- one of the most common pathologies of the lower respiratory tract. It is characterized by diffuse inflammation of the bronchi. The main symptom is cough. Differential diagnosis of bronchitis helps to separate this disease from other similar symptoms, and assign proper treatment.

The appearance of bronchitis contributes to various factors that can be divided into two groups: and the impact of the negative external environment per respiratory system.

The first group includes:

• respiratory viruses;
• pneumococci;
• pofaffer wand;
• less frequently - fibrousosis and alpha-1-antitripsey insufficiency.

The second group is:

• unfavorable living conditions;
• long inhalation of contaminated air (smoke, dust, allergens, harmful chemical compounds - gases, evaporation, fine dust).

Pre-providing factors:

• chronic inflammatory and purulent processes of the respiratory system;
• infectious pathologies of the upper respiratory tract;
• reducing the reactivity of the body;
• heredity;
• immunodeficiency states;
• smoking, alcohol abuse;
• children's and old age.

Symptomatic disease

Classifying types of bronchitis, usually divide them into two main groups: acute and. With each form, obstruction can occur - the violation of the bronchi passability.

It is considered the so-called childhood form of the disease. It occurs most often in children under 3 years old, due to the characteristics of the immature respiratory system. If an acute obstructive pathology is diagnosed in an adult, this is most likely indicative of the presence of another disease of the respiratory system (with similar symptoms).

Acute obstructive bronchitis is different:

• violation of the work of the fiscal epithelium and the development of the Qatar of the Upper Respiratory Departments;
• dry bake-up cough, especially at night or in the morning, lack or small amount of sputum;
• temperature below 38 degrees;
• breath;
• And noises that are heard even without special devices.

With frequently repeated sharp bronchitis, the disease can go to chronic staging, more characteristic of adults. Her signs:

• During the year, a total of at least 3 months;
• the wet is viscous and heavily departs, in the case of attaching a bacterial or viral infection It becomes purulent, with a greenish tinge;
• after the acute phase, remission usually occurs, during which the cough happens in the morning;
• difficulty breathing, a characteristic whistle is heard;
• dyspnea, especially during exercise, develops breathing failure.

Methods Survey at bronchitis

Differential diagnosis of bronchitis implies a comprehensive examination:

• study clinical signs - cough, weakness, temperature, discharge, muscle pain, fever, difficulty breathing, wheezing, etc.;
• laboratory testing of blood and;
• conducting bronchography and radiography, MRI, etc.

Bronchoscopy helps to significantly clarify the picture of the disease and put a differential diagnosis. With the help of it, you can visually assess the character inflammatory process (purulent, hemorrhagic, atrophic, etc.), as well as to produce the biopsy of the mucosa to refine the nature of the damage.

Bronchography and radiography allow us to identify pathological changes caused by a long flow chronic bronchitis. In this case, the defeat is localized most often in the small branches of the bronchial tree, and the picture of the "Dead tree" is clearly visible on the bronchogram. It is caused by the cliffs of middle-caliber bronchi and unfilled small branching.

Using radiographs, it is possible to detect the deformation and amplification of the pulmonary pattern by type, which often accompanies the emphysema of the lungs.

Bronchoscopy helps differentiate bronchitis from bronchial asthma. With the symptoms of the impairment of bronchial patency (during physical exertion or when the cold exit, the release of a small amount of sputum after a long cough attack, whistling sounds on exhalation) are used by bronchopholics and conduct a study before and after their use. If, after use, ventilation indicators and respiratory mechanics have improved, this indicates the presence and reversibility of violations of bronchial patency.

Differential diagnosis of pathology

Differential diagnosis of obstructive bronchitis due to the similarity of the clinical picture of this pathology with other respiratory diseases, such as bronchial asthma, Pneumonia and tuberculosis.

Differentiation from lung inflammation

The optimal method of differentiation of obstructive bronchitis from lung inflammation is x-ray. Often it is quite enough, and do not have to resort to additional laboratory diagnostics. If the picture of the disease is insufficiently clear on the X-ray, bronchoscopy, MRI and other studies are appointed.

Differential diagnosis of bronchitis from pneumonia looks like this:

• bronchitis - temperature below 38 degrees, dry cough, turning into a productive, painless, feverish condition - not more than 3 days;
• pneumonia - The temperature is above 38 degrees, a strong cough with an abundant highlight of sputum, fevering condition over 3 days.

In addition, pneumonia is distinguished by the sinusiness of the limbs and face trembling in the voice, shortening of the percussion sound, the presence of wheezing, crepitiation.

If, with pneumonia, radiography clearly determines the presence of characteristic features for this disease, it is not so easy to distinguish obstructive bronchitis from asthma. Both diseases of the respiratory system are diagnosed based on the signs that have appeared, and the complexity is to similar symptoms. The main diagnostic syndromes include:

• cough - when the bronchitis is a constant, overwhelming, with the release of sputum, during asthma - the bakery, the sputum is distinguished by little or there is no one;
• dyspnea - with bronchitis is constant, enhanced when driving, asthma is distinguished by the bakeful character of shortness of breath and the presence of remission;
• availability of allergies - with bronchitis, allergies, as a rule, is absent, and bronchial asthma is almost always accompanied by allergic signs;
• the use of broncholitikov - At bronchitis, it is used periodically, with asthma - constantly.

Differentiation from other respiratory pathologies

In addition to the above-sized pathologies, bronchitis must be differentiated from such respiratory diseases:

• tuberculosis of the lungs - Features: Enhanced sweating, fast fatigue, weakness, weight loss, the presence of koche sticks in sputum;
• cardiac or pulmonary failure;
• bronchiectatic disease - more often diagnosed in children, bronchoscopy shows local bronchitis, while chronic form Bronchitis is diffuse;
• blood vessel thromboembolia;
• some infectious diseases - Cort, Poklush, etc.;
• oncology is characterized by pain in the chest, weakness, lack of purulent sputum.

Acute bronchitis and inflammation of the lungs

Differential diagnosis acute bronchitis and extremely important on early stages Diseases. The earlier the diagnosis was made and prescribed treatment, the higher the likelihood of the early recovery of the patient. As a rule, in the case of pneumonia, antibacterial therapy is prescribed, and with acute bronchitis - antiviral and symptomatic.

The main method of differentiation of acute bronchitis and pneumonia is a laboratory test of blood. Special attention is paid to leukocyte indicators, serum C-reactive protein. With pneumonia, there is an increase in leukocytes by 3.7 times. If this characteristic sign It is absent, the probability of the presence of pneumonia is half decreased. In addition, the concentration of serum C-jet protein is higher than the 150 mg / l indicator also indicates the inflammation of the lungs.

Radiography is also carried out - usually the signs of an inflammatory process characteristic of pneumonia are clearly different in the picture.

The most obvious signs of inflammation of the lungs are voice trembling, the noise of friction of the pleura, dulling of the percussion sound and the egophony. The presence of them in symptoms in 99.5% indicates pneumonia. And when coughing and purulent wet, pneumonia is diagnosed only in 1 person out of 10.

conclusions

Bronchitis with his different forms and manifestations, has many common features with bronchial asthma, pneumonia, tuberculosis, oncological and other diseases of the respiratory system. Therefore, in the formulation of diagnosis, it is extremely important to learn all the available symptoms, to find out the genesis of the disease and carry out the necessary specific research to confirm or refutate other respiratory pathologies.

In case of a tendency to diseases of the bronchopulmonary system, it is necessary to pass fluorography annually. This is an excellent prophylactic method for preventing pathologies of the respiratory system.

Chronic (simple) bronchitis is a diffuse damage of the bronchial mucosa, due to the long-term irritation of the air pathways by volatile pollutants of a domestic and industrial nature and / or damage to viral-bacterial infection, characterized by the restructuring of the epithelial structures of the mucous membrane, the development of the inflammatory process, accompanied by the hypersection of mucus and disruption of the cleansing Bronchi functions. This is manifested by a constant or periodically arising cough with a wet branch (for more than 3 months a year for over 2 years), not related to other bronchopile processes or damage to other organs and systems. With a simple (unstructive) bronchitis amazed, mainly large (proximal) bronchi.

Epidemiology

The proportion of chronic bronchitis (HB) in the structure of diseases of the breathing organs of the Nuberculosis Nature among the urban population is 32.6% among adults. Prevails (in patients) chronic simple (unstructive) bronchitis. Studies made in various countries indicate a significant increase in HB for the last 15-20 years. The disease is striking the most able-bodied part of the population, forming aged 20-39 years. Chronic bronchitis more often sick men, smokers, physical workers at enterprises of industrial and agricultural production.

Etiology

In the emergence and development of chronic bronchitis, volatile pollutants and non-infinity dust are played with a significant role, which have a harmful irritant (mechanical and chemical) effect on the bronchi mucous membrane. In the first place among them, there should be inhalation of tobacco smoke during smoking or inhalation of the smoke of other smokers ("Passive smoking"). The smoking of cigarettes is most harmful, while the number of cigarettes smoked per day and the depth of inhalation into light tobacco smoke is. The latter reduces the natural resistance of the mucous membrane to volatile pollutants. The second place in etiological significance is occupied by volatile pollutants of industrial - industrial nature (products of incomplete combustion of coal, oil, natural gas, sulfur oxides, etc.). All of them in different extent are irritating or damaging effect on the mucous membrane of the bronchi. Pneumatic viruses and bacteria (influenza virus, adenoviruses, rhinosinecitic viruses, pneumococcus, hemophilic stick, Moraxella Catarlis, pneumonia's mycoplasma) most often cause aggravation of the disease. As predisposing to chronic bronchitis, factors should include the pathology of the nasopharynx with impaired breathing through the nose, when the functions of purification, humidification and heating of inhaled air are disturbed. Adverse climatic factors predispose to the exacerbations of the disease.

Pathogenesis

In the pathogenesis of the hB, the main role is played by the state of mukiciliary clearance of bronchi with a violation of the secretory, cleansing, protective functions of the mucous membrane and the state of the epithelial liner. In practical healthy man Clearance of bronchi, being an important component of the mechanisms of santogenesis, occurs continuously, as a result, the mucous membrane is cleaned of foreign particles, cellular daddy, microorganisms by transferring them to ciliates of focusing epithelium together with a more viscous surface layer of bronchial mucus from deep bronchial wood departments towards trachea and Large. In this cleansing, the mucous membranes are actively involved in other, in particular, cellular, elements of bronchial content (first and foremost, alveolar macrophages). The effectiveness of the Mukiciliary clearance of bronchi depends on the two main factors: a mucocyllary escalator determined by the function of the soliculous epithelium of the mucous membrane, and the rheological properties of the bronchial secret (its viscosity and elasticity), which is ensured by the optimal ratio of its two layers - "outdoor" (gel) and "internal" ( Zola). Pathogenic risk factors - volatile pollutants when they are constant and intense effects on the mucous membrane of the bronchi becomes etiological. This contributes to their combined impact, as well as a decrease in the local nonspecific resistance of the mucous membrane. Mechanical and chemical (toxic) action of pathogenic irritants on the bronchi mucosa leads to hyperfunction of secretory cells. The emerging hypercreene is initially protective in nature, it causes a decrease in the concentration of irritating mucosa of antigenic material by dilution by the increased volume of bronchial content, excites the protective cough reflex. However, along with hypercrinics, a change in the optimal ratio of sol and gel (discritory) inevitably takes place, the viscosity of the secret increases, which makes it difficult to eliminate it. As a result of the toxic influence of pollutants, it changes (slows down, becomes ineffective) the movement of the creation epithelium, i.e., the mucociliary escalator. Under these conditions, the influence of pathogenic irritants on a highly differentiated semicircle epithelium is enhanced, which leads to dystrophy and death of semicircle cells. A similar situation occurs and under action on the camcorder epithelium pathogenic respiratory viruses. As a result, the so-called mucous membranes are formed on the mucous membrane. « bald spots ", that is, plots free from the fiscal epithelium. In these places, the function of the mukiciliary escalator is interrupted, and the possibility of adhesion (adhesion) to damaged areas of the mucous membrane of conditionally pathogenic bacteria, first of all, high-type pneumococci and hemophilic sticks are appeared. With a relatively low virulence, these microbes are characterized by a pronounced sensitizing ability, thereby creating conditions for chronizing the emerging inflammatory process in bronchial mucosa (endobronchite). In the event of the latter, the cell composition of bronchial content changes: alveolar macrophages are inferior to neutrophilic leukocytes, and with allergic reactions, the number of eosinophils increases. The indicated change of "leaders" can be traced on a cytogram of sputum or bronchial wasches, which is diagnostic to characterize the clinical features of the endobronchite. Development against the background of "bald spots" of the mucous membrane of the bronchi foci of inflammation is usually a turning point in the deterioration of the familiar well-being of a smokers; The cough becomes less productive, symptoms of general intoxication and others appear, which is in most cases the reason to appeal to the doctor. With the current inflammatory process, the products of decay of neutrophilic leukocytes and alveolar macrophages, in particular, proteinase enzymes, change the ratio of proteinase and antiproteinase (inhibitory) activity, which can give an impetus to the destruction of the elastic island of alveol (the formation of centrcial emphysema). This is facilitated, apparently, genetically mediated and not sufficiently studied mechanisms of pathogenesis, which are characteristic of a hob patient.

Patomorphology

One of the main manifestations of the disease is changes in the mucus-forming cells of the bronchial glands and the epithelium of the bronchi. Changes in bronchial glands are reduced to their hypertrophy, and the bronchial epithelium is to an increase in the number of glass-shaped cells and, on the contrary, a decrease in the number of eyelash cells, the number of their veins, the appearance of individual sections of the epithelium flat-cell metaplasia. These changes occur mainly in large (proximal) bronchops. Inflammatory changes have a superficial character. Cellular infiltration of deeper layers of bronchi is poorly expressed and mainly represented by lymphoid cells. Weak or moderate signs of sclerosis are noted only in 1/3 patients.

Clinic HB

About simple (unstructive) HB should be said when the patient makes complaints on cough, the wet branch, shortness of breath and / or difficulty breathing are not characteristic ("bronchitis without shortness"), symptoms out of exacerbation do not violate the quality of life.

Exacerbationsdiseases are characterized by an increase in cough and an increase in the wet branch, most patients occur no more than two to three times a year. It is typical of their seasonality - marked during the off-season, that is, in early spring or late in the fall, when the differences of climatic factors are most pronounced. The exacerbation of the disease in the absolute majority of these patients arises against the background of the so-called cold, under which an episodic or epidemic (during the registered flu epidemic) is usually a viral infection, to which the bacterial (usually pneumococci and hemophilic wand) will soon join. The external reason for the exacerbation of the disease is hypothermia, close contact with coughing "influenza" patients and others. In the aggravation phase, the patient's well-being is determined by the ratio of two main syndromes: cash and intoxication. Degree of severity inxication The syndrome determines the severity of the exacerbation and is characterized by the symptoms of a general nature: an increase in body temperature, usually to subfebrile values, rarely - above 38 ° C, sweating, weakness, headache, reduced operation. Complaints and changes on the side of the upper respiratory tract (rhinitis, sore throat when swallowing, etc.) are determined by the peculiarities of viral infection and the presence of chronic nasophary disease (inflammation putty sinuses, compensated tonsillit and others), which during this period are usually sharpened. The main components kashlevoy Syndrome having diagnostic value are cough and sputum. At the beginning of the exacerbation, the cough may be unproductive ("Dry Qatar"), but more often accompanied by a sputum separation from several spitts to 100 g (rarely more) per day. When inspecting the wet is a water-bearing or mucosa with pus residences (with a catarial endobronchite) or purulent (with purulent endobronchite). The lightness of the wet wet when coughing is determined mainly with its elasticity and viscosity. With increased viscosity of sputum, as a rule, there is a long-lasting adsatory cough, extremely painful for the patient. In the early stages of the disease and with a weakly pronounced exacerbation, the sprinkling of sputum occurs usually in the morning (during washing), with a more pronounced exacerbation of the sputum can be separated during cough periodically throughout the day, often against the background of physical stress and breathing. The hemoplary in such patients is rare, to it, as a rule, predisposes the thinning of the bronchi mucosa, usually associated with professional hazards.

When examining the patient of visible deviations from the norm from the respiratory authorities may not be. With a physical study of the chest organs, the results of auscultation are of the greatest diagnostic value. For chronic simple (unstructive) bronchitis, tough breathing is characterized, which is usually listened to the entire surface of the lungs and dry scattered wheels. Their occurrence is associated with a violation of the drainage function of the bronchi. The timbre of wheezing is determined by the caliber of the affected bronchi. Buzzing wheezing low tone, increasing in coughing and forced breathing, are suspended with endobronchite with a lesion of large and medium bronchi; With a decrease in the lumen of the affected bronchi, wheezing become highly tonic. If there is a wet wipes, usually fine-pushed, their caliber also depends on the level of damage to the bronchial tree, can be heard in the bronchus of the liquid secrecy. The ventilation ability of the lungs in the unstructive bronchitis in the clinical remission phase can be maintained normal for decades. In the aggravation phase, the ventilation ability of the lungs can also remain in normal limits. In such cases, you can talk about functionally stable Bronchitis. However, part of patients, usually in the aggravation phase, join the phenomena of moderately pronounced bronchospasm, the clinical signs of which are the difficulty of breathing at exercise, transition to a cold room, at the time of a strong cough, sometimes at night, and dry high-tone wheels. The study of the respiration function during this period of time detects moderate obstructive violations of the lungs, i.e., the bronchospast syndrome takes place. This kind of patients can talk about functionally unstable bronchitis, Unlike COPD obstruction It is completely reversible after treatment. It is assumed that the transient bronchial obstruction is associated with a persistent viral infection (flu virus in, adeno and rhinosticitial virus). For progression or, on the contrary, the state of local immunological reactivity is important, the stabilization of the CNB is essential. In the aggravation phase, the level of secretory immunoglobulin A is usually reduced, the functionality of alveolar macrophages (AM) and the phagocytic activity of neutrophils in serum; Increases the level of interleukin - 2, the higher the pronounced activity of inflammation; Approximately half of the patients noted an increase in the level of circulating immune complexes (CEC) in the blood. These indicators are stored about half of the patients and in the remission phase, with duration of the disease under 5 years. This, apparently, is associated with the presence of pneumococcal and hemophilic sticks in the bronchial content of antigens, which are preserved there in the clinical remission phase. Changes from other organs and systems are either no, or reflect the severity of the exacerbation of the disease (intoxication, hypoxemia) and the concomitant pathology.

Diagnostics simple bronchitis is based on an assessment of the history of the patient, the presence of symptoms indicating the possible defeat of the bronchi (cough, sputum), the results of the physical study of the respiratory and exclusion of other diseases that can be characterized in many ways similar clinical symptoms (pulmonary tuberculosis, bronchiectasis, bronchi cancer).

Laboratory research.

Laboratory data data are used to diagnose hb exacerbation, clarify the degree of activity of the inflammatory process, the clinical form of bronchitis and differential diagnosis. Indicators of clinical analysis of blood and soe During the catarial endobronchite, it is rarely changed, more often - with purulent, when moderate leukocytosis and the leukocytaric formula shift appears to the left. ABOUTfrom trophazic biochemical tests( determination of the total protein and proteinogram, C-reactive protein, gaptoglobin, sialic acids and serum serum) . Have a diagnostic value in the sluggish inflammation.

Cytological study of sputum, and in its absence - the contents of the bronchi obtained at bronchoscopy, characterizes the degree of inflammation. So, for pronounced exacerbation of inflammation (3 degrees) neutrophilic leukocytes (97.4-85.6%) predominate in cytograms, in small amounts there are dystrophically changed cells of the bronchial epithelium and am; for moderately pronounced inflammation (2 degrees) along with neutrophilic leukocytes (75.7%) in the contents of the bronchi there is a significant amount of mucus, AM and the cells of the bronchial epithelium; with weakly pronounced inflammation (1 degree)the secret is predominantly mucous, the solid cells of the bronchial epithelium, neutrophils and macrophages are prevailed (52.3-37.5%, and 26.7-31.1%, respectively). A certain connection is revealed between the activity of inflammation and the physical properties of sputum (viscosity, elasticity). With purulent bronchitis in the aggravation phase, the content of acid mucopolysaccharides and deoxyribonucleic acid fibers and the content of lysozyme, lactoferrin and secretory Iga decreases. This reduces the resistance of the bronchial mucosa to the effects of infection.

Instrumental research.

Bronchoscopy.in chronic bronchitis is shown with diagnostic and / or medical goals. Endoscopic examination is required. With a resistant cough syndrome, expiratory collapse (discs) of trachea and large bronchi, manifested by an increase in respiratory mobility and expiratory narrowing of respiratory tract, is often detected. Dyskinesia trachea and main bronchi II-III degree has an adverse effect on the flow of inflammatory process in bronchi, disrupts the efficiency of sprinkling sputum, predisposes to the development of purulent inflammation, causes the emergence of obstructive violations of the lungs. With purulent endobronchite, the bronchial tree is carried out.

Radiography

With a radiological study chest In patients with simple bronchitis there are no changes in the lungs. With purulent bronchitis after therapeutic and diagnostic bronchoscopy and course of the Bronchial Tree Sanations, a computed tomography is shown, which allows diagnosing bronchiectases and determine the further medicinal tactics.

Differential diagnosis

Acute bronchitis

Simple (unstructive) bronchitis should be distinguished from acute protracted and recurrentbronchitis. For the first characteristic: the presence of a protracted (more than 2 weeks) of the flow of a sharply occurred colds, for the second - repeated short episodes of it three or more than a year. Bronchiectase Characterized by a cough from childhood after transferred "epithelotropic" infections (measles, cough, etc.), the discharge of purulent sputum "full mouth", there is a link to the discharge of sputum with the position of the body, with bronchoscopy, the local purulent (mucous-purulent) endobronchite is revealed, with CT Light and bronchography revealed bronchiectases.

Mukobovysidosis

Mukobovysidosis It is a genetically deterministic disease for which the appearance of symptoms in childhood, the defeat of the exocrine glands with the presence of purulent bronchitis, violation of the secreter function of the pancreas, the diagnostic marker is the increased Na content in the sweat fluid (40 mmol / l.).

Tuberculosis of respiratory organs

For tuberculosis signs of intoxication, night sweats, micookoline tuberculosis in sputum and washing waters of bronchi, with bronchoscopy, the local endobronchite with scars, fistulas with positive serological reactions to tuberculosis, positive results from the use of tuberculostatic preparations are revealed (THERAPIA EX JUVANTIBUS).

Lung cancer

Central Cancermore often occurs in men after 40 years, malicious smokers; Challenges are characteristic, blood streaks and "atypical" cells in sputum, characteristic results of bronchoscopy and biopsy.

Tracheobronchial dyskinesia

Tracheobronchial dyskinesia (expiratory collapse of trachea and large bronchi) It is characterized by an adsadd cough cough, with bronchoscopy, the prolapse of the membrane part of the trachea is revealed to the lumen various degrees severity.

Bronchial asthma

With functionally unstable bronchitis with bronchospast syndrome, it is necessary to carry out a differential diagnosis with b ronchial asthmafor which the young age is characterized, the presence of an allergy in history or respiratory infection in the debut of the disease, an increase in the number of eosinophils in sputum and blood (\u003e 5%), the parietal difficulty of breathing or the occurrence of cough, both in the afternoon and especially during sleep, mainly high-tone scattered dry Wheems, therapeutic effect of bronchussessing drugs (mainly  2 -agonists).

Classification

By pathogenesis:

primary bronchitis - as an independent nosological form;

secondary bronchitis - as a result of other diseases and pathological conditions (tuberculosis, bronchiectase, uremia, etc.).

According to the functional characteristic (shortness of breath, spirometrical indicators of FEV 1, FEZ, FEV 1 / Fire):

unstructive (simple) chronic bronchitis (hnb): Dyspnea is absent, spirometrical indicators - FEV 1, FEZ, FEV 1 / Fan are not changed;

obstructive:expuratory shortness of breath and change in spirometrical indicators (decrease in FEV 1, FEV 1 / FER) during the exacerbation period.

On clinical and laboratory characteristics (the nature of the sputum, the cytological picture of bronchial wasches, the degree of neutrophilosis in peripheral blood and sharp-phase biochemical reactions):

catarler;

mucoby-purulent.

In the phase of the disease:

aggravation;

clinical remission.

According to bond complications of the obstruction of the bronchi:

chronic lonantic Heart;

respiratory (pulmonary) failure, heart failure.

Treatment

In the area of \u200b\u200bexacerbation of the disease, with increasing body temperature, patients are subject to exemption from work. With pronounced intoxication, obstructive syndrome, in the presence of severe concomitant diseases, especially in senior patients, hospitalization is advisable. Smoking tobacco is categorically prohibited.

Given the greatest role of respiratory viral infection in the exacerbation of the disease, all sorts of measures are carried out to accelerate the removal of antigenic material (toxins) from the body. Reasonable drinking warm liquid: hot tea with lemon, honey, raspberry jam, tea from linden color, from dry raspberries, heated alkaline mineral waters - canteens and medicinal (bors, Smirnovskaya et al.); Official "sweat" and "breast" fees of medicinal herbs. Useful steam ("not deep") indifferent inhalations. Amxin, Inhavirin, Relza, Arbidol, Interferon, or Interferon in the form of nasal drops of 2-3 drops in each nasal stroke with an interval of 3 hours or in the form of a 0.5 ml of 0.5 ml, or in the form of inhalations of 0.5 ml, is prescribed from antivony days; Anti-hygospose -globulin (with influenza and other respiratory viral infections), anticorrosive -globulin (with adenine and PC infections). All gamma globulins are introduced intramuscularly at 2-3 doses, daily or every other day, usually 6 injections depending on the state of the patient. Perhaps one-day local application of immunoglobulins (instillation in the nose) with an interval of 3 hours. Among other antiviral drugs, it is advisable to appoint Chigain (current start - secretory IGA) 3 drops in each nasal stroke 3 times a day. If there are manifestations of allergies and increasing levels of eosinophils in sputum and blood (\u003e 5%), the purpose of antihistamine preparations, ascorbic acid is shown. These measures, as a rule, reduce the symptoms of intoxication, improve overall health. With an increase in the degree of mochemnosis (change in the color of the sputum in yellow, green), the presence of neutrophilic leukocytosis in peripheral blood, preserving the symptoms of intoxication shows the purpose of antibiotics (natural and semi-synthetic penicillins, macrolides or tetracyclines), dioxidine in inhalations (1% -10 ml ). These chemotherapy products are applied under the control of clinical symptoms usually no longer than 2 weeks. For cleansing the bronchi from an excess viscous secret, an expectorant means should be prescribed inside or in inhalations: 3% rr iodide potassium (on milk, after meals), infusions and champs of thermopsis, altea, thoracic herbs and composed on their basis mixtures, Warm up to 10 times a day, ambroxol, bromgexine, acetylcysteine. The purification of the bronchi largely depends on the degree of hydration of bronchial content, this contributes to the inhalation of warm sodium bicarbonate or hypertonic solution. With functionally unstable bronchitis and bronchospast syndrome in a complex of drug therapy, short-range  2 -Gonists (Berothek and its analogs), cholinolics (atrownt) or their combination (Berodal) should be included.

Under the election of signs of the activity of the inflammatory process, the inhalation of garlic or onion juice, which prepare ex temporae on the day of inhalation, can be used, are mixed with a 0.25% novocaine solution in proportions 1: 3; Using up to 1.5 ml of solution on one inhalation twice a day, only 9-15 procedures. The above treatment is combined with the use of vitamins C, A, group B, biostimulants (aloe juice, propolis, licorice root, sea buckthorn oil, pregoiosis, etc.), methods of therapeutic physical education and physical methods of regenerative treatment. With purulent endobronchite, such treatment should be supplemented with a bronchial tree sanations. The duration of the course of treatment depends on the speed of eliminating the purulent secret in the bronchial tree. For this, it is usually enough 2-4 herapeutic bronchoscopy at intervals of 3-7 days. If clinically, during re-bronchoscopy, a clear positive dynamics of the inflammatory process in bronchops is revealed, the course of the sanations is already completed with the help of endotracheal injections or aerosol inhalations with iodinol and other means of symptomatic action.

Prevention

Primary prevention includes the fight against the harmful habit of smoking tobacco, rehabilitation of the external environment, prohibition of work in a polluted (dusty or tanned) atmosphere, organism hardening measures, treatment of foci of infection in the nasopharynk, establishing normal respiration through the nose. To prevent the exacerbations of a simple hb, it is recommended to exclude the fact of active and passive smoking, carry out charming (aqueous) procedures and methods of rehabilitation leaf, increasing nonspecific resistance and tolerance to physical exertion, rational employment. In periods of off-season, adaptogens (Eleutherokok, Chinese Lemongrass, etc.), as well as antioxidants (vitamin C, rutin, etc.) should be recommended. During the remission of the inflammatory process, it is necessary to radically sanitize the foci in the nasopharynk, oral cavity, correct the defects of the nasal partition, which make breathing through the nose. For the prevention of the expected exacerbation of the disease in the period of the impending flu epidemic, flu vaccinations can be carried out; To prevent exacerbation in the most dangerous period of the year (late autumn), a pneumococcal or combined vaccine vaccination is possible. Preventive use of antibiotics is not appropriate.

With functionally unstable chronic bronchitis, annual spirographic control should be carried out. For the purposes of reducing treatment and rehabilitation of these patients, it is necessary to more widely use the possibilities of sanatorium-resort treatment on climatic resorts. In patients after 50 years and with multiple pathology from other bodies and systems, preference should be given to local sanatoriums.

Forecast

The forecast for chronic bronchitis is favorable. Usually hb does not cause a resistant reduction in the function of the lungs. However, the relationship between the hypersection of mucus and the decrease in the FEV1 was revealed, and it was also established that young smoking people have chronic bronchitis increases probabolism of COPD.

- This is a diffuse progressive inflammatory process in bronchi, leading to the morphological restructuring of the bronchial wall and peribroscial tissue. The exacerbations of chronic bronchitis occur several times a year and flow with cough enhancement, the release of purulent sputum, shortness of breath, bronchial obstruction, subfebilitation. The examination in chronic bronchitis includes the carrying radiography of light, bronchoscopy, microscopic and bacteriological analysis of sputum, FVD, etc. In the treatment of chronic bronchitis combine drug therapy (antibiotics, muscolics, bronchophyters, immunomodulators), sanitation bronchoscopy, oxygen therapy, physiotherapy (inhalation, massage, respiratory Gymnastics, medicinal electrophoresis, etc.).

MKB-10.

J41 J42.

General

The incidence of chronic bronchitis among the adult population is 3-10%. Chronic bronchitis is 2-3 times more often in men aged 40. About chronic bronchitis in modern pulmonology speak if over the course of two years there are exacerbations of the disease with a duration of at least 3 months, which are accompanied by a productive cough with sputum release. With a long-term course of chronic bronchitis, the likelihood of such diseases such as COPD, pneumosclerosis, lung emphysema, pulmonary heart, bronchial asthma, bronchiectatic disease, lung cancer are significantly increasing. In chronic bronchitis, the inflammatory lesion of the bronchi is diffuse and over time leads to structural changes in the wall of the bronchus with the development of peribronchite around it.

The reasons

In a number of reasons causing the development of chronic bronchitis, the leading role belongs to the long-term inhalation of the portable - various chemical impurities contained in the air (tobacco smoke, dust, exhaust gases, toxic vapors, etc.). Toxic agents have an irritant effect on the mucous membrane, causing the restructuring of the secretory apparatus of bronchi, the hypersection of mucus, inflammatory and sclerotic changes of the bronchial wall. Quite often, chronic bronchitis is transformed in a non-time or not to the end of healing acute bronchitis.

The mechanism of the development of chronic bronchitis is based on the damage to the various links of the local bronchopulmonal protection system: mucocyllure clearance, local cell and humoral immunity (the drainage function of the bronchi is disturbed; the activity of the interferon, lysozyme, Iga, the pulmonary surfactant is reduced; the phagocytic activity of alveolar macrophages is deproed and neutrophils).

This leads to the development of the classical pathological triad: hypercreene (hyperfunction of the bronchial glands with the formation of a large amount of mucus), discrimination (increasing the viscosity of sputum due to changes in its rheological and physicochemical properties), mucostase (stagnation of thick viscous sputum in bronchi). These violations contribute to the colonization of the mucous membranes infectious agents and further damage to the bronchial wall.

The endoscopic pattern of chronic bronchitis in the aggravation phase is characterized by hyperemia of mucous membranes, the presence of a mucous-purulent or purulent secret in the lumen of the bronchial tree, in the later stages - atrophy of the mucous membrane, sclerotic changes in the deep layers of the bronchial wall.

Against the background of inflammatory edema and infiltration, hypotonic dyskinesia of large and collapse of small bronchi, the hyperplastic changes of the bronchial wall are easily joined by bronchial obstruction, which supports respiratory hypoxia and contributes to the increase in respiratory failure during chronic bronchitis.

Classification

The clinical and functional classification of chronic bronchitis distinguishes the following forms of the disease:

1. By the nature of the changes: catarrhal (simple), purulent, hemorrhagic, fibrinous, atrophic.
2. By level of lesion: proximal (with predominant inflammation of large bronchi) and distal (with preemptive inflammation of small bronchi).
3. According to the presence of a bronchospast component: unstructive and obstructive bronchitis.
4. For clinical flow: chronic bronchitis of latent flow; with frequent exacerbations; with rare exacerbations; Continuously recurrent.
5. According to the phase of the process: remission and aggravation.
6. According to the presence of complications: chronic bronchitis, complicated emphysemic lungs, hemoplange, respiratory failure of varying degrees, chronic pulmonary heart (compensated or decompensated).

Symptoms of chronic bronchitis

Chronic unstructive bronchitis is characterized by a cough with a mystery-purulent sputum. The number of flaky bronchial secretions outside the exacerbation reaches 100-150 ml per day. In the phase of exacerbation of chronic bronchitis, cough is enhanced, the sputum acquires a purulent nature, its number increases; Subfebrile, sweating, weakness are joined.

With the development of bronchial obstruction to the main clinical manifestations, expiratory shortness of breath is added, the swelling of the neck of the neck on exhalation, whistling wheezes, a collow-like sloping cough. Perennial flow of chronic bronchitis leads to the thickening of the end phalange and nails of the fingers ("drumsticks" and "hour glass").

The severity of respiratory failure in chronic bronchitis can vary from minor shortness of breath to severe ventilation violations that require intensive therapy and IVL. Against the background of the exacerbation of chronic bronchitis, the decompensation of concomitant diseases can be noted: IBS, diabetes, dyscirculatory encephalopathy, etc. The criteria for gravity of the exacerbation of chronic bronchitis are the severity of the obstructive component, respiratory failure, decompensation of concomitant pathology.

In the catarial uncomplicated chronic bronchitis of exacerbations, there are up to 4 times a year, the bronchial obstruction is not expressed (OFV1\u003e 50% of the norm). Frequent exacerbations occur during obstructive chronic bronchitis; They are manifested by an increase in the amount of sputum and changes in its nature, significant impaired bronchial patency (FEV1 purulent bronchitis proceeds with constant highlighting of sputum, decreased OFV1

Diagnostics

In the diagnosis of chronic bronchitis, it is essential to clarify the anamnesis of disease and life (complaints, seniorship of smoking, professional and domestic hazards). Auscultative signs of chronic bronchitis are hard breathing, elongated exhalation, dry wheezes (whistling, buzzing), wet solubyliber wheezes. When the emphysema of the lungs is determined by the box percussion sound.

Verification of the diagnosis contributes to the conduct of lung radiography. The x-ray picture in chronic bronchitis is characterized by a mesh deformation and an increase in the pulmonary pattern, in a third of patients - signs of lung emphysema. Radiation diagnosis makes it possible to exclude pneumonia, tuberculosis and lung cancer.

Microscopic sputum examination reveals its increased viscosity, sulphous or yellowish-green, mucous-purulent or purulent character, a large amount of neutrophilic leukocytes. Bacteriological sowing sputum allows you to identify microbial pathogens (Streptococcus Pneumoniae, Staphylococcus aureus, Haemophilus influenzae., Moraxella Catarrhalis, Klebsiella Pneumoniae, Pseudomonas SPP., Enterobacteriaceae, etc.). With the difficulties of collecting sputum, it is shown to conduct a bronchoalveolar lava and bacteriological studies of the washing waters of the bronchi.

The degree of activity and the nature of inflammation in chronic bronchitis is specified in the process of diagnostic bronchoscopy. With the help of bronchography, architectonics of the bronchial tree is estimated, the presence of bronchiectasis is excluded.

The severity of disorders of the function of external respiration is determined when conducting spirometry. A spirogram in patients with chronic bronchitis demonstrates a decline in varying degrees, an increase in mod; With bronchial obstruction - reducing FZHL and MVL indicators. With pneumotographics, there is a decrease in the maximum volumetric rate of exhalation.

From laboratory tests in chronic bronchitis are held general analysis urine and blood; Determination of general protein, protein fractions, fibrin, sialic acids, CRH, immunoglobulins, etc. indicators. With pronounced breathing insufficiency, Kos and gas composition blood.

Treatment of chronic bronchitis

The aggravation of chronic bronchitis is treated in stationary, under the control of a pulmonologist. In this case, the basic principles of treatment of acute bronchitis are observed. It is important to exclude contact with toxic factors (tobacco smoke, harmful substances etc.).

Pharmacotherapy of chronic bronchitis includes the appointment of antimicrobial, musolitic, armored, immunomodulatory drugs. For antibacterial therapy Penicillins, macrolides, cephalosporins, fluoroquinolones, tetracycles inside, parenterally or endobronchial are used. With a difficult viscous sputum, mercolytic and expectorant (ambroxol, acetylcysteine, etc.) are used. In order to relieve bronchospasm during chronic bronchitis, Broncholitics (Eutillin, Teofillin, Salbutamol) are shown. Reception of immunoregulating agents (levamizol, methyluracil, etc.).

With severe chronic bronchitis, medical (sanational) bronchoscopy, bronchoalveolar lavage can be carried out. To restore the drainage function of the bronchi, the methods of auxiliary therapy are used: alkaline and pulmonary hypertension. Preventive work on the prevention of chronic bronchitis is to promote the abandonment of smoking, eliminating adverse chemical and physical factors, treatment of concomitant pathology, improving immunity, timely and complete treatment acute bronchitis.

Chronic bronchitis - diffuse progressive inflammation of bronchi, not related to local or generalized lung damage and manifesting cough. Chronic is called such bronchitis, in which the productive cough, not related to any other disease (for example, tuberculosis, bronchi tumor, etc.), continues at least 3 months a year for 3 years in a row.

Chronic bronchitis is a disease characterized by chronic diffuse inflammation of the mucous membranes of the bronchi, the restructuring of its epithelial structures, hypersecretion and an increase in the viscosity of the bronchial secretion, a violation of the protective cleansing function of the bronchi and a constant or periodically arising cough with a sputum separation that is not associated with other diseases of the bronchopulmonary system. Chronic inflammation of the bronchial mucosa is due to the long irritation of the air pathways by volatile pollutants of a domestic or industrial nature (most often tobacco smoke) and / or viral-bacterial infection.

The determination of chronic bronchitis is fundamentally important, since, firstly, it allows you to clearly allocate and diagnose chronic bronchitis as an independent nosological form and, secondly, forces the therapist to conduct differential diagnosis With the diseases of the lungs, accompanied by a cough with a wet separation (pneumonia, tuberculosis, etc.).

Code of the ICD-10

J41.0 simple chronic bronchitis

J41 Simple and mucule-purulent chronic bronchitis

J41.1 mucous-purulent chronic bronchitis

J41.8 Mixed, simple and mucule-purulent chronic bronchitis

J42 Chronic Bronchitis Uncomfortable

Epidemiology of chronic bronchitis

Chronic bronchitis is a widespread disease and occurs in 3-8% of the adult population. According to A. N. Kokosov (1999) the prevalence of chronic bronchitis in Russia is 16%.

Most pulmonologists offer to allocate primary and secondary chronic bronchitis.

Under primary chronic bronchitis, chronic bronchitis is understood as an independent disease that is not related to any other bronchopulmonal pathology or the defeat of other organs and systems. In the primary chronic bronchitis, the diffuse damage of the bronchial tree takes place.

Secondary chronic bronchitis is etiologically related to chronic inflammatory diseases of the nose, apparent sinuses; with chronic limited inflammatory lung diseases (chronic pneumonia, chronic abscess); with pulmonary tuberculosis; with severe heart disease flowing with stagnation in a small circle; with chronic renal failure and other diseases. Usually secondary chronic bronchitis is a local less often diffuse.

Chronic bronchitis is the most common disease of the bronchopulmonary system. In the United States, for example, only chronic obstructive bronchitis (hob), i.e. About 6% of men and 3% of women, in the UK - 4% of men and 2% of women are sick of the most prognostically unfavorable form of chronic bronchitis. In persons over 55 years old, the prevalence of this disease is about 10%. The proportion of the chronic bronchitis in the overall structure of the diseases of the breather of the Nonuberculosis Nature reaches more than 30%.

Depending on the nature of the flow, the severity of the pathological process in bronchi and the characteristics of the clinical picture of the disease distinguish between two main forms of chronic bronchitis:

1. Chronic simple (unstructive) bronchitis (CHNB) is a disease characterized by the defeat of predominantly proximal (large and medium) bronchi and a relatively favorable clinical flow and a forecast. Basic clinical manifestation Chronic unstructive bronchitis is constant or periodically and coughing with a wet wet. Signs of unbearable bronchial obstruction arise only during periods of exacerbation or in the latest stages of the disease.
2. Chronic obstructive bronchitis (hob) - a disease characteristic of deeper deerately inflammatory and sclerotic changes not only for proximal, but also distal departments Air pathways. The clinical course of this form of chronic bronchitis is usually unfavorable and characterized by a long cougium, gradually and steadily increasing shortness, decreased to the tolerance for physical exertion. Sometimes in chronic obstructive bronchitis, signs of local lesions of the bronchi (bronchiectases, scar changes in the bronchi wall, pneumosclerosis) are detected.

The main distinguishing feature of chronic obstructive bronchitis is an early defeat of respiratory departments of the lungs, manifested by signs of respiratory failure, slowly progressing in parallel increasing the degree of bronchial obstruction. It is believed that with chronic obstructive bronchitis, the annual reduction in the grinding is more than 50 ml per year, whereas with chronic unstructive bronchitis - less than 30 ml per year.

In this way, clinical Evaluation Patients with chronic bronchitis involves the mandatory allocation of two major forms of the disease. In addition, it is important to diagnose the phase of the disease of the disease (exacerbation, remission), the nature of the inflammation of the mucous membrane (catarrhal, mucule-purulent, purulent), the severity of the disease, the presence of complications (respiratory failure, compensated or de compensated chronic pulmonary heart, etc.) .

Below is the most simple and affordable classification of chronic bronchitis.

The cause of chronic bronchitis

The disease is associated with long irritation of the bronchi by various harmful factors (smoking, inhalation of air contaminated with dust, smoke, carbon oxide, sulfur anhydride, nitrogen oxides and other chemical compounds) and recurrent respiratory infection (respiratory viruses, pofaffer wand, pneumococci), less often occurs when cystic acidity, alpha1-antitripsemic insufficiency. Pre-providing factors - chronic inflammatory and incoding processes in the lungs, upper respiratory tract, reducing the resistance of the organism, hereditary predisposition to respiratory diseases.

Pathological anatomy and pathogenesis

Hypertrophy and hyperfunction of bronchial glands are revealed, increased mucus secretion, relative reduction in serous secretion, the change in the status of the Secret is a significant increase in acidic mucopolysaccharides in it, which increases the viscosity of sputum. Under these conditions, the camcorder epithelium does not ensure the purification of the bronchial tree and the usual update of the entire layer of the secret; The emptying of the bronchi with this state of mukiciliary clearance occurs only when coughing. Such conditions for the mukiciliary apparatus are detrimental: Dystrophy and the atrophy of the creation epithelium occur. At the same time, an ironic device producing lysozyme and other antibacterial protectors is also subjected to the same degeneration. Under these conditions, the development of bronchiogenic infection, the activity and recurrence of which is largely dependent on the local immune bronchi immunity and the development of secondary immune failure.

In the pathogenesis of the disease, spasm, swelling, fibrous change in the wall of the bronchi with the stenosis of its lumen or its obliteration is important. The obstruction of small bronchi leads to an abstraction of the alveoli on exhalation and disruption of the elastic structures of alveolar walls, as well as to the appearance of hyperventilated and fully ventilated zones that function as arteriovenous shunt. Due to the fact that the blood passing through these alveoli is not enriched with oxygen, arterial hypoxemia develops. In response to alveolar hypoxia, spasm of lung arterioles comes with an increase in total pulmonary arterial resistance; There is preconqualist pulmonary hypertension. Chronic hypoxemia leads to polycythemia and increasing blood viscosity, accompanied by metabolic acidosisEven more reinforcing vasoconstriction in a small circulation circle.

In large bronchops, surface infiltration is developing, in medium and small bronchops, as well as in bronchioles, this infiltration may be deep with the development of erosions, ulcerations and the formation of the meso and panberrychitis. Phase remission is characterized by a decrease in inflammation in general, a significant decrease in the amount of exudate, proliferation connective tissue and epithelium, especially with the ulceration of the mucous membrane. The final phase of the chronic inflammatory process in bronchi is sclerosation of their walls, atrophy of glands, muscles, elastic fibers, cartilage. It is possible an irreversible sampling of the lumen of the bronchi or its expansion with the formation of bronchiectasis.

Symptoms and clinical course of chronic bronchitis

The beginning of the disease is gradual. The first symptom is the morning cough with a wet mucosa separation. Gradually, cough begins to arise at night and in the afternoon, intensifying, as in chronic bronchitis, when inhaling cold raw or hot dry air. The amount of sputum increases, it becomes mucous-purulent and purulent. A shortness of breath appears and progresses, first at physical exertion, and then alone.

IN clinical flow Chronic bronchitis distinguish between four stages: catarrhal, purulent, obstructive and purulent obstructive. For the third stage, emphysema and bronchial asthma are characterized, for the fourth - purulent complications (bronchiectatic disease).

The diagnosis is established using FNBrobronchoscopy, in which endobronchial manifestations of the inflammatory process (catarrhal, purulent, atrophic, hypertrophic, hemorrhagic, fibrous-ulcene endobronchitis) and its seventure (but only to the level of subsegimentary bronchi) are visually evaluated. Bronchoscopy allows the biopsy of the mucous membrane and the histological methods to clarify the nature of the morphological changes of it, as well as to identify the tracheosobronchial hypotonic dyskinesia (an increase in the mobility of the trachea walls and bronchi during breathing, up to expiratory falling of the tracheal walls and the main bronchi - like during laryngomation, only with the opposite sign ) and a static retraction (change in configuration and reduction of the lumen of trachea and bronchi), which can complicate chronic bronchitis and be one of the reasons for the obstruction of the bronchi. However, in chronic bronchitis, the main pathological changes arise in smaller bronchops, therefore broncho- and radiography are used in the diagnosis of this disease.

Classification of chronic bronchitis

Shape of chronic bronchitis:

• simple (unstructive);
• obstructive.

Clinical and laboratory and morphological characteristics:

• catarrhal;
• mucinous-purulent or purulent.

Phase of the disease:

• aggravation;
• clinical remission.

Severity:

• easy - FEV1 more than 70%;
• average - OFV1 ranging from 50 to 69%;
• heavy - FEV1 less than 50% of the due value.

Complications of chronic bronchitis:

• lung emphysema;
• respiratory failure (chronic, acute, sharp on chronic background);
• bronchiectase;
• secondary pulmonary arterial hypertension;
• pulmonary heart (compensated and decompensated).

The given classification takes into account the recommendations of the European respiratory society, in which the severity of chronic bronchitis is assessed by the increase in the decrease in the FEV1 compared with due values. Primary chronic bronchitis should also be distinguished - independent nosological form, and secondary bronchitis, as one of the manifestations (syndrome) of other diseases (for example, tuberculosis). In addition, when formulating the diagnosis of chronic bronchitis in the exacerbation phase, it is advisable to specify the possible causative agent of the bronchology infection, although in the wide clinical practice This approach has not yet been distributed.

1 Currently, the diagnosis of chronic bronchitis (HB) is improved as an independent nosological form in children and adolescents. This direction provides for the differentiation of hB from other bronchopulmonary diseases (blus) flowing with bronchitis syndrome. It is known that HB is a permanent satellite of bronchiectatic disease, primary ciliary dyskinesia and its main form - the Kartagenier syndrome, and is also one of the manifestations of the fibrosis. The definition of the development of the bronchopulmonary system (aplasia, lung hypoplasia, Munya-Kun syndrome, Williams-Campbell syndrome, polycystic lungs, anomalies of bronchi branching), as a rule, predisposes to the formation of chronic bronchitis.

The purpose of this study: to explore the clinical and paraklinic manifestations of HB as an independent nosological form and as a block syndrome and on this basis to develop differential-diagnostic criteria for the proposed states.

To achieve the goal, 184 children and adolescents aged from 3 months to 18 years old were included. Of these were boys 106 (57.6 ± 3.6%) and girls 78 (42.4 ± 3.6%). All the examined were on hospitalization to Muses "Children's City clinical Hospital"And music" Children's city \u200b\u200bHospital №4 "G.Vladivostok during 19902007 The diagnosis of blocks was carried out on the results of comprehensive studies, including clinical, radiological, bronchological, functional, cytological and some special methods. The data obtained were statistically processed by biometric analysis.

Diagnostic blocks were presented with hB in 106, bronchiectic disease (Bab) in 52, cystic fibrosis (MV) in 16, the Cartageger syndrome in 5, the lung hypoplasia in 2 and the polycystic lung in 3 patients.

2 forms of HB were isolated: chronic obstructive bronchitis (hob) and chronic unstructive bronchitis (CHNB). The main differential diagnostic criteria for HB were determined as follows: clinical (productive cough with a single amount of various sputum, symptoms of intoxication and respiratory failure (DN), physical changes in the lungs - hard breath, diffuse varnotonic dry and solid-caliber wet wheezing on both sides, Broncho-constructive syndrome (BOS) at Kob et al.); X-ray (enhancement of bronchiestically painted pattern with a stalled local or diffuse deformation); bronchoscopic (the presence of diffuse endobronchite of catarrhal or catarrhal-purulent); bronchographic (bronchial deformation without expansion); Functional (ventilation failure of the I-II degree, the predominance of obstructive type of disorders of the FVD at KOB); Cytological (in sputum and bronchoalveolar beep fluid - signs of deeobylization, local leukocytosis, imbalance, destruction and cellization of cells, mucocyllary insufficiency, microbial colonization of epithelium, disruption of phagocytic activity of neutrophils and alveolar macrophages).

BES's diagnostic criteria were a group of signs: clinical (productive cough with a separation of a significant amount of mucous-purulent or purulent sputum, symptoms of purulent intoxication and chronic hypoxia, physical changes in the lungs

Local shortening of percussion sound, breathing weakening, resistant local dry varnotonic and wet metropolibal wheels); X-ray (enhancement of bronchiestically painted pattern with local deformation); bronchoscopic (the presence of catarrhal-purulent or purulent endobronchite); bronchographic (expansion of distal parts of the bronchi, the presence of cylindrical, fabricated or mixed bronchiectasis); Functional (ventilation failure of the I-III degree, the predominance of restrictive disorders of FVD); Cytological (in sputum and ballers Signs of epithelial exfoliation, local leukocytosis and macrophageal deficiency, destruction and cellization of cells, mucocyllary insufficiency and microbial colonization of the epithelium, violation of phagocytic activity of neutrophils and alveolar macrophages, etc.).

Differential-diagnostic criteria of MV were considered: anamnous (lungs and intestines and intestinal diseases in a family history, preceding foreframes and spontaneous abortions, continuously recurrent process in the bronchopulmonary system from the first months of life, recurrent diseases of the ENT organs), clinical (physical development below average and low, thoracic deformation, frequent wet bake-up (collow-eyed) cough with a difficultly separated by viscous mucous-purulent sputum, DN of mixed type, physical changes in the lungs - the local shortening of the percussion sound, dry varnotonic and wet solid-caliber wheels; with a mixed form, a malabsorption syndrome was determined); X-ray (common deformations of bronchopulmonary pattern and atelectase); bronchoscopic (purulent and catarist-purulent endobronchitis, obturation of the bronchi viscous mucous-purulent secret); bronchographic (bronchial deformations and cylindrical bronchiectases); Functional (persistent obstructive and restrictive violations). The pathognomonic laboratory feature in all patients was an increase in chloride content in a sweat exceeding 60 mmol / l.

Cartageger syndrome characterized as follows: anamnestic (chronic bronchopulmonary pathology in a genealogical history, recurrent diseases of the respiratory tract from the first weeks and months of life); Clinical (frequent wet cough with a separation of mucous-purulent sputum, a mixed type DN, amplifying during exercise, physical development below average and low, physical data - shortening the percussion sound over pathologically changed areas of lungs and common wet solubular wheels); radiological (deformations of the pulmonary pattern and focal seals of the pulmonary fabric, Situs Viscerus Inversus); bronchoscopic (purulent and cataral-purulent diffuse endobronchitis); bronchographic (bronchial deformations and small bronchiectases); Functional (more often obstructive violations). Other anomalies and malformations of development (heart, kidney, etc.) were also determined in patients. Studies of the motor function of the fiscal epithelium showed its decrease of 3.6-5.2 times (compared to the norm).

The lung hypoplasia was characterized by clinical (physical development below the average, shortening of the percussion sound and the weakening of breathing over the affected light, unilateral local wheezing, the mediastinal shift towards the underdeveloped light), radiological (decrease in the volume of lung, the absence of small bronchial branches), bronchoscopic (catarrhal or catarral -Gurnal one-sided bronchitis), functional (mainly restrictive disorders of FVD) signs.

Polycystrosis revealed clinical (continuous-absidious flow, low physical development, cough with purulent sputum, signs of DN, the presence of wet wheezes), radiological (long-distance education), bronchoscopic (purulent diffuse bilateral endobronchitis) and functional (pronounced obstructive and restrictive violations) criteria.

Thus, the presented clinical and paraklinic groups of the data of these blocks allow differentially approach to the diagnosis of HB as an independent nosological form and inherent and congenital diseases.

Bibliographic reference

Osin A.Ya., Uskova A.V. Differential diagnosis of chronic bronchitis in children and adolescents // Succes modern natural science. - 2009. - № 4. - P. 27-28;
URL: http://natural-sciences.ru/ru/article/view?id\u003d13541 (Date of handling: 30.01.2020). We bring to your attention the magazines publishing in the publishing house "Academy of Natural Science"