Chronic bronchitis – independent disease (proceeding with aggravations and remissions), characterized diffuse defeat of respiratory ways with excessive secretion of slime in a bronchial tree. As it is impossible to measure quantity of a bronchial secret precisely, the clinical criterion of disease – chronic or palindromic cough till 3 months throughout 2th years on end with allocation of a phlegm which can't be carried to other diseases now is accepted. The last means definition of a chronic bronchitis by process of elimination in connection with nonspecificity its clinical displays.
Principal cause of a chronic bronchitis is long influence on a mucous membrane of a bronchial tube of harmful impurity to inhaled air, first of all, a tobacco smoke. Essential value production factors (have a dust content and a gassed condition of workplaces), and also the general impurity of air pool. The big role in development of a chronic bronchitis is played by a pathology of LOR-BODIES, probably, being display of the general prevalence a respiratory path, and infringement of conditioning function of nasal breath.
The factors set forth above lead to reorganization of the mucous membrane consisting in a hypertrophy of mucous glands and increase of number producing tears of cages bronchial epithelium, gradually replacing the ciliary cages responsible for evacuation of slime and mechanical clarification of bronchial tubes from dust and microbic pollution. Simultaneously to slime hypersecretion there is an infringement physical and chemical (viscosity, elasticity) and antimicrobic properties (dyscrinia).
It conducts to stagnation of slime together with pollution containing in it, causes necessity of its evacuation by means of pathological process – cough and promotes secondary development of the intrabronchial infection which main activators are pneumotropic microorganisms – a streptococcus and haemophilus a stick. The intrabronchial infection usually flows with periodic aggravations, factors which there are adverse weather conditions, cooling, infection with a virus infection.
Infringement of protectively-cleaning functions of bronchial tubes and persistence in them infections define the raised probability of development in a pulmonary fabric of infectious processes (acute pneumonias, a destructive pneumonia) which at sick of a chronic bronchitis are observed several times more often, than at persons without a previous pathology of bronchial tubes, also are quite often characterized by the long and complicated current.
Division of a chronic bronchitis on obstructive and not obstructive is essentially important. In the diagnosis also reflect presence of mucopurulent inflammatory process. Distinguish 4 forms of a chronic bronchitis: simple, purulent, obstructive and is purulent-obstructive. Important characteristics of illness are its current (latent, with rare aggravations, with frequent aggravations, it is continuous relapsing) and a phase (an aggravation or remission). Last years under recommendations of the European respiratory society suggest to estimate severity level COPD or a chronic obstructive bronchitis depending on size FEV1 expressed in percentage of due size: easy FEV1 70%, average – in limits from 50–69% and heavy – FEV1 is less than 50%.
For a chronic bronchitis absence of the sharp beginning of disease and its slow progressing are characteristic. The first symptom of illness usually is morning cough which amplifies in a cold and crude season, weakens or completely stops in the summer. Further cough gradually accrues and it is marked the whole day long and at night. The quantity of a phlegm at a chronic bronchitis is insignificant. Aggravations of a chronic bronchitis are characterized as languid, shown by an indisposition, a disposition to sweating, especially at night, cough strengthening, a tachycardia, normal or subfebrile body temperature, occurrence or short wind strengthening.
Duration of an aggravation of a chronic bronchitis can make 3–4 weeks and more. Along with recurrent a current at a chronic bronchitis quite often long time is marked latent or little symptomatic a current, without the expressed aggravations. At a chronic obstructive bronchitis there are proof symptoms of chronic bronchial obstruction: – a short wind at physical activity; – strengthening of a short wind under the influence of nonspecific stimulus; – hoarse unproductive cough at which allocation of a small amount of a phlegm demands considerable efforts of the patient, but tussive the push turns out weak because of weakness of respiratory muscles and a collapse of respiratory ways at increase of intrachest pressure; – lengthening of a phase of an exhalation at the quiet and especially forced breath; – absent-minded dry rattles mainly high-pitch tones on an exhalation; – symptoms raised air fullness lungs.
Results of long-term supervision over patients have allowed to establish that the chronic obstructive bronchitis – slowly progressing disease beginning for many years before occurrence of clinical symptoms of respiratory insufficiency, and the forecast depends on rates of progressing of process. Principal causes of death sick of a chronic bronchitis are the sharp respiratory insufficiency arising against chronic infringements of breath, active inflammatory process in bronchopulmonary to system and insufficiency of blood circulation. Also there are instructions on thromboembolism a pulmonary artery and a spontaneous pheumothorax.
Special value at a chronic bronchitis is given causal to the treatment giving the greatest effect. All other kinds of therapy as a matter of fact are symptomatic. The smoking termination – a basis of the beginning of therapy. Already after some months after the smoking termination usually considerably decrease or completely cough and the phlegm allocation stop, however before the generated irreversible changes in respiratory ways and lungs don't disappear. Sanitation of the centers of an infection also has paramount value in connection with removal of places of a congestion of pathogenic microorganisms.
Thereupon huge value is given to appointment as the patient of antibacterial therapy. As the basic indications for prescription of antibiotics at a chronic bronchitis active bacterial inflammatory process serves in a bronchial tree. Optimum it is considered use of an antibiotic, specifically active concerning the significant infectious agent. Application of preparations of a wide spectrum of the action, suppressing normal microflora, promotes growth resistant gram microorganisms in a nasopharynx and to the further progressing of chronic inflammatory process. The way of introduction of a preparation (intake, parenteral introduction or in the form of an aerosol) is defined by weight of an aggravation and ability of an antibiotic to create high concentration in fabrics of bronchial tubes and in bronchial slime. The clinical result (instead of the data antibiotic program) is a basis for judgement about correctness of a choice of a preparation.
It is necessary to notice that at a chronic bronchitis effective antibacterial therapy can become the reason of deterioration of allocation of a phlegm as its decrease infection is accompanied by reduction mucolytic actions bacterial enzymes. As it was told above, the most frequent activators of infectious process in bronchial tubes are H. Influenzae and S. Aureus, the basic mechanism of which development of stability to antibiotics is production?-laktamaz a wide spectrum (to 10 % strains H. Influenzae and 70–80 % strains S. Aureus), accordingly the given microorganisms are capable to destroy natural and semisynthetic penicillin, cephalosporins I generations.
Therefore preparations of a choice for treatment of a bronchitis of the given etiology are protected aminopenicillins (for example, amoksitsillin/klavulanat) and cephalosporins II generations (cephalosporins III–IV generations and carbapenems have no advantages). The combination amoksitsillin/klavulanat (Pank lavas) provides high bactericidal activity of a preparation. The basic pharmacokinetic parameters amoxicillin and clavulanic acids are similar. After intake both components of a preparation are quickly absorbed from GIT. Simultaneous food intake doesn't influence absorption.
Cmax in blood plasma are reached approximately through 1 hour after reception. Both components in high concentration are found out in liquids and organism fabrics, including in a bronchial secret. The preparation is appointed inside to adults and children is more senior 12 years (or with weight of a body more than 40 kg) on 1 tablet 250 mg 3 times/days at a lung and moderate a current and on 2 tablet On 250 mg or 1 tablet On 500 mg 3 times/days In case of a heavy current of an infection the maximum daily dose clavulanic acids (in shape potassium salts) makes for adults of 600 mg, for children – 10 mg/kg of weight of a body. The maximum daily dose amoxicillin online makes for adults 6 g, for children – 45 mg/kg of weight of a body. The majority of preparations of group cephalosporins the second and third generation are entered parenterally and can be used at a heavy aggravation of a chronic bronchitis in the conditions of a hospital.
For therapy of not complicated forms of a chronic bronchitis the macroleads possessing ability to create high local concentration of a preparation in fabrics can be recommended and to get in cages, suppressing growth of obligate parasites which can cause aggravations of a chronic bronchitis. These preparations seldom cause allergic reactions and don't cooperate with theophylline.
Tetracyclines (in particular, doxycycline) keep value at a chronic bronchitis only as preparations second row. The majority fluoroquinolones poorly influence streptococci, but wide enough spectrum of action, especially at legionella, mycoplasma, chlamydia infections, ability to create high concentration in fabrics of bronchial tubes and bronchial slime does their claimed at patients with high risk of development of a dysbacteriosis and at the weakened patients.
Thus, enough big list of antibacterial preparations gives the chance to the doctor taking into account a condition of the patient, severity level of its disease, the microorganism which has caused pathological process, to make a correct choice of a preparation and a way of its introduction.
Cheer on the rules
