Acute purulent bronchitis treatment. How to treat purulent bronchitis with antibiotics and folk remedies. Features of the course of bronchitis in older people

Among the many forms of bronchitis, purulent bronchitis is the most dangerous. This pathology is fraught with the development of serious complications (inflammation affects not only the bronchi, but also other internal organs). This type of disease does not develop suddenly; a person has a chance to recognize and get rid of the danger in time.

Purulent bronchitis is an inflammatory process that covers the entire bronchial tree.

The disease occurs with copious discharge of purulent mucus. Pathology is a type of chronic or acute bronchitis.

The nature of the disease always begins with the initial development of a bacterial type infection, which is why characteristic signs are observed:

shortness of breath;
sweating;
increased fatigue;
painful sensations when breathing;
low-grade fever (+37-37.2⁰ C);
wet cough with greenish-yellow sputum;

Purulent bronchitis worsens 2-3 times a year. Hypothermia, additional colds, and stress lead to relapse. With relapse, the clinical picture of the pathology becomes more pronounced. The cough intensifies, and the volume of expectorated mucus increases sharply.

Types of disease

Pulmonologists divide the purulent complication of the disease into three types:

Catarrhal. The disease manifests itself with a strong, painful cough and profuse expectoration (when analyzed, leukocytes are found in the mucus).
Purulent-obstructive. In the sputum, purulent streaks are visible in large quantities, and there may be an admixture of blood.
Chronic. Sluggish purulent bronchitis with periods of relapse and remission.

The purulent-obstructive type of the disease is of great danger. This pathology develops due to the exacerbation of infectious diseases caused by pathogenic microorganisms. The patient's temperature rises, muscle and joint aches develop.

Important! Delay in therapy during the development of purulent-obstructive bronchitis causes irreversible changes in the pulmonary system and can be fatal.

How does the disease develop?

Bacteria are the culprits of this dangerous pathology. Carriers of infection enter the body through airborne droplets (if bronchitis is secondary, through blood and lymph flow).

An organism weakened after suffering from influenza, sore throat, tracheitis, or acute respiratory viral infection is not able to resist bacterial activity.

Rapidly multiplying microorganisms cause swelling of the bronchi, causing shortness of breath and the appearance of thick sputum. Air pollution, passive smoking, allergic reactions, irritating the bronchi, make them even more vulnerable to bacteria.

The mechanism of disease development is divided into two phases:

Primary. Damage to the alveoli and bronchi.
Secondary. The inflammatory process also affects other respiratory organs, and deep damage to the lungs occurs.

The development of the disease takes a long time. If the disease is recognized at the first stage and therapy is carried out correctly, recovery is guaranteed. But, when the patient again surrounds himself with provoking factors, purulent bronchitis returns and develops into a chronic form.

How to recognize chronic purulent bronchitis

Chronic purulent bronchitis characterized by a long-term, sluggish form with periods of remission and relapse.

This type of disease does not have pronounced symptoms. The pathology is diagnosed when periods of exacerbations occur from 2-3 months a year for 2 years.

A distinctive feature of the disease is a sharp increase in the amount of expectorated sputum(volume can reach 250 ml per day). In addition to pus, blood streaks are observed in the mucus. Relapses are provoked by even the slightest hypothermia of the body and a mild cold.

Danger of pathology

For purulent bronchitis high risk of developing pulmonary obstruction (COPD). This probability increases when the patient is over 60 years of age. Obstruction of the lungs leads to irreversible changes in the lung tissue and disruption of the entire respiratory system.

Important! If a patient has obstruction of the lungs, it is no longer possible to restore and normalize the functions of the respiratory apparatus.

Purulent bronchitis is an extremely dangerous and serious pathology. The disease must be diagnosed promptly and treated immediately.

At the first alarming symptoms, especially if a person already suffers from chronic bronchitis, a comprehensive examination should be carried out. More often the development of pathology can be detected by fluorography. Laboratory cultures of sputum establish the presence of bacteria inherent in the disease.

Carry out and blood chemistry, which during the disease will show acceleration of ESR, increased leukocytosis, sialic acids and seromucoid.

Attention! For purulent bronchitis, chest x-rays are rarely performed as a diagnostic method. It is not considered informative.

But bronchoscopy is necessary. When examining the bronchi, signs of hyperemia (blood overflow of the organ), swelling of the mucous membrane and copious amounts of pus are detected. When performing a bronchoscopy, doctors take sputum to determine its sensitivity to antibiotics. And they develop a treatment plan.

Since the culprit of purulent bronchitis is the activity of bacterial microorganisms, doctors for treatment antibiotics are used. Antibacterial drugs are administered to the patient orally (tablets), endotracheal infusions, or injections.

Endotracheal infusions are performed under local anesthesia using a laryngeal syringe or rubber catheter. This is how precise sanitation of the affected areas of the bronchi is achieved.

Attention! With purulent bronchitis, it is strictly forbidden to self-medicate. Incompetent therapy leads to a worsening of the situation and the development of deadly complications.

Many people who do not understand the intricacies of medications like to take a course of antiviral drugs for any infection. For purulent bronchitis, such treatment is useless! Antiviral drugs help only when treatment for viral bronchitis in adults is required.

Treatment of purulent bronchitis with antibiotics

Antibiotics for purulent bronchitis are taken under the supervision of a doctor, the patient needs to undergo control bronchoscopy every 5-7 days to detect the attenuation of inflammation. In addition to antibiotics, the following are used in the treatment of purulent bronchitis:

mucolytics to liquefy and remove sputum;
bronchodilators to relieve swelling of the bronchi and improve breathing;
antihistamines that relieve sensitivity to disease-provoking allergens or prescribed medications.

The course of therapeutic therapy is complemented by physiotherapy, exercise therapy, massage, inhalations for chronic bronchitis and postural drainage (a special procedure that facilitates the discharge of bronchial sputum).

At the same time, it is necessary to treat concomitant diseases in order to prevent exacerbation of the pathology and the development of its complications.

What complications does purulent bronchitis cause?

Without proper therapy, the disease provokes the development of emphysema and severe pneumonia with acute respiratory failure. Signs of beginning deterioration:

lengthening the inhalation;
heavy sweating;
grayish skin tone;
breathing tension (wheezing, whistling);

What helps in treatment

During treatment, patients with purulent bronchitis (especially the elderly) should maintain strict bed rest and completely eliminate smoking (passive smoking too). Preventive measures are also important:

improvement of inhaled air parameters;
timely vaccination during influenza epidemics;
immediate treatment of emerging colds;
Regular monitoring by a doctor for diagnosed chronic bronchitis.

Such a gentle regimen with strict adherence to all prescriptions contributes to favorable treatment. A standard treatment regimen may look like this:

Group of drugs	View	Name	How does it help?
Antibiotics	Aminopenicillins	Arlet, Amoxiclav, Augmentin, Ampicillin, Amoxicillin	Destroy the walls of harmful bacteria, leading to their death
	Macrolides	Sumamed, Macropen, Clarithromycin, Azithromycin,	Inhibits the proliferation of pathogenic microflora by destroying bacterial protein
	Fluoroquinolones	Moxifloxacin, Ofloxacin, Sparfloxacin, Levofloxacin
	Cephalosporins	Cephalexin, Cefazolin, Cefotaxime, Ceftriaxone, Cephelin
Mucolytics		Acetycysteine, Bromhexine, Ambroxol, Lazolvan, Fluditec	Liquefaction and removal of mucus from the bronchi
Bronchodilators		Atrovent, Berodual, Salbutamol, Teofedrine	Elimination of bronchospasms

Treatment of purulent bronchitis with folk remedies

Methods of healers in the treatment of purulent bronchitis aimed at cleansing the bronchi from accumulated mucus. Traditional healers advise how to clear the bronchi of phlegm:

Include natural antibiotics in your menu: garlic, horseradish, onions, honey, propolis, ginger, black radish.
Drink more healing drinks (raspberry, ginger, linden tea, cranberry, lingonberry fruit drinks).
Treat yourself with decoctions and infusions of medicinal herbs: breast tea, sage, mint, chamomile, elderberry, linden blossom, plantain.
Use animal fats (badger, lamb, pork). It is used as a remedy internally and for rubbing the patient’s back and chest.

Proper treatment of purulent bronchitis will help you forget about the disease after 1.5-2 weeks. After the symptoms disappear, you can return to your normal lifestyle, but do not forget to take a course to strengthen the body’s immune forces.

Useful video

From the video below you will learn what purulent bronchitis is and how to treat it.

Among the various forms, purulent bronchitis is the most severe and dangerous. Let us remember that bronchitis is a common complication of a viral infection. Each patient experienced simple bronchitis at least once in his life after suffering from acute respiratory viral infection. The danger is that simple bronchitis sometimes transforms into purulent bronchitis. Any purulent pathology can lead to many dangerous complications.

The transition of bronchitis to a purulent form does not occur in one day. This is quite a long process. And this transition, with careful attention to treatment, can be prevented.

This transition is especially dangerous for people of the older generation (over 65 years old) in whom, due to a decrease in the volume of movement, obstruction occurs and the purulent process turns into a purulent-obstructive one.

Attention! This development of pathology often ends in respiratory failure or even pneumonia with a fatal outcome.

What is purulent bronchitis

Bronchitis called inflammation of the bronchial mucosa.

For reference. Viral bronchitis is called simple. It becomes purulent if bacterial flora appears.

Normally, the bronchial mucosa is resistant to the effects of infectious agents, which is why bronchitis appears in an already compromised bronchial tree.

Normal mucosa is covered with ciliated epithelium. The cylindrical cells fit tightly to each other, preventing infection from going deeper. The cilia move towards the nasal passages, as if sweeping away dirt and dust that enters the bronchi.

The epithelium is covered on top with mucoid – mucus. It is necessary to glue particles of dirt and infectious agents together. This makes them easier to remove from the bronchial tree. In addition, the mucoid contains immunoglobulins that neutralize foreign antigens.

Under the mucous membrane is connective tissue with blood vessels and immune cells. The latter are necessary in order to fight infection that penetrates the epithelial barrier. As a result of the action of these cells, inflammation occurs.

For reference. When the epithelial lining changes under the influence of viruses or unfavorable environmental factors, bacteria can freely penetrate into the submucosal layer.

Here they are encountered by immune cells, primarily neutrophils. As a result of their interaction, inflammation occurs, the bronchial mucosa becomes swollen, and the lumen is filled with exudate. This exudate contains a large number of bacteria and dead neutrophils, which makes it purulent.

Pus comes out when you cough in the form of sputum. Cough is caused by irritation of receptors on the surface of the bronchi. In addition, dead neutrophils release mediators that contribute to an increase in body temperature. The patient's general condition worsens.

For reference. Over time, the exudate becomes more viscous, now it coughs up worse and clogs the bronchi. Obstruction occurs - narrowing of the lumen of the bronchial tree.

If treatment is not started in a timely manner, changes occur not only in the bronchial mucosa, but also in the submucosal layer. Here, elastic tissue is replaced with collagen, which cannot expand and contract. This is how chronic bronchitis and its complications arise.

Causes

For reference. Purulent bronchitis develops when a bacterial infection enters the bronchi compromised by the pathological process.

The reason for the decrease in the barrier function of the bronchial mucosa may be:

ARVI. Each respiratory virus has a tropism for its own part of the respiratory system. As a rule, they affect the upper respiratory tract, and then spread to the lower respiratory tract. In this case, simple bronchitis or bronchiolitis occurs.
Smoking. Cigarette smoke causes the bronchial epithelium to transform from ciliated to squamous. This process is called metaplasia. Due to metaplasia, firstly, the likelihood of a bacterial infection increases, and secondly, the development of a tumor process is possible. It is worth remembering that not only active smoking is dangerous, but also passive inhalation of tobacco smoke.
Industrial hazards. Risk groups include workers in mines, factories, paint and varnish production, and flour shops. They inhale dust, which damages the bronchi and promotes metaplasia, just like cigarette smoke.
Decreased immunity. Immune cells play an important role in protecting the bronchi from bacterial infection. A decrease in immunity can occur as a result of a long-term illness, exposure to ionizing radiation, or taking glucocorticoids or cytostatics.
Hypothermia. Staying in low temperatures for a long time is dangerous for two reasons. The first is that the overall reactivity of the body and, as a consequence, the immune response in the bronchi decreases. The second is caused by damage to the mucous membrane of the bronchial tree by cold air flows.

For reference. All of the above reasons in one way or another reduce the local protection of the bronchi, opening the way for bacterial infection.

The infectious agent itself can be of exogenous origin if it enters the bronchi from the environment or endogenous etiology. In the second case, bacteria penetrate into the bronchi from a chronic source of infection, for example, from the maxillary sinus with sinusitis or from the carious cavity of a diseased tooth.

Classification

For ease of diagnosis and treatment, purulent bronchitis is usually divided into three types as follows:

Catarrhal. Qatar is an inflammation in which mucus predominates in the exudate. Mucopurulent bronchitis occurs when bacterial flora joins simple bronchitis and yellow-green streaks begin to appear in the sputum. This is the very beginning of purulent inflammation.
Purulent-obstructive. It can be called the next stage of inflammation. Purulent exudate becomes predominant, sputum acquires a viscous consistency, an unpleasant odor and a yellow-green color. The viscous secretion clogs the bronchi, and an obstructive component appears.
Chronic. The first two types were acute or subacute, while changes in the bronchi were reversible. With chronic purulent bronchitis, remodeling occurs not only of the mucous membrane, but also of the bronchi themselves. Most often, chronic purulent bronchitis is caused by bronchiectasis - areas of expansion in the bronchi, where infection periodically enters and the disease acquires a wave-like character - periods of remission are replaced by periods of exacerbation.

As a rule, the listed types of purulent bronchitis develop sequentially one after another if the pathology is not treated on time.

Symptoms

Manifestations of the disease depend on its type. Acute purulent bronchitis is manifested by the following symptoms:

Temperature increase. With simple bronchitis, the temperature rises briefly to subfebrile levels. Purulent bronchitis is characterized by a longer-lasting fever, with the temperature rising to 38-39°C.
Cough. The catarrhal form is characterized by a productive cough with mucous sputum, in which streaks of pus appear. Gradually, the sputum becomes completely purulent.
Hemoptysis. This is an optional symptom that appears as a result of a prolonged painful cough. Due to the constant increase in pressure in the bronchi, small vessels rupture, blood from which enters the lumen of the bronchial tree. Blood appears in the sputum when coughing.
Decreased performance, rapid fatigue. These symptoms are part of the asthenovegetative syndrome, which is characteristic of any infectious disease.

For reference. If purulent-obstructive bronchitis develops, the patient experiences expiratory shortness of breath.

First, the patient notices that it is difficult for him to breathe when performing physical exercises. The breathing frequency increases, it becomes shallower than usual, and exhalation lengthens.

Over time, these symptoms appear at rest, which indicates the development of respiratory failure.

Attention. With purulent-obstructive bronchitis, the temperature rarely reaches 39 ° C, more often remaining at the level of low-grade fever. The cough becomes less productive, and the sputum becomes viscous.

Chronic purulent bronchitis flows in waves. Exacerbations are similar to catarrhal or purulent-obstructive bronchitis, and during the period of remission the patient feels satisfactory. However, even in remission, low-grade fever and respiratory failure may persist.

Danger of pathology

Attention. Among all inflammatory diseases of the bronchial tree, purulent bronchitis is the most dangerous.

As with any purulent inflammation, the infection can spread further throughout the body in several ways:

To continue. In this case, bronchogenic pneumonia occurs. Purulent inflammation of the lungs leads to rapid exhaustion of the body; foci of necrosis and islands of connective tissue proliferation can form in the lungs. In severe cases, pneumonia can be fatal or lead to lifelong respiratory failure.
Lymphogenic. The infectious agent flows through the lymph into the lungs, mediastinal lymph nodes, and pleura. Purulent inflammation of the chest organs develops, which also significantly worsens the condition.
Hematogenous. This is the most unfavorable option, in which bacteria are spread throughout the body by the bloodstream. This condition is called sepsis; it is dangerous due to the development of infectious-toxic shock and secondary infectious foci in various organs and tissues. These conditions are more common in children and people with weakened immune systems.

In addition to the spread of infection, purulent bronchitis is dangerous with a number of complications. With purulent-obstructive bronchitis, respiratory failure develops due to narrowing of the lumen of the bronchial tree.

The patient, weakened by the disease itself and the fight against bacterial infection, becomes difficult to breathe. Choking when obstructive bronchitis occurs rarely, but the patient’s quality of life is significantly reduced.

Chronic bronchitis itself is a complication. The transition of the disease to a chronic form indicates the lack of adequate treatment of acute pathology.

Attention! Chronic purulent bronchitis is dangerous because irreversible changes occur in the bronchi. The bronchial tree forever loses its original properties.

In this case, the development of bronchiectasis, emphysema and chronic obstructive disease is possible. It is impossible to cure these diseases; the patient is forced to take maintenance therapy throughout his life.

Diagnosis of purulent bronchitis

If any disease of the bronchopulmonary system is suspected, the following diagnostic methods are used:

Physical examination. Includes percussion and auscultation of the lungs. It is impossible to detect bronchitis by percussion. If there are no pathological changes, then pneumonia can be ruled out. Auscultation reveals scattered wheezing, most often moist, medium- and coarse-bubbly.
General blood test with leukogram. Allows you to identify bacterial diseases. In this case, an increase in the number of leukocytes, an increase in the proportion of band neutrophils, and an acceleration of ESR are observed.
Sputum analysis. It is necessary in order to establish the nature of the exudate, identify the pathogen and establish its sensitivity to antibiotics. With purulent bronchitis, a large number of neutrophilic leukocytes and bacteria of a certain type are found in the sputum.
X-ray of the chest organs. Necessary to rule out pneumonia. Bronchitis itself on an x-ray may appear as an increase in the intensity of the shadow of the bronchial tree. In addition, a number of complications are identified in this way, for example, pulmonary emphysema. To detect obstruction and bronchiectasis, an X-ray examination is performed after inhalation administration of a contrast agent - bronchography.
Spirometry. This study allows you to identify the presence of functionally significant obstruction. The patient's breathing is assessed by the computer using several indicators. With purulent-obstructive bronchitis, changes in forced expiratory volume and Tiffno index are observed, with chronic bronchitis - in the vital capacity of the lungs. Catarrhal bronchitis, as a rule, does not change the spirogram.
Bronchoscopy. It is not performed on all patients because the technique is invasive. A probe with a camera allows you to see the condition of the mucous membrane of the bronchial tree, areas of obstruction and other changes in the lumen of the bronchi.

How to treat purulent bronchitis in adults

For reference. Treatment of this disease is divided into etiotropic, pathogenetic and symptomatic.

The first is aimed at destroying bacterial flora in the bronchi. First, antibiotics or synthetic broad-spectrum chemotherapy drugs are prescribed. This is necessary because antibiotic sensitivity testing takes at least a week. When the results of this analysis are received and it is known which antibiotic can destroy a given type of bacteria, the drugs are changed.

Attention. It is important to take antibiotics strictly as prescribed by the doctor at the same time, in the same dosage and for the full course.

Pathogenetic therapy is aimed at reducing inflammation and obstruction. For catarrhal bronchitis it may not be prescribed. Treatment consists of inhaled bronchodilators and glucocorticoids. The first include such groups of drugs as: beta-agonists, anticholinergics and xanthines. Sometimes combinations of these drugs are prescribed in one inhaler.

Symptomatic therapy is indicated for any type of bronchitis. Mucolytic drugs are used, for example, Ambroxol or ACC. In addition, it is possible to prescribe vitamin preparations and plenty of warm drinks.

There are also physiotherapeutic methods, for example, lavage of the bronchial tree, postural therapy and physical therapy. Purulent bronchitis in children is treated according to the same scheme, but in smaller dosages.

Forecast

The prognosis of the disease depends on its type and timeliness of diagnosis. Catarrhal bronchitis that is detected in time is highly treatable. The prognosis is favorable, and full recovery is possible.

Purulent-obstructive bronchitis is more severe and its treatment requires more drugs. The prognosis of the disease is doubtful.

For reference. Chronic purulent bronchitis has an unfavorable prognosis, since it is not possible to cure it completely.

Prevention

Prevention of bronchitis involves reducing exposure to risk factors that lead to its occurrence. First of all, this is a cessation of active and passive smoking, which are currently the most common causes of various diseases of the bronchial tree.

In addition, it is important to follow a gentle regimen when ARVI occurs. It is impossible to cure a viral infection, but it is worth spending more time in bed, taking vitamins, and eating protein-enriched foods when this pathology occurs. Then the body will cope with ARVI on its own and bronchitis will not occur.

People with occupational hazards are entitled to vouchers to sanatorium-resort institutions, which allow them to restore the function of the bronchopulmonary system.

For patients with reduced immunity, hypothermia, overheating, and being in crowded places are contraindicated. When leaving the ward or their own room, they must wear a medical mask.

Purulent bronchitis is an inflammatory process of the upper respiratory tract, which affects the bronchi. The production and secretion of mucopurulent or purulent secretion occurs. The etiology of the disease is caused by an infectious agent. The main complaint is a cough with purulent sputum. Patients also complain of fever, shortness of breath, and intoxication of the body.

The diagnosis is established after examining the patient, determining the symptoms and clinical picture, studying a chest x-ray, and microscopic examination of sputum. Purulent bronchitis in adults and children can be treated with antibiotics, physiotherapeutic procedures, and expectorants.

Types of disease

Depending on the type of inflammatory process, the disease occurs in catarrhal or purulent form. Some doctors distinguish two additional forms of bronchitis - fibrinous and hemorrhagic.

The pathology can be primary or secondary, developing against the background of another process - bronchiectasis, pneumonia, tuberculosis. Because of this, it is impossible to indicate the exact prevalence of the disease.

Causes

The development of purulent or mucopurulent bronchitis is caused by the complex influence of infectious agents, exposure to a polluted environment and endogenous (internal) factors.

External factors

air pollution;
complicated climatic conditions;
household agents - house dust, detergents.

Internal factors

bad habits;
advanced age;
unhealthy diet;
immunodeficiency of various origins.

These triggers damage the mucous membrane of the respiratory tract and facilitate the attachment of infectious agents. A significant role is played by the reduction of local and general resistance of the body due to respiratory viruses and influenza.

Bacteria play the main role in the formation and development of purulent bronchitis. More often than others, the disease is provoked by the addition of pneumococcus. The infection is maintained and aggravated by chronic infectious foci in the nasopharynx or paranasal sinuses. In this case, tonsillitis and sinusitis develop.

Helpful advice: To sanitize possible infectious foci, treatment should be accompanied by consultations with related doctors.

The course of the disease may become more complicated due to smoking, concomitant pathologies of the respiratory system - obstructive pulmonary disease, pneumonia, tuberculosis, bronchial asthma.

Chronic and acute purulent bronchitis sometimes develops against the background of inadequate treatment for a viral infection, the catarrhal form of the disease. Sometimes there is a reduced sensitivity of microorganisms to antibacterial drugs, which aggravates the clinical symptoms and course of the disease.

If the respiratory organs are exposed to irritation for a long time due to mechanical action, physical or chemical agents, a violation of secretory activity is formed. This leads to deterioration of self-cleaning of the airway lumen.

For your information: Catarrhal and purulent bronchitis have a similar etiology and clinical manifestations.

The increased function of secretory cells in adults and children leads to changes in the nature and composition of mucus. This entails a decrease in the protective properties of the bronchi, which has a beneficial effect on the vital activity of pathogenic microorganisms.

The inflammatory process caused by these changes affects the composition of the produced mucus, which takes on the character of purulent sputum due to an increase in the concentration of neutrophilic leukocytes in the mucus. The mucus becomes purulent and viscous, making it difficult to cough up.

Symptoms

A patient’s “acquaintance” with catarrhal or purulent bronchitis begins after a cold, hypothermia, an episode of allergies, or due to reinfection from a chronic focus. The preceding clinical manifestations are rhinitis and tracheitis. This is explained by the descending development of the disease.

Precursors of bronchitis

The basic syndrome of purulent bronchitis is intoxication of the body, accompanied by shortness of breath, hacking cough with the release of yellow or green purulent sputum. There is weakness, lethargy, sweating, and a gradual increase in body temperature to 37.2–38 ºC. The chronic version of the course is characterized by episodic expectoration. Due to severe weakness and shortness of breath, patients are advised to avoid physical activity.

For your information: Hemoptysis is a rare symptom. Doctors explain it as an injury to the mucous membrane of the respiratory tract.

If purulent bronchitis drags on, obstruction may develop. In this case, an obstructive form of bronchitis occurs. Shortness of breath noticeably increases, whistling appears when breathing, patients complain of difficult coughing up mucus. The course of the disease worsens, and there is a risk of developing pulmonary emphysema and complications of the cardiovascular system.

Diagnostics

The diagnosis is determined by the clinical manifestations of the disease, as well as analysis of anamnestic data, laboratory and instrumental examinations. Sometimes patients establish a clear connection between the development of a cough with a previous cold, some indicate chronicity of bronchitis. The doctor listens for dry and wet rales, which do not always persist after clearing the throat.

The acute stage is characterized by the appearance of neutrophilic leukocytosis, an increase in ESR (erythrocyte sedimentation rate). A biochemical blood test shows an increase in acute phase values. X-ray examination is not considered indicative of this disease. But the X-ray image shows signs of bronchitis - increased pulmonary pattern, expansion of the roots of the lungs. In the chronic process, emphysematous markers are noted.

Severe cases require bronchoscopy (a method of examining the condition of the mucous membranes of the bronchial tree). The doctor detects swelling, redness of the mucous membrane, as well as the presence of purulent mucus in the lumen of the respiratory tract, filling the gaps even after suction.

The secretion collected during bronchoscopy is sent to the laboratory for cytology and culture. This procedure is necessary to determine adequate antibiotic therapy that can affect pathogenesis.

Treatment

Exacerbation of pathology requires bed rest. In addition, factors that irritate the bronchi should be excluded - smoking, dry and dusty room air, and the presence of household chemicals in the patient’s room. Of course, treatment will not be possible without drugs that destroy bacterial agents.

Antibiotics

The use of antibiotic drugs does not apply to symptomatic therapy. Antibiotics act on the main cause of pathology – bacteria. Most often, doctors use cephalosporins - Ceftriaxone, Cefogram.

On an outpatient basis, the protocol for the treatment of upper respiratory tract infections allows the prescription of macrolides - Sumamed, Azitrox. Sometimes therapy is carried out with penicillin drugs, including Amoxil and Amoxicillin.

If the therapeutic effect of these drugs does not manifest itself, doctors use “Gentamicin” for intratracheal administration together with parenteral intravenous therapy.

The therapeutic effect increases with good ventilation of the lungs, outflow of pus and sputum from the respiratory lumens. For this, doctors prescribe bronchodilator or expectorant medications - “Mukaltin”, “Lazolvan”, “Acetylcesteine”, “Carbocisteine”, “Bromhexine”. The drugs relax the smooth muscles of the respiratory tract, thin out mucus, and stimulate the removal of mucus.

Folk remedies

Traditional medicine helps traditional methods speed up treatment. At the same time, doctors recommend normalizing the diet and enriching the food range with meat and fish broths.

Among the recipes, badger fat is noted, which is mixed with boiled milk in the proportion of one tablespoon of fat per glass of milk. To improve the taste, honey or cocoa is added to milk. You need to take the mixture twice a day, one glass.

Helpful advice: If you find it difficult to drink this, spread the fat on bread and eat the resulting “sandwich.”

Rubbing with animal fat before bed helps well in treatment. The areas for the procedure are the chest and back, while it is better to bypass the projection of the heart. After rubbing, the patient is put to bed, wrapped in a towel or cellophane with a warm sheet.

Don't forget about the accompanying natural remedies with antibacterial properties. Compared to medications, the effect of natural “healers” is softer, more gentle, and does not disturb the intestinal microflora. Prominent representatives of natural “doctors” are onions, garlic, cranberries, and ginger root.

Complications

The most dangerous complication of the disease is pneumonia, which develops with improper treatment of bronchitis. There is also swelling of the mucous membrane of the respiratory tract, which leads to changes and atrophy of the epithelial layer. This is fraught with deterioration of the drainage properties of the bronchopulmonary system.

Other complications are possible:

allergy;
bronchial asthma;
dissemination of infection;
development of pneumosclerosis;
bronchiectasis;
respiratory failure;
chronicity of the process, especially with an obstructive component;
formation of the pulmonary heart with subsequent symptoms of circulatory failure.

Prevention

Basic measures to prevent the disease:

Vaccination against influenza, ARVI.
Therapy of diseases of the respiratory system.
Rejection of bad habits. This includes giving up smoking, passive inhalation of tobacco smoke, and drinking alcohol.
Regular wet cleaning of the house. Cleaning will reduce dust in the air in the room and prevent the growth of bacteria.

If the patient is diagnosed with chronic bronchitis, he is indicated for clinical observation by a pulmonologist and sanatorium-resort treatment. The southern coast of Crimea is best suited for speleotherapy sessions in salt mines.

Therapist, Pulmonologist.

He treats patients with a therapeutic profile, including respiratory diseases such as chronic bronchitis, chronic obstructive pulmonary disease, bronchial asthma, pneumonia, and interstitial lung diseases.

11 years of experience.

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The most severe and dangerous type of bronchitis is purulent bronchitis, the symptoms of which have a detrimental effect on many human organs, causing various complications. It is worth noting that the treatment of this disease is a rather long process, so it is better not to allow catarrhal bronchitis to turn into a purulent form, but to consult a doctor in a timely manner.

Triggers and mechanism for launching purulent bronchitis

The triggers of the disease in most cases are coccal bacteria. Their vital activity in the bronchi leads to symptoms such as swelling of the organ and difficulty breathing. In addition, with purulent bronchitis, a fairly large daily volume of sputum is formed (up to 300 ml), which is quite viscous and can have different characteristics.

Bacterial microorganisms can enter the bronchi in several ways:

Respiratory, for diseases of the upper respiratory tract of bacterial origin.
With lymph flow, when there is an infectious inflammatory process of the lymph nodes.
With the bloodstream, with infectious pathologies of internal organs.

Often the disease is a consequence of incorrect or ineffective treatment of such ailments as:

ARVI or influenza with a bacterial infection;
sore throat of bacterial origin;
tracheitis;
acute bronchitis.

In addition, a favorable environment for various pathogenic microorganisms to enter and develop in the bronchi is created by:

Infectious diseases of the ENT organs.
Inhalation of chemical vapors.
Hypothermia.
Passive and active smoking.
Living in a region with bad air or too dry a climate.

IMPORTANT! Purulent bronchitis often develops against the background of a chronic type of bronchitis. And such an unpleasant symptom of the disease as the separation of sputum with pus may be present even when the disease is “calm”.

Symptoms of purulent bronchitis

The basic symptoms of the disease are cough and shortness of breath. Often a person is negligent and inattentive to his own health, which leads to the progression of symptoms of the disease or the development of complications.

When you suffer from influenza or ARVI, the immune system is sharply weakened and the body can no longer resist the influence of various provocateurs. Therefore, often, even with adequate treatment, the disease in question manifests itself, which has the following symptoms:

wet cough with difficult to remove, thick, mucopurulent or purulent sputum;
dyspnea;
increased sweating;
constant malaise;
low-grade fever;
muscle pain during exacerbation of the disease, associated with muscle strain when coughing.

If treatment is delayed for a long time, a symptom such as bronchial obstruction may appear. This symptom develops against the background of accumulation of secretions and is dangerous for the development of purulent obstructive chronic bronchitis, which is considered the most severe type of the disease and can develop into pneumonia. Therefore, during an exacerbation, the patient is recommended to undergo treatment in a hospital.

It is also worth noting that an exacerbation of the disease in question can occur due to any type of overexertion, colds or allergic manifestations.

Causes and symptoms

The causative agents of purulent bronchitis are pathogenic microorganisms, such as streptococcus, pneumococcus and Haemophilus influenzae. This disease is characterized by the formation of mucopurulent plaque in the bronchi, which leads to disruption of the functions and patency of the respiratory tract. Thick and viscous bronchial secretions, formed as a result of bacterial infection, disrupt the self-cleaning function of the bronchial mucosa. Lingering in the bronchi, sputum provokes the proliferation of pathogenic bacteria, and pus appears in it.

Experts identify the following causes of the disease:

weak immunity;
frequent ARVI;
hypothermia or overheating;
allergic reactions;
smoking;
inhalation of polluted air;
diseases of the nasopharynx.

In some cases, a purulent form of bronchitis develops with prolonged self-medication or uncontrolled use of medications. The most common symptoms are:

general intoxication of the body;
dyspnea;
cough with purulent sputum;
lack of appetite;
fast fatiguability;
increase in body temperature to 38ºС and above;
increased sweating;
difficulty breathing and wheezing;
pain when coughing and breathing.

If a patient notices such symptoms, then it is necessary to immediately seek medical help, since the lack of treatment is fraught with complications in the form of tuberculosis and pneumonia.

Diagnosis and treatment

Diagnosis of the disease is carried out on the basis of laboratory tests and instrumental examinations.

The first includes blood and sputum analysis; radiography and bronchoscopy are used as instrumental examinations. For the prescribed treatment to be effective, it is necessary to accurately determine the cause that caused purulent inflammation of the bronchi.

X-rays are not always indicative of this disease, so the doctor may prescribe bronchoscopy. Its essence lies in determining which bacteria were the causative agents of this disease.

Treatment of purulent bronchitis can be carried out both on an outpatient basis and in a hospital setting. This will depend on the patient's condition. First of all, it is necessary to achieve the removal of purulent sputum from the bronchi. In severe cases of the disease, it is advisable to carry out treatment in a hospital setting, since this form of the disease may require the use of resuscitation measures. The main treatment is carried out with antibiotics, therefore, before prescribing medications, it is recommended to conduct a bacterial culture of the sputum flora. This is necessary to determine the sensitivity of microorganisms to antibiotics and select the right medicine. Most often they are prescribed drugs such as Amoxiclav, Sumamed, Cefazolin, Ceftriaxone.

To improve the discharge of purulent sputum, mucolytic and expectorant drugs are prescribed, for example Gedelix, Lazolvan. A good effect in the treatment of purulent bronchitis can be achieved using inhalations; they are recommended to be carried out with drugs such as Ambroxol or Berodual.

In addition to drug treatment, it is advisable to use physiotherapeutic procedures and massage, which will promote better mucus discharge. With the help of physiotherapeutic procedures, in particular electrophoresis, the bronchi and lungs are affected - their drainage function is improved. This method of treatment can relieve inflammation and reduce swelling of the mucous membrane. It is important to take the required amount of fluid, at least 2 liters, in order to thin the mucus. It is recommended to spend more time in the fresh air and strengthen your immune system. During illness, it is recommended to eat light foods that do not put stress on the gastrointestinal tract.

Chronic form

Chronic purulent bronchitis is determined by analyzing how long a wet cough lasts. If it continues for more than 3 months within one year, then this is the basis for making such a diagnosis. Another sign of the transition of purulent bronchitis to a chronic form is the release of a certain amount of sputum per day - 250 ml.

In the chronic form of the disease, the obstructive effect increases and symptoms of respiratory failure appear. In addition, the bacterial infection spreads to the lungs. A patient’s respiratory dysfunction can be judged by the following signs:

when breathing, a dry and whistling sound appears;
there is intense breathing;
exhalation is prolonged.

An exacerbation of the disease can occur under the influence of certain factors, which include: hypothermia, the development of an infectious disease, a sudden change in climate or temperature, and decreased immunity.

In case of frequent exacerbations, immunomodulatory drugs are prescribed, these can be Timalin, Ribomulin. The general treatment regimen will not differ from the therapeutic measures carried out during the acute stage of the disease. Outside the acute stage, anti-inflammatory and antibacterial drugs can be prescribed. A fairly effective method of treating the chronic form of the disease is special breathing exercises.

Chronic purulent bronchitis - features of the disease

The main difference between chronic purulent bronchitis and the simple form is the sluggish nature of the disease. The pathology occurs with hidden symptoms and clearly manifests itself with annual relapses. Exacerbations last more than 3 months. They pass with a painful cough and increased mucus secretion.

Symptoms of chronic purulent bronchitis

Chronic purulent bronchitis is characterized by a protracted process and increased blockage of the bronchi (obstruction). Bronchial obstruction causes increased production and accumulation of sputum. During an exacerbation of the disease, up to 250-300 ml of mucus can be released daily when coughing.

Symptoms of chronic purulent bronchitis vary and depend on the type and duration of the inflammatory process. These include:

tachycardia;
lack of appetite;
pallor of the epidermis;
change in taste sensations;
unpleasant odor from the mouth;
painful cough with attacks of shortness of breath;
slight increase in body temperature;
increased sweating, especially at night;
constant fatigue with asthenic signs;
soreness in the sternum area, aggravated by coughing.

Relapse of chronic purulent bronchitis can begin even after the slightest hypothermia of the body. This situation is especially dangerous for elderly and frail people. In such individuals, the process causes a sharp deterioration in respiratory function and the development of obstructive bronchitis.

The complication is manifested by lengthening the inhalation and strained breathing, accompanied by bulging veins and dry whistling sounds when breathing.

Chronic mucopurulent bronchitis in the acute stage - risk factors

The frivolity of the patient himself is involved in the transition of purulent bronchitis to a chronic form.

Illiterate treatment, and sometimes even lack of therapy, becomes the main basis for the development of a chronic form of pathology.

The following provoking factors add to the threat:

sudden climate change;
chest injury;
diseases of the immune system;
long-term smoking (and passive smoking as well);
prolonged stress, overwork;
long course of chemotherapy;
additionally developed infection;
predisposition to allergic manifestations;
past infectious diseases: whooping cough, influenza, measles;
living in areas with unfavorable environmental conditions.

Chronic purulent bronchitis develops over a long period of time, gradually covering all organs of the respiratory system. This process is dangerous and insidious, especially during the period of relapse. The infection easily provokes the development of pneumonia and emphysema.

If you notice any alarming symptoms, you should immediately consult a doctor and begin treatment for the disease.

Treatment of chronic purulent obstructive bronchitis

Before starting basic drug therapy, doctors find out the cause that led to the development of a chronic form of purulent bronchitis.

For example, if purulent chronic bronchitis of a smoker is detected, therapy will be useless until the patient gives up the addiction.

When choosing medications, doctors are guided by the patient’s age, duration of the disease and factors that caused the transition of purulent bronchitis to the chronic form.

Antibiotics. Prescribed if the disease was caused by a bacterial infection. Before prescribing antibacterial treatment, sputum is examined to determine its sensitivity to antibiotics.

If there is no time for sputum analysis, and chronic purulent bronchitis is in the relapse stage, doctors give preference to broad-spectrum antibiotics of the penicillin group: Amoxiclav, Amoxicar, Amoxicillin Sandoz, Flemoxin, Augmentin.

Expectorants. To improve the patency of the bronchi and cope with the difficulties that arise during the removal of sputum, the patient is prescribed expectorants of a number of mucolytics.

Mucolytics affect the structure of mucus and destroy negative compounds that make mucus sticky.

The following mucolytic drugs are most often prescribed: Carbocysteine, Acetylcysteine, Ambroxol, Bromhexine.

Antiviral drugs. Used if the pathological process is viral in nature. This treatment makes sense during periods of remission of the pathology. Most often, doctors prescribe the following drugs: Leukocyte Interferon, Amiksin, Tsitovir-3, Lokferon, Remantadine.

When treating chronic purulent bronchitis in the acute stage, therapeutic bronchoscopy is performed using endotracheal infusion. Sanitation of the bronchi is carried out using a rubber catheter or a special laryngeal syringe. The frequency of procedures depends on the volume of mucus discharge and the severity of suppuration.

After sanitation and coughing up sputum, antiseptic drugs are injected into the bronchi: solutions of dioxidin, furatsilin or Kalanchoe juice. If the pathology is accompanied by dilation of the bronchi (bronchiectasis), after treatment with antiseptics, an antibiotic solution (3-5 ml) is also injected into the bronchi.

Therapy of the pathological process is a comprehensive measure, including physiotherapeutic methods: electrophoresis, UHF, inhalation, ICV therapy, massages and physical therapy. Treatment of chronic bronchitis at home can be combined with the use of traditional medicine methods.

Problems of a patient with chronic purulent bronchitis - advice from healers

Traditional healers It is recommended to use animal fat as an effective means of removing phlegm. Fats can be taken internally as rich broths and as external rubs.

Herbs. Medicinal infusions with sage, chamomile, thyme, plantain, licorice and linden blossom will be a good help in the fight for health. Herbs can be used together or separately. To prepare a healing drink, you need to steam a tablespoon of herb with ½ liter of boiling water, leave for a quarter of an hour and drink three times a day.

Healing tea. Tea made from bran helps to cope with the manifestations of purulent bronchitis. Take bran (400 g), brew with boiling water (1.5 l) and leave the mixture for half an hour. The medicine should be taken after meals 3-4 times a day.

Amazing aloe. This recipe is for use by adults only (it is not recommended for pregnant women). Four large leaves of the plant should be poured with a bottle of strong red wine and the container should be placed in a dark place for 4-5 days. Take the finished medicine 30 ml before meals 3-4 times a day.

Miracle figs. Take 10 figs, pour hot milk (500 ml). Simmer the mixture over low heat until thickened for 10-15 minutes. Take a tablespoon three times a day. This medicine perfectly relieves attacks of painful cough and helps remove phlegm.

Famous radish. The cough recipe of black radish and honey is known to many. This medicine restores the functioning of the bronchi and removes mucus. The top of the vegetable is cut off and a hole is made into which honey is poured.

The cavity filled with sweet mass must be closed with the cut off top and left for 3-4 days (or baked in the oven). Take the mass one teaspoon 4-5 times a day. You can use beets instead of radishes.

A competent approach to combating the manifestations of purulent chronic bronchitis includes preventive measures. Paying close attention to your health will help you avoid recurrent conditions and get rid of the disease as quickly as possible.

Prevention measures

Whatever measures are used in the treatment of chronic purulent bronchitis, to achieve effective results the patient should follow the following recommendations:

Treat otolaryngeal diseases in a timely manner.
During the off-season, take vitamin complexes.
Be sure to get vaccinated during seasonal epidemics.
Protect your body from hypothermia and drafts.
Forget about bad habits (smoking, excessive alcohol consumption).
Maintain a nutritious diet with limited carbohydrate and salt intake.
Drink more warm liquids. It is better to opt for decoctions, herbal teas and freshly squeezed juices.
Be in the fresh air every day, do not forget to carry out wet cleaning and regularly ventilate living spaces.

If you have chronic purulent bronchitis, be sure to go for spa treatment, preferably on the Black Sea coast with the opportunity to visit salt caves and conduct mud therapy. If you follow all the advice and a competent approach to therapy, you can forget about the pathology after 1-1.5 months of treatment.

Good health!

Depending on the type of inflammatory process, the disease occurs in catarrhal or purulent form. Some doctors distinguish two additional forms of bronchitis - fibrinous and hemorrhagic.

Causes

The development of purulent or mucopurulent bronchitis is caused by the complex influence of infectious agents, exposure to a polluted environment and endogenous (internal) factors.

External factors

air pollution;
complicated climatic conditions;
household agents - house dust, detergents.

Internal factors

bad habits;
advanced age;
unhealthy diet;
immunodeficiency of various origins.

Helpful advice: To sanitize possible infectious foci, treatment should be accompanied by consultations with related doctors.

The course of the disease may become more complicated due to smoking, concomitant pathologies of the respiratory system - obstructive pulmonary disease, pneumonia, tuberculosis, bronchial asthma.

Chronic and acute purulent bronchitis sometimes develops against the background of inadequate treatment for a viral infection or disease. Sometimes there is a reduced sensitivity of microorganisms to antibacterial drugs, which aggravates the clinical symptoms and course of the disease.

For your information: Catarrhal and purulent bronchitis have a similar etiology and clinical manifestations.

Symptoms

The patient’s “acquaintance” with catarrhal or purulent bronchitis begins after hypothermia, an episode of allergy, or due to reinfection from a chronic focus. The preceding clinical manifestations are rhinitis and tracheitis. This is explained by the descending development of the disease.

Precursors of bronchitis

For your information: Hemoptysis is a rare symptom. Doctors explain it as an injury to the mucous membrane of the respiratory tract.

If purulent bronchitis drags on, obstruction may develop. In this case it occurs. Shortness of breath noticeably increases, whistling appears when breathing, patients complain of difficult coughing up mucus. The course of the disease worsens, and there is a risk of developing pulmonary emphysema and complications of the cardiovascular system.

Diagnostics

The secretion collected during bronchoscopy is sent to the laboratory for cytology and culture. This procedure is necessary to determine adequate antibiotic therapy that can affect pathogenesis.

Treatment

Antibiotics

The use of antibiotic drugs does not apply to symptomatic therapy. Antibiotics act on the main cause of pathology – bacteria. Most often, doctors use cephalosporins - Ceftriaxone, Cefogram.

If the therapeutic effect of these drugs does not manifest itself, doctors use “Gentamicin” for intratracheal administration together with parenteral intravenous therapy.

The therapeutic effect increases with good ventilation of the lungs, outflow of pus and sputum from the respiratory lumens. For this, doctors prescribe bronchodilator or expectorant medications - "", "Lazolvan", "Acetylcestein", "Carbocysteine", "Bromhexine". The drugs relax the smooth muscles of the respiratory tract, thin out mucus, and stimulate the removal of mucus.

Folk remedies

Traditional medicine helps traditional methods speed up treatment. At the same time, doctors recommend normalizing the diet and enriching the food range with meat and fish broths.

Among the recipes it is noted that it is mixed with boiled milk in the proportion of one tablespoon of fat per glass of milk. To improve the taste, honey or cocoa is added to milk. You need to take the mixture twice a day, one glass.

Helpful advice: If you find it difficult to drink this, spread the fat on bread and eat the resulting “sandwich.”

Complications

Purulent bronchitis exhibits different symptoms (depending on the form and stage). The reasons for the development of this disease are associated with insufficient treatment of the acute form. In this case, fluid forms in the bronchi and purulent discharge appears. A patient can produce up to 250 ml of sputum per day.

Doctors include cough and shortness of breath as the main symptoms of the disease. Purulent bronchitis can be diagnosed in adults after suffering from the flu. With weakened immunity and improper treatment of the disease in question, a chronic form develops. The patient exhibits the following symptoms:

moist cough;
purulent or purulent-mucous sputum;
dyspnea;
fast fatiguability;
sweating;
muscle pain.

Signs of a protracted course of the disease are associated with impaired bronchial patency as a result of the accumulation of secretions. Obstructive purulent chronic bronchitis is a severe form of the disease that can develop into pneumonia. Doctors distinguish the following forms of the disease:

primary;
secondary.

Primary purulent chronic bronchitis is characterized by damage to the bronchial tree. In the secondary form of the disease, other respiratory organs are affected. The disease is recommended to be treated in a hospital. Doctors include the following reasons for the development of complications:

overvoltage;
cold;
severe stress;
allergies.

The main risk factors for the occurrence of the disease in question include smoking, negative climate, dry or cold air, the effect of chemicals on the respiratory system, damage to the chest, the presence of infection in the body, and treatment of cancer.

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Diagnostics and therapy

Treatment of purulent bronchitis is prescribed after examining the patient. The patient is prescribed x-ray and laboratory tests. The chronic form of the disease is detected using fluorography. To determine the bacterial microflora of sputum, laboratory tests are prescribed:

Microscopy.
Biochemistry of blood.
Cytology.

If necessary, the patient is prescribed an ultrasound examination. To cure purulent bronchitis, the patient is prescribed antibiotics. A smear taken from sputum allows you to determine the sensitivity of microbes to drugs.

Therapy for purulent bronchitis involves taking broad-spectrum medications. Mucolytics and antihistamines are used to remove sputum. Along with medications, the patient is recommended to undergo physical therapy (electrophoresis, UHF) and mustard plasters.

This technique stimulates the removal of phlegm. Gymnastics is carried out after the body temperature decreases. Doctors include its main advantages:

strengthening the respiratory muscles;
restoration of normal blood circulation in the bronchi;
elasticity of lung tissue;
prevention of possible complications;
strengthening the immune system.

Therapeutic exercises for purulent bronchitis restore the functions of the respiratory organs, promoting blood supply to the chest.

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Chronic form of the disease

Treatment of chronic purulent bronchitis is carried out comprehensively. The patient is prescribed expectorants, vitamins and antibiotics. If the disease occurs in a complex form, then sanitary bronchoscopy is performed. This technique consists of visual inspection and assessment of the bronchial mucosa. To do this, specialists use an optical device - a bronchoscope. The device is inserted into the airway. On the monitor, the doctor sees their condition.

At the same time, the doctor examines the nose and its sinuses, oral cavity, and tonsils. Therapy is carried out on an outpatient or inpatient basis. The main criteria for hospitalization of a patient are:

age;
state;
the presence of concomitant ailments.

If the disease is caused by a virus, then antiviral drugs are prescribed (Amiksin, Arbidol). Purulent bronchitis can be treated using traditional recipes after consultation with a doctor. To get rid of the symptoms of the disease in question, internal animal fats are used. Fatty soups and broths promote rapid sputum separation.

Purulent bronchitis is an inflammation of the bronchial tree without involving lung tissue in the process, in which the patient is bothered by a cough, accompanied by the discharge of purulent or purulent-mucous sputum.

The disease can be both acute and chronic. In the first case, it lasts on average 10-12 days. After recovery, the symptoms disappear quickly enough, respiratory discomfort is eliminated, and the patient has no complaints. In chronic bronchitis, cough with sputum bothers the patient for at least 3 months a year, while the disease lasts for at least 2 years. Exacerbations alternate with periods of well-being (remission). Their frequency is individual and depends on the severity of the process: from 2-3 times a year to continuous recurrence. Symptoms of the disease may persist even without exacerbations.

Bronchitis with purulent sputum can occur with symptoms of obstruction, then it is called obstructive, or without it - simple bronchitis. The obstructive process implies a violation of bronchial patency. This is due to swelling of the mucous membrane, impaired formation of bronchial secretions, which become abundant, viscous and viscous, and the development of bronchospasm. In this case, respiratory failure gradually appears: the efficiency of breathing is significantly reduced, and oxygen starvation of organs and tissues occurs.

Children are characterized by high activity of the inflammatory process and rapid development of complications, so it is necessary to start antibiotic therapy as early as possible.

Causes

Several external and internal circumstances are responsible for the formation of the disease: infection with pathogenic bacteria or viruses, decreased local immune defense, systematic exposure to risk factors, the presence of chronic diseases of other organs and systems, genetic predisposition, etc.

The activity of the ciliated epithelium of the bronchi decreases. Normally, cilia sweep away mucus with dust particles, allergens, and bacteria adhering to it. As the disease develops, the mechanism for removing bronchial secretions becomes untenable. The mucus stagnates, becomes thick and difficult to separate. Pus in the sputum appears as a result of the addition of a secondary bacterial infection.

The most significant risk factors:

chronic infections of the throat, nose and paranasal sinuses, ear;
active or passive smoking;
abuse of alcoholic beverages;
frequent pharyngitis, laryngitis, tracheitis;
hereditary predisposition (failure of local immunity, features of the anatomical structure of the bronchi, etc.);
living in regions with aggressive climatic conditions (high air humidity combined with low temperatures, excessively dry climate with high ambient temperatures) or unfavorable environmental conditions;
occupational hazards (contact with varnishes and paints, gasoline vapors, agricultural chemicals, industrial poisons, work at mining and processing plants, in mines, hot shops).

Bronchitis with purulent sputum can form as a complication or be an independent disease. In any case, for pus to appear in the bronchial mucus, pathogenic microorganisms must join, so antibacterial drugs must be included in the treatment of the disease.

Acute bronchitis lasts on average 10-12 days. After recovery, the symptoms disappear quickly enough, respiratory discomfort is eliminated, and the patient has no complaints.

Symptoms of purulent bronchitis

The symptoms of the disease are formed from the main manifestations that are characteristic of bronchitis of any form, and from additional ones that are caused by the influence of pathogenic bacteria.

Cough with phlegm

They are the main manifestations of the disease and have different characteristics depending on the type of bronchitis.

If the disease is simple and acute in nature and is not accompanied by bronchial obstruction, the cough will initially be drier, gradually transforming into a wet one. In this case, the patient coughs up greenish-yellow sputum, often with an unpleasant odor. Its quantity varies - from a few milliliters to 200-250 ml with active inflammation. As you recover, the intensity of the cough decreases, although residual effects in the form of periodic coughing may bother you for several weeks.

With obstructive bronchitis, the cough is more painful, persistent, and paroxysmal. The patient experiences difficulty in expelling sputum: he cannot cough for a long time, sometimes up to an hour. The amount of sputum is less than during the normal process; it is thick, viscous, yellow-green, and sometimes brownish-green. Breathing becomes harsh, whistling, and dry wheezing can be heard.

In the chronic course of bronchitis, purulent sputum appears during an exacerbation of the inflammatory process or outside of exacerbations, under the influence of aggressive external or internal factors (respiratory infectious diseases, acute stress or chronic psycho-emotional overstrain, seasonal decrease in immune activity, hypothermia, etc.).

Dyspnea

In some cases, there may be no breathing difficulties; this symptom manifests itself most actively in the presence of bronchial obstruction. In this case, exhalation becomes difficult, and the frequency of respiratory movements increases. Some patients complain of a feeling of unsatisfactory breathing, congestion and heaviness in the chest.

Bronchitis with purulent sputum can form as a complication or be an independent disease.

Shortness of breath is most pronounced during physical activity, although with intense inflammation it can also bother you at rest.

Symptoms of intoxication

The appearance of these complaints indicates the activity of inflammation in the bronchial tree. Its severity can vary from minor to very intense. Some patients report slight sweating during exercise, while others experience heavy sweating when completely at rest. Body temperature also rises from subfebrile levels to 38-39 ° C, and can be easily relieved with antipyretics or be persistent.

In addition, patients complain of unmotivated weakness, a feeling of weakness, drowsiness, and intolerance to usual stress.

Treatment of purulent bronchitis

When the disease is accompanied by the appearance of signs of purulent inflammation, therapy is carried out with the mandatory use of antibacterial drugs.

Standardly, in the treatment of bronchitis of any form and etiology, drugs are used that help eliminate cough and improve sputum discharge:

mucolytics;
bronchodilators;
reflex expectorants.

Muco- and bronchodilators, what are they and how do they differ?

Mucolytic drugs help thin the mucus, which speeds up and facilitates its removal from the bronchi. While taking these medications, it is recommended to change your usual drinking regimen: increase the amount of fluid consumed by 1-2 liters per day. Recently, a new generation of mucolytics – mucoregulators – has found widespread use. They thin out thick bronchial secretions without increasing their quantity; in addition, they stimulate the work of the cilia of the ciliated epithelium and have anti-inflammatory and local immunostimulating activity.

Bronchitis with purulent sputum can occur with symptoms of obstruction, then it is called obstructive, or without it - simple bronchitis.

Bronchodilators expand the lumen of the bronchi, which is especially important in the presence of obstruction. In this case, sputum is much more actively evacuated from the lumen of the bronchial tree.

An obligatory component of pharmacotherapy for a purulent process is the use of antibacterial drugs. Preference is given to medications that are capable of creating high concentrations in the tissues of the bronchopulmonary zone. The most frequently used groups are:

semisynthetic protected penicillins;
cephalosporins of the second and third generations;
macrolides and azalides;
fluorinated quinolones.

In addition to the listed medications, multivitamins, adaptogens, and immunostimulants are used in complex therapy. For intoxication symptoms, antihistamines and antipyretics are used; as well as vasoconstrictors for a runny nose, painkillers for headaches, glucocorticosteroid inhalations for severe inflammation.

How to treat purulent bronchitis in a child?

If a child's cough is accompanied by yellow-green sputum, you should immediately contact your doctor. Children are characterized by high activity of the inflammatory process and rapid development of complications, so in this case it is necessary to start antibiotic therapy as early as possible.

Doing this yourself, at home, without prior consultation with a specialist is highly not recommended. The selection of the drug, its dosage and route of administration, determination of the duration of treatment and frequency of administration can only be made by a doctor after assessing the individual characteristics of the child and the severity of the inflammation.

Pus in the sputum appears as a result of the addition of a secondary bacterial infection.

Is bronchitis with purulent sputum contagious or not?

When coming into contact with a sick person, there is actually a chance of becoming infected. It is necessary to understand that it is not the disease itself that is transmitted, but pathogenic microorganisms, its causative agents, which are released into the environment when sneezing, coughing, and remain in particles of saliva on cutlery or dishes. The risk of infection is determined by the strength of the contactee’s immune defense.

Video

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If bronchitis is accompanied by a severe cough with copious discharge of purulent sputum, doctors diagnose purulent bronchitis of an acute inflammatory form with bacterial damage to the organ mucosa.

In case of unfavorable developments purulent bronchitis develops into a chronic stage.

Is this situation dangerous?

Chronic purulent bronchitis - features of the disease

Symptoms of chronic purulent bronchitis

Symptoms of chronic purulent bronchitis vary and depend on the type and duration of the inflammatory process. These include:

tachycardia;
lack of appetite;
pallor of the epidermis;
change in taste sensations;
unpleasant odor from the mouth;
painful cough with attacks of shortness of breath;
slight increase in body temperature;
increased sweating, especially at night;
constant fatigue with asthenic signs;
soreness in the sternum area, aggravated by coughing.

The complication is manifested by lengthening the inhalation and strained breathing, accompanied by bulging veins and dry whistling sounds when breathing.

Chronic mucopurulent bronchitis in the acute stage - risk factors

The frivolity of the patient himself is involved in the transition of purulent bronchitis to a chronic form.

Illiterate treatment, and sometimes even lack of therapy, becomes the main basis for the development of a chronic form of pathology.

The following provoking factors add to the threat:

sudden climate change;
chest injury;
diseases of the immune system;
long-term smoking (and passive smoking as well);
prolonged stress, overwork;
long course of chemotherapy;
additionally developed infection;
predisposition to allergic manifestations;
past infectious diseases: whooping cough, influenza, measles;
living in areas with unfavorable environmental conditions.

If you notice any alarming symptoms, you should immediately consult a doctor and begin treatment for the disease.

Treatment of chronic purulent obstructive bronchitis

Before starting basic drug therapy, doctors find out the cause that led to the development of a chronic form of purulent bronchitis.

For example, if purulent chronic bronchitis of a smoker is detected, therapy will be useless until the patient gives up the addiction.

When choosing medications, doctors are guided by the patient’s age, duration of the disease and factors that caused the transition of purulent bronchitis to the chronic form.

Antibiotics. Prescribed if the disease was caused by a bacterial infection. Before prescribing antibacterial treatment, sputum is examined to determine its sensitivity to antibiotics.

Expectorants. To improve the patency of the bronchi and cope with the difficulties that arise during the removal of sputum, the patient is prescribed expectorants of a number of mucolytics.

Mucolytics affect the structure of mucus and destroy negative compounds that make mucus sticky.

The following mucolytic drugs are most often prescribed: Carbocysteine, Acetylcysteine, Ambroxol, Bromhexine.

Problems of a patient with chronic purulent bronchitis - advice from healers

Traditional healers It is recommended to use animal fat as an effective means of removing phlegm. Fats can be taken internally as rich broths and as external rubs.

The cavity filled with sweet mass must be closed with the cut off top and left for 3-4 days (or baked in the oven). Take the mass one teaspoon 4-5 times a day. You can use beets instead of radishes.

Prevention measures

Whatever measures are used in the treatment of chronic purulent bronchitis, to achieve effective results the patient should follow the following recommendations:

Treat otolaryngeal diseases in a timely manner.
During the off-season, take vitamin complexes.
Be sure to get vaccinated during seasonal epidemics.
Protect your body from hypothermia and drafts.
Forget about bad habits (smoking, excessive alcohol consumption).
Maintain a nutritious diet with limited carbohydrate and salt intake.
Drink more warm liquids. It is better to opt for decoctions, herbal teas and freshly squeezed juices.
Be in the fresh air every day, do not forget to carry out wet cleaning and regularly ventilate living spaces.

Mucopurulent chronic bronchitis (J41.1)

Version: MedElement Disease Directory

general information

Short description

Chronic bronchitis in children - chronic inflammatory damage to the bronchi, occurring with exacerbations at least 3 times over the past two years. In most cases, this disease in children is a syndrome of other chronic lung diseases (including congenital and hereditary).

Specification of mucopurulent chronic bronchitis implies:
- absence of asthma attacks;
- presence of mucopurulent or purulent sputum.

Etiology and pathogenesis

Etiological factors:
- smoking (active and passive) is the main reason;
- acute bronchitis;
- air pollution with smoke, dust, carbon monoxide, nitrogen oxides, sulfur dioxide and other chemical compounds;
- recurrent respiratory infection (mainly respiratory viruses, Pfeiffer's bacillus, pneumococci).

Pathologically, chronic bronchitis is represented by diffuse damage to large and medium bronchi. According to the depth of the lesion there are:
- endobronchitis (superficial) - the inflammatory process is localized in the bronchial mucosa;
- mesobronchitis - inflammation of the muscular or submucosal layer of the bronchial wall;
- panbronchitis - inflammation of all layers of the bronchial wall.

Epidemiology

Risk factors and groups

Clinical picture

Clinical diagnostic criteria

Symptoms, course

Anamnesis associated with smoking, working or living in areas with polluted air, and the presence of chronic respiratory diseases.

Complaints:
1. Perennial cough, duration - no less than 3 months for 2 years in a row.
2. Mucopurulent discharge after a significant cough. Sputum production does not stop even during the remission phase and intensifies in winter.

Diagnostics

1. For diagnosing the activity of chronic bronchitis, great importance is attached to sputum examination: macroscopic, cytological, biochemical. The sputum is purulent in nature, contains predominantly neutrophilic leukocytes, there is an increased content of acidic mucopolysaccharides and DNA fibers, which increase the viscosity of sputum, a decrease in the content of lysozyme, etc.

3. The main lesion in chronic bronchitis is most often localized in the smaller branches of the bronchial tree; therefore, it is used in its diagnosis bronchial and radiography.
In the initial stages of the disease, there are no changes in bronchograms in most patients.
In case of chronic bronchitis, which has a long course, bronchograms may reveal breaks in the medium-sized bronchi and lack of filling of small branches (due to obstruction), which creates a picture of a “dead tree”. In the peripheral parts, bronchiectasis can be detected in the form of small cavity formations filled with contrast (up to 5 mm in diameter) connected to small bronchial branches.

Plain radiographs may show deformation and enhancement of the pulmonary pattern, similar to diffuse reticular pneumosclerosis, often with concomitant pulmonary emphysema.

Indications for instrumental diagnostics

1. Radiography is mainly used:
- in elderly patients, because this category of patients may not have clinical signs of pneumonia even when it occurs;
- if the development of bronchopneumonia is suspected in patients of any age;
- for differential diagnosis in smoking patients.

2. Bronchoscopy is indicated for:
- prolonged intractable cough;
- hemoptysis;
- carrying out differential diagnostics.

Laboratory diagnostics

General blood analysis, as a rule, is not informative. Possible changes are associated with the addition of an infection.

Cytological examination of sputum useful for persistent cough. Exfoliated epithelial cells, neutrophils and alveolar macrophages are detected. The number and proportions of neutrophils and alveolar macrophages vary depending on the phase of the process.

Differential diagnosis

Differential diagnosis is carried out with the following diseases:
- asthma;
- COPD;
- cystic fibrosis;
- alpha-1-antitrypsin deficiency;
- bronchopneumonia;
- bronchial cancer;
- tuberculous lesions of the bronchi;
- bronchiectasis.

Most often there is a need to differentiate chronic bronchitis from chronic pneumonia, bronchial asthma, tuberculosis and lung cancer.

Chronic bronchitis is different from bronchial asthma First of all, the absence of asthma attacks - obstructive bronchitis is characterized by constant coughing and shortness of breath. In chronic obstructive bronchitis, the difference between morning and evening peak flow measurements is reduced (variability less than 15%), in bronchial asthma the difference is increased (variability more than 20% indicates increased bronchial reactivity). In addition, obstructive bronchitis is not characterized by concomitant allergic diseases, eosinophilia of blood and sputum.

Differential diagnosis of chronic bronchitis and pulmonary tuberculosis based on the presence or absence of symptoms of tuberculosis intoxication, Mycobacterium tuberculosis in sputum, as well as on data from bronchoscopic and x-ray studies, tuberculin tests.

Early recognition is important lung cancer against the background of chronic bronchitis. Suspicious signs of a tumor are a hacking cough, chest pain, and hemoptysis. Their presence requires urgent X-ray and bronchological examinations of the patient; The greatest amount of information is provided by tomography and bronchography. A cytological examination of sputum and bronchial contents for atypical cells is necessary.

Complications

Treatment

Quitting smoking and staying in a polluted atmosphere is the main key to successful treatment.

1. Antitussives containing codeine and dextromethorphan can only be used short-term in patients with severe persistent cough.

2. Short-acting beta-agonist therapy, ipratropium bromide and theophylline can be used to control symptoms such as bronchospasm, dyspnea and chronic cough in stable patients with chronic bronchitis. In this same group, treatment with long-acting beta-agonists in combination with inhaled corticosteroids may also be offered to control chronic cough.

3. Mucolytics are used in patients with severe, prolonged exacerbations (usually in winter). Their use may be effective in reducing the frequency and duration of exacerbations in patients with severe forms of the disease.

4. Antibacterial drugs are prescribed for documented bacterial respiratory infection. Preference is given to the oral route of administration. The change in color of sputum is due to peroxidase released from white blood cells, so color alone cannot be taken as evidence of a bacterial infection.

Academic medical history (Chronic obstructive bronchitis)

Work pages

Ministry of Health of the Republic of Belarus

Gomel State Medical Institute

Department of Internal Medicine

Course of propaedeutics of internal diseases

Head of the Department Associate Professor

Curator 3rd year 19gr.

Supervision time: May 1, 2002

Educational medical history

I. Questioning the patient (subjective research)

1. Passport part

g) home address

h) date of receipt

i) by whom it was sent

2. Patient complaints

The patient complains of a cough, which usually occurs in the morning with the release of a small amount of sputum. Cough of moderate intensity. The nature of the sputum is mucous, gray-white when settling, viscous, odorless. There are complaints of expiratory shortness of breath not associated with physical activity. The patient also complains of swelling of the legs.

3. History of present illness

The patient notes the onset of the disease in 1997, when the above complaints appeared. The patient associates the onset of the disease with hypothermia. The onset of the disease is gradual. He first sought medical help on April 23, 2002. He is not registered with a dispensary. He was treated as an outpatient. The reason for hospitalization is the low effectiveness of outpatient treatment.

4. Life history of the patient

Born on February 13, 1930. in the city of Gomel in a family of workers. He grew and developed according to his age. Received secondary specialized education. A mechanic by profession. Material and living conditions - conditions in childhood are satisfactory. In mental and physical development he did not lag behind his peers. He worked as a mechanic. Currently retired. Lives in an apartment, living conditions are satisfactory. Meals are irregular and inadequate. Married, has a son. Maintains personal hygiene. Parents and immediate relatives did not suffer from hereditary diseases. The patient notes previous illnesses. Denies tuberculosis, venereal diseases, Botkin's disease. The patient smokes but does not drink alcohol. There is an allergy to pinicillin (loses consciousness).

II. Objective research

1. General inspection

The patient's condition is satisfactory, the position is active, consciousness is clear. The facial expression is normal. The physique is normosthenic, height 168 cm, weight 70 kg, correct posture. The gait is slow. The skin is pale with a pink tint, dry, turgor is reduced, there is no rash. Gray hair. Oval shaped nails with a smooth surface. Subcutaneous fatty tissue at the level of the navel is 2 cm, at the level of the angle of the scapula 1.5 cm, on the back surface of the shoulder 1.5 cm. The lymph nodes of the submandibular, cervical, occipital, subclavian, supraclavicular, axillary, ulnar, and inguinal are not palpable. The muscles are well developed, tone is preserved, and strength is sufficient. The bony skeleton is developed proportionally. The shape of the head is oval, the nose is saddle-shaped. There are no changes in the configurations and sizes of the joints. The skin around the joints is not hyperemic.

2. Respiratory system

2.1 Chest examination

The shape of the chest is normosthenic, symmetrical. The supraclavicular and subclavian cavities are slightly expressed. The position of the collarbones and shoulder blades is symmetrical. The shoulder blades fit tightly to the chest. Mixed breathing type. The number of respirations is 18 per minute, deep breathing. The breathing rhythm is correct.

2.2 Palpation of the chest

Palpation of the chest did not reveal any pain; vocal tremor was the same in symmetrical areas. The chest is elastic.

2.3 Percussion of the lungs

Comparative percussion revealed a clear pulmonary sound of symmetrical localization. Topographic percussion revealed: the height of the apexes of the lungs above the collarbones on the left is 2.5 cm, on the right 2.5 cm. The width of the Krenig fields on the left is 6 cm, on the right 5 cm.

Chronic purulent bronchitis medical history

Main disease:

Bronchiolitis associated with interstitial lung disease (pneumonia?).

Background disease:

Common variable immune deficiency

with decreased IgG and absence of IgA

Accompanying illnesses:

Varicose veins of the lower extremities.

Subserous uterine fibroids.

Idiopathic (autoimmune?) thrombocytopenia treated with glucocorticosteroids in high doses.

I. Passport part

Full Name: K.O.Y.

Floor: female

Date of Birth: Born 02/23/1977 (33 years old)

Permanent residence: Ulyanovsk

Profession: endocrinologist

Receipt date: 29.11.10

Date of supervision: 8.12.2010 - 13.12.2010

cough with purulent sputum,

· moderate weakness in the afternoon.

III. History of present illness (Anamnesis morbi)

In 1993 (at the age of 16 years), 2 weeks after the Mantoux reaction, a flu-like condition developed, for which she received sulfadimezin, 2 tablets. 3 r/day. While taking the drug, she noted the appearance of nausea, vomiting, and severe weakness. On the third day, a lemon-yellow coloration of the skin and darkening of the urine appeared. Hospitalized in the hematology department of the Ulyanovsk Regional Clinical Hospital No. 1. The examination revealed a decrease in hemoglobin to 30 g/l, platelets to 144.4 thousand/μl, reticulocytes to 9.6%, and an increase in ESR to 65 mm/h. A bone marrow puncture was performed: the bone marrow was abundantly cellular, polymorphic, erythropoiesis was of the normoblastic type. Autoimmune hemolytic anemia and hemolytic crisis were diagnosed. Prednisolone 60 mg per day was prescribed with complete gradual withdrawal over 4 months with a positive effect. Red blood cell transfusions were performed twice. I was observed by a hematologist for a year. There were no relapses of hemolysis.

Until 2001, she made no complaints. In 2001, while taking combined oral contraceptives, she noted the appearance of ecchymoses and hematomas on the lower third of the legs, and also noted severe metrorrhagia. A decrease in platelet level to 28 thousand/μl was detected, LE cells were not detected, antiDNA, antibodies to cardiolipin, RF were within normal limits. Contraceptives were stopped. For 2 months she took prednisolone 60 mg per day, against which the platelet level returned to normal. Subserous uterine fibroids were detected.

In 2002, after taking Postinor, she noted the appearance of pinpoint hemorrhagic rash on her legs and severe metrorrhagia. Hospitalized in the hematology department of the Ulyanovsk Regional Clinical Hospital No. 1. Upon admission it was revealed: hemoglobin level 144 g/l, leukocytes 4.7 thousand/μl, platelets 9,2 thousand/μl, ESR 32 mm/h. A diagnosis was made: systemic lupus erythematosus, chronic, with skin lesions. She took plaquenil 200 mg, prednisolone 40 mg/day with a gradual dose reduction for 6 months. During therapy, platelet levels returned to normal.

At the end of 2003, due to pregnancy, she stopped taking all medications. In 2004, childbirth occurred without complications.

In the spring of 2006, she noted the appearance of fever with an increase in temperature to 40˚C, the appearance of shortness of breath, cough, first dry, then with scanty sputum. She took ampiox 4 g/day IM and paracetamol without any significant effect. Hospitalized in the pulmonology department of the Ulyanovsk Regional Clinical Hospital No. 1. During the examination: hemoglobin 134 g/l, leukocytes 6.4 thousand/μl, platelets 151 thousand/μl, ESR 25 mm/h, CRP - negative, on the radiograph - signs of right-sided focal pneumonia. Therapy with oral ceftriaxone was started, which was replaced with erythromycin 1 g/day IV due to the development of an allergic reaction in the form of a skin rash. Despite the positive dynamics of clinical manifestations - body temperature normalized, weakness, cough, and chest pain decreased - a control radiograph after 10 days of treatment showed negative dynamics in the form of an increase in infiltrative changes, pleural overlays on both sides. Erythromycin was replaced with ampicillin 1.0 6 times a day IM. On the fourth day, she noted the appearance of a pinpoint rash in the area of the ankle joints and ecchymoses. The CBC revealed a decrease in platelets to 1 thousand/μl. She was transferred to the rheumatology department of the Ulyanovsk Regional Clinical Hospital No. 1, where she was treated with Plaquenil 200 mg/day and prednisolone 60 mg/day. The platelet level returned to normal; there were no complaints of cough, chest pain, shortness of breath, or increased body temperature during therapy. Over the course of 5 months, the dose of prednisolone was reduced to 10 mg/day; the patient took the drug at this dose until 2009.

In January 2008, he was hospitalized at the Ulyanovsk Regional Clinical Hospital No. 1 for right-sided lower lobe pneumonia. In the CBC: hemoglobin level 121 g/l, leukocytes 11.7 thousand/μl, platelets 119 thousand/μl, ESR 15 mm/h, CRP ++. Therapy was carried out with intravenous erythromycin. In October 2008 – right-sided middle lobe pneumonia, treatment with cefotaxime. The patient herself notes that since 2006 she has suffered from pneumonia at least twice a year, for some of which she did not even go to medical institutions. Since 2006, he has also noted 5-6 cases of rhinosinusitis annually. Since 2006, courses of antibacterial therapy (Panklav, Sparflo, Tavanik) have been carried out independently (up to 10 times a year).

In the spring of 2010, nosebleeds, metrorrhagia, and fever up to 38.8˚C appeared. Hospitalized in the rheumatology department of the Ulyanovsk Regional Clinical Hospital No. 1. During the examination, a decrease in the level of hemoglobin to 101 g/l, platelets to 28 thousand/μl was noted; ESR 37 mm/h, AHHA – negative, LE cells three times – not found, AB to DNA, CEC, AB to cardiolipins – normal. Antiplatelet antibodies were detected. She takes Cellcept 0.5 mg/day for 3 days. The patient's condition was discussed at the consultation. An exact diagnosis has not been made; hospitalization at the Research Institute of Rheumatology of the Russian Academy of Medical Sciences is recommended. From August 18 to September 16, she was hospitalized at the Research Institute of Rheumatology of the Russian Academy of Medical Sciences. Based on the examination results, the presence of a systemic connective tissue disease is not confirmed. On CT scan of the chest dated September 14, 2010: against the background of a diffusely dense interlobular interstitium, numerous nodes of various sizes are identified, located chaotically, with a tendency to merge and perivascular spread. Numerous pleurodiaphragmatic adhesions and adhesions. Conglomerates of slightly enlarged lymph nodes of the middle mediastinum are identified. The spleen is enlarged in size to 15.9-10.5-8.7 cm. At the hilum of the lungs there are enlarged lymph nodes (?), the parenchyma is homogeneous. Conclusion: The CT picture may be consistent with fibrosing Pneumocystis pneumonia; pulmonary aspergillosis or lymphocytic interstitial pneumonia are less likely. Discharged with a diagnosis of Idiopathic thrombocytopenia. Varicose veins. Large subserous uterine fibroids.

On November 15, 2010, she applied to the State Research Center “Institute of Immunology of the Federal Medical and Biological Agency of Russia”, where outpatient tests were carried out: PCR for toxoplasma, chlamydia, mycoplasma, Streptococcus pneumoniae - negative, AT to aspergillus, toxoplasma - negative. For the first time, an almost complete absence of immunoglobulins A and G and hypogammaglobulinemia were revealed. A diagnosis of common variable immune deficiency was made.

IV. Life history (Anamnesis vitae)

Brief biographical information. Born in 1977 in Yekaterinburg. She did not lag behind her peers in development. Higher education, medical.

Work history. She began working at the age of 22 as an endocrinologist in Ulyanovsk. Works in clinics and hospitals, dealing with emergency patients. Notes occupational hazards in the form of possible contact with infectious patients.

Family and sexual history. Menstruation since the age of 13, established immediately, every 3-5 days, after 28 days, regular, heavy, painful. First marriage at 23, 3 years. Second marriage to this day. Subserous uterine fibroids since 2001. She had one pregnancy, which ended in normal birth in 2004; there were no abortions or miscarriages.

Household history and nutritional pattern satisfactory.

Bad habits. He does not abuse alcoholic beverages and does not smoke. Denies drug use.

Past illnesses. Childhood infections: chickenpox. Hemolytic crisis in 1993. Since 2001, subserous uterine fibroids. In 2002 and 2010, cases of autoimmune thrombocytopenia. SLE since 2002, diagnosis removed in 2010. Since 2006, frequent pneumonia and sinusitis.

Epidemiological history without features. Denies contact with patients with viral hepatitis and tuberculosis. In 1993, red blood cell transfusions were performed twice.

Allergy history. According to the type of urticaria to ceftriaxone.

Heredity: Father, 58 years old, suffers from ischemic heart disease and exertional angina. Mother, 59 years old, suffers from diffuse toxic goiter. Brother, 29 years old, healthy. Daughter, 6 years old, healthy.

Insurance history: There is an insurance policy.

V. Present state (Status praesens)

General inspection

The condition at the time of inspection was satisfactory. The mental state has not changed. Consciousness is clear. Position active.

The physique is normosthenic. Height – 165 cm. Body weight – 62 kg. BMI – 22.9 (normal). The posture is straight, the gait is fast. Body temperature 36.6 O C

The facial expression is calm. The skin is of normal color and moist. Turgor is preserved. Female pattern hair growth. Nails are regular in shape, pink in color, no brittleness or striations. Visible mucous membranes are pink, moist, there are no rashes on the mucous membranes (enanthems).

Subcutaneous fat is moderately developed and evenly distributed. Swelling of the legs. No tenderness of the subcutaneous fat was detected, no crepitus. Submandibular, occipital, parotid, supra- and subclavian, axillary, ulnar, and inguinal lymph nodes are not palpable. The skin over the lymph nodes is not changed, there is no pain on palpation.

The pharynx is not hyperemic, the tonsils do not protrude from under the anterior arches. There is no swelling or plaque.

The muscles are developed satisfactorily. Tone and strength are preserved. No pain or induration is detected on palpation.

The shape of the bones is not changed. There are no deformations. There is no pain on palpation or tapping.

The joints are of normal configuration, there is no pain, skin hyperemia, or swelling over the joints. Active and passive movements in the joints are within the physiological norm, there is no crunching during movements.

Respiratory system

The shape of the nose has not been changed. Breathing through the nose is difficult, through both nostrils. Purulent discharge from the nose. Pain at the root of the nose, in the places of the frontal and maxillary sinuses is not observed independently or with pressure and tapping. The larynx is not deformed, not displaced, not swollen. The voice is loud, clear, there is no hoarseness or aphonia.

The chest is normosthenic, conical in shape. The supraclavicular and subclavian fossae are pronounced. The width of the intercostal spaces is moderate. The shoulder blades are at the same level and fit snugly to the chest. The chest is symmetrical. There are no curvatures of the spine. Chest circumference 86 cm. Respiratory excursion 6 cm.

Mixed breathing type. Respiratory movements are symmetrical, auxiliary muscles are not involved. The number of respirations is 16 per minute at rest. Breathing is rhythmic.

The chest is painless on palpation, elasticity is not reduced. Voice tremor in symmetrical areas of the chest is the same and not changed.

A clear pulmonary sound is detected over the entire surface of the chest.