Bronchitis is a chronic nonspecific inflammation of the trachea, bronchial mucosa and surrounding tissues. The main cause of bronchitis is the formation of chronic non-specific inflammation of the bronchi due to recurrent infection by viruses and bacteria. The disease is facilitated when the temperature drops, the small blood vessels in the respiratory tract spasm and ischemia, and the defense function decreases; chronic stimuli such as smoke and dust and polluted atmosphere can also develop; smoking causes bronchospasm, mucosal degeneration, reduced cilia movement, and increased mucus secretion favoring infection; allergic factors are also relevant.
Clinical manifestations
1.Acute bronchitis
Acute bronchitis often shows symptoms of upper respiratory tract infection at the beginning of the disease, and patients usually have clinical manifestations such as nasal congestion, runny nose, sore throat and hoarse voice. Systemic symptoms are milder, but low fever, chills, peripheral weakness, self-conscious itching in the throat, and irritating cough and pain behind the sternum may occur. In the early stage, the amount of sputum is not much, but the sputum is not easy to cough up, and the sputum may change from mucous to mucopurulent after 2 to 3 days. The cough can be aggravated or triggered by cold, inhalation of cold air or irritating gases. The patient’s cough is often more pronounced in the morning or at night. The cough may also be paroxysmal and sometimes persistent. The cough is often accompanied by nausea, vomiting and pain in the chest and abdominal muscles when it is severe. If bronchospasm is present, there may be croup and shortness of breath. In general, the course of acute bronchitis is somewhat self-limiting, with systemic symptoms subsiding within 4 to 5 days, but the cough can sometimes extend for several weeks.
Dry rales can sometimes be detected on examination and disappear after coughing; wet rales can occasionally be heard at the base of the lungs, and croup can be heard in the presence of bronchospasm. The white blood cell count is usually normal, and there are no abnormal findings on chest X-ray.
2.Chronic bronchitis
Chronic bronchitis is defined as chronic cough and sputum for more than three months per year and for two consecutive years after excluding various other causes of chronic cough. It is not necessarily accompanied by persistent airflow restriction.
(1) Long-term, recurrent and gradually worsening cough is the prominent manifestation of this disease. In mild cases, the onset is only in winter and spring, especially around waking up in the early morning, with less coughing during the day. In summer and autumn, the cough decreases or disappears. In severe cases, the cough is present in all seasons, intensifying in winter and spring, and is particularly intense in the morning and evening.
(2) Coughing sputum is generally white mucus foamy, more in the morning, and often not easy to get out due to stickiness. After infection or cold, the symptoms are rapidly aggravated, the sputum volume increases, the viscosity increases, or the sputum is yellow and purulent or accompanied by wheezing. Occasionally there is blood in the sputum due to severe cough.
(3) Asthma When combined with respiratory tract infection, asthma (wheezing) symptoms can be produced due to congestion and edema of the fine bronchial mucosa, sputum obstruction and narrowing of the bronchial lumen. Patients have wheezing sounds in the throat during breathing and croup on auscultation of the lungs.
(4) Repeated infections are likely to occur during the cold season or when there is a sudden change in temperature. At this time, the patient’s shortness of breath worsens, sputum volume increases significantly and is purulent, accompanied by general weakness, chills and fever. There are wet sounds in the lungs and an increase in blood white blood cell count. Repeated respiratory infections are particularly likely to worsen the condition of elderly patients and must be given due attention.
In the early stages of the disease, there are no specific signs. In most patients, a few wet or dry rales can be heard at the base of the lungs. Sometimes they may disappear temporarily after coughing or coughing up sputum. Signs of emphysema may be found in cases of long-term attacks.
The relationship between chronic bronchitis and chronic obstructive pulmonary disease (COPD), emphysema, and bronchial asthma: chronic bronchitis is closely related to COPD and emphysema, and the clinical diagnosis of COPD is not immediately available when the patient has symptoms such as cough and sputum. If a patient has only the clinical manifestations of “chronic bronchitis” and/or “emphysema” without persistent airflow limitation, the patient cannot be diagnosed with chronic obstructive pulmonary disease, and the patient can only be diagnosed with “chronic bronchitis “and/or “emphysema”. However, if the patient’s lung function suggests persistent airflow limitation, then the diagnosis is slow-onset lung. Some patients can have bronchial asthma along with chronic bronchitis and emphysema. For example, patients with bronchial asthma who are frequently exposed to irritants, such as smoking, may also develop cough and sputum, which is an important feature of chronic bronchitis. These patients may be diagnosed with “wheezing bronchitis”.
Examination
The diagnosis of acute bronchitis is based on history and clinical manifestations, with no abnormalities on x-ray or only darkened lung texture. In viral infections, the white blood cell count is not increased and the lymphocytes are relatively mildly increased. In bacterial infections, the total white blood cell count and neutrophil ratio are increased. Sputum smear or sputum culture, serological tests, etc. sometimes reveal the causative pathogen.
Differential diagnosis
A variety of acute infectious diseases such as tuberculosis, lung abscess, mycoplasma pneumonia, measles, pertussis, acute tonsillitis, etc., as well as postnasal drip syndrome, cough variant asthma, gastroesophageal reflux disease, interstitial lung disease, acute pulmonary embolism and lung cancer often have cough at the onset, similar to the cough symptoms of acute bronchitis, and therefore should be examined in depth and clinically need to be differentiated in detail.
The symptoms of influenza are quite similar to those of acute bronchitis, but it is not difficult to differentiate from the widespread epidemic of influenza, the acute onset of the disease, the obvious signs of systemic toxicity, high fever and generalized muscle pain, etc. Virus isolation and complement binding tests can confirm the diagnosis.
Treatment
1.Patients with systemic symptoms should pay attention to rest and keep warm
The purpose of treatment is to reduce the symptoms and improve the function of the body. Patients often need to supplement fluids and apply antipyretic drugs. Appropriate cough suppressants can be applied. Expectorants can be applied when the sputum volume is high or sticky.
2.Patients with acute bronchitis
There is no obvious therapeutic effect on antibacterial drugs, and abuse of antibacterial drugs should be avoided when treating patients with acute bronchitis. However, if the patient has fever, purulent sputum and severe cough, it is an indication for the application of antibacterial drugs. The application of antibacterial drugs for the treatment of patients with acute bronchitis can be applied against Chlamydia pneumoniae and Mycoplasma pneumoniae, such as erythromycin, but also clarithromycin or azithromycin. During influenza epidemic, anti-influenza treatment measures should be applied if there are manifestations of acute bronchitis.
3, chronic bronchitis acute exacerbation treatment
(1) Control the infection depending on the main causative organism and severity of the infection or select antibacterial drugs according to the results of drug sensitivity of the pathogenic bacteria. If the patient has purulent sputum, it is an indication for the application of antibacterial drugs. Mild cases can be taken orally, more serious patients with intramuscular or intravenous injection of antibacterial drugs. Commonly used are penicillin G, erythromycin, aminoglycosides, quinolones, cephalosporins and other antibacterial drugs.
(2) Expectorant and cough suppressants are applied to patients in the acute exacerbation period along with anti-infection treatment to improve symptoms. Commonly used drugs include ammonium chloride combination, bromhexine, aminoglutethimide, carboxymethylcysteine and potent dilute mucin. Chinese herbal medicines can also have certain effect in relieving cough. For elderly people who are weak and unable to cough up sputum or those who have more sputum, they should assist in sputum discharge and clear the airway. The application of cough suppressants should be avoided to avoid inhibiting the center and aggravating the obstruction of the respiratory tract and generating complications.
(3) Antispasmodic and wheezing drugs are often used, such as aminophylline and terbutaline orally, or short-acting bronchodilators such as salbutamol by inhalation. If airflow restriction persists, pulmonary function tests are required. If the diagnosis of chronic obstructive pulmonary disease is clear, use long-acting bronchodilator inhalation, or glucocorticoid plus long-acting bronchodilator inhalation if necessary.
(4) Nebulization therapy can dilute the secretions in the airways and facilitate sputum excretion. If the sputum is sticky and not easy to cough up, nebulized inhalation can help to a certain extent.
4, chronic bronchitis stable treatment
The actual fact is that you can find a lot of people who have been in the market for a long time. In a longer period of time (at least 1 year), it is important to have regular preventive treatment for colds, such as flu vaccine, or herbal medicine to prevent colds.