Factors of the therapeutic effect of psychotherapy. The effectiveness of psychotherapy. Clinical psychotherapy: conclusions. Treatment of chronic bronchitis with folk remedies

As Avicenna said, a doctor has three main tools: words, medicine and a knife. In the first place, undoubtedly, is the word - the most powerful way to influence the patient. A bad doctor is the one whose conversation with him does not make the patient feel better. A sincere phrase, support and acceptance of a person with all his vices and shortcomings - this is what makes a psychiatrist a true healer of the soul.

The above applies to all specialties, but most importantly to psychotherapists.

Psychotherapy can be used either alone or in combination with medication. Psychotherapy has the greatest effect on patients with neurotic spectrum disorders (anxiety-phobic and obsessive-compulsive disorders, panic attacks, depression, etc.) and psychogenic diseases.

Classification of psychotherapy

Today there are three main areas of psychotherapy:

• Dynamic
• Behavioral (or behavioural)
• Existential-humanistic

They all have different mechanisms of influence on the patient, but their essence is the same - focusing not on the symptom, but on the whole personality.

Depending on the desired goal, practical psychotherapy can be:

• Supportive. Its essence is to strengthen and support the patient’s existing defenses, as well as to develop behavioral patterns that will help stabilize emotional and cognitive balance.
• Retraining. Complete or partial reconstruction of negative skills that worsen the quality of life and adaptation in society. The work is carried out through support and approval positive forms patient behavior.

Depending on the number of participants, psychotherapy can be individual and group. Each option has its pros and cons. Individual psychotherapy is a springboard for patients who are not prepared for group sessions or who refuse to participate in them due to their character traits. In turn, the group option is much more effective in terms of mutual communication and exchange of experience. A special variety is family psychotherapy , which involves working together with two spouses.

Areas of therapeutic influence in psychotherapy

Psychotherapy is a good treatment method due to three areas of influence:

Emotional. The patient is provided with moral support, acceptance, empathy, the opportunity to express his own feelings and not be judged for it.

Cognitive. There is awareness and “intellectualization” of one’s own actions and aspirations. In this case, the psychotherapist acts as a mirror that reflects himself to the patient.

Behavioral. During psychotherapy sessions, habits and behavior patterns are developed that will help the patient adapt to the family and society.

A good combination of all the above areas is practiced in cognitive behavioral psychotherapy (CBT).

Types and methods of psychotherapy: characteristics

One of the pioneers of psychotherapy and psychoanalysis was the famous Austrian psychiatrist and neurologist Sigmund Freud. He formed the psychodynamic concept of the emergence of neuroses based on the suppression of the needs and demands of the individual. The psychotherapist’s task was to transfer unconscious stimuli and make the client aware of them, thereby achieving adaptation. Subsequently, Freud's students and many of his followers founded their own schools of psychoanalysis with principles that differed from the original doctrine. This is how the main types of psychotherapy that we know today arose.

Dynamic psychotherapy

We owe the formation of dynamic psychotherapy as an effective method of combating neuroses to the works of K. Jung, A. Adler, E. Fromm. The most common variant of this direction is person-centered psychotherapy.

The treatment process begins with a long and scrupulous psychoanalysis, during which the patient’s internal conflicts are clarified, after which they move from the unconscious to the conscious. It is important to bring the patient to this point, and not just voice the problem. Effective treatment of the client requires long-term cooperation with the doctor.

Behavioral psychotherapy

Unlike proponents of psychodynamic theory, behavioral psychotherapists see the cause of neurosis as incorrectly formed behavioral habits, and not hidden incentives. Their concept states that a person’s behavior patterns can be changed, depending on which his condition can be transformed.

Behavioral psychotherapy methods are effective in treating various disorders (phobias, panic attacks, obsessions, etc.). Showed itself well in practice confrontation and desensitization technique. Its essence is that the doctor determines the cause of the client’s fear, its severity and connection with external circumstances. Then the psychotherapist carries out verbal (verbal) and emotional influences through implosion or flooding. At the same time, the patient mentally imagines his fear, trying to paint a picture of it as brightly as possible. The doctor reinforces the patient’s fear so that he feels the reason and gets used to it. A psychotherapy session lasts about 40 minutes. Gradually, a person gets used to the cause of the phobia, and it ceases to worry him, that is, desensitization occurs.

Another subtype of behavioral technique is rational-emotive psychotherapy. Here the work is carried out in several stages. The first is to determine the situation and the person’s emotional connection with it. The doctor determines the client’s irrational urges and ways to overcome them. difficult situation. Then he evaluates the key points, after which he clarifies (clarifies, explains) them, and analyzes each event together with the patient. Thus, irrational actions are recognized and rationalized by the person himself.

Existential-humanistic psychotherapy

Humanistic therapy is the newest method of verbal influence on the patient. What is being analyzed here is not the deepest motives, but the formation of a person as an individual. The emphasis is on higher values ​​(self-improvement, development, achieving the meaning of life). Viktor Frankl contributed a major role to existentialism, who saw the lack of personal fulfillment as the main cause of human problems.

There are many subtypes of humanitarian psychotherapy, the most common of which are:

Logotherapy– a method of dereflection and paradoxical intention, founded by V. Frankl, which allows you to effectively cope with phobias, including social ones.

Client-centered therapy- a special technique in which main role The treatment is performed not by the doctor, but by the patient himself.

Transcendental Meditation– a spiritual practice that allows you to expand the boundaries of your mind and find peace.

Empirical therapy– the patient’s attention is focused on the deep emotions he experienced earlier.

The main feature of all of the above practices is that the line in the doctor-patient relationship is blurred. The psychotherapist becomes a mentor, as equal as his client.

Other types of psychotherapy

In addition to the verbal method of communication with the doctor, patients can attend classes in music, sand, and art therapy, which help them relieve stress, show their creativity and open up.

Clinical psychotherapy: conclusions

Psychotherapy has an invaluable influence on the patient during treatment and rehabilitation. Neurotic spectrum disorders are more effectively amenable to drug correction if it is combined with the work of a psychotherapist or psychologist, and sometimes even without taking medications; psychotherapy can lead to the complete disappearance of painful manifestations. In the future, patients move from taking medications to using the skills acquired in psychotherapy sessions. IN in this case it acts as a step from pharmacotherapy to self-control over painful manifestations (phobias, panic attacks, obsessions) and the patient’s mental state. Therefore, working with a psychotherapist should mandatory carried out with patients and their relatives.

A universal drug having several important pharmacological effects:
- anxiolytic (sedative and vegetotropic)
- nootropic
- stress-protective

Effective therapy vegetative-vascular dystonia in young patients

E. N. Dyakonova, Doctor of Medical Sciences, Professor
V. V. Makerova
State Budgetary Educational Institution of Higher Professional Education IvSMA Ministry of Health of the Russian Federation, Ivanovo Summary. Approaches to the treatment of vegetative-vascular dystonia in young patients in combination with anxiety and depressive disorders are considered. The study included 50 patients aged 18 to 35 years with vegetative-vascular dystonia syndrome; the effectiveness and safety of therapy were assessed during treatment and after discontinuation.
Keywords: vegetative-vascular dystonia, anxiety-depressive disorders, asthenia.

Abstract. The treatment of vegetative-vascular dystonia in young patients in combination with anxiety and depressive disorders was discussed. The study included 50 patients aged 18 to 35 years with a syndrome of vegetative-vascular dystonia. In the course of the treatment and after its cancellation, the efficacy and safety of the therapy were evaluated.
Keywords: vegetative-vascular dystonia, anxiety and depressive disorders, asthenia.

The term “vegetative-vascular dystonia” (VSD) is often understood as psychogenically caused multisystem autonomic disorders, which can be an independent nosology, and also act as secondary manifestations somatic or neurological diseases. At the same time, the severity of vegetative pathology aggravates the course of the underlying disease. The syndrome of vegetative-vascular dystonia significantly affects the physical and emotional state of patients, determining the direction of their appeal for medical care. In structure general morbidity disorders of the autonomic nervous system occupy one of the leading places (category G90.8 according to ICD-10). Thus, the prevalence of vegetative-vascular dystonia in the general population, according to various authors, ranges from 29.1% to 82.0%.

One of the most important features of VSD is the polysystemic nature of clinical manifestations. Vegetative-vascular dystonia includes three generalized syndromes. The first is psychovegetative syndrome (PVS), which is manifested by permanent paroxysmal disorders caused by dysfunction of nonspecific brain systems (suprasegmental autonomic systems). The second is the syndrome of progressive autonomic failure and the third is the vegetative-vascular-trophic syndrome.

Anxiety spectrum disorders are observed in more than half of patients with VSD. They acquire particular clinical significance in somatic patients, including functional pathology, since in these cases there are always anxious experiences varying degrees severity: from psychologically understandable to panic or to generalized anxiety disorder (GAD). As evidenced daily practice, all patients with this type of disorder are prescribed anxiolytic or sedative therapy. In particular, various tranquilizers are used: benzodiazepines, non-benzodiazepines, antidepressants. Anxiolytic therapy significantly improves the quality of life of these patients and contributes to their better compensation during the treatment process. However, not all patients tolerate these drugs well due to the rapid development of side effects in the form of lethargy, muscle weakness, impaired attention, coordination, and sometimes symptoms of addiction. Taking into account the noted problems in last years There is an increasing need for drugs with an anxiolytic effect of a non-benzodiazepine structure. These may include the drug Tenoten, which contains antibodies to the brain-specific protein S-100, which have undergone technological processing during the production process. As a result, Tenoten contains release-active antibodies to the brain-specific protein S-100 (PA-AT S-100). Release-active drugs have been shown to have a number of typical characteristics that allow them to be integrated into modern pharmacology(specificity, non-addiction, safety, high efficiency).

The properties and effects of release-active antibodies to the brain-specific protein S-100 have been studied in many experimental studies. Drugs created on their basis are used in clinical practice as anxiolytic, vegetostabilizing, stress-protective agents for the treatment of anxiety and autonomic disorders. The molecular target of PA-AT S-100 is the calcium-binding neurospecific protein S-100, which is involved in the coupling of information and metabolic processes in the nervous system, signal transmission by secondary messengers (“messengers”), the processes of growth, differentiation, apoptosis of neurons and glial cells. In studies on the Jurkat and MCF-7 cell lines, it was shown that PA-AT S-100 exerts its action, in particular, through the sigma1 receptor and the glycine site of the NMDA glutamate receptor. The presence of such an interaction may indicate the influence of the drug Tenoten on various mediator systems, including GABAergic and serotonergic transmission.

It should be noted that, unlike traditional benzodiazepine anxiolytics, PA-AT S-100 does not cause sedation and muscle relaxation. In addition, PA-AT S-100 contributes to the restoration of neuronal plasticity processes.

S. B. Shvarkov et al. found that the use of RA-AT S-100 for 4 weeks in patients with psychovegetative disorders, including those caused by chronic cerebral ischemia, led not only to a significant decrease in the severity of anxiety disorders, but also to a noticeable decrease in autonomic disorders. This gave the authors the opportunity to consider Tenoten not only as a mood corrector, but also as a vegetative stabilizer.

M. L. Amosov et al. when observing a group of 60 patients with transient ischemic attacks in various vascular territories and accompanying emotional disorders, they found that the use of RA-AT S-100 can reduce anxiety. The anxiolytic effect was practically no different from the anti-anxiety effect of phenazepam, while the tolerability of the drug containing PA-AT S-100 turned out to be significantly better and, unlike the use of benzodiazepine derivatives, there were no side effects.

However, there is not enough work demonstrating the effectiveness of Tenoten in the correction of autonomic disorders in young people.

The purpose of this work was to evaluate the effectiveness and safety of the drug Tenoten in the treatment of vegetative-vascular dystonia in young patients (18–35 years).

Materials and research methods

A total of 50 patients (8 males and 42 females) aged from 18 to 35 years (mean age 25.6 ± 4.1 years) with autonomic dystonia syndrome were included in the study. emotional disturbances, decreased performance.

The study did not include patients taking psychotropic and vegetotropic drugs during the previous month; pregnant women during lactation; with signs of severe somatic diseases according to anamnesis, physical examination and/or laboratory and instrumental tests, which could interfere with participation in the program and influence the results.

All patients received Tenoten orally, according to the instructions for medical use of the drug, 1 tablet 3 times a day for 4 weeks (28–30 days) without food intake, sublingually. During the study, the use of vegetotropic, sleeping pills, sedatives, as well as tranquilizers and antidepressants.

All patients were assessed for autonomic disorders using the Wein table (more than 25 points indicate the presence of vegetative-vascular dystonia); assessment of the level of anxiety - according to the HADS anxiety scale (8–10 points - subclinically expressed anxiety; 11 or more points - clinically expressed anxiety); depression - according to the HADS depression scale (8–10 points - subclinically expressed depression; 11 or more points - clinically expressed depression). During the study period, the patients' condition was assessed 4 times: 1st visit - before starting the drug, 2nd visit - after 7 days of therapy, 3rd visit - after 28–30 days of treatment, 4th visit - after 7 days from the end of therapy (37th day from the start of therapy). At each stage, the neurological status, heart rate variability (HRV) and state were assessed on the following scales: A. M. Vein’s autonomic dysfunction, HADS anxiety/depression, as well as the SF-36 questionnaire (Russian version, created and recommended by the ICCI), which allows determining the level of physical functioning (PF) and psychological health (MH). After the 30th day of taking Tenoten, the effectiveness of the therapy was additionally assessed on the CGI-I scale.

HRV analysis was carried out for all subjects initially in the supine position and under conditions of an active orthostatic test (AOP) in accordance with the “Recommendations of the working group of the European Society of Cardiology and the North American Society of Stimulation and Electrophysiology” (1996) on the VNSspectr device. The study was carried out no earlier than 1.5 hours after eating, with the obligatory cancellation of physical procedures and drug treatment taking into account the timing of drug removal from the body after a 5-10 minute rest. Vegetative status was studied by analyzing HRV using 5-minute recordings of cardiointervalogram (CIG) in a state of relaxed wakefulness in a supine position after 15 minutes of adaptation and during an orthostatic test. Only stationary sections of rhythmograms were taken into account, i.e., recordings were allowed for analysis after eliminating all possible artifacts and if the patient had sinus rhythm. The spectral characteristics of the heart rhythm were studied, which make it possible to identify periodic components in heart rate fluctuations and quantify their contribution to the overall dynamics of the rhythm. Spectra of variability of R-R intervals were obtained using the Fourier transform. When conducting spectral analysis, the following characteristics were assessed:

• TP “total power” - the total power of the spectrum of neurohumoral regulation, characterizing the total effect of all spectral components on sinus rhythm;
• HF “high frequency” - high-frequency vibrations reflecting steam activity sympathetic division autonomic nervous system;
• LF “low frequency” - low-frequency oscillations reflecting the activity of the sympathetic part of the autonomic nervous system;
• VLF “very low frequency” - very low frequency oscillations, which are part of the spectrum of neurohumoral regulation, which includes the complex various factors, affecting heartbeat(cerebral ergotropic, humoral-metabolic influences, etc.);
• LF/HF - an indicator reflecting the balance of sympathetic and parasympathetic influences, measured in normalized units;
• VLF%, LF%, HF% - relative indicators, reflecting the contribution of each spectral component to the spectrum of neurohumoral regulation.

All of the above parameters were recorded both at rest and during an active orthostatic test.

Statistical analysis of the study results was carried out using Statistics 6.0 using parametric and non-parametric methods (Student's, Mann-Whitney tests). The threshold level of statistical significance was set to p = 0.05.

Results and its discussion

All patients complained of decreased performance, general weakness, fatigue, fluctuations in blood pressure (in 72% it was reduced and amounted to 90–100/55–65 mm Hg; in 10%, blood pressure periodically increased to 130–140/90 –95 mmHg). Headaches in 72% of patients were not constant and were associated with increased mental or emotional stress. 24% periodically experienced pain in the scalp and upon palpation of the pericranial muscles. 72% of patients had sleep disturbances, 18% had cardialgia and a feeling of interruptions in heart function. Hyperhidrosis of the palms and feet, persistent red dermographism, and acrocyanosis were noted by half of the patients. Clinical manifestations functional disorders gastrointestinal tract (GIT) (constipation, flatulence, abdominal pain) were recorded in 10% of total number examined patients.

Analysis of anamnestic data showed that about 80% of the subjects had a stress factor. During the survey, 30% of patients associated stress with professional activities, 25% with studies, 10% with family and children, and 35% with personal relationships.

Analysis of the Hospital Anxiety and Depression Scale (HADS) revealed subclinically expressed anxiety in 26% of patients, and clinically significant anxiety in 46% of patients. Half of the patients (50%) often experienced tension and fear; 6% of patients constantly felt a feeling internal tension and anxiety. Panic attacks occurred in 16% of respondents. 10% of patients had subclinical and clinically significant depression.

Violations in the psychological component of health (MH) were significant according to the SF-36 questionnaire, and they were associated with increased level anxiety. At the same time, physical functioning (PF) did not affect the daily activities of the subjects.

Evaluation of the effectiveness and safety of treatment showed a clear prevalence positive results when using the drug Tenoten.

Subsequently, based on the results of a dynamic study of heart rate variability, all patients were retrospectively divided into two groups.

The first group consisted of 45 people (90%), initially having autonomic disorders with clear positive dynamics according to HRV results after the 30th day of taking Tenoten. They were patients without signs of clinically significant depression. The initial data for this group of patients were: the number of points on the Wein scale - 25–64 (average 41.05 ± 12.50); on the HADS anxiety scale - 4–16 (9.05 ± 3.43); on the HADS depression scale - 1–9 (5.14 ± 2.32). When assessing the quality of life on the SF-36 scale, the level of physical health (PF) was 45.85 ± 7.31 and the level mental health(MH) 33.48 ± 12.

After seven days of taking Tenoten, all patients subjectively noted an improvement in their well-being, however, the average numerical values ​​revealed significant differences in this group only on the HADS anxiety scale (p
Rice. 1. Dynamics of scores on the HADS anxiety scale in patients of the first group (*p). Further analysis of the dynamics of indicators within the scales in the first group showed that the greatest and most significant changes in the state occurred after 30 days from the start of taking Tenoten. Positive dynamics were observed in the form of a decrease in the number and severity of symptoms of vegetative-vascular dystonia: on the Wayne scale, the number of points significantly decreased to 8–38 (average 20.61 ± 9.52) (p
Rice. 2. Dynamics of scores on the A. M. Wein scale in patients of the first group (*p The mental health (MH) indicator increased significantly to 54.6 ± 4.45 points (p

Rice. 3. Dynamics of physical (PF) and mental (MH) health indicators in patients of the first group (*p Analysis of the HADS anxiety scale showed that 68% did not experience tension at all versus 100% who experienced tension before treatment; in 6%, the number of points remained unchanged; in the remaining 26%, the number of points decreased (patients no longer felt a sense of fear). During the observation period, no periods of increased blood pressure were observed in patients of the first group. Patients did not present active complaints of soreness in the area of ​​the pericranial muscles, however, after focusing attention on this area, they noted rare headaches. Dermographism remained unchanged. Rare interruptions in heart function were noted by 4% of patients. In 26 out of 40 people, sleep returned to normal.

A study conducted on the 37th day (seven days after discontinuation of the drug) did not reveal significant differences from the indicators on the 30th day of taking Tenoten, i.e., the resulting effect from taking the drug persisted.

The second group included 5 people with weak positive dynamics in heart rate variability study indicators. They were patients who initially had signs of clinically significant anxiety and depression.

Data before the start of therapy for this group of patients were: the number of points on the Wein scale 41–63 (average 51.80 ± 8.70); HADS anxiety scale 9–18 (13.40 ± 3.36); HADS depression scale 7–16 (10.60 ± 3.78). When assessing the quality of life on the SF-36 scale, these patients had a significantly reduced level of physical health, which was 39.04 ± 7.88, as well as a level of mental health - 24.72 ± 14.57. Analysis of the dynamics of indicators in the second group after 30 days of taking Tenoten revealed a trend towards a decrease in autonomic dysfunction on the Wein scale - from 51.8 to 43.4 points; anxiety-depressive symptoms on the HADS anxiety/depression scale - from 13.4 to 10.4 points and from 10.6 to 8.6 points, respectively; according to SF-36, the mental health (MH) score increased from 24.72 to 33.16, and the physical health (PF) score increased from 39.04 to 43.29. However, these values ​​did not reach statistically significant differences, which indicates the need for individual selection of the duration and regimen of therapy in patients with clinically significant anxiety and depression.

Thus, a retrospective division of patients into two groups during an in-depth examination made it possible to identify signs of clinically significant anxiety and depression in one of the groups, which initially did not differ significantly from the majority of respondents. Analysis of the dynamics of indicators on the main scales after a month of taking Tenoten, 1 tablet 3 times a day, did not reveal significant differences in this group. The anxiolytic and vegetostabilizing effects of Tenoten in the group of clinically severe anxiety and depression with the usual (1 tablet 3 times a day) treatment regimen appeared only in the long term, which can serve as a justification for correcting the treatment regimen and prescribing 2 tablets 3 times a day. Consequently, the data obtained indicate the need to select different regimens for the use of Tenoten depending on the severity of anxiety and depressive symptoms, which provides an individual approach for each patient, forming a high adherence to treatment.

Analysis of heart rate variability in patients of the first group showed significantly significant changes after 30 days of taking Tenoten, which persisted 7 days after discontinuation of the drug. At spectral analysis at the end of a month of therapy, the absolute values ​​of the power of the LF and HF components, and due to this the total power of the spectrum (TP), were significantly higher than in the study before taking the drug (from 1112.02 ± 549.20 to 1380.18 ± 653 .80 and from 689.16 ± 485.23 to 1219.16 ± 615.75, respectively, p

Rice. 4. Spectral indicators of HRV at rest in patients of the first group (* significance of differences: compared with the initial indicator, p During spectral analysis during an active orthostatic test after therapy, a lower reactivity of the sympathetic division of the autonomic nervous system (ANS) was noted compared with the initial data , this is evidenced by the values ​​of the LF/HF and %LF indicators, namely LF/HF - 5.89 (1.90–11.2) and 6.2 (2.1–15.1), respectively, %LF - 51 .6 (27–60) and 52.5 (28–69) (p

Rice. 5. Spectral indicators of HRV during an orthostatic test in patients of the first group (* significance of differences: compared with the initial indicator, p Thus, in the first group, when performing HRV after 30 days of taking Tenoten, there is an increase in the total power of the spectrum due to the increased influence of HF- component, as well as the normalization of sympathetic-parasympathetic influences during the background test. In the active orthostatic test, the same trends remain, but less pronounced. Analysis of the dynamics of the coefficient 30/15 suggests an increased reactivity of the parasympathetic section of the ANS and, consequently, an increase in the adaptive potential as a result of therapy in patients of the first group (Table 1).

Table 1
Spectral indicators of HRV at rest and during an orthostatic test in patients of the first group

In patients of the second group, spectral analysis of heart rate variability indicators (background recording and active orthostatic test) at the end of a month of therapy did not reveal any significantly significant dynamics in the numerical values ​​of the power indicators of the LF and HF components, and due to this, the total power of the spectrum (TP) . All patients had hypersympathicotonia and high sympathetic reactivity before the start of therapy and a slight decrease in numerical values ​​at the end of therapy, however, the percentage contribution of the sympathetic division of the ANS “before”, “during therapy” and “after its end” remained unchanged (Fig. 6, 7 ).

Rice. 6. Spectral indicators of HRV at rest in patients of the second group

Rice. 7. Spectral indicators of HRV during an orthostatic test in patients of the second group

Analysis of the dynamics of the coefficient 30/15 suggests low parasympathetic reactivity and reduced adaptive potential before the start of therapy with Tenoten and increased reactivity and, therefore, an increase in adaptive potential as a result of treatment in patients of the second group by the end of therapy (Table 2).

table 2
Spectral indicators of HRV at rest and during an orthostatic test in patients of the second group

Thus, the drug Tenoten had a positive effect on the state of the autonomic nervous system in patients with VSD in combination with clinically significant depression. However, a treatment duration of 30 days is insufficient for this group of patients, which serves as a basis for continuing treatment or using an alternative regimen of 2 tablets 3 times a day.

Conclusion

Tenoten is a sedative and vegetative stabilizing drug with a proven high level of safety. The use of Tenoten seems extremely promising in young patients with vegetative-vascular dystonia.

• The study recorded that Tenoten leads to normalization (stabilization) of the autonomic balance in any type of vegetative-vascular dystonia (sympathetic-tonic, parasympathetic-tonic), increased autonomic support of the body’s regulatory functions and increased adaptive potential.
• Tenoten has a pronounced anti-anxiety and vegetative-stabilizing effect.
• During Tenoten therapy, the level of mental and physical health (according to the SF-36 questionnaire) became significantly higher, indicating an improvement in the quality of life of patients.
• Reception of Tenoten by patients with clinically significant signs of anxiety and depression requires differentiated approach to the treatment regimen and its duration.
• The study noted that Tenoten does not cause side effects and is well tolerated by patients.
• Tenoten can be used as monotherapy for vegetative-vascular dystonia in young patients (18–35 years).

How to treat bronchitis in adults? Effective medicines and methods

Bronchitis - inflammatory disease bronchial mucosa. Most often it develops against the background of respiratory infections, but it can also have other causes. To understand how to treat bronchitis in a particular case, it is important to identify these causes. Competent therapeutic tactics will help eliminate the main symptoms of the disease in a few days.

Basic principles of treatment of bronchitis in adults

Treatment of bronchitis is the competence of a pulmonologist, but in mild forms this disease is treated by specialists generalist- therapists.

What drugs and antibiotics help with the disease?

Before prescribing any drug, the doctor determines the cause of the disease. Bronchitis of a viral, bacterial and allergic nature requires a different approach.

Therefore, the list of drugs for the treatment of bronchitis includes drugs from different groups:

Antibiotics for bronchitis are prescribed only if an infection is detected bacterial origin. Antiviral drugs are recommended for treatment infectious bronchitis viral nature. Bronchodilators - with the development of bronchospasms or in cases where hypersecretion of mucus is observed in the bronchi and they cannot get rid of mucus on their own.

Therapy for bronchitis of various origins also involves the use of anti-inflammatory and immunomodulatory drugs: Timogen, Aflubin, Immunal. Can be assigned and antihistamines- “Suprastin”, “Zirtek”.

Inhalations as a treatment method

Inhalations are a mandatory procedure included in the bronchitis treatment program.

Direct delivery of the drug to the bronchi helps achieve the following effects:

• thinning thick sputum;
• moisturizing the mucous membrane;
• reduction of inflammation;
• relieving bronchospasm.

You can carry out inhalation at home using the “old-fashioned” method - breathe over a hot solution, covered with a towel. But it is much more convenient and safer to perform this procedure using a nebulizer.

Nebulizer allows use for inhalation pharmaceutical drugs for bronchitis - “Fluimucil”, “Lazolvan”, “Gensalbutamol”, “Berodual”. In the absence of a device, steam inhalations are carried out with homemade solutions, which will be discussed below.

Also, this procedure is contraindicated in case of cardiovascular diseases, a history of heart attacks and strokes, severe pathologies respiratory system(emphysema, pneumothorax, etc.).

Folk remedies

In the collection of folk remedies there are many useful recipes that can be used as aids in the treatment of bronchitis:

• Infusion for inhalation of chamomile and pine buds. Place 30 grams of chamomile flowers and 30 grams of pine buds in a thermos and brew 0.5 liters of boiling water. Screw on the lid and leave for 1 hour.
• Expectorant and anti-inflammatory infusion for inhalation. Make an herbal mixture: 1 tablespoon each of eucalyptus leaf, licorice root, calendula and chamomile flowers, sage herb. Place everything in a thermos, pour 0.5 liters of boiling water and screw on the lid. Leave for 2 hours.
• Propolis solution for inhalation. Pour 1 tablespoon of propolis alcohol tincture into 1 glass hot water and use for steam inhalation.
• Expectorant with honey and aloe. Mix 120 ml of honey, 150 grams of butter and 20 ml of aloe juice and store in the refrigerator. For bronchitis, dilute 2 teaspoons of the product in 1 glass of hot milk 2 times a day.
• Marshmallow root decoction. Put 2 tablespoons of dry crushed marshmallow root into 1 glass of hot water and place on water bath. Keep covered for 30 minutes, cool, filter and consume 0.5 cups 4 times a day.

For bronchitis, it is useful to drink a lot of warm vitamin drinks. For this purpose, restorative infusions of rose hips and dried fruit compotes will be useful. At this temperature you can prepare fruit drinks from cranberries, lingonberries, black currant. Raspberry tea is another universal traditional medicine for the treatment of many respiratory diseases.

Massage and therapeutic exercises

Auxiliary methods for the treatment of bronchial inflammation are massage and breathing exercises.

Treatment of bronchitis at home: acute, chronic, folk remedies

Bronchitis most often begins as part of the flu or acute respiratory viral infection or as a complication of them, when a runny nose and red throat is accompanied by a dry, debilitating or wet cough, and if you help your body in time, quickly transform the dry cough into a wet one, then bronchitis can be cured faster than in 10 days.

Any treatment must be comprehensive:

• Active fight against virus and infection
• Improving bronchial patency, thinning mucus and removing it as quickly as possible
• Elimination of provoking factors

Regimen for bronchitis

At the very beginning of the disease, it is simply necessary to remain in bed for 2-3 days, then you can remain in semi-bed rest for another 3-4 days, when it becomes easier, the temperature is normal, you can go out and take small walks in the fresh air, preferably in the park, and not along the highway.

You should follow a predominantly plant-based - cereal, dairy diet; during illness, the body especially needs vitamins, it is better if these are natural vitamins- fruits and vegetables.

If a person smokes, quitting smoking should happen as if by itself, since smoking increases and provokes a dry cough so much, and delays the day of recovery that it’s not even worth talking about. Many heavy smokers who care about their health quit smoking precisely after acute bronchitis, pneumonia or obstructive bronchitis!

One of the options for a quick recovery from bronchitis is to quickly liquefy mucus and remove it from the body, and this is very easily achieved by drinking plenty of warm drinks. This is trivial advice, but the most correct and true: the more liquid a patient with bronchitis drinks, the faster the sputum is liquefied, and therefore the bronchi are released.

Also, during inflammation during intoxication, a mass of harmful toxic substances is formed that poison the body, and drinking plenty of water up to 2-3 liters per day is the path to cleansing of toxins and a speedy recovery.

You can drink any drinks, it is best if they are fortified natural vitamins- decoction of rose hips, raspberries, linden, mint, chamomile tea, milk-mineral honey cocktails (mineral water without gases Borjomi, Narzan + milk + honey). And from strong tea and coffee should be avoided, since caffeine dehydrates the body, which is not advisable for any illness.

When the air is dry, the cough is much stronger, so try to humidify the air in the room where the patient is. It is best to use an air purifier and humidifier for this purpose. It is also advisable to carry out daily wet cleaning of the patient’s room to purify the air.

Are antibiotics needed for bronchitis?

There are cases of very severe bronchitis with obstructive syndrome and respiratory failure; in such a situation, hospitalization in the pulmonology department is indicated. At mild form bronchitis, uncomplicated by other pathologies, after consulting a doctor, you can treat acute bronchitis at home, using various medicines or traditional medicine.

Usually, it is not advisable to use antibiotics for bronchitis if it is caused by the influenza virus or a cold. A strong immune system copes well with bronchial inflammation. Antimicrobial agents, in the absence of corresponding changes in the blood and in the absence of purulent sputum, cannot be used for bronchitis, since they not only do not have anti-inflammatory and antiviral effect, but also increase allergenicity and can provoke broncho-obstructive syndrome. But in case:

• High fever lasts for a long time, purulent sputum is released when coughing
• or after an acute period of illness, after 4-5 days, the condition suddenly worsens, a new jump in high temperature appears, purulent sputum (yellow or green) is released when coughing, general state the patient is deteriorating

You should once again consult a doctor who will examine, listen to the patient, refer you for tests and x-rays, and then recommend a course of antibiotics aimed at destroying the attached bacterial infection. You should never start taking antibiotics without a doctor's recommendation. 11 rules - how to take antibiotics correctly.

How to quickly cure bronchitis at home

Antiviral agents

If bronchitis occurs against the background of influenza, then for therapy you can use antiviral drugs. Interferon preparations can be used intranasally, that is, instilled into the nose for both children and adults; the use of other antiviral drugs for acute respiratory viral infections and influenza is today widely advertised and recommended, however, there are no convincing studies and evidence of their effect and safety, so the decision to use them - everyone's personal business.

Expectorants

To improve sputum discharge, the doctor prescribes expectorants, mucolytic drugs, there are many of them in the pharmacy network - the most popular and effective among them are: Lazolvan, Ambrohexol, Bromhexine, Herbion, herbal breast infusions (which can be used in the absence of allergies to medicinal herbs). At lingering cough and elements of bronchial obstruction, Ascoril (Joset, Cashnol) containing salbutamol is prescribed.

At the very beginning of bronchitis, the patient usually experiences a prolonged, dry, nonproductive cough. Therefore, to alleviate the condition, you should take drugs such as Glaucin, Libexin, Tusuprex, Levopront, which suppress dry cough, and expectorants are taken later, when the cough turns into a wet one. You can also use combination drugs, such as Sinecode - instructions, Bronchicum, Broncholitin. To treat bronchitis with folk remedies, for dry coughs, thermopsis, licorice, and coltsfoot are used.

After 4 days, as a rule, sputum begins to disappear, so cough suppressants should be discontinued and sputum thinners should be taken:

• Mucolytics - these include acetylcysteine ​​- ACC, Muconex, Fluimucil, as well as carbocysteine ​​- Fluifort.
• Expectorants are means that improve coughing up sputum, that is, a reflex effect, these include the well-known plantain (Gerbion), ivy leaves (Prospan), marshmallow, thyme, anise drops, as well as Chest collection.
• Mucokinetics are agents that facilitate the movement of sputum, for example, Bromhexine. Such popular medicines as Lazolvan (in Ambroxol tablets), Ambrobene, in addition, have the property of thinning sputum, making it less viscous, and easily remove it from the body.

Inhalations

It is very effective to treat bronchitis using various inhalations. If you want to quickly cure bronchitis, then you should definitely do inhalations. Just make sure first that there is no high temperature or palpitations.

There are many recipes for steam inhalations for bronchitis - these include salt and soda solutions, and essential oils of eucalyptus, pine, washed, herbal teas, inhalation of phytoncides, which are rich in essential oils of garlic and rosemary, reduce cough impulses and facilitate the process of coughing. However, it is not uncommon for allergic reactions to occur to essential oils and medicinal herbs, and therefore people prone to allergies (hay fever) are better off not taking risks and avoiding the use of various herbs and essential oils.

Also, for those who have a home inhaler, you can carry out inhalations for bronchitis with a nebulizer with Lazolvan, Ambrobene, etc. special medicinal solutions, designed to improve the release of phlegm from the bronchi.

In the case of obstructive bronchitis in children or adults, the drug Berodual is an effective bronchodilator; special solutions are available for inhalation.

Massage, breathing exercises

Massage always effectively and quickly helps to cope with almost all diseases; for bronchitis, it can only be carried out if the body temperature is normalized; you can do it yourself, using various massagers, a Kuznetsov applicator, or vibration massage. To date various types There are many massagers, so you can purchase any of them.

After the acute period of inflammation ends and there are only residual effects in the form of a rare cough, you can begin to do therapeutic breathing exercises, for example, according to Strelnikova. Women can try to perform simple exercises from the Bodyflex breathing exercises, which not only strengthens the respiratory system, but also normalizes metabolism and promotes weight loss.

Oddly enough, but old proven remedies are forgotten modern man, and methods such as cupping, mustard plasters, and warm compresses were rarely used by people. But these are safe and very effective procedures.

Treatment of chronic bronchitis with folk remedies

Every family has grandmothers and great-grandmothers who used to treat all diseases exclusively with folk remedies. Among all the methods of treating chronic bronchitis with folk remedies, we will talk about the simplest and most accessible to everyone:

Radish, honey

A very old and effective recipe is a radish, a small depression is made in it, into which a teaspoon of honey is placed. After some time, the radish produces juice and can be consumed 3 times a day. This is a good way to relieve cough if you are not allergic to honey.

Chamomile, St. John's wort, sage, calendula, calamus

Medicinal herbs such as chamomile, St. John's wort, sage, calamus, calendula have anti-inflammatory properties and, in the absence of allergies, you can make infusions - 1 tbsp is enough. spoons per glass of boiling water, leave for an hour and drink 3 times a day.

Garlic, dill, butter

Sandwiches with garlic, dill and butter - to prepare such a sandwich, take 5 cloves of garlic, squeeze through a garlic press, mix with 100 grams of butter, you can add finely chopped dill or parsley. Eat this sandwich 3 times a day.

Medicinal plants

• Plantain has always been valued by traditional healers for its excellent expectorant properties. Therefore, to treat bronchitis, you can buy plantain leaves, 4 tbsp. Grind spoons of leaves, pour half a glass of boiling water, let it brew for 4 hours, strain and drink this amount throughout the day.
• Such medicinal plants like thyme, eucalyptus, pine buds, caraway, St. John's wort, fennel have an expectorant effect, so you can also make infusions and inhalations from them.
• Medicinal plants such as decoctions of plantain, yarrow, violet, marshmallow roots, and coltsfoot help to increase immunity in chronic bronchitis.
• Taking natural mumiyo, echinacea tincture, and licorice root syrup also helps improve immunity.
• Decoctions of parsley, juniper, horsetail, birch, lingonberry leaves. These remedies are not direct methods of treating acute bronchitis at home, but they are very helpful in strengthening the body and speedy recovery.

Sorbents

To relieve symptoms of intoxication in viral and infectious diseases, in order to quickly remove toxins from the body, you can also use pharmaceutical sorbents - Polysorb, Enterosgel, Filtrum STI, Polyphepan, etc., but they should be taken in the intervals between taking medications and food, preferably 1 time a day at night, 2 hours after the last meal and medication, and for a short course.

Psychological attitude

It may seem strange and unacceptable to many, but a psychological, emotional, positive attitude towards recovery is always of great importance, especially with chronic diseases. Belief in healing gives the brain a very strong impetus to intensify the body’s own fight against the disease. Daily Reading positive attitudes, which you can come up with for yourself, speaking affirmations, practicing self-hypnosis, meditation - can help more than some medications. The main thing is to believe that it works, to believe in the strength of your body and the disease will go away.

Juice therapy

Juice therapy has long been considered a powerful way to heal the entire body. Vegetable juices are especially useful:

• Beetroot juice is considered the most highly effective juice for cleansing the blood of toxins, it helps normalize blood composition, increases platelets especially well, the only condition for taking it is that you cannot drink freshly squeezed juice, first raw beets grate, squeeze out the juice, and then put it in the refrigerator, after 3-4 hours you can drink it.
• Carrot juice - it is not recommended to drink a lot of beet juice, no more than 100 ml. It is better to dilute it with healthy freshly squeezed carrot juice. It is both tasty and extremely healthy.
• Lingonberry juice is very good for removing phlegm.
• Freshly squeezed cabbage juice is not very pleasant to drink, but if you add a little sugar, it is very effective as an expectorant. In addition, cabbage juice also helps with stomach diseases.

Treatment of bronchitis at home in adults and children

One of the most common diseases of the human respiratory system is bronchitis. This disease is an inflammatory process that affects, among other things, the bronchi. Bronchitis occurs due to infection: in most cases, viral, less often bacterial in origin. In the international classification of diseases, bronchitis is presented in two forms: acute and chronic. They differ in etiology, pathogenesis and necessary therapy.

The main symptom of bronchitis is cough. In the first days of the disease it is dry with severe attacks at night. Because of the cough, the patient often cannot sleep normally and suffers from physical illness. After a few days, the cough becomes wet and with the right treatment tactics, bronchitis goes away within 10 days. Quite often there are cases when a cough, as a residual phenomenon after bronchitis, lasts much longer than the disease itself. This is due to the fact that the process of restoration of the bronchi after the inflammatory process is quite long.

The only cause of concern is a cough that lasts more than four weeks. In such cases, you need to consult a pulmonologist, who will determine the presence of third-party causes of cough. In addition, foreign inclusions in the sputum, especially blood, should alert you during bronchitis. They should prompt an immediate visit to the hospital, where they will be examined for tuberculosis and lung cancer, for which blood in the sputum is a fairly characteristic symptom.

Treatment of bronchitis

When considering the issue of therapy for bronchitis, first you need to identify two important points:

• The treatment tactics for bronchial inflammation are influenced by the form of the disease (infectious or bacterial) and the type of course (acute or chronic);
• Treatment of bronchitis must be comprehensive. The result of taking medications alone in most cases will not be effective enough.

At the same time, drug therapy for bronchitis is quite simple. In itself, it does not require any complex drugs or procedures. The main thing this disease requires is the correct identification of the causative agent of the inflammatory process and the form of its course.

Antibiotic therapy for bronchial inflammation

The issue of using antibacterial drugs for bronchitis causes quite a lot of debate. But official medical protocols state that the use of antibiotics to treat this disease is necessary in two cases:

• if inflammation of the bronchi is caused by a bacterial infection;
• if the course of viral bronchitis is accompanied by complications or the patient is diagnosed with concomitant diseases.

The list of antibiotics here is classic for bacterial infections: penicillins, cephalosporins, macrolides. The choice depends on the individual characteristics of the patient.
In most cases, with viral origin of bronchial inflammation, antibacterial drugs do not have the necessary effective effect. In addition, they can cause the development of broncho-obstructive syndrome - blockage of the bronchi caused by swelling of the mucous membrane.

The main symptom of bronchitis, which indicates the need to use antibiotics, is sputum with purulent patches. If present, the doctor prescribes additional research, based on the results of which he appoints antibacterial agent. But in no case should an antibiotic be prescribed independently for bronchitis. The probable harm from its use may significantly exceed the expected effect.

Acute bronchial inflammation is almost always treated at home and requires only topical medications. Antibiotics for bronchitis are not a key medication.

Use of antiviral drugs for bronchitis

The fact that inflammation of the bronchi is provoked by a viral infection itself hints at the need to use antiviral drugs to treat this disease. But the issue of using medications in this group is very, very controversial. Many doctors are sure that antiviral agents there is no proven effectiveness and to fight viruses the body just needs to create optimal conditions. In some ways they will be right. Another group of doctors insists that viruses need to be suppressed with antiviral drugs and that without them the disease cannot be dealt with.

Used for viral infections two drugs: interferon and oseltamivir. At the same time, no one takes them from a pharmacy without a prescription or drinks them without a medical prescription. The use of antiviral drugs is indicated for the treatment of chronic bronchitis, in most cases with concomitant hospitalization.

The truth, in fact, is somewhere in the middle. During normal course, bronchitis can be overcome without antiviral drugs, as well as without antibiotics. If the disease is accompanied by complications or there are individual prerequisites, the use of medications in this group may be justified and necessary.
Now let’s talk about what you really can’t do without when you have bronchitis.

Expectorants for bronchitis

Bronchitis always begins with a strong and dry cough. Therefore, the only group of drugs that are really necessary for inflammation of the bronchi are expectorants.
In medicine, this group of drugs is divided into two subgroups based on the way they affect the body:

• medications to stimulate expectoration,
• drugs to thin sputum.

Medicines to stimulate expectoration

This subgroup is also called secretomotor means. The action of stimulant drugs is aimed at irritating the gastric mucosa, which provokes increased work of the cough and vomiting centers medulla oblongata. The consequence of this is an increase in the production of liquid secretion in the bronchi and an increase in cough reflexes.

The main drugs in this group are thermopsis herb, a number of essential oils, ammonium chloride and others. It should be noted that drugs to stimulate expectoration have a fairly short-term effect, and an overdose can lead to vomiting, nausea, nasal congestion and tearfulness.

Medications that thin phlegm

A subgroup of these drugs, also called mucolytics, thins sputum without causing it to increase in volume. This effect is achieved due to the fact that disulfide bonds in acidic mucopolysaccharides are broken. The main prerequisite for their use is the viscous sputum that is produced in diseases respiratory tract, including bronchitis.

The most popular thinning drugs are:

In principle, all these drugs can be considered as analogues of each other, and the prescription of a specific drug is carried out solely based on the preferences of the doctor and the individual characteristics of the patient’s body.

In addition to the above-mentioned groups of medications, the occurrence of bronchitis may require the use of antipyretics. In most cases, inflammation of the bronchi is accompanied by only a slight increase in body temperature, at which the body is given the opportunity to cope with the problem itself. But if the temperature goes beyond 38 degrees, then drug therapy you need to add classic ibuprofen or paracetamol.

This is where the drug treatment of bronchial inflammation ends. In its normal course, this disease does not require other medications, but it does require a special regime for keeping the patient and physiotherapeutic procedures.

Changing your lifestyle and regimen for bronchitis

When wondering how to quickly cure bronchitis, you need to remember: with bronchitis, the main condition for recovery is to create the most favorable environment for the natural restoration of normal functioning of the respiratory system.

The first and most important thing for bronchitis is moisture. At the same time, in addition to the moist air in the room where the patient is, he needs to be provided with as much fluid as possible. Moreover, you can drink absolutely everything, with the exception of soda: water, juices, herbal teas. The main thing is that the drinking temperature is comfortable.

To ensure sufficient humidity in the room, it is best to use humidifiers. If they are not there, hang wet towels on the radiators, spray water with a spray bottle - do everything to increase the water content in the air.

Already these two rules will create favorable conditions for overcoming a dry cough and beginning the process of sputum separation.

In addition, with bronchitis, especially in the first three days, bed rest and absence physical activity. Short walks are allowed only at the first relief, and they need to be carried out in places with clean air: in squares, parks, in the forest.

A separate point of the regime for bronchitis - complete failure from smoking. Inhalation of tobacco smoke is a provoking factor for dry cough and smoking during bronchitis can not only prolong the recovery process over time, but also cause the development of serious complications. By the way, doctors believe that inflammation of the bronchi is an excellent (so to speak) reason to quit smoking.

Adhering to these simple rules, treatment bronchitis will go away in the shortest possible time and with a minimum of necessary medications.

Physiotherapy for bronchitis

• inhalation,
• massage,
• breathing exercises.

Inhalations for bronchitis

It is recommended to carry out inhalations using special devices - inhalers. Steam inhalations are also possible, but, especially for children, you need to be extremely careful to avoid burns to the mucous membranes.
Inhalation of the following drugs is effective for bronchitis:

• saline and soda solutions;
• essential oils of eucalyptus tree, pine, mint, garlic and rosemary;
• Lazolvan, Ambrobene and other medications whose action is aimed at removing phlegm from the bronchi.

There are only two contraindications for inhalation: high temperature and rapid heartbeat. But immediately after overcoming them, inhalations can be used. This is one of the most effective methods with inflammation of the bronchi.

Breathing exercises for bronchitis

Technique breathing exercises for pathologies of the respiratory tract, there are quite a lot. Regardless of who developed a specific set of exercises, they all have a positive effect on the rate of overcoming bronchitis. You need to choose the appropriate breathing exercises yourself or on the recommendation of a doctor. The most popular are the methods of Strelnikova, Buteko, Kofler, as well as yoga and martial arts Wushu.
Any set of exercises for the respiratory system prioritizes the following goals:

• increasing the functional reserves of the respiratory system;
• changes in the functioning of organs, which are achieved by influencing the respiratory system.

And most importantly: when performing such exercises, you need to remember that they need to be carried out in the fresh air, which in itself has a positive effect on the condition of the respiratory system.

Massage for bronchitis

Massage during inflammation of the bronchi is prescribed when the disease has subsided: there is no high temperature, the cough has passed into the wet stage, there are no associated complications.
The massage should be preceded by a very warm bath, which will soften the skin and allow you to spend some time in a room with one hundred percent humidity. There are several massage techniques for bronchitis. Let's describe them:

• 1. The patient lies on his back on a hard surface. During inhalation, the massage therapist runs his hands along the sides in the direction from the chest to the back, and during exhalation, back. Rib cage during this it should squeeze a little.
• 2. Lying on his back on a hard surface, the patient needs to slightly raise his head with a pillow. With the pressed palms of the massage therapist's hands, movements are carried out from the abdomen to the shoulders. Similar movements are carried out with the patient lying on his stomach. Hand movements, respectively, are carried out along the back. This allows you to stimulate the removal of mucus from the bronchi.
• 3. Another massage procedure to improve phlegm removal is as follows: the patient lies on his stomach so that his head extends beyond the massage table and is slightly lowered down. At the same time, a pillow is placed under the feet so that they are raised. In this position, intercostal massage is performed. The recommended duration of the procedure is 25 minutes.

Finally, we note that the treatment of bronchial inflammation in its normal course is quite simple, but at the same time it requires competent tactics for taking medications and using physical procedures. Therefore, if you get bronchitis, consult a doctor. He will tell you how to treat bronchitis at home, accurately determine the characteristics of the disease and select therapy that will give the most effective result in a short time.

Tactics of drug treatment of bronchitis

Bronchitis is an inflammatory disease of the bronchial tree, which is characterized by hypersecretion of mucus, productive or unproductive cough. Bronchitis occurs in acute and chronic form. A special problem is chronic bronchitis, which occurs as a result of prolonged exposure to an irritating factor and entails processes of sclerosis of the bronchial wall and surrounding tissues, as well as a violation of the cleansing and protective functions of the bronchi. Worldwide, about 10% of the population suffers from chronic bronchitis. The majority are males over the age of 40.

Etiology of bronchitis

There are many reasons for the development of bronchitis.

In this case, it is more appropriate to talk about risk factors for developing the disease:

1. Smoking, including passive smoking.
2. The effect of various pollutants: street (exhaust gases, industrial emissions into the atmosphere); household (from finishing materials - benzene, formaldehyde, styrene, nickel, phenol, cobalt and others).
3. Occupational hazards among construction workers, weaving factory workers, miners, chemical workers, steelworkers.
4. Physiological factor – old age, male gender.
5. Congenital antitrypsin deficiency.
6. Infections, especially long-term persistent cytomegalovirus.
7. Chronic alcoholism and drug addiction.

Mechanism of disease development

The mechanism of development of bronchitis is based on morphological reversible and irreversible changes in the bronchi.

Reversible changes:

• hypertrophic changes in the bronchial glands;
• increased secretion of bronchial mucus;
• swelling of the mucous membrane;
• infiltrative changes in the mucous membrane and submucosal layer.

Irreversible changes (develop only in chronic form):

• inflammation outer shell bronchus;
• development of pneumosclerosis;
• development of emphysema;
• respiratory failure;
• "pulmonary heart" syndrome.

Clinical picture of bronchitis

The acute form of bronchitis is very often a complication of respiratory infectious disease. It is characterized by low-grade and febrile fever, the appearance of symptoms of general malaise - drowsiness, weakness, headache. Then a cough appears. As a rule, the cough at the beginning of the disease is dry and unproductive. During treatment, the cough becomes moist and the amount of sputum produced increases.

Exacerbation of chronic bronchitis manifests itself with the same symptoms, but the disease lasts longer. In addition, there are symptoms such as shortness of breath and a feeling of lack of air. Breathing is harsh and wheezing may be heard. Also, with chronic bronchitis, the patient may intensively lose weight. Weight loss occurs due to muscle and fat tissue. This is a sure sign of development respiratory failure. Possible sleep disturbances: intermittent, short sleep, accompanied by snoring, frequent awakenings. Sleep disturbances lead to irritability, increased fatigue, and sexual dysfunction.

Diagnosis of the disease

Diagnosis of bronchitis is mainly based on data clinical picture, as well as interviewing the patient. As a result of the survey, predisposing factors can be found out, which will help to make a correct diagnosis.

In addition to collecting anamnesis and examining the patient, complex diagnostic methods are used:

1. X-ray method. The method allows you to exclude pneumonia and suspect emphysema.
2. Sputum cytology examination. Allows you to determine the type of inflammatory process. Helps differentiate between catarrhal, purulent and hypertrophic bronchitis.
3. Microbiological analysis of sputum. Used to determine sensitivity to antibacterial agents.
4. Bronchoscopy can exclude cancer lungs and bronchi, tuberculosis, bronchiectasis.

Treatment of bronchitis

Before starting treatment, the patient and his relatives should explain the causes of the disease and predisposing factors. Compliance with certain restrictions will ease the course of the disease and help achieve highly effective treatment. Treatment of acute bronchitis consists of prescribing antitussives, expectorants, anti-inflammatory drugs, and in more severe cases, the use of antibacterial therapy. Herbal medicine and physiotherapy are also indicated. Treatment of exacerbation of chronic bronchitis is always more complex and lengthy.

The basic principles of treatment of chronic bronchitis require more detailed consideration:

1. Complete smoking cessation required. If refusal is not possible, then replacement therapy is carried out with drugs containing nicotine in transdermal form or in the form of chewing gum.
2. An important point in treatment is maintaining hygiene at home and in the workplace.. Recommended daily wet cleaning at home and eliminating harmful working conditions. If it is impossible to comply with these conditions in the workplace, then you should consider changing your professional activity.
3. Compliance with seasonality in choosing clothes. Avoid drafts and hypothermia. It is advisable to wear clothes made from natural, simple fabrics that prevent heat loss and overheating.
4. Compliance with the rules of therapeutic nutrition. The basic principles of nutrition for chronic bronchitis are quite simple: meals should be fractional - up to 5 times a day; the content of fats and carbohydrates in food should not exceed the norm, and the amount of protein should be significantly increased; dishes must be fortified; a large amount of warm drinks is desirable. Recommended: dairy and fermented milk products, lean meats, fatty fish, eggs, strong chicken broth, fruits and vegetables rich in vitamin C (cabbage, onion, tomatoes, citrus fruits, kiwi), rosehip decoction with honey.

Drug therapy:

Antibacterial drugs. Treatment with antibiotics is prescribed only if the clinical picture includes a cough with purulent sputum, fever, increase ESR indicator. The drugs of choice in this case are bactericidal antibiotics belonging to the group of semisynthetic penicillins, in combination with clavulanic acid. One of these drugs is Amoxiclav. It is also possible to prescribe a combination drug containing ampicillin and sulbactam. It is also possible to prescribe antibiotics from the group of 3rd generation cephalosporins and macrolides. As a rule, exacerbation of chronic bronchitis is treated on an outpatient basis, so medications are prescribed in the form of tablets or oral suspensions.

Important! Antibacterial drugs are not prescribed for prophylactic purposes!

Medicines that have a bronchodilator effect. Most often, a drug is used for this purpose, the active substance of which is Ipratropium bromide - Atrovent. The drug does not have a systemic effect because it does not have the ability to be absorbed into the bloodstream. The medicine is not used for emergency care, since its effect develops only 30 minutes after entering the body. Atrovent is used by inhalation. Also used to dilate the bronchi Berotek, Ventolin. Drugs are also administered by inhalation. Suitable for rendering emergency care, since they act after 3-8 minutes. Drugs from the theophylline group may be prescribed - Teopek, Theotard. These medications relieve fatigue of the respiratory muscles, reduce pressure in the pulmonary circulation, and moderately dilate the bronchi. It is worth highlighting the drug separately Erespal, which in addition to its bronchodilator effect has an anti-inflammatory effect.

Drugs that reduce sputum viscosity– mucolytics and mucoregulating agents. Mucoregulators include Bromhexine, Ambroxol. Drugs of this group disrupt the synthesis of sialomucoproteins, which entails a decrease in the viscosity of bronchial mucus. Mucolytics prescribed for chronic bronchitis: Acetylcysteine, Carbocysteine— destroy mucoproteins, which also leads to a decrease in sputum viscosity.

Expectorants. Herbal medicines are very effective in this group: Licorice syrup, Thermopsis tablets, Chest collection No. 2.4, as well as decoctions Coltsfoot, Thyme, Violets tricolor. The drugs have reflex action, as a result of which the action of the bronchial glands is enhanced.

Antitussives medicines used for dry cough with difficult to separate sputum. Drugs in this group suppress the cough reflex, affect the viscosity of sputum and promote moderate dilation of the bronchi. These include: Libexin, Sinekod, Omnitus, Herbion with plantain.

Hormonal drugs glucocorticoid series. at severe course chronic bronchitis is prescribed Prednisolone in individual dosages. During treatment with systemic glucocorticoids, the prescription of calcium supplements is indicated to prevent the development of osteoporosis.

Oxygen therapy. Oxygen treatment is carried out during the period of remission of the disease. at systematic application Using this technique, the prognosis of the disease improves and life expectancy increases to 10 years.

Rehabilitation treatment:

1. Medical examinations up to four times a year, preferably with consultation of a pulmonologist.
2. Monitoring laboratory parameters of blood (ESR), sputum (cytology, bacteriology, general analysis).
3. Assessment of immunological status.
4. Pneumotachometry is a method for determining air flow during inhalation and exhalation. Widely used in the diagnosis of bronchopulmonary diseases.
5. Preventive administration in the spring and autumn of expectorants containing herbal components: Thermopsis, Ledum, Thyme, Althaea, Coltsfoot, Plantain.
6. Maintenance treatment with inhalation methods. For inhalations during the period of remission, sodium chloride 0.9% solution, Sodium bicarbonate 2% solution, Eucalyptus tincture are usually used. Oil inhalations using natural oils of Eucalyptus, Sea Buckthorn, and Almond are also shown. Oil inhalations should not be prescribed to people who work in dusty industries. Oil in combination with dust can form crusts that can affect the patency of the bronchi.
7. Immunorehabilitation treatment. Most often it is carried out with the drug Ribomunil. The drug causes an immune response, which provides lasting immunity against pathogens of respiratory infectious diseases. It has been noted that after treatment with Ribomunil, the incidence of exacerbations of bronchitis is noticeably reduced. In addition, concomitant pathologies are cured - sinusitis, rhinitis, tonsillitis with a predominance of purulent processes.
8. Sanatorium-resort treatment in specialized institutions year-round is also indicated.

Features of drug therapy for certain categories of patients:

• pregnant women. Antibiotics are prescribed that are not capable of negatively affecting the development of the unborn child. These are penicillin drugs and cephalosporins. The bronchodilator drug Atrovent is contraindicated. According to indications, it is possible to prescribe glucocorticoids in small doses, expectorants and mucolytics;
• elderly and senile age. Before prescribing antibacterial drugs, it is necessary to determine sensitivity to antibiotics. Drugs without nephrotoxic effects are used. M-anticholinergics are used extremely rarely, as they can cause constipation, urinary retention, and increased intraocular pressure. Glucocorticoids are prescribed only in hospital settings under the strict supervision of a physician. Together with hormones, taking mineral complexes is indicated for the prevention of osteoporosis. Antitussive drugs should be prescribed very carefully, as they can depress the respiratory center.

Treatment of bronchitis is always complex and difficult. It can only be effective combination therapy. It is highly not recommended to treat bronchitis on your own, since irrational therapy can lead to a chronic process and the development of severe complications

JMedic.ru

Chronic bronchitis is an inflammatory disease of the bronchial tree, characterized by cough with sputum and shortness of breath. The inflammatory process occurs with constant exacerbations and remissions.

Therapy methods

Chronic bronchitis should be treated only conservatively. What methods apply to conservative treatment? These are all non-invasive treatment methods, namely drug treatment, treatment using inhalation via inhalers, folk and physiotherapeutic treatment.

It should be noted that drug treatment is the most effective remedy against chronic bronchitis. IN this treatment includes both tablet and injection forms of drugs. Typically, to treat the disease in adults, medications such as antibiotics and antiviral drugs are prescribed, followed by anti-inflammatory drugs, mucolytics, antitussives, antihistamines, hormones and bronchodilators.

Medicines in tablets and injections

• One of the very first drugs for the treatment of chronic bronchitis in adults are antibiotics, which act against bacteria that cause an exacerbation of the disease in the bronchi. It should be remembered that if within 3 days after starting antibiotic treatment the general condition has not improved and the temperature has not returned to normal, then another antibiotic must be prescribed, since this one did not give the desired effect.

The following antibiotics are used to treat chronic bronchitis:

Penicillin antibiotics: Amoxicillin (Amoxil, Flemoxin), Amoxicillin with clavulanic acid (Augmentin, Flemoxin Solutab), which have broad-spectrum antibacterial activity, i.e. effective against gram-positive (staphylococcal, streptococcal, pneumococcal flora) and gram-negative (legionella, proteus, mycoplasma, ureaplasma, Pseudomonas aeruginosa) infections. Penicillin antibiotics are prescribed at a dose of 1000 mg, they must be taken 2 times a day. They need to treat chronic bronchitis for 7–14 days.

Cephalosporin antibiotics - Norfloxacin, Ciprofloxacin, Ofloxacin - have a pronounced antibacterial and bacteriostatic effect only for gram-negative flora; such a narrow focus on bacteria makes their effect much stronger than simply broad-spectrum antibacterial drugs. For adults, the drug is prescribed 200 mg 2 times a day. The course of treatment is on average 10–14 days.

Antibiotics from the macrolide group - Klabax, Fromilid, Azithromycin, Rovamycin - have a bacteriostatic effect and are effective primarily for intracellular forms of infections, which makes them indispensable in the treatment of chronic bronchitis. For adults, the drugs are prescribed at a dose of 500 mg; it should be taken at the same time, on an empty stomach, 1-2 times a day. This disease needs to be treated for 3–7 days.

Antibiotics from the fluoroquinolone group - Ciprofloxacin, Levofloxacin, Leflock - belong to broad-spectrum antibacterial drugs, but these drugs are effectively used only for the treatment of the bronchopulmonary system; another name for this group is respiratory fluoroquinolones. Chronic bronchitis in adults should be treated with these drugs for no more than 7 days at a dose of 500 mg once a day. Leflock has an injection form of release, which allows intravenous or intramuscular injections. It is also necessary to remember that antibiotic injections should only be taken for severe exacerbations.

• If viruses have contributed to the exacerbation of the disease, then medications against viruses are prescribed:

• Mucolytics are substances that promote expectoration of sputum. Depending on which cough predominates in the patient, different drugs are prescribed:

When a dry cough predominates, medications are prescribed that help thin the sputum, i.e. reduce its viscosity - this is Acetylcysteine ​​(Acysteine, Mukobene, Mukonex) 200 mg 4 times a day, 400 mg 2 times a day or 800 mg 1 time a day. You can also use plantain syrup, which you take 1 tablespoon 3 times a day. The cough first becomes unproductive, and then productive with the release of a large amount of sputum. It takes quite a long time to treat a cough, up to 10–15 days.

When a wet cough immediately appears during illness, drugs from the ambroxol group (Flavamed, Abrol, Ambroxol) are prescribed for adults. The drugs are prescribed at 75 mg 1 time per day or 30 mg 3 times per day. If the cough is with a large amount of sputum, then Erespal should be added to this group of drugs, which is taken 1 tablet 2 times a day; if the cough is with a small amount of sputum, then this drug is not needed. The cough must be treated for 10–20 days.

One of the representatives of this group, Lazolvan, has an injection form of release and allows intramuscular injections. Due to the speed of action medicinal substance, injections are considered more effective.

Inhalation therapy

Inhalations with delivery medicinal substances through inhalers directly into the bronchi are one of the effective methods of treating chronic bronchitis.

Inhalations are done with medicines– hormones, antihistamines, mucolytics and bronchodilators. With the help of inhalation, the active substances enter in sufficient quantities directly into the focus of the inflammatory process, and do not require initial passage gastrointestinal tract and absorption into the blood. Inhalations deliver unchanged medications in active forms.

Inhalations can also be carried out with soda and aromatic oils, which have an antibacterial and bronchodilator effect. The following oils are suitable for inhalation: pine, lavender, tea tree, eucalyptus and thyme.

For inhalations, you can use special inhalers - nebulizers, as well as, although less effective, inhalers, but at home from a saucepan or kettle.

Unconventional methods

Traditional methods of treatment are well suited for chronic bronchitis during remission. Traditional methods reduce the frequency of exacerbations of the disease, and also improve overall well-being, increase immunity and give strength.

Traditional methods of treatment using decoctions and infusions of herbs help the body fight cough and reduce the amount of sputum secreted by the bronchi. Suitable for decoctions: plantain herb, medicinal chamomile, licorice root, sage, mint, linden leaves, marshmallow root.

Traditional methods of treatment using rubbing help to better cleanse the bronchi from bacteria, viruses and sputum, and normalize the function of the lungs and bronchi in general. Honey, goose, lamb or badger fat are suitable for rubbing.

Video: Chronic bronchitis. Description, symptoms and treatment

I chose inhalation treatment for myself. Since childhood, I remember how potatoes and herbs quickly put my brother and me on our feet. I bought a nebulizer and Prospan drops for my family. I dilute 20 drops in saline and let my son breathe for 10 minutes several times a day. This is how we treated bronchitis a month ago.

A post about serious medical research.

Not long ago, PubMed published a meta-analysis of comparative effectiveness different techniques treatment of anxiety disorders. Randomized controlled trial, all business. In total, almost 40,000 patients participated in all this. Three “diagnoses” were examined: panic disorder, generalized anxiety disorder and social phobia. The effectiveness of several drug treatment options and various “psychological” techniques was assessed and compared.

Among other things, when summing up the results in the PubMed publication, there was the following phrase: “Pre-post ES for psychotherapies did not differ from pill placebos; this finding cannot be explained by heterogeneity, publication bias or allegiance effects” (c). Seeing her, some agitated individuals with attention deficit disorder began to joyfully exclaim in capslock: I knew, I believed, I hoped - psychotherapy is ineffective, it’s all a scam, the effect is like a placebo... They say “who would doubt it” (c).

Since these enthusiastic cries began to be reposted across the network, even on the pages of quite serious people related to both science and medicine, I consider it necessary to analyze in detail the essence of the research conducted. Because the topic is interesting, and a lot of work was done by researchers just to skim the text without bothering themselves with trying to understand the essence of what was written. But this essence can be quite unexpected for someone who doesn’t read carefully >:3

In the first lines there is a bit of obligatory skepticism. A publication in PubMed is a so-called abstract; only brief results are indicated there and that’s all. There is no description of research methods and other important details on which the interpretation of the results depends.

For example, there is no description of the exact clinical picture of anxiety disorders. Agree that to evaluate the effectiveness of therapy:
-in a person experiencing psychological discomfort from large crowds of people public transport or in the crowd...
-an agarophobe who panics when he has to cross the threshold of his home...
-a terry persecuted schizophrenic who experiences panic anxiety from the fact that right now huge orangutans from the future with lasers in their hands are chasing him across the roofs of houses...

These are three big differences, although in all three options can also be diagnosed as an "anxiety disorder". In all three options, the effectiveness of the same techniques will be completely different - and this does not cause any surprise, taschemta. That's how it should be.
There is no description of a universal effectiveness indicator and a method for calculating it for different therapy methods.
There is also no detailed description of the research methodology, that is, for example, it is unknown how the researchers formulated and defined “psychological placebo” - yes, they have a similar indicator in the publication.

But - chu! I don’t want the post to look like an attempt at justification by looking for a speck in someone else’s eye. Yes, from the abstract it is not clear what conditions were studied (clinical form, severity of anxiety, and so on), it is not clear how exactly the analysis was carried out and according to what criteria. This is a moment of obligatory skepticism. Let's take it as an axiom that this study was organized correctly, the indicators were formulated accurately and reliably, and the methods were fully consistent with the clinic.

So, the researchers assessed the effectiveness of the therapy. For this purpose, the universal indicator “effect sizes” (hereinafter ES) was used.

Indicators of effectiveness of therapy for anxiety disorders are:

ES of non-selective serotonin reuptake inhibitors = 2.25
ES of selective serotonin reuptake inhibitors = 2.09
Benzodiazepine ES = 2.15
ES of tricyclic antidepressants = 1.83

ES of mindfulness cognitive therapy = 1.56
ES "relaxation" (no explanation, interpret it as you wish) = 1.36
ES of individual cognitive behavioral therapy = 1.30
ES of group cognitive behavioral therapy = 1.22
ES of psychodynamic therapy = 1.17
ES of remote impersonal psychotherapy (for example, psychotherapeutic correspondence over the Internet) = 1.11
ES method of processing emotional trauma using eye movements Francine Shapiro = 1.03
ES of interpersonal therapy = 0.78

ES combinations of cognitive psychotherapy and “drugs” (that is, medications without specifying which ones) = 2.12

ES of "exercise" (whatever that means) = 1.23

ES of drug placebo = 1.29
ES of psychological placebo = 0.83
ES waitlists = 0.20

Here are all the main figures that can be compared and analyzed.

From these data it is clear that truly individual cognitive psychotherapy Its effectiveness exceeds that of a medicinal placebo, and the group group falls slightly short of the effectiveness of a medicinal placebo.

But let's take a moment to remember what a drug placebo is. The “placebo effect” refers to the situation when, during medical research, patients are quietly fed pacifiers - and the patients still get better. That is, the patient in the control group is confident that he is being treated with real medications, like everyone else, but he is secretly given a pacifier. Placebo. This is done with patients in control groups to compare the results of drug treatment and non-treatment.

The placebo effect is a pronounced psychological effect. A classic example is when patients in group 1 are given a pacifier by an ugly, angry, rude and always irritated nurse, and patients in group 2 are given a pacifier by a kind and smiling manager. department. The nurse rudely forces you to drink and stick out your tongue, and the head of the department talks about the achievements of medicine and describes the pacifier given as the latest, unique and very effective remedy. And in the second group the placebo effect was significantly higher than in the first.

When a person receives a drug placebo, he is sure that he is participating in a drug study, and a new one at that (the person was notified, he signed consent to participate). The person is convinced that he is being fully treated with the latest medications; all the conditions, all the treatment, all the events, actions, and the surrounding environment point precisely to this. And his conviction helps him recover. This is nothing more than an element of “suggestion”, that is, it is an element of psychotherapeutic influence.

Thus the ecstatic cry" THE EFFECTIVENESS OF PSYCHOTHERAPY WAS THE SAME AS THE EFFECTIVENESS OF DRUG PLACEBO" actually makes sense "THE EFFECTIVENESS OF PSYCHOTHERAPY WAS THE SAME AS THE EFFECTIVENESS OF PSYCHOTHERAPY." Let's give a pat to those people who read diagonally and, taking a few words out of context, make themselves look like fools ^_^
It was not for nothing that the researchers separated the medicinal placebo from the psychological placebo (no matter how they defined the latter, but skepticism was higher).

The effectiveness of drug therapy is higher than the effectiveness of psychotherapy, especially when it comes to a generalized clinic of psychiatric conditions
- the effectiveness of cognitive psychotherapy is 1.5-2 times higher than the effectiveness of “psychological placebo”. Drug therapy is also approximately one and a half times more effective than drug placebo.
-the total effectiveness of cognitive psychotherapy and drug therapy exceeds the effectiveness of almost all isolated techniques.
- the effectiveness of cognitive psychotherapy is significantly higher compared to Shapiro’s technique and interpersonal ( interpersonal) psychotherapy

If these conclusions are expressed in simple human language:

-IN severe cases Medicines help better than psychotherapy
-Psychotherapy has proven effectiveness.
-Psychotherapy and medications are more effective together than separately.
-Psychotherapy is more effective the less “dancing with a tambourine” in it. The more of these dances, the less the result.

And now, placing your hand on the fifth intercostal space on the left, tell me: these conclusions turned out to be really breaking news for you, or did you already guess about something like this before?)))

I can’t say anything about the effectiveness of physical exercise. Go figure what they meant: an active lifestyle and physical work in the fresh air, regular fitness in a club, yoga meditation in a Tibetan monastery, the author’s semi-secret rehabilitation program for special forces and athletes... A detailed text of the study would have helped here, probably “physical exercises” are described in at least some detail >:3