home > Planning > Presentation of acute and chronic bronchitis. Presentation on the topic “Chronic bronchitis. Symptoms and course of acute bronchitis


Presentation of acute and chronic bronchitis. Presentation on the topic “Chronic bronchitis. Symptoms and course of acute bronchitis




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Acute bronchitis Acute bronchitis (AB) is an inflammatory disease of the trachea and bronchi, which is characterized by an acute course and reversible diffuse lesions of the mucous membrane. AB is one of the most common respiratory diseases, which is more common in children and the elderly (more often men). This disease is more susceptible to people living in areas with a cold and humid climate, working in drafts, in damp cold rooms. OB is often combined with lesions of the upper respiratory tract (nasopharyngitis, laryngitis, tracheitis), or is observed in isolation.

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Etiology Causal factors: infectious (viruses, bacteria); physical (exposure to excessively hot or cold air); chemical (inhalation of vapors of acids, alkalis, poisonous gases); allergic (inhalation of plant pollen, organic dust).

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Contributing factors: acute infections of the upper respiratory tract; focal infections of the paranasal sinuses and tonsils; violation of nasal breathing; cooling; smoking; decrease in the reactivity of the body (after serious illnesses, operations, with hypovitaminosis, poor nutrition, etc.).

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Clinic The disease begins acutely. Sometimes symptoms of acute respiratory disease precede - runny nose, sore throat, hoarseness. The clinical picture of OB consists of symptoms of general intoxication and bronchial lesions. Symptoms of general intoxication: weakness, headache, pain in the muscles of the back and legs, aches, chills. The temperature may rise to subfebrile, sometimes high, or remain normal.

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Symptoms of bronchial lesions: dry, rough, painful, unproductive cough with a small amount of mucous sputum; after 1 - 3 days, the cough becomes wet, mucopurulent sputum is coughed up. Pain in the throat and trachea decreases, the temperature decreases, the general condition improves; shortness of breath is possible - a symptom of obstruction (impaired patency) of the bronchi;

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with percussion of the chest - no change (clear lung sound); during auscultation - hard breathing and dry rales, during the period of sputum liquefaction - moist rales of various sizes.

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Additional studies: X-ray picture of the lungs - no changes, sometimes the pulmonary pattern is enhanced and the roots of the lungs are expanded; KLA - neutrophilic leukocytosis, increased ESR.

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The prognosis is usually favorable - recovery after 2 to 3 weeks; In the absence of proper treatment, OB can acquire a protracted course (up to 1 month or longer) or become complicated.

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Complications bronchopneumonia, acute pulmonary heart failure (ALHF), chronic bronchitis.

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Treatment Treatment of OB is mainly symptomatic, usually outpatient, in severe cases - inpatient: bed rest at high temperature measures that eliminate bronchial irritation, facilitate breathing (airing the room, avoiding smoking, cooking, using odorous substances. plentiful warm drink (tea with raspberry , lemon, honey, lime blossom, milk with soda.

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When the temperature drops, the following are used: distractions for chest pains (mustard plasters, pepper plaster or warming compresses on the sternum and interscapular region, warm foot baths);

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phytotherapy of expectorant action: steam inhalation of decoctions of herbs (eucalyptus, St. John's wort, chamomile), essential oils(anise, eucalyptus, menthol); ingestion of herbal infusions of thermopsis, licorice root, marshmallow, plantain leaves, coltsfoot, thyme herb, anise fruit, eucalyptus tincture.

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Drug therapy includes: antitussive sedatives for dry painful cough (codeine, codterpin, sinekod, libexin, levopront); bronchodilators for broncho-obstructive syndrome (salbutamol, berotek in inhalations, eufillin tablets, broncholithin in the form of syrup, etc.); expectorants (Coldrex broncho, Doctor Mom, bronchipret, herbion primrose syrup, marshmallow syrup, etc.); mucolytics (fluditec, fluimucil, acetylcysteine, carbocysteine, mucodin; ambroxol, bromhexine, ambrobene, lazolvan, solvin, etc.); local antiseptics, anti-inflammatory and analgesic drugs with simultaneous damage to the nasopharynx (hexoral, strepsils, septolete, stopangin, iox, etc.); antipyretic drugs (analgin, acetylsalicylic acid, paracetamol, etc.);

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drugs of combined action are also used: bronchodilator and antitussive (broncholitin), expectorant and anti-inflammatory (plantain herbion syrup), expectorant and antitussive (codelac), antitussive, antiallergic and antipyretic (coldrex night) general tonic (vitamins, immunomodulators); antibacterial drugs (better taking into account the microbial spectrum) are used in the absence of the effect of symptomatic treatment, high fever, the appearance of purulent sputum, as well as in elderly and debilitated patients. The minimum duration of treatment is 5 - 7 days. The most commonly used antibiotics are: semi-synthetic penicillins (ampicillin, amoxicillin), macrolides (erythromycin, rovamycin, azithromycin), cephalosporins (cefaclor, cephalexin), tetracyclines (doxycycline) and sulfonamides: biseptol (bactrim), sulfalene, etc.

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The tactics of the FAP paramedic is the appointment of treatment and the issuance of a sick leave for 5 days; Zdravpunkt - recommendations for treatment, issuance of a certificate-exemption for 3 days, during which, if necessary, the patient must contact the local doctor; SMP - the provision of emergency care (antipyretics, bronchodilators) and a recommendation to call a local doctor.

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Prevention Hardening, prevention of SARS; Treatment of diseases of the upper respiratory tract, removal of polyps, treatment of deviated nasal septum; sanitary and hygienic measures - the fight against humidity, dust, smoke, smoking, etc.

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Chronic bronchitis Chronic bronchitis (CB) is a progressive diffuse lesion of the mucous membrane and deeper layers of the bronchi, caused by prolonged irritation of the bronchial tree by various harmful agents, manifested by cough, sputum, shortness of breath and impaired respiratory function. According to WHO recommendations, bronchitis can be considered chronic if it is accompanied by a persistent cough with sputum production for at least 3 months a year for 2 or more years. CB occurs mainly in people over 40 years old, in men 2-3 times more often than in women.

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Etiology In the etiology of chronic bronchitis, prolonged exposure to the bronchial mucosa of irritating factors is important, among which we can conditionally distinguish: exogenous: tobacco smoke; substances of industrial production origin; dust; climatic factors, cooling; infectious factors;

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endogenous: frequent SARS, untreated acute bronchitis, protracted bronchitis; focal URT infections; pathology of the nasopharynx, respiratory failure through the nose; hereditary violation of enzyme systems; metabolic disease. The main role in the occurrence of CB belongs to pollutants - various impurities contained in the inhaled air. The main cause of exacerbation of the disease is infection.

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Classification of CP The nature of the inflammatory process: simple (catarrhal), purulent, mucopurulent, special forms (hemorrhagic, fibrinous). Presence or absence of bronchial obstruction: non-obstructive, obstructive. The level of damage to the bronchial tree: with a primary lesion of large bronchi, with damage to small bronchi and bronchioles. Course: latent, with rare exacerbations, with frequent exacerbations, continuously relapsing.

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Phase: exacerbation, remission. Complications: pulmonary emphysema, diffuse pneumosclerosis, hemoptysis, respiratory failure (RD) (acute, chronic stage I, II, III), secondary pulmonary hypertension (transient, with or without circulatory failure).

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Diagnosis example: Chronic obstructive bronchitis, continuously relapsing course, exacerbation phase, pulmonary emphysema, diffuse pneumosclerosis. DN I - II.

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Clinic In the acute phase: patients report an increase in temperature to subfebrile, weakness, sweating, and other symptoms of general intoxication; there is an increase in cough, an increase in sputum, especially in the morning, a change in its nature (purulent) - with non-obstructive bronchitis; as the disease progresses and the small bronchi are involved in the process, a pronounced violation of bronchial patency (obstructive bronchitis) occurs with the development of shortness of breath up to suffocation. Cough unproductive "barking", sputum is excreted in a small amount; patients may complain of pain in the muscles of the chest and abdomen, which are associated with frequent coughing;

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auscultation - hard breathing, various dry and wet rales; in the blood - leukocytosis, increased ESR; in sputum - leukocytes, erythrocytes, epithelium. In remission phase: symptoms of bronchitis are absent or mild. But signs of pulmonary heart failure and emphysema (if any) persist

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Complications caused directly by infection: pneumonia; bronchiectasis; bronchospastic and asthmatic components; due to the progressive development of bronchitis: hemoptysis; emphysema; diffuse pneumosclerosis; pulmonary (respiratory) insufficiency, which leads to pulmonary hypertension, the formation of chronic cor pulmonale.

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Diagnosis A preliminary diagnosis of chronic bronchitis is made if the patient has: cough with sputum, possibly shortness of breath, hard breathing with prolonged expiration, scattered dry and wet rales, "cough history" (long-term smoking, nasopharyngeal pathology, occupational hazards, prolonged or recurrent course of OB and etc.). The diagnosis can be confirmed: signs of inflammation of the bronchi according to bronchoscopy, examination of sputum and bronchial contents, it is necessary to exclude other diseases with similar symptoms (pneumonia, tuberculosis, bronchiectasis, pneumoconiosis, lung cancer, etc.). In obstructive CB, unlike non-obstructive CB, the following are observed: signs of pulmonary emphysema on the radiograph; violation of bronchial patency in the study of the function of external respiration (data of spirography, peak flowmetry)

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Outpatient or inpatient treatment (depending on the severity of the patient's condition, the presence of complications, the effectiveness of previous treatment): exclusion of factors that contribute to the exacerbation of the disease; a diet with a high content of vitamins and protein, (restriction of salt, liquid); in the acute phase: antibiotic therapy antibiotics are prescribed as early as possible, more often administered parenterally in large doses, in severe cases - intratracheally (through a bronchoscope); expectorants, bronchodilators; distractions; in remission phase: FTL, exercise therapy, SKL.

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The tactics of the FAP paramedic is to refer the patient to the local therapist in case of exacerbation of chronic bronchitis. Health center - refer to a shop or district doctor to clarify the diagnosis and prescribe outpatient treatment, or resolve the issue of hospitalization according to indications. SMP - providing emergency care adequately to the symptoms: at high temperature - antipyretics, with hemoptysis - hemostatic, with shortness of breath - humidified oxygen, bronchodilators, etc. Depending on the patient's condition: either hospitalization in a therapeutic department, or a recommendation to call a local doctor.

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Recipes Rp.:Tab. Libexini 0.1 №20 D.S. 1-2 tablets 3-4 times a day. Rp.: Dragee Bromhexini 0.04 №20 D.S. 2 tablets 3 times a day, regardless of food intake. Rp.: Biseptoli 480 D.t.d. No. 20 in tabl. S. 2 tablets 2 times a day after meals. Rp.:Azithromycini 0.25 D.t.d. No. 6 in caps. S. 1 capsule 1 time per day 1 hour before meals or 2 hours after meals for 5 days.

Acute bronchitis Acute bronchitis (AB) is an inflammatory disease of the trachea and bronchi, which is characterized by an acute course and reversible diffuse lesions of the mucous membrane. AB is one of the most common respiratory diseases, which is more common in children and the elderly (more often men). This disease is more susceptible to people living in areas with a cold and humid climate, working in drafts, in damp cold rooms. OB is often combined with damage to the upper respiratory tract (rhinopharyngitis, laryngitis, tracheitis), or is observed in isolation. isolated.




Contributing factors: acute infections of the upper respiratory tract; focal infections of the paranasal sinuses and tonsils; violation of nasal breathing; cooling; smoking; decrease in the reactivity of the body (after serious illnesses, operations, with hypovitaminosis, poor nutrition, etc.).


Clinic The disease begins acutely. Sometimes symptoms of acute respiratory disease precede - runny nose, sore throat, hoarseness. The clinical picture of OB consists of symptoms of general intoxication and bronchial lesions. Symptoms of general intoxication: weakness, headache, pain in the muscles of the back and legs, aches, chills. The temperature may rise to subfebrile, sometimes high, or remain normal.


Symptoms of bronchial lesions: dry, rough, painful, unproductive cough with a small amount of mucous sputum; after 1 - 3 days, the cough becomes wet, mucopurulent sputum is coughed up. Pain in the throat and trachea decreases, the temperature decreases, the general condition improves; shortness of breath is possible - a symptom of obstruction (impaired patency) of the bronchi;










Treatment Treatment of OB is mainly symptomatic, usually outpatient, in severe cases - inpatient: bed rest at high temperature measures that eliminate bronchial irritation, facilitate breathing (airing the room, avoiding smoking, cooking, using odorous substances. plentiful warm drink (tea with raspberry , lemon, honey, lime blossom, milk with soda.


Phytotherapy with expectorant action: steam inhalation of herbal decoctions (eucalyptus, St. John's wort, chamomile), essential oils (anise, eucalyptus, menthol); ingestion of herbal infusions of thermopsis, licorice root, marshmallow, plantain leaves, coltsfoot, thyme herb, anise fruit, eucalyptus tincture.


Drug therapy includes: - antitussive sedatives for dry painful cough (codeine, codterpine, sinekod, libexin, levopront); – bronchodilators for broncho-obstructive syndrome (salbutamol, berotek in inhalations, eufillin tablets, broncholithin in the form of syrup, etc.); – expectorants (Coldrex broncho, Doctor Mom, bronchipret, herbion primrose syrup, marshmallow syrup, etc.); – mucolytics (fluditec, fluimucil, acetylcysteine, carbocysteine, mucodin; ambroxol, bromhexine, ambrobene, lazolvan, solvin, etc.); -local antiseptics, anti-inflammatory and analgesic drugs with simultaneous damage to the nasopharynx (hexoral, strepsils, septolete, stopangin, iox, etc.); – antipyretic drugs (analgin, acetylsalicylic acid, paracetamol, etc.);


– preparations of combined action are also used: bronchodilator and antitussive (broncholitin), expectorant and anti-inflammatory (psyllium herbion syrup), expectorant and antitussive (codelac) antitussive, antiallergic and antipyretic (coldrex night) – general tonic (vitamins, immunomodulators); -antibacterial drugs (better taking into account the microbial spectrum) are used in the absence of the effect of symptomatic treatment, high temperature, the appearance of purulent sputum, as well as in elderly and debilitated patients. The minimum duration of treatment is 5 - 7 days. The most commonly used antibiotics are: semi-synthetic penicillins (ampicillin, amoxicillin), macrolides (erythromycin, rovamycin, azithromycin), cephalosporins (cefaclor, cephalexin), tetracyclines (doxycycline) and sulfonamides: biseptol (bactrim), sulfalene, etc.



SOGBPOU "Vyazemsky Medical College named after E.O. Mukhina PM. 02. Participation in medical diagnostic and rehabilitation processes MDK. 02.01.01. Peculiarities of nursing care for children

Presentation on the topic:

"BRONCHITIS IN CHILDREN"

Completed by: student of group 31C Popova Ekaterina

Pediatrics teacher:

Myrinova S.N.

Vyazma, 2017


Bronchitis- this is an inflammatory disease of the bronchi of various etiologies (infectious, allergic, etc.), occurring without signs of damage to the lung tissue.

  • The incidence of bronchitis in childhood It is caused by an unformed respiratory and immune system.

TYPES OF BRONCHITIS

There are several classifications of bronchitis in children. Depending on the origin, this disease can be primary or secondary .

  • In the first case, the disease develops directly in the bronchial tree and does not penetrate deeper.
  • Secondary bronchitis in children already acts as a complication of some other pathology, such as influenza or acute respiratory infections. In this case, the spread of infection to the bronchi occurs from other parts of the respiratory system.

By the nature of the flow bronchitis in childhood is:

  • sharp - there is an increase in temperature, dry cough and shortness of breath, combined with general fatigue and weakness of the body.
  • chronic - characterized by an erased clinical picture with periodic exacerbations;
  • recurrent - the frequency of exacerbations is three or more relapses per year, with an average duration of one month.

By prevalence pathological process, bronchitis can be divided into:

  • limited - the inflammatory process does not extend beyond one segment of the lung.
  • common - inflammation covers two or more lobes of the bronchi;
  • diffuse - the pathological process extends to almost the entire area of ​​the child's bronchi.

  • In childhood, bronchitis of the catarrhal and catarrhal-purulent type is most often diagnosed.
  • If there is a narrowing of the airway lumen and signs of respiratory failure, we are talking about the so-called obstructive bronchitis.
  • In other cases, a simple form of the disease is diagnosed.

  • viral infections - the virus first enters the upper respiratory tract, and then penetrates further, provoking an inflammatory process on the bronchial mucosa;
  • bacterial infections - the pathogen can enter the respiratory tract along with any foreign object that the child puts in his mouth;
  • hypothermia ;
  • dustiness of the room ;
  • inhalation of chemical vapors ;
  • congenital respiratory system abnormalities child;
  • untreated viral and colds ;
  • weak immunity.

CLINICAL FEATURES OF BRONCHITIS

  • Dry cough, which gradually becomes wet with sputum.
  • Discomfort in the chest .
  • Increased sweating .
  • subfebrile temperature .
  • With tracheobronchitis - hoarseness

DIAGNOSTICS BRONCHITIS

  • bacteriological culture of sputum;
  • general and biochemical blood tests (moderate acceleration of ESR);
  • examination of smears from the larynx and nasopharynx;
  • determination of the functions of external respiration (a decrease by 15-20% of VC is noted);
  • x-ray examination of the lungs;
  • bronchography and bronchoscopy;
  • auscultation.

  • Compliance bed rest on the first day of illness. Staying in bed is recommended until the child feels well and his body temperature returns to normal.
  • Special diets with the use of light food with a predominance of dairy products, vegetables and fruits (milk-vegetarian diet). In the absence of appetite, the child should not be force-fed. It is also important to ensure plenty of fluids.
  • Antipyretics in an age dosage with an increase in body temperature above 38.5-39.0 ° C.
  • The drug of choice is paracetamol. A single dose of paracetamol is 10-15 mg/kg orally, 10-20 mg/kg suppositories. Amidopyrine, antipyrine, phenacetin are excluded from the list of used antipyretic drugs. Due to possible side effects, it is not recommended to use acetylsalicylic acid (aspirin) and metamizole sodium (analgin).
  • The drug of choice is paracetamol. A single dose of paracetamol is 10-15 mg/kg orally, 10-20 mg/kg suppositories.
  • Amidopyrine, antipyrine, phenacetin are excluded from the list of used antipyretic drugs.
  • Due to possible side effects, it is not recommended to use acetylsalicylic acid (aspirin) and metamizole sodium (analgin).
  • For bronchitis of a viral nature, the pediatrician may prescribe gargle medicinal or herbal solutions to reduce the inflammatory process.
  • Reception expectorants(thermopsis preparations, marshmallow, saline solutions) and mucolytic(cysteine, acetylcysteine, chymotrypsin, bromhexine, ambroxol) as prescribed by a doctor.

  • Antivirals, which should be started in the early stages of illness (Arbidol, Aflubin, Acyclovir, Viferon or Cycloferon).
  • Steam inhalation with alkaline solutions, including mineral ones.
  • Drainage and removal of sputum with therapeutic gymnastics, vibration massage, postural drainage.

  • organization of a good rest for the child;
  • providing the opportunity to consume a sufficient amount of drink;
  • provision of air conditioning in the premises;
  • conducting wellness massage sessions, including light chest massage;
  • increase the immunity of the child;
  • hygiene;
  • timely treatment of respiratory diseases.

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Acute bronchitis Acute inflammation of the bronchial mucosa with an increase in bronchial secretion, leading to sputum and coughing, and in case of damage to the small bronchi (bronchiolitis) to shortness of breath Has an infectious etiology, caused by a virus There are: 1. Catarrhal (acute) bronchitis 2. Purulent bronchitis

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Clinic: Dry cough, which gradually becomes soft with sputum. Discomfort in the chest. Subfebrile temperature. With tracheobronchitis - hoarseness. Percussion: The sound is not changed Auscultatory: Breathing is vesicular, if edema is pronounced, it is hard. In case of damage to large bronchi - dry rales, which, with progression, are replaced by wet In case of damage to medium and small bronchi - whistling rales Laboratory data: In case of bronchitis - Increased ESR, leukocytosis from 9000-12000 (if higher - pneumonia) most often Ampicillins, Macrolides) Treatment:

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Chronic bronchitis - Inflammation of the mucous membranes of the bronchial tree, due to prolonged irritation of the bronchi, various harmful agents, characterized by a violation of the secretion and draining function of the bronchi Etiology: Infectious factor (Streptococcus, Staphylococcus, Pneumococcus, Klebsiella, Mycoplasma) Hereditary factor activity Cellular metaplasia Sclerosis, ectasia, obliteration of the bronchus or deformation of the bronchus

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Symptoms: Severe weakness Cyanosis of the mucous membranes and skin Unproductive cough Mucopurulent sputum Swelling of the veins of the neck ('' with cor pulmonale'') On examination: Palpation: Voice trembling is not changed Percussion: (in the presence of emphysema) Box sound High standing of the apex of the lung Auscultatory: (with exacerbation) Harsh breathing Uniform dry rales Instrumental data: Decreased VC; X-ray: Net deformation of the lung pattern Treatment: Bronchodilators, Antispasmodics

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Pneumonia Community-acquired Nosocomial Aspiration Severity of pneumonia: Extremely severe Severe Moderate Mild Pneumonia phases: 1. Flare 2. Resolution 3. Reconvalescence Complications of pneumonia: Pulmonary Extrapulmonary (for example: pulmonary hemorrhage) Disease outcome: Recovery or death In HIV-infected people

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Croupous pneumonia Stages: 1. Hot flush stage (from 12 hours to 3 days) Increase in inflammatory edema in the lung tissue 2. Hepatization stage (from 2 days to 8 days) a) Red hepatization stage b) Gray hepatization stage 3. Resolution stage Resorption of inflammatory foci

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fever, chills, headache; From the second day - rust-colored sputum On examination: Hyperemia of the cheeks (corresponding to the side of the lesion) Cyanosis of the lips, earlobes, Swelling of the wings of the nose Lag in the act of breathing, the affected side of the chest Palpation: Voice trembling and bronchophony - enhanced Percussion: Art. High Tide - Dull Sound Art. Hepatization - Dull sound Art. resolution - dull with a transition to a clear pulmonary sound Auscultatory: Weakened vesicular breathing in the tide stage with a transition to hard and bronchial depending on morphological changes in the lung. Crepitus, dry and moist sonorous rales radiograph: ''infiltration of lung tissue'' Treatment: Antibacterial therapy (amoxiclav and macrolides)

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Bronchiectasis A chronic disease with recurrent purulent-inflammatory process in the bronchi with a transition to the peribronchial tissues, due to difficulty in exudate discharge from the pathologically dilated sections of the bronchi. Factors leading to the development of bronchiectasis. Genetic predisposition Immobility of the ciliated epithelium with a deficiency of α1-antitrypsin Bronchial tree defects Foreign bodies Infectious agents (Staphylococci, viruses, fungi, Kweiner rod)

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Classification (N. V. Putov, 1984)

Form of bronchial expansion: 1. Cylindrical. 2. Saccular. 3. Fusiform. 4. Mixed. Condition of the parenchyma of the affected lung: 1. Atelectatic. 2. Not associated with atelectasis. Clinical course (form): 1. Light. 2. Expressed. 3. Heavy. 4. Complicated. Phase. 1. Aggravation. 2. Remission. The prevalence of the process: 1. Unilateral. 2. Bilateral. With an indication of the exact localization of changes by segments.

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Clinic:

Main complaints: cough with discharge of purulent sputum of an unpleasant odor, especially in the morning ("full mouth"), as well as when taking a drainage position in an amount of 20-30 to several hundred milliliters; possible hemoptysis; general weakness; anorexia; increase in body temperature.

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Inspection

On examination: pallor of the skin and visible mucous membranes, with the development of DN - cyanosis, shortness of breath; thickening of the terminal phalanges ("drumsticks") and nails ("watch glasses"); lag of children in physical and sexual development.

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Physical data

Physical examination of the lungs: lag of lung mobility on the side of the lesion; auscultatory - hard breathing and dullness of percussion sound, coarse and medium bubbling rales over the lesion.

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Clinical forms

In mild form, patients experience 1-2 exacerbations during the year; during periods of long remissions, they feel practically healthy and quite efficient. With a pronounced form of exacerbation, they are more frequent and prolonged, 50-200 ml of sputum is secreted per day. Outside of exacerbation, patients continue to cough, separating 50-100 ml of sputum per day. Moderate disturbances of respiratory function are observed; load tolerance and performance are reduced.

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The severe form of bronchiectasis is characterized by frequent and prolonged exacerbations, accompanied by a noticeable temperature reaction. They produce more than 200 ml of sputum, often with a fetid odor. Remissions are short-term, observed only after long-term treatment. Patients remain able-bodied and during remissions. With a complicated form of bronchiectasis, various complications join the signs inherent in a severe form: cor pulmonale, pulmonary heart failure, focal nephritis, amyloidosis, etc.

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Laboratory data

OAK: signs of anemia, leukocytosis, shift of the leukocyte formula to the left and an increase in ESR (in the acute phase). Urinary OA: proteinuria. BAC: decrease in albumin content, increase in α2 and γ-globulins, as well as sialic acids, fibrin, seromucoid, haptoglobin in the acute phase. Sputum OA: purulent; when settling - two or three layers; in sputum there are many neutrophils, elastic fibers, erythrocytes can be found.

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Bronchography

Cylindrical bronchiectasis

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Diagnosis example

Bronchiectasis, severe course, in the acute phase; cylindrical bronchiectasis in the lower lobes of both lungs.

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Bronchial asthma

Chronically persistent inflammation of the airways, accompanied by a change in the sensitivity and reactivity of the bronchi, and manifested by asthma attacks 1. Exogenous (Atopic, Immunological) Asthma degree: 1. Intermittent asthma 2. Mild asthma 3. Moderate asthma 4. Severe asthma '' Asthma '' Nocturnal '' asthma Physical effort Cough variant of asthma

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Degree Clinic before treatment Display. lung function Intermittent Suffocation less than once a week, Short exacerbations; Night symptoms less than 2 times a month max. PSV; FEV 80% Daily Variability 20% Slight Choking from 1 time per week to 1 time per day; Exacerbations no more than 2 times a year; Nocturnal symptoms more than 2 times a month max. PSV; FEV 80% Moderate Asphyxia - daily Exacerbations 3 - 5 times a year; Possible ‘Status asthmatics’ ; Night symptoms. more than 1 time per week; PSV \u003d 60 -80%; FEV \u003d 60 -80%; Day. Variability 30% Severe Choking - persistent attacks; Frequent exacerbations; Possible ‘Status asthmatics ; Persistent nocturnal asthma; limited physical activity; PSV 60%; FEV 60%; Day. Variability 30%

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Factors leading to the development of bronchial asthma 1. Atopy - the body's tendency to increased production of immunoglobulin E in response to contact with allergens. 2. Heredity Causal factors: Household allergens: house dust, animal allergens, fungi. Medicines (Aspirin, etc.) Occupational allergens Factors contributing to the development of bronchial asthma: ARI; Air pollutants; External pollants; pollutants of premises; Smoking; Factors aggravating the course of bronchial asthma: allergens, physical activity, weather conditions, food additives

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At the heart of the pathogenesis: Change in the sensitivity and reactivity of the bronchi, leading to the onset of an asthma attack, due to bronchospasm. Cough, with bronchial asthma, can be paroxysmal in nature, not ending in suffocation - a cough variant of asthma. Attacks of suffocation may be preceded by aura (precursors): Nasal congestion; sneezing; Itching of the eyelids; itchy skin; Feeling of respiratory discomfort;

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1. Exogenous (Atopic, Immunological) bronchial asthma

Characteristic: Causally determined Elimination effect Spontaneous remission Tendency to allergic rhinitis Aspirin asthma (10% mortality, among asthmatics) Severe course as inoculated, Asthmatic triad: 1. Asthma 2. Polyposis 3. Aspirin asthma Important! Removal of polyps leads to an increase in M2B prostaglandins, which aggravates the course of B.A.

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2. Endogenous bronchial asthma

Associated with the presence of an infectious agent. The difference between bronchial asthma and obstructive bronchitis: Bronchial asthma is a reversible process (after taking bronchodilators, normal breathing is restored). Spirogram is carried out with bronchodilators Nocturnal asthma Caused by the presence of an allergen in the bedroom and an increase in parasympathetic tone. Nutritional (nutritive) asthma Characteristic: Presence of skin syndrome (urticaria, Quincke's edema, Atopic dermatitis)

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Asthma criteria: 1. Atopic syndrome 2. Combination with extrapulmonary symptoms of atopy 3. Burdened heredity 4. Daily and seasonal variability 5. Eosinophilia Features of obstructive disorders: Positive results of an allergological examination Detection of immunoglobulin E Spirography Peak flowmetry: Formula of daily variability: PSV in the evening - PSV in the morning * 100% = 20% 1/2 (PSV in the evening + PSV in the morning) If more than 20%, the development of bronchial asthma is likely.

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Having an asthmatic condition is a new condition compared to asthma attacks. At the same time, progressive respiratory failure is caused by obstruction of the airways with complete resistance to bronchodilators. 3 options for the course of an asthmatic state: 1. Slowly progressive (as a result of deep blockade of bronchial B2 receptors, under the influence of infection, allergens, steroid therapy, sympatholytics) 2. Anaphylactic state bronchospasm up to asphyxia. 3. Anaphylactoid state Develops in response to irritation of the respiratory tract by a mechanical, physical, chemical agent or a histamine-liberator

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Clinical stages of AS:

1. Stage of compensation: Frequent severe attacks of suffocation, against the background of constantly difficult breathing Non-productive cough Resistance to bronchodilators Tachypnea (up to 30 per minute) Tachycardia (up to 120 - 130 per minute) Hypertension (150-160 / 100-110) 2. Stage decompensation Painful suffocation No cough Tachypnea (up to 40 per minute) Tachycardia (up to 140 per minute) Hypertension (180/110) Silent lung syndrome 3. Hypoxic coma Loss of consciousness Cold diffuse cyanosis Decrease in breathing Decreased blood pressure Convulsions

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Principles of treatment:

1. Anti-inflammatory drugs 2. Basic drugs: Nedocrolit sodium 3. GCS 4. Symptomatic drugs: Selective B2-agonists of prolonged and short action 5. Long-acting and short-acting xanthines 6. Inhaled MCL

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emphysema

Pulmonary emphysema is a disease characterized by a pathological expansion of the air spaces located distal to the terminal bronchioles, and is accompanied by destructive changes in the alveolar walls.

slide 30

Classification of emphysema

By pathogenesis: 1. Primary (idiopathic). 2. Secondary (developing against the background of other lung diseases). By prevalence: 1. Diffuse. 2. Localized. According to morphological features: 1. Panacinar (panlobular) - with the defeat of the entire acinus. 2. Centrilobular (centriacinar) - with damage to the central part of the acinus (respiratory alveoli). 3. Periacinar (perilobular, paraseptal) - with damage to the periphery of the acinus. 4. Irregular (near scarring). 5. Bullous (with the presence of bulls).

Slide 31

Main pathogenetic mechanisms

a progressive decrease in the total functioning surface of the lung as a result of destruction of the interalveolar septa, which leads to a decrease in the diffusion capacity of the lungs and the development of respiratory failure; a change in the mechanical properties of the lung tissue, as a result of which small cartilaginous bronchi, devoid of elastic support, collapse during exhalation with the formation of a mechanism of secondary bronchial obstruction characteristic of emphysema. Large bullae compress and disrupt the ventilation of the still functioning lung tissue and thereby exacerbate respiratory disorders.

slide 32

Clinical symptoms

Shortness of breath, the severity of which reflects the degree of respiratory failure. Cough with mucous or mucopurulent sputum (in chronic bronchitis).

Slide 33

Inspection

expanded barrel-shaped chest, enlarged in the anterior-posterior size; shallow breathing and participation in breathing of auxiliary muscles; in men, a decrease in the distance between the thyroid cartilage and the handle of the sternum; expansion of intercostal spaces and epigastric angle (greater than 90°); The supraclavicular fossae are protruded and filled with dilated apices of the lungs. Patients exhale with closed lips, puffing out their cheeks ("puff"); with severe respiratory failure (DN) - cyanosis, puffiness of the face.

slide 34

Physical data

Percussion: descent of the lower border of the lungs and a decrease in the mobility of the lower pulmonary edge, boxed percussion sound; decrease in absolute dullness of the heart Auscultatory: weakening of vesicular respiration ("cotton breath"), deafness of heart tones.

The clinical picture of dry pleurisy is characterized by two main symptoms: pain in the side during breathing and pleural friction noise. Often there is a small dry cough (reflex).

Slide 38

The clinical picture of exudative pleurisy The temperature is high, remittent or constant, of the wrong type. Cough dry, Pain in the chest aggravated by deep breathing and coughing.

Slide 39

Inspection:

an increase in the volume of the corresponding half of the chest, more in the lower section; the intercostal spaces are smoothed out, and with very large exudates they even protrude somewhat. The diseased half of the chest lags behind during breathing, and in the case of extensive exudates, it does not participate in the act of breathing.

Slide 40

The configuration of dullness in exudative pleurisy. Damoiseau line. Rauchfus triangle

Slide 41

Department of Propaedeutics of Internal Diseases

Doctor of Medical Sciences, Professor Adamchik A.S.

Acute bronchitis:

Acute bronchitis (AB) is an inflammatory disease of the trachea and bronchi, which is characterized by an acute course and reversible diffuse lesions of the mucous membrane.

OB is one of the most common organ diseases

breathing, which is more common in children and the elderly (usually men).

This disease is more susceptible to people living in

areas with a cold and humid climate, working in drafts, in

damp cold rooms. OB is often combined with damage to the upper

respiratory tract (rhinopharyngitis, laryngitis, tracheitis), or there is

Etiology:

1. Infectious (viruses, bacteria);

2. physical (exposure to excessively hot or cold air);

3. chemical (inhalation of vapors of acids, alkalis, poisonous gases);

4. allergic (inhalation of plant pollen, organic dust).

Contributing factors:

1. Acute infections of the upper respiratory tract;

2. focal infections of the paranasal sinuses and tonsils;

3. violation of nasal breathing;

6. decrease in the reactivity of the body (after serious illnesses, operations,

with hypovitaminosis, irrational nutrition, etc.).

Clinic:

The disease begins acutely. Sometimes symptoms of acute respiratory disease precede - runny nose, sore throat, hoarseness. The clinical picture of OB consists of symptoms of general intoxication and bronchial lesions.

Symptoms of general intoxication:

weakness, headache, pain in the muscles of the back and legs, aches, chills. The temperature may rise to subfebrile, sometimes high, or remain normal.

Bronchial symptoms:

1. Dry, rough, painful, unproductive cough with a small amount of mucous sputum;

2. after 1-3 days, the cough becomes wet, mucopurulent coughs up

3. pain in the throat and trachea decreases, the temperature decreases, the general condition

is improving; 4. shortness of breath is possible - a symptom of obstruction (impaired patency) of the bronchi;

Physical data:

1. With percussion of the chest - no changes (clear pulmonary sound);

2. during auscultation - hard breathing and dry rales, during the period of sputum liquefaction - moist rales of various sizes.

Additional research:

1. X-ray picture of the lungs - unchanged, sometimes enhanced

pulmonary pattern and expanded roots of the lungs;

2. KLA - neutrophilic leukocytosis, increased ESR.

Forecast:

1. Usually favorable - recovery after 2 - 3 weeks;

2. in the absence of proper treatment, OB can acquire a protracted

course (up to 1 month or longer) or become complicated.

Treatment:

Treatment of OB is mainly symptomatic, usually outpatient, in severe

1. bed rest at high temperature;

2. measures that eliminate irritation of the bronchi, facilitate

breathing (airing the room, avoiding smoking, cooking,

use of odorous substances);

3. plentiful warm drink (tea with raspberry, lemon, honey, lime blossom,

Presentation on the topic: Bronchitis

Acute bronchitis Acute bronchitis (AB) is an inflammatory disease of the trachea and bronchi, which is characterized by an acute course and reversible diffuse lesions of the mucous membrane. AB is one of the most common respiratory diseases, which is more common in children and the elderly (more often men). This disease is more susceptible to people living in areas with a cold humid climate, working in drafts, in damp cold rooms.

Etiology Causal factors: infectious (viruses, bacteria); physical (exposure to excessively hot or cold air); chemical (inhalation of vapors of acids, alkalis, poisonous gases); allergic (inhalation of plant pollen, organic dust).

Contributing factors: acute infections of the upper respiratory tract; focal infections of the paranasal sinuses and tonsils; violation of nasal breathing; cooling; smoking; a decrease in the reactivity of the body (after serious illnesses, operations, with hypovitaminosis, poor nutrition, etc.).

Clinic The disease begins acutely. Sometimes symptoms of an acute respiratory disease precede - runny nose, sore throat, hoarseness. The clinical picture of AB consists of symptoms of general intoxication and bronchial lesions. Symptoms of general intoxication: weakness, headache, pain in the muscles of the back and legs, aches, chills. The temperature may rise to subfebrile, sometimes high, or remain normal.

Symptoms of bronchial lesions: dry, rough, painful, unproductive cough with a small amount of mucous sputum; after 1-3 days, the cough becomes wet, mucopurulent sputum is coughed up. The pain in the throat and trachea decreases, the temperature decreases, the general condition improves; shortness of breath is possible - a symptom of obstruction (impaired patency) of the bronchi;

on percussion of the chest - no change (clear pulmonary sound); on auscultation - hard breathing and dry rales, during the period of sputum liquefaction - wet rales of various sizes.

Additional studies: X-ray picture of the lungs - unchanged, sometimes the pulmonary pattern is enhanced and the roots of the lungs are expanded; KLA - neutrophilic leukocytosis, increased ESR.

The prognosis is usually favorable - recovery after 2-3 weeks; In the absence of proper treatment, OB can acquire a protracted course (up to 1 month or longer) or become complicated.

Complications: bronchopneumonia, acute pulmonary heart failure (ALHF), chronic bronchitis.

Treatment Treatment of OB is mainly symptomatic, usually outpatient, in severe cases - inpatient: bed rest at high temperature, activities that eliminate bronchial irritation, facilitate breathing (airing the room, avoiding smoking, cooking, using odorous substances. Abundant warm drink (tea with raspberries, lemon, honey, lime blossom, milk with soda.

With a decrease in temperature, the following are used: distractions for chest pains (mustard plasters, pepper plaster or warming compresses on the sternum and interscapular region, warm foot baths);

herbal medicine with expectorant action: steam inhalation of decoctions of herbs (eucalyptus, St. , tinctures of eucalyptus.

Drug therapy includes: antitussive sedatives for dry painful cough (codeine, codterpine, sinekod, libexin, levopront); bronchodilators for broncho-obstructive syndrome (salbutamol, berotek in inhalations, eufillin tablets, broncholithin in the form of syrup, etc.); expectorant drugs (Coldrex broncho, Dr. Mom, bronchipret, herbion primrose syrup, marshmallow syrup, etc.); local antiseptics, anti-inflammatory and analgesic drugs with simultaneous damage to the nasopharynx (geksoral, strepsils, septolet, stopangin, iox, etc.); antipyretic drugs (analgin, acetylsalicylic acid, paracetamol, etc.);

drugs of combined action are also used: bronchodilator and antitussive (broncholitin), expectorant and anti-inflammatory (herbion plantain syrup) expectorant and antitussive (codelac) antitussive, antiallergic and antipyretic (Coldrex night) general strengthening agents (vitamins, immunomodulators); antibacterial drugs (better taking into account microbial spectrum) are used in the absence of the effect of symptomatic treatment, high temperature, the appearance of purulent sputum, as well as in elderly and debilitated patients. The minimum duration of treatment is 5 - 7 days. The most commonly used antibiotics are: semi-synthetic penicillins (ampicillin, amoxicillin), macrolides (erythromycin, rovamycin, azithromycin), cephalosporins (cefaclor, cephalexin), tetracyclines (doxycycline) and sulfonamides: biseptol (bactrim), sulfalene, etc.

Tactics of the FAP paramedic - prescribing treatment and issuing a sick leave for 5 days; Health center - recommendations for treatment, issuing a certificate-exemption for 3 days, during which, if necessary, the patient should contact the local doctor; SMP - emergency care (antipyretic, bronchodilators) and a recommendation to call a local doctor.

Prevention Hardening, prevention of SARS; Treatment of URT diseases, removal of polyps, treatment of deviated nasal septum; sanitary and hygienic measures - combating moisture, dust, smoke, smoking, etc.

Chronic bronchitis Chronic bronchitis (CB) is a progressive diffuse lesion of the mucous membrane and deeper layers of the bronchi, caused by prolonged irritation of the bronchial tree by various harmful agents, manifested by cough, sputum, shortness of breath and impaired respiratory function. According to WHO recommendations, bronchitis can be considered chronic if accompanied by a persistent cough with sputum production for at least 3 months a year for 2 or more years. HB occurs mainly in people over 40 years old, in men 2-3 times more often than in women.

Etiology In the etiology of chronic bronchitis, prolonged exposure to the bronchial mucosa of irritating factors is important, among which one can conditionally distinguish: exogenous: tobacco smoke; substances of industrial origin; dust; climatic factors, cooling; infectious factors;

endogenous: frequent acute respiratory viral infections, untreated acute bronchitis, protracted bronchitis; focal infections of the upper respiratory tract; pathology of the nasopharynx, respiratory failure through the nose; hereditary violation of enzyme systems; metabolic disorders. The main role in the occurrence of chronic bronchitis belongs to pollutants - various impurities contained in the inhaled air. The main cause of exacerbation of the disease is infection.

Classification of chronic bronchitis The nature of the inflammatory process: simple (catarrhal), purulent, mucopurulent, special forms (hemorrhagic, fibrinous). Presence or absence of bronchial obstruction: non-obstructive, obstructive. The level of damage to the bronchial tree: with a predominant lesion of large bronchi, with lesions of small bronchi and bronchioles. Course: latent, with rare exacerbations, with frequent exacerbations, continuously relapsing.

Phase: exacerbation, remission. Complications: pulmonary emphysema, diffuse pneumosclerosis, hemoptysis, respiratory failure (DN) (acute, chronic stage I, II, III), secondary pulmonary hypertension (transient, with or without circulatory failure).

An example of the formulation of the diagnosis: Chronic obstructive bronchitis, continuously relapsing course, exacerbation phase, pulmonary emphysema, diffuse pneumosclerosis. DN I - II.

Clinic In the acute phase: patients note an increase in temperature to subfebrile, weakness, sweating, and other symptoms of general intoxication; as the disease progresses and the small bronchi are involved in the process, a pronounced violation of bronchial patency (obstructive bronchitis) occurs with the development of shortness of breath up to suffocation. Cough unproductive "barking", sputum is excreted in a small amount; patients may complain of pain in the muscles of the chest and abdomen, which are associated with frequent coughing;

on auscultation - hard breathing, various dry and moist rales; in the blood - leukocytosis, increased ESR; in sputum - leukocytes, erythrocytes, epithelium. In remission: symptoms of bronchitis are absent or mild. But signs of pulmonary heart failure and emphysema (if any) persist

Complications caused directly by the infection: pneumonia; bronchiectasis; bronchospastic and asthmatic components; due to the progressive development of bronchitis: hemoptysis; pulmonary emphysema; diffuse pneumosclerosis; pulmonary (respiratory) insufficiency, which leads to pulmonary hypertension, the formation of chronic cor pulmonale.

Diagnosis A preliminary diagnosis of chronic bronchitis is made if the patient has: cough with sputum, possibly shortness of breath, hard breathing with prolonged expiration, scattered dry and wet rales, "cough history" (long-term smoking, nasopharyngeal pathology, occupational hazards, prolonged or recurrent course of OB and etc.). The diagnosis can be confirmed: signs of inflammation of the bronchi according to bronchoscopy, sputum and bronchial contents, it is necessary to exclude other diseases with similar symptoms (pneumonia, tuberculosis, bronchiectasis, pneumoconiosis, lung cancer, etc.). In obstructive chronic bronchitis, unlike non-obstructive are observed: signs of emphysema on the radiograph; violation of bronchial patency in the study of the function of external respiration (data of spirography, peak flowmetry)

Outpatient or inpatient treatment (depending on the severity of the patient's condition, the presence of complications, the effectiveness of previous treatment): the exclusion of factors contributing to the exacerbation of the disease; a diet with a high content of vitamins and protein (restriction of salt, liquid); in the acute phase: antibacterial therapy antibiotics are prescribed as early as possible, more often administered parenterally in large doses, in severe cases - intratracheally (through a bronchoscope); expectorants, bronchodilators; distractions; in the remission phase: FTL, exercise therapy, SCL.

Clinical examination 1. Non-obstructive chronic bronchitis with exacerbations no more than 3 times a year without DN: examination by a therapist, KLA, sputum and sputum analysis for BC 2 times a year; examination by an ENT doctor and dentist once a year; ECG, bronchological examination according to indications; anti-relapse treatment 2 times a year: inhalations, vitamins, expectorants, FTL, exercise therapy, massage, hardening, sports, sanitation of foci of infection, SCL, smoking cessation, rational employment.

2. Non-obstructive chronic bronchitis with frequent exacerbations without DN: examinations by a therapist, OAC, spirography 3 times a year; fluorography, biochemical blood test 1 time per year, other studies as in the first group; anti-relapse treatment 2-3 times a year (as in the first group + immunocorrective therapy).

3. Obstructive chronic bronchitis with DN: medical examinations 3-6 times a year; other examinations as in the second group; anti-relapse treatment 3-4 times a year (as in the second group + bronchodilators, endobronchial sanitation)

The tactics of the FAP paramedic - in case of exacerbation of chronic bronchitis, refer the patient to a local therapist. Health center - refer to a shop or district doctor to clarify the diagnosis and prescribe outpatient treatment, or resolve the issue of hospitalization according to indications. , with hemoptysis - hemostatic, with shortness of breath - moistened oxygen, bronchodilator drugs, etc. Depending on the patient's condition: either hospitalization in a therapeutic department, or a recommendation to call a local doctor.

Prevention of bronchitis

Prevention of bronchitis. Long chronic colds should not be allowed, inflammatory diseases of the respiratory tract should be treated in a timely manner. Quit smoking and alcohol, of course. These habits weaken the body. Hypothermia, chronic and inflammatory diseases also contribute to bronchitis. To protect the body, it is imperative to take vitamins so that bronchitis no longer bothers.

slide 16 from the presentation "Diseases and injuries of the respiratory system". The size of the archive with the presentation is 611 KB.

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