrong, bronchitis threatens with severe course and serious consequences.

One of them is the transition of normal bronchitis to an obstructive form. Obstructive bronchitis in children is one of the types of bronchial damage caused by inflammation, which is manifested by a violation of their patency.

The causes of the disease are different:

• congenital disorders of the respiratory system;
• hypoxia;
• trauma of the chest;
• prematurity.

Symptoms of obstructive bronchitis

The main symptoms of obstructive bronchitis are severe attacks of cough, cyanosis of the fingers of the crumbs and his lips. Due to bright manifestations, it is easy to establish the form of the disease. This helps to start the right treatment. Acute obstructive bronchitis in children develops very quickly and affects healthy parts of the respiratory system. In such cases, the state of the baby deteriorates sharply with every second. Characteristic signs of obstructive bronchitis include coughing attacks at night, especially if the baby was active during the day and communicated with peers.

If it is a question of a babe, then his behavior will be restless: the baby cries unconsciously, can not fall asleep, rushes in a dream. If you listen to the breath, you can hear wheezing and bubbling, whistling in your chest. Another sure sign of obstructive bronchitis is shortness of breath, which is accompanied by the involvement of ancillary muscles in the procedure of breathing. This can be seen if you pay attention to the child's ribs and abdomen: the intervals between the ribs are drawn inward, the stomach is strained, and the chest looks constantly filled with air. It seems that the baby breathed in the air, and can not exhale.

Dry cough, which eventually turns into a wet cough with sputum discharge, is the main sign of bronchitis. Its progression is indicated by the onset of respiratory failure, manifested by frequent and intermittent breathing, palpitations.

The development of obstructive bronchitis in young children directly depends on the provoker of the disease and the reactivity of the baby's bronchial system. There is obstruction in the form of a spasm of smooth muscles of the bronchi, edema of the mucous membrane and the release of thick mucus in large quantities.

And each of these processes is affected by their microorganisms. Some viruses affect the nerve nodes surrounding the bronchi, which leads to a loss of their tone and the appearance of a spasm. Others cause too much mucus secretion. And the attack of the third leads to mucosal edema, in which its lumen narrows. Usually a combination of these characteristics is observed, i.e., several types of bacteria enter the body at once, which leads to an increase in obstruction.

Most susceptible to the disease of obstructive bronchitis are children who suffer from allergies or who are overweight. These factors increase the propensity to spasm and reactive edema of the bronchi irrespective of the action of the microbes.

How to treat obstructive bronchitis?

The treatment process in the presence of obstructive bronchitis is quite heavy and long, it consists of various procedures. As soon as a diagnosis is made or a suspicion of the presence of this type of bronchitis appears, it is urgent to take measures to fight the disease, especially if the baby is several months old.

The first thing that needs to be done is to reduce the manifestations of bronchial obstruction and restore the patency of the organs.

First you need to try to calm the crumbs. Excitation and anxiety increase breathing problems and worsen the patency of the bronchi. For this, calming drugs are used on a natural basis in a dosage appropriate to the age of the baby.

Inhalations with special preparations should be carried out, since this is the most effective and effective method of arresting obstruction.

For babies you can use such devices as a nebulizer or an ultrasonic inhaler. Mixtures that are intended for inhalation should contain glucocorticoids and salbutamol. The method of inhalation is useful in that all medications are delivered by inhalation directly to the bronchi and the result is visible after a few minutes of the first procedure.

.

Obligatory are inhalations of moistened oxygen, which are carried out in parallel with other medical measures. If inhalations do not give the proper effect, the introduction of bronchodilators with the help of droppers is carried out. Obligatory this procedure is and in case of onset of intoxication of the organism, accompanied by dehydration.

General recommendations for the treatment of obstructive bronchitis

Obligatory measure - an appeal to a specialist. Self-medication in the case of young children is completely unacceptable. If the doctor discovers the danger of bronchitis switching to a heavier form or if the baby is fever, it must be hospitalized, because in small children the respiratory system does not function completely. As additional measures you can use abundant warm drink, antipyretic medicines, strict bed rest is required.

If there is no improvement within a week, an additional examination of the child will be required. Reception of antibiotics is extremely undesirable for the baby, but in severe cases, they can not be avoided. Appointment of their child alone or on the advice of friends can not be done by the attending physician who will determine the dosage of the drugs.

It is worth remembering that children under the age of one are prohibited from giving drugs containing codeine. It is possible to use folk methods of treating bronchitis, but they must be coordinated with a specialist and act as an auxiliary therapy.

.

To prevent the occurrence of bronchitis, you need to monitor the clothes of the child in the winter: do not strongly insulate the crumbs to avoid excessive sweating and overheating. But the hypothermia of the body, too, should not be tolerated, since it is an important factor contributing to the development of bronchitis. Walking should take place in places protected from excessive dust and gas contamination, that is, away from the carriageway, factories and manufacturing enterprises. The premises where the child lives and plays should be regularly ventilated and cleaned in them. It also shows the use of immunomodulating drugs that help to increase the body's defenses.

respiratoria.ru

Similar articles