Chronic non-obstructive bronchitis treatment

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What is non-obstructive bronchitis and how to treat it

Non-obstructive bronchitis is considered a common disease of the lower respiratory tract with the production of mucopurulent sputum. Among adults, it is very common: the proportion of patients with chronic non-obstructive bronchitis is 8–20%.

Table of contents:

Men are most susceptible to infection, since this gender makes up 2/3 of the total number of patients. Most often, this disease is diagnosed in the fifth decade of life in women and in the sixth decade in men.

Mechanism of the disease

Damage to the respiratory system manifests itself in the inflammatory process of the internal mucous membrane of the airways. Non-obstructive bronchitis is distinguished by the fact that the process of ventilation of the lungs is not impaired, the airways do not narrow.

The localization here is mainly in the proximal bronchi, that is, pain and discomfort are felt in the medium and large airways.

The process also comes with some additional features:

  • intensive production of protective mucus;
  • hyperplasia of glands in the bronchi;
  • epithelial protection of the bronchi weakens;
  • discrinia is observed - the viscosity of the bronchial secretion increases.

An increased risk of bronchitis is typical for smokers. This is the main factor in the long-term impact of toxins on the bronchi; other causes of inflammation of the organ can also be noted: prolonged contact with allergens, hazardous production, inhalation of chemicals, lack of vitamin C, living in heavily polluted areas of megalopolises, etc.

Systematic irritation of the epithelium rearranges the structure of the glands, secretory function increases, and the viscosity of mucus in the bronchi increases. At the same time, the ciliated cells are damaged and the villi move less easily. This condition leads to the cessation of the functioning of the mucociliary escalator, the protection and cleaning of the mucous membrane no longer occurs properly.

Symptoms of non-obstructive bronchitis

The most common symptoms of non-obstructive bronchitis are:

  • wet cough with discharge of pus and mucus;
  • moderate intoxication;
  • heavy and harsh breathing;
  • scattered dry rales in the lungs of low pitch.

The exacerbation phase in only some patients is notable for the features of broncho-obstructive syndrome, when the patient’s breathing is difficult, thin wheezing is heard in the chest, and frequent bouts of unproductive cough occur. These phenomena are caused by bronchial spasms and the presence of viscous sputum.

When chronic non-obstructive bronchitis enters the remission phase, only a wet cough remains from the previous symptoms, and other associated factors completely disappear.

This form of bronchitis can be primary or secondary. Primary is understood as a self-current disease that is not associated with any pathological changes in the body. And secondary bronchitis, as a rule, accompanies other serious disorders of the respiratory and cardiovascular systems. Here, the root cause may be tuberculosis, uremia, neoplasms in the respiratory tract and organs, bronchiectasis, heart failure, etc.

Diagnostic methods

When establishing a diagnosis, a blood test will not be required from the patient; here it will be important to examine the sputum, as well as visually examine the changes occurring in the lungs and bronchi.

For these purposes, the following types of hardware diagnostics are used:

  • X-ray of the lungs - used rather as a technique to exclude other pathologies;
  • bronchoscopy – reveals diffuse endobronchitis and neoplasms in the bronchi; this study is also used during treatment to administer drugs into the bronchi;
  • complete examination of the lower respiratory tract;
  • pneumotachometry, spirography;
  • CTG – computed tomography of the chest.

A comprehensive anamnesis is important for drawing up a complete clinical picture. The patient must tell about his addiction to bad habits, in particular smoking, about working conditions, and occupational hazards. You should also remember about regular consumption of food with harmful impurities, additives, spicy foods, and allergic foods. The medical history should reflect all cases of acute respiratory infections, bronchitis and other similar diseases. Having determined their frequency, it will be possible to draw conclusions about the causes of bronchial lesions.

Treatment of non-obstructive bronchitis

Symptoms and treatment must correspond, the doctor must select an effective program of complex therapy.

When developing a treatment method, it is necessary to take into account the following factors:

  • severity of the disease;
  • functional changes in the bronchi and lungs;
  • nature of inflammation;
  • the presence of any complications;
  • individual characteristics of the patient's body.

The main thing in the acute form of non-obstructive bronchitis is to relieve symptoms and defeat the infection.

For this purpose, several groups of drugs are selected:

  1. Antibiotics – in the first stages, the disease must be treated with broad-spectrum antibacterial drugs such as Tetracycline, Ampicillin, Levomycetin. When the desired effect is not observed, they move on to stronger antibiotics after determining the degree of sensitivity of the microflora. Reducing inflammatory activity allows you to stop antibacterial therapy with drugs and replace it with inhalations with onions or garlic.
  2. Expectorants - antibacterial drugs make the secretion thicker, and it needs to be removed from the bronchi, for this they use Trypsin, Bromhexine, Ribonuclease, Rinatiol, Bisolvon. You can also use herbal remedies from chamomile, marshmallow, thermopsis, coltsfoot.
  3. Drugs that restore bronchial patency - anticholinergics (Atrovent, Astmatol), sympathomimetics (Berotec, Alupent, Ventolin), myotropic antispasmodics (Eufillin, Theophylline), complex drugs (Efatin, Teofedrine).
  4. Desensitizers are aspirin and calcium and should be taken simultaneously with anti-inflammatory medications.
  5. Corticosteroids - prescribed when other drugs have no effect, first in the form of aerosols and then orally.
  6. Antihistamines - Suprastin, Diazolin and others. For bronchitis they are taken according to indications.

Quiz: How susceptible are you to lung disease?

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Information

Our immunity is directly dependent on our lifestyle and nutrition. Only a small part of it is initially genetic. Throughout life, a person acquires immune deficiency, which subsequently leads to various kinds of diseases, allergic reactions and poor health. By taking care of your diet, you will also take care of your immunity, which will subsequently save you from many health problems. This test will show you what to pay attention to in your current diet. What to add, what to reduce, and what should be abandoned completely.

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Something needs to be changed urgently!

Judging by your diet, you don’t care about your immune system or your body at all. Most likely, you get sick often, suffer from intestinal problems, and are haunted by a feeling of constant fatigue. It's time to love yourself and start improving. It is urgent to adjust your diet, to minimize fatty, starchy, sweet and alcoholic foods. Eat more vegetables and fruits, dairy products. Feed the body by taking vitamins, drink more water (precisely purified, mineral). Strengthen your body, reduce the amount of stress in your life, think more positively and the transition to a healthy diet will be much easier, you just need to start.

Your immune system is in fairly good condition.

So far, it’s good, but if you don’t start taking care of her more carefully, health problems may begin (if the prerequisites haven’t already existed). Namely, allergies, frequent colds, intestinal problems and other “charms” of life accompany weak immunity. You should think about your diet, minimize fatty, flour, sweets and alcohol. Eat more vegetables and fruits, dairy products. To nourish the body by taking vitamins, do not forget that you need to drink a lot of water (precisely purified, mineral water). Strengthen your body, reduce the amount of stress in your life, think more positively and your immune system will be strong for many years to come.

Congratulations! Keep it up!

You care about your nutrition, health and immune system. Continue in the same spirit and health problems will not bother you for many years to come. Don't forget that this is mainly due to the fact that you eat right. Eat proper and healthy food (fruits, vegetables, dairy products), do not forget to drink plenty of purified water, strengthen your body, think positively. Just love yourself and your body, take care of it and it will definitely reciprocate your feelings.

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How often do you eat fast food?

  • Few times a week
  • Once a month
  • Several times a year
  • I don't eat at all

Do you eat healthy and nutritious food?

  • Always
  • I strive for this
  • No

How often do you eat foods containing high amounts of sugar?

  • Daily
  • Few times a week
  • Once a month or less
  • I don't use it at all

Do you carry out fasting days or any other cleansing procedures?

  • 1-2 times a week
  • Several times a month
  • Several times a month

How many times a day do you eat?

  • Less than 3 times
  • Breakfast lunch and dinner
  • More than 3 times

What type of people do you consider yourself to be?

  • Optimist
  • Realist
  • Pessimist

How often do you eat baked goods and pasta made from light flour?

  • Daily
  • Few times a week
  • Several times a month or less

Do you eat a varied diet?

  • Yes
  • No
  • I eat a variety of foods, but the same dishes for many years

What products do you have for breakfast?

  • Porridge, yogurt
  • Coffee, sandwiches
  • Other

What time do you have breakfast?

  • Before 7.00
  • 07.00-09.00
  • 09.00-11.00
  • Later 11.00

Do you have food intolerances?

  • Yes
  • No

Do you take vitamins?

  • Yes, regularly
  • Every season
  • Very rarely
  • I don't accept it at all

How much pure water do you drink per day?

  • Less than 1.5 liters
  • 1.5-2.5 liters
  • 2.5-3.5 liters
  • More than 3.5 liters

Have you ever had a food allergy?

  • Yes
  • No
  • I find it difficult to answer

What portions do you eat?

  • While it fits
  • I'm still a little hungry
  • I eat up, but not to the point of being full

Are you taking antibiotics?

  • Yes
  • No
  • In case of urgent need

How often do you eat vegetables and fruits?

  • Daily
  • Few times a week
  • Very rarely

What kind of water do you drink?

  • Mineral
  • Cleaned with household appliances with filters
  • Boiled
  • Raw

How often do you consume fermented milk products?

  • Daily
  • Few times a week
  • Once a month or even less often

Do you always eat at the same time?

Source: http://pulmonologi.ru/bronhit/neobstruktivnyj.html

Chronic non-obstructive bronchitis: symptoms, diagnosis and treatment

Causes

Non-obstructive bronchitis can be triggered by several main factors. It is advisable to consider each of them in more detail.

Endogenous factors

The appearance of the disease is influenced not only by external factors, but also by internal ones. Among them are the following:

  • Genetic predisposition
  • Age limits up to 40 years
  • Diseases of the nasopharynx
  • Excessive activity of the mucous membrane of the lungs
  • Lack of immunoglobulin group A.

Exposure to pollutants

Polluants are chemical compounds that are commonly classified as household and industrial air pollution. The disease was observed in patients who were exposed to harmful compounds for a long time.

Toxic factors

Important factors that provoke the appearance of bronchial diseases are toxic. In this case we are talking about tobacco smoke, dust and other pathogens.

Tobacco smoke deserves special attention. Its components have a detrimental effect on the bronchial epithelium, which causes disruption of the protective and cleansing function of the epithelium. According to medical observations, about 85% of chronic non-obstructive bronchitis is recorded in passive and active smokers.

Etiological factors

The etiological factors are bacterial and viral infections that provoke special symptoms of the disease.

Patients experience a strong inflammatory process, purulent sputum accumulates in the lumen of the bronchi, and the lymph nodes become enlarged. Among the most common infections, experts identify influenza viruses, Moraxella and adenoviruses.

Symptoms

Patients need to listen carefully to their body to identify symptoms of the disease. This is due to the fact that at the first stage the disease practically does not manifest itself; the main symptom is a wet cough.

As a rule, cough appears in the morning. When exposed to cold air or even minor physical activity, the cough intensifies.

When the disease reaches the acute stage, the symptoms appear quite clearly. Among the most characteristic symptoms are the following:

  • Coughing
  • Fever
  • Excessive weakness
  • Loss of appetite
  • Pain in the chest area.

Experts recommend not to wait for the disease to worsen, but to undergo appropriate diagnostics when the slightest symptoms of the disease appear.

Diagnostics

To diagnose the disease, patients need to see a doctor. Specialists prescribe examinations, including the following:

  • General examination by the attending physician
  • Blood analysis
  • Bronchoscopy
  • Radiography
  • Serological analysis.

Based on a competent diagnosis, the attending physician will be able to identify the specifics of the disease and prescribe effective treatment.

Treatment

To eliminate chronic non-obstructive bronchitis, medical workers prescribe complex treatment that allows you to quickly eliminate the symptoms of the disease.

According to experts, the disease responds well to treatment procedures. Properly prescribed therapy makes it possible to eliminate obstructive syndrome and respiratory failure. After two to three weeks of active treatment, patients experience recovery.

Medications

Treatment of patients with drugs is aimed at performing several basic functions. In this case, we are talking about eliminating the inflammatory process, infection, as well as respiratory failure.

For the treatment of chronic non-obstructive bronchitis, experts prescribe the following medications:

  • Antibiotics (macrolides, penicillin) - recommended at the stage of exacerbation of the disease
  • Bronchodilators (theophylline, zuphylline) – intended to eliminate cough
  • Expectorant drugs (“Acetylcysteine”) - prescribed to remove phlegm from the bronchi
  • Anti-inflammatory drugs - in this case, Ibuprofen is effective, as well as Erespal.

Inhalations

For surgical treatment of the disease, medical workers prescribe inhalations to patients. Their advantages are obvious; the procedure promotes deeper penetration of the drug into the bronchial mucosa.

As a rule, the attending physician recommends inhalations for 5 to 10 days, the duration of one procedure varies between 3-5 minutes.

Therapeutic measures

As experts note, drug treatment is not enough. The timing of elimination of the disease directly depends on the regimen followed by the patient. For the treatment of chronic non-obstructive bronchitis, it is recommended to take the following measures:

  • Compliance with pastel mode
  • Minimizing any physical activity
  • Drinking a lot of water
  • To give up smoking
  • Walks in the open air
  • Following a diet, it is necessary to include proteins, vitamins and minerals in the diet.

Prevention

A disease such as chronic non-obstructive bronchitis can be avoided by following simple preventive measures. The main risk factor is smoking. In order to minimize the risk of developing the disease, it is necessary to get rid of a bad habit.

Also, experts recommend avoiding contact with people with nasopharyngeal diseases to prevent infection from entering the body. As a preventative measure, you need to strengthen the immune system using additional medications, such as vitamins.

Source: http://lekhar.ru/bolesni/pulmonologija/hronicheskij-neobstruktivnyj-bronhit/

Causes and treatment of chronic non-obstructive bronchitis

Chronic non-obstructive bronchitis is a progressive inflammatory disease of the airways that causes increased sputum production and coughing. This pathological condition is diagnosed, as a rule, when a person has characteristic manifestations for 3 months a year, and for at least 2 years in a row.

According to statistics, at least 10% of the adult population of the planet suffers from chronic non-obstructive bronchitis. Men are much more likely than women to suffer from this disease. Among other things, it is worth considering that this disease is age-related, so its greatest prevalence is observed in people aged 50 to 60 years.

Etiology and pathogenesis

The causes of the development of chronic non-obstructive bronchitis are extremely diverse. The main predisposing factor to the appearance of this disease is systematic inhalation of tobacco smoke. In this case, there is systematic irritation of the mucous membranes of the bronchi, which leads to the appearance of symptomatic manifestations characteristic of chronic non-obstructive bronchitis. It is worth noting that in most cases, before the development of the chronic form of non-obstructive bronchitis, pneumonia, acute bronchitis or another variant of acute respiratory disease occurs. Typically, the development of chronic bronchitis is associated with the influence of pathogenic organisms such as:

If the primary acute disease has not been completely cured, it may later develop into a chronic form of non-obstructive bronchitis. Allergic reactions play a significant role in the development of the chronic form of the disease. It has been noted that in most cases, the bronchi of a person suffering from chronic non-obstructive bronchitis are extremely susceptible to irritants such as dust, pollen, gases, smoke and other substances that can enter the mucous membrane during breathing. Thus, it becomes clear why chronic bronchitis manifests itself most acutely in people suffering from nicotine addiction.

Against the background of constant destruction of the bronchial mucosa, an increase in mucus secretion is observed, and the viscosity of the secretion can increase significantly. In addition, further changes in the bronchi lead to damage to the ciliated epithelium, which leads to disruption of the protective and cleansing function of the bronchial mucosa. All these changes inevitably lead to the emergence of chronic inflammatory processes.

Symptoms

Chronic non-obstructive bronchitis is characterized by a relapsing course. Typically, obvious symptoms appear only during periods of exacerbation, which can be extremely protracted. Typically, patients with chronic obstructive bronchitis during an exacerbation experience the following symptoms:

  • severe cough in the morning;
  • shallow breathing;
  • increased wheezing;
  • separation of large amounts of sputum;
  • increasing shortness of breath.

In the vast majority of cases, exacerbation of chronic non-obstructive bronchitis does not lead to an increase in body temperature. Chronic non-obstructive bronchitis is an excellent basis for viral or bacterial damage to the tissues of the lungs and bronchi, so often during periods of exacerbation of this disease an infectious component is also added. Some patients also experience hoarseness, which persists not only during exacerbations.

A condition such as chronic non-obstructive bronchitis is quite dangerous, since in the future emphysema or chronic pulmonary heart disease may occur. With such an unfavorable course of exacerbation, chronic non-obstructive bronchitis can be supplemented by blueness of the skin and severe coughing attacks.

Diagnosis and treatment

Diagnosis of such a pathological condition as chronic non-obstructive bronchitis is largely based on information obtained from collecting anamnesis. In addition, to complement the picture the following may be assigned:

  • sputum examinations;
  • blood chemistry;
  • blood gas analysis;
  • electrocardiography;
  • spirography;
  • radiography;
  • bronchoscopy.

In rare cases, bronchial lavage may be prescribed - testing the obtained swabs for pathogenic microflora. After confirming the diagnosis, it is very important to begin treatment for this disease in order to reduce the rate of progression of inflammatory processes affecting the bronchial mucosa. Treatment of this pathological condition is a very long process that requires an integrated approach. During the period of exacerbation, patients need drug treatment, which involves taking:

  • antibacterial drugs;
  • expectorants;
  • antitussive drugs;
  • mucoregulators.

During an exacerbation of chronic non-obstructive bronchitis, it is necessary to drink as much warm fluid as possible. As a warm drink, it is better to use herbal teas, which include:

  • chamomile flowers;
  • wild mallow flowers;
  • dried raspberries;
  • plantain leaves;
  • liquorice root;
  • St. John's wort;
  • oregano;
  • tricolor violet leaves;
  • root of nine strength;
  • primrose;
  • black elderberry flowers.

Considering that during an exacerbation, sputum can be extremely difficult to clear even with the use of medications, to facilitate this process you can use inhalations based on:

  • boiled potatoes;
  • onion juice dissolved in hot water;
  • grated garlic dissolved in hot water.

Among other things, it is recommended to use essential oils of tea tree, fir, eucalyptus or pine for inhalation.

After the general condition improves and remission is achieved, measures should be taken to strengthen the immune system and the overall health of the body.

To improve the condition of the respiratory system, it is recommended to carry out daily breathing exercises, as well as engage in physical therapy, preferably in the fresh air.

It is important to normalize the work and rest schedule, and carefully monitor the cleanliness of the room where the patient spends a lot of time. It is very important that the air is fresh, so it is necessary to ventilate the room as often as possible. The use of salt rooms and heat treatment using healing clay and paraffin have a positive effect on the general condition of patients suffering from chronic bronchitis. Among other things, the patient must undergo a course of sanatorium-resort treatment several times a year.

Source: http://pneumon.ru/bronhit/hronicheskij-neobstruktivnyj-bronhit.html

Chronic non-obstructive bronchitis: symptoms and treatment

Non-obstructive (chronic) bronchitis is a pathology of the respiratory system, during which inflammation of the medium and large bronchi, as well as their membranes, occurs.

Chronic non-obstructive bronchitis is a seasonal exacerbation that most often occurs in late autumn or early spring.

If a person develops such a disease, it is recommended to begin timely treatment, as a result of which the symptoms can be alleviated. It is necessary to understand that such a disease requires periodic treatment, since it occurs with periodic regularity.

Epidemiology of the disease

Quite often, people experience the chronic form of the disease; doctors detect it in approximately 22% of people living in our country.

Most often, it is representatives of the stronger sex who encounter this disease; the percentage of men who encounter this particular form of the disease ranges from 35 to 60%.

If we talk about statistical data, then based on the last few years, we can see that the frequency of occurrence of such a disease is only increasing with each passing year. Most often, the disease occurs in the working-age population, whose age ranges from 40 to 60 years.

To ease the course of the disease, timely treatment is necessary.

Causes of the disease

The etiology of this disease is mainly associated with prolonged exposure to toxic irritating factors on the bronchi (for example, dust or cigarette smoke). Substances with a high degree of toxicity, which are found in tobacco smoke, have a negative effect on the ciliary epithelium of the bronchi.

Such a negative impact can lead to changes in the structure of the glandular apparatus - discrinia and hypersecretion. During exposure of this kind, mucociliary transport is disrupted, which leads to negative consequences on the cleansing and protective functions of the ciliated epithelium.

As a result of exposure to tobacco smoke, a decrease in the immunoresistance of the mucous membrane is observed, and the “gate” for viruses and bacteria opens. Non-obstructive bronchitis is diagnosed in 90% of all cases in passive and active smokers. The pathology begins its further development with the frequency of smoking and the number of cigarettes smoked per day.

Scientists have proven that the most irritating effect is on the mucous membrane of the respiratory tract after smoking cigarettes, and to a lesser extent after smoking a pipe and cigars. To eliminate the possibility of developing pathology, it is better to give up cigarettes.

The second most important factor causing the development of CNB is considered to be prolonged exposure of the patient’s body to pollutants (toxic volatile compounds) related to industrial and household air pollution (silicon, cadmium, nitrogen dioxide).

Also, the manifestation of such an enemy may depend on the pathogenic effects of the products listed above on the bronchial mucosa. To alleviate the general condition, it is necessary to try to avoid inhaling such air, because it is this air that has a negative effect, contributing to the further development of chronic bronchitis.

The third environmental factor includes various bacterial and viral infections that can be transmitted by airborne droplets. These include acute respiratory viral infection, pneumonia of viral etiology and tracheobronchitis. In most cases, the cause of this disease is infections such as:

As a result of bacterial contamination of the bronchial mucosa, an inflammatory diffuse process develops; a moderate amount of purulent or mucopurulent sputum accumulates in the bronchial lumen. In some cases, an increase in tracheobronchial and bronchopulmonary lymph nodes is observed.

It should be noted that the formation of chronic simple bronchitis can occur not only as a result of exposure to exogenous, but also a number of endogenous factors:

  1. Male gender.
  2. Genetic predisposition;
  3. Age not exceeding 40 years.
  4. Diseases of the nasopharynx;
  5. Lack of category A immunoglobulins in the body.
  6. Hyperreactivity of the bronchial mucosa.
  7. Dysfunction of alveolar macrophages and neutrophils.

Symptoms of the disease

Before starting treatment it is necessary to make a diagnosis. First of all, a person develops a severe cough, one of its causes may be eosinophilic bronchitis. Based on medical statistics, this type of bronchitis is in fourth place among all existing respiratory pathologies.

This type of bronchitis can be diagnosed by conducting a sputum test in a laboratory. During a microscopic examination of sputum, it is possible to find cells called eosinophils.

During CNB, periods of an exacerbation phase (no more than one to three times a day) and stable remission are clearly observed. In the remission stage, chronic bronchitis shows almost no symptoms. Many patients do not consider themselves sick; they attribute a wet cough that occurs mainly in the morning to the habit of smoking tobacco.

When inhaling cold air, an increase in cough is observed, and it can also occur after severe physical exertion. As a rule, it is not possible to determine the remaining symptoms in the presence of chronic bronchitis in a state of remission. Otherwise, the patient may feel normal without experiencing any health problems.

If there is auscultation of the lungs, you can hear harsh breathing, in some cases low-pitched dry snoring, especially if the person exhales forcefully. After clearing my throat well, the wheezing disappears. But during the exacerbation phase, the picture of non-obstructive chronic bronchitis becomes more vivid.

As a rule, such a disease worsens when a bacterial or viral infection enters the body. In a number of other situations, frequent smoking or diseases of the pharynx and oral cavity (laryngitis, pharyngitis, sore throat) may be a provoking factor.

Very often, patients with such a diagnosis may complain of pain in the head, cough with sputum, muscle pain, excessive sweating, hyperthermia (not a mandatory sign), intoxication syndrome and general weakness.

Diagnosis of the disease

Chronic bronchitis can be diagnosed based on available anamnestic data, results of laboratory and instrumental studies:

  • Spirometry;
  • Serological tests;
  • Bronchoscopy;
  • X-ray of the chest organs;
  • Conducting a general analysis of sputum (number of epithelial cells, neutrophils, alveolar macrography), culture of sputum for sensitivity to antibiotics and microflora.

Treatment of the disease

Treatment of chronic bronchitis includes breathing exercises. Thanks to this, a sick person can cleanse his bronchi of accumulated mucus. Treatment also includes the prescription of special expectorants, which must be used on an ongoing basis.

If there is an exacerbation of chronic bronchitis, the patient’s treatment should include medications aimed at thinning the mucus. A good remedy for thinning sputum is a drug such as Acetylcysteine.

If the period of exacerbation of the disease ends, the cough begins to bother the patient less and less, and the amount of sputum produced has significantly decreased, then treatment should include medications based on plants. In this case, taking conventional medications is not recommended.

If you want to get an expectorant effect, you can try taking drugs such as Levopront and Bitodin. In the presence of strong viscosity of sputum, it is recommended to use Lazolvan and ACC. All these drugs are aimed at alleviating the general well-being of the patient during chronic bronchitis.

However, you should not start treatment without confirming the disease. If you suspect chronic bronchitis, you must consult a doctor to confirm an accurate diagnosis and prescribe effective treatment. The video in this article will help you understand the symptoms of the disease.

Source: http://stopgripp.ru/bolezn/bronchitis/hronicheskij-neobstruktivnyj-bronhit.html

Chronic obstructive bronchitis - Treatment

For a disease such as chronic obstructive bronchitis, treatment is long-term and symptomatic. Due to the fact that chronic pulmonary obstruction is characteristic of smokers with many years of experience, as well as people employed in hazardous industries with a high content of dust in the inhaled air, the main goal of treatment is to stop the negative impact on the lungs.

Chronic obstructive bronchitis: treatment with modern means

Treatment of chronic obstructive bronchitis in most cases is an extremely difficult task. First of all, this is explained by the basic pattern of development of the disease - the steady progression of bronchial obstruction and respiratory failure due to the inflammatory process and bronchial hyperreactivity and the development of persistent irreversible disorders of bronchial patency caused by the formation of obstructive pulmonary emphysema. In addition, the low effectiveness of treatment for chronic obstructive bronchitis is due to their late visit to the doctor, when there are already signs of respiratory failure and irreversible changes in the lungs.

Nevertheless, modern adequate comprehensive treatment of chronic obstructive bronchitis in many cases makes it possible to reduce the rate of progression of the disease leading to an increase in bronchial obstruction and respiratory failure, reduce the frequency and duration of exacerbations, increase performance and tolerance to physical activity.

Treatment of chronic obstructive bronchitis includes:

  • non-drug treatment of chronic obstructive bronchitis;
  • use of bronchodilators;
  • prescription of mucoregulatory therapy;
  • correction of respiratory failure;
  • anti-infective therapy (for exacerbations of the disease);
  • anti-inflammatory therapy.

Most patients with COPD should be treated on an outpatient basis, according to an individual program developed by the attending physician.

Indications for hospitalization are:

  1. Exacerbation of COPD, not controlled in an outpatient setting, despite the course (persistence of fever, cough, purulent sputum, signs of intoxication, increasing respiratory failure, etc.).
  2. Acute respiratory failure.
  3. Increasing arterial hypoxemia and hypercapnia in patients with chronic respiratory failure.
  4. Development of pneumonia against the background of COPD.
  5. The appearance or progression of signs of heart failure in patients with chronic cor pulmonale.
  6. The need for relatively complex diagnostic procedures (for example, bronchoscopy).
  7. The need for surgical interventions using anesthesia.

The main role in recovery undoubtedly belongs to the patient himself. First of all, you need to give up the addiction to cigarettes. The irritating effect that nicotine has on lung tissue will nullify all attempts to “unblock” the functioning of the bronchi, improve blood supply to the respiratory organs and their tissues, eliminate coughing attacks and bring breathing to normal.

Modern medicine offers to combine two treatment options – basic and symptomatic. The basis of the basic treatment of chronic obstructive bronchitis consists of drugs that relieve irritation and congestion in the lungs, facilitate mucus discharge, expand the lumen of the bronchi and improve blood circulation in them. These include xanthine drugs and corticosteroids.

At the stage of symptomatic treatment, mucolytics are used as the main means to combat cough and antibiotics, in order to exclude the addition of a secondary infection and the development of complications.

Periodic physical procedures and therapeutic exercises are indicated for the chest area, which greatly facilitates the outflow of viscous mucus and ventilation of the lungs.

Chronic obstructive bronchitis - treatment with non-drug methods

A set of non-drug therapeutic measures for patients with COPD includes unconditional cessation of smoking and, if possible, elimination of other external causes of the disease (including exposure to household and industrial pollutants, repeated respiratory viral infections, etc.). Sanitation of foci of infection, primarily in the oral cavity, and restoration of nasal breathing, etc. are of great importance. In most cases, within a few months after quitting smoking, the clinical manifestations of chronic obstructive bronchitis (cough, sputum and shortness of breath) decrease and the rate of decline in FEV1 and other indicators of external respiratory function slows down.

The diet of patients with chronic bronchitis should be balanced and contain sufficient amounts of protein, vitamins and minerals. Particular importance is attached to additional intake of antioxidants, such as tocopherol (vitamin E) and ascorbic acid (vitamin C).

The diet of patients with chronic obstructive bronchitis should also include an increased amount of polyunsaturated fatty acids (eicosapentaenoic and docosahexaenoic) contained in seafood and having a unique anti-inflammatory effect due to a decrease in the metabolism of arachidonic acid.

In case of respiratory failure and acid-base disorders, a hypocaloric diet and limiting the intake of simple carbohydrates are advisable, which, due to their accelerated metabolism, increase the formation of carbon dioxide and, accordingly, reduce the sensitivity of the respiratory center. According to some data, the use of a hypocaloric diet in severe patients with COPD with signs of respiratory failure and chronic hypercapnia is comparable in effectiveness to the results of using long-term low-flow oxygen therapy in these patients.

Drug treatment of chronic obstructive bronchitis

The tone of bronchial smooth muscles is regulated by several neurohumoral mechanisms. In particular, bronchial dilatation develops when stimulated:

  1. beta2-adrenergic receptors with adrenaline and
  2. VIP receptors of the NANC (non-adrenergic, non-cholinergic nervous system) with vasoactive intestinal polypeptide (VIP).

On the contrary, narrowing of the bronchial lumen occurs when stimulated:

  1. M-cholinergic receptors acetylcholine,
  2. receptors for P-substance (NAH-system)
  3. alpha adrenergic receptors.

In addition, numerous biologically active substances, including inflammatory mediators (histamine, bradykinin, leukotrienes, prostaglandins, platelet activating factor - PAF, serotonin, adenosine, etc.) also have a pronounced effect on the tone of bronchial smooth muscles, contributing mainly to reduction of the lumen of the bronchi.

Thus, the bronchodilation effect can be achieved in several ways, in which blockade of M-cholinergic receptors and stimulation of bronchial beta2-adrenergic receptors are currently most widely used. In accordance with this, M-anticholinergics and beta2-agonists (sympathomimetics) are used in the treatment of chronic obstructive bronchitis. The third group of bronchodilator drugs that are used in patients with COPD includes methylxanthine derivatives, the mechanism of action of which on bronchial smooth muscle is more complex

According to modern concepts, the systematic use of bronchodilators is the basis of basic therapy for patients with chronic obstructive bronchitis and COPD. This treatment of chronic obstructive bronchitis turns out to be more effective the more it is used. a reversible component of bronchial obstruction is expressed. True, the use of bronchodilators in patients with COPD, for obvious reasons, has a significantly less positive effect than in patients with bronchial asthma, since the most important pathogenetic mechanism of COPD is progressive irreversible obstruction of the airways due to the formation of emphysema in them. At the same time, it should be taken into account that some modern bronchodilator drugs have a fairly wide spectrum of action. They help reduce swelling of the bronchial mucosa, normalize mucociliary transport, reduce the production of bronchial secretions and inflammatory mediators.

It should be emphasized that often in patients with COPD the functional tests described above with bronchodilators turn out to be negative, since the increase in FEV1 after a single use of M-anticholinergics and even beta2-sympathomimetics is less than 15% of the expected value. However, this does not mean that it is necessary to abandon the treatment of chronic obstructive bronchitis with bronchodilators, since the positive effect from their systematic use usually occurs no earlier than 2-3 months from the start of treatment.

Inhalation administration of bronchodilators

It is preferable to use inhaled forms of bronchodilators, since this route of drug administration facilitates faster penetration of drugs into the mucous membrane of the respiratory tract and long-term maintenance of a sufficiently high local concentration of drugs. The latter effect is ensured, in particular, by the repeated entry into the lungs of medicinal substances, absorbed through the mucous membrane of the bronchi into the blood and passing through the bronchial veins and lymphatic vessels to the right side of the heart, and from there again to the lungs

An important advantage of the inhalation route of administration of bronchodilators is the selective effect on the bronchi and a significant reduction in the risk of developing side systemic effects.

Inhalation administration of bronchodilators is ensured by the use of powder inhalers, spacers, nebulizers, etc. When using a metered dose inhaler, the patient needs certain skills in order to ensure more complete penetration of the drug into the airways. To do this, after a smooth, calm exhalation, wrap your lips tightly around the mouthpiece of the inhaler and begin to inhale slowly and deeply, press the canister once and continue to inhale deeply. After this, hold your breath for 10 seconds. If two doses (inhalations) of the inhaler are prescribed, you should wait at least seconds and then repeat the procedure.

In elderly patients who find it difficult to fully master the skills of using a metered dose inhaler, it is convenient to use so-called spacers, in which the medicine in the form of an aerosol is sprayed into a special plastic flask by pressing the canister immediately before inhalation. In this case, the patient takes a deep breath, holds his breath, exhales into the mouthpiece of the spacer, after which he takes a deep breath again without pressing the canister.

The most effective is the use of compressor and ultrasonic nebulizers (from Latin: nebula - fog), which spray liquid medicinal substances in the form of fine aerosols, in which the medicine is contained in the form of particles ranging in size from 1 to 5 microns. This can significantly reduce the loss of medicinal aerosol that does not enter the respiratory tract, as well as ensure a significant depth of penetration of the aerosol into the lungs, including medium and even small bronchi, whereas when using traditional inhalers, such penetration is limited to the proximal bronchi and trachea.

The advantages of inhaling drugs through nebulizers are:

  • the depth of penetration of medicinal fine aerosol into the respiratory tract, including medium and even small bronchi;
  • simplicity and convenience of inhalation;
  • no need to coordinate inspiration with inhalation;
  • the possibility of administering high doses of drugs, which allows the use of nebulizers to relieve the most severe clinical symptoms (severe shortness of breath, an attack of suffocation, etc.);
  • the possibility of including nebulizers in the circuit of ventilators and oxygen therapy systems.

In this regard, the administration of drugs through nebulizers is used primarily in patients with severe obstructive syndrome, progressive respiratory failure, in elderly and senile people, etc. Through nebulizers, not only bronchodilators, but also mucolytic agents can be administered into the respiratory tract.

Anticholinergic drugs (M-cholinergics)

Currently, M-anticholinergics are regarded as the first choice drugs in patients with COPD, since the leading pathogenetic mechanism of the reversible component of bronchial obstruction in this disease is cholinergic bronchoconstruction. It has been shown that in patients with COPD, anticholinergics have a bronchodilator effect that is not inferior to beta2-adrenergic agonists and superior to theophylline.

The effect of these bronchodilators is associated with the competitive inhibition of acetylcholine on the receptors of the postsynaptic membranes of the smooth muscles of the bronchi, mucous glands and mast cells. As is known, excessive stimulation of cholinergic receptors leads not only to increased smooth muscle tone and increased secretion of bronchial mucus, but also to degranulation of mast cells, leading to the release of a large number of inflammatory mediators, which ultimately increases the inflammatory process and bronchial hyperreactivity. Thus, anticholinergics inhibit the reflex response of smooth muscles and mucous glands caused by activation of the vagus nerve. Therefore, their effect is manifested both when using the drug before the onset of irritating factors and when the process has already developed.

It should also be remembered that the positive effect of anticholinergics is primarily manifested at the level of the trachea and large bronchi, since this is where the maximum density of cholinergic receptors is located.

Remember:

  1. Anticholinergics are the first choice drugs in the treatment of chronic obstructive bronchitis, since parasympathetic tone in this disease is the only reversible component of bronchial obstruction.
  2. The positive effect of M-anticholinergics is:
    1. in reducing the tone of bronchial smooth muscles,
    2. decreased secretion of bronchial mucus and
    3. reducing the process of mast cell degranulation and limiting the release of inflammatory mediators.
  3. The positive effect of anticholinergics is primarily manifested at the level of the trachea and large bronchi

In patients with COPD, inhaled forms of anticholinergics are usually used - the so-called quaternary ammonium compounds, which penetrate poorly through the mucous membrane of the respiratory tract and practically do not cause systemic side effects. The most common of them are ipratropium bromide (Atrovent), oxytropium bromide, ipratropium iodide, tiotropium bromide, which are used mainly in metered aerosols.

The bronchodilator effect begins 5-10 minutes after inhalation, reaching a maximum after about 1-2 hours. The duration of action of ipratropium iodide, ipratropium bromide (atroventa)h, oxytropium bromide 8-10 hours and tiotropium bromide.

Side effects

Undesirable side effects of M-anticholinergic drugs include dry mouth, sore throat, and cough. Systemic side effects of blockade of M-cholinergic receptors, including cardiotoxic effects on the cardiovascular system, are practically absent.

Ipratropium bromide (Atrovent) is available in the form of a metered dose aerosol. Prescribe 2 puffs (40 mcg) 3-4 times a day. Inhalation of Atrovent, even in short courses, significantly improves bronchial patency. Long-term use of Atrovent is especially effective for COPD, which significantly reduces the number of exacerbations of chronic bronchitis, significantly improves oxygen saturation (SaO2) in arterial blood, and normalizes sleep in patients with COPD.

For COPD of mild severity, a course of inhalation of Atrovent or other M-cholinergic agents is acceptable, usually during periods of exacerbation of the disease; the duration of the course should not be less than 3 weeks. For COPD of moderate and severe severity, anticholinergics are used constantly. It is important that with long-term therapy with Atrovent, drug tolerance and tachyphylaxis do not occur.

Contraindications

M-anticholinergic drugs are contraindicated for glaucoma. Caution should be exercised when prescribing them to patients with prostate adenoma

Selective beta2-agonists

Beta2-adrenergic agonists are rightfully considered the most effective bronchodilators, which are currently widely used for the treatment of chronic obstructive bronchitis. We are talking about selective sympathomimetics, which selectively have a stimulating effect on beta2-adrenoreceptors of the bronchi and have almost no effect on beta1-adrenoreceptors and alpha receptors, which are only present in small quantities in the bronchi.

Alpha adrenergic receptors are determined mainly in the smooth muscle of blood vessels, in the myocardium, central nervous system, spleen, platelets, liver and adipose tissue. In the lungs, a relatively small number of them are localized mainly in the distal parts of the respiratory tract. Stimulation of alpha-adrenergic receptors, in addition to pronounced reactions from the cardiovascular system, central nervous system and platelets, leads to increased tone of bronchial smooth muscles, increased secretion of mucus in the bronchi and the release of histamine by mast cells.

Beta1-adrenergic receptors are widely represented in the myocardium of the atria and ventricles of the heart, in the conduction system of the heart, in the liver, muscle and adipose tissue, in blood vessels and are almost absent in the bronchi. Stimulation of these receptors leads to a pronounced response from the cardiovascular system in the form of positive inotropic, chronotropic and dromotropic effects in the absence of any local response from the respiratory tract.

Finally, beta2-adrenergic receptors are found in the smooth muscles of blood vessels, the uterus, adipose tissue, as well as in the trachea and bronchi. It should be emphasized that the density of beta2-adrenergic receptors in the bronchial tree significantly exceeds the density of all distal adrenergic receptors. Stimulation of beta2-adrenergic receptors by catecholamines is accompanied by:

  • relaxation of bronchial smooth muscles;
  • decreased release of histamine by mast cells;
  • activation of mucociliary transport;
  • stimulation of the production of bronchial relaxation factors by epithelial cells.

Depending on the ability to stimulate alpha, beta1 and/or beta2 adrenergic receptors, all sympathomimetics are divided into:

  • universal sympathomimetics, acting on both alpha and beta adrenergic receptors: adrenaline, ephedrine;
  • non-selective sympathomimetics that stimulate both beta1 and beta2 adrenergic receptors: isoprenaline (novodrine, isadrin), orciprenaline (alupept, asthmapent) hexaprenaline (ipradol);
  • selective sympathomimetics that selectively act on beta2-adrenergic receptors: salbutamol (Ventolin), fenoterol (Berotec), terbutaline (Bricanil) and some prolonged forms.

Currently, universal and non-selective sympathomimetics are practically not used for the treatment of chronic obstructive bronchitis due to the large number of side effects and complications caused by their pronounced alpha and/or beta1 activity

Currently widely used selective beta2-adrenomimetics almost do not cause serious complications from the cardiovascular system and the central nervous system (tremor, headache, tachycardia, rhythm disturbances, arterial hypertension, etc.), characteristic of non-selective and especially universal sympathomimetics. Nevertheless It should be borne in mind that the selectivity of various beta2-agonists is relative and does not completely exclude beta1 activity.

All selective beta2-agonists are divided into short-acting and long-acting drugs.

Short-acting drugs include salbutamol (Ventolin, fenoterol (Berotec), terbutaline (Bricanil), etc. Drugs in this group are administered by inhalation and are considered the drug of choice mainly for the relief of attacks of acute bronchial obstruction (for example, in patients with bronchial asthma) and treatment chronic obstructive bronchitis. Their action begins 5-10 minutes after inhalation (in some cases earlier), the maximum effect appears after a minute, the duration of action is 4-6 hours.

The most common drug in this group is salbutamol (Ventolin), which is considered one of the safest beta-agonists. The drugs are most often used by inhalation, for example, using spinhaler, at a dose of 200 mm no more than 4 times a day. Despite its selectivity, even with inhaled use of salbutamol, some patients (about 30%) experience undesirable systemic reactions in the form of tremor, palpitations, headache, etc. This is explained by the fact that most of the drug settles in the upper respiratory tract, is swallowed by the patient and absorbed into the blood in the gastrointestinal tract, causing the described systemic reactions. The latter, in turn, are associated with the presence of minimal reactivity in the drug.

Fenoterol (Berotec) has slightly greater activity and a longer half-life than salbutamol. However, its selectivity is approximately 10 times less than salbutamol, which explains the worse tolerability of this drug. Fenoterol is prescribed in the form of dosed inhalations pmkg (1-2 puffs) 2-3 times a day.

Side effects are observed with long-term use of beta2-agonists. These include tachycardia, extrasystole, increased frequency of angina attacks in patients with coronary artery disease, increased systemic blood pressure and others caused by incomplete selectivity of drugs. Long-term use of these drugs leads to a decrease in the sensitivity of beta2-adrenergic receptors and the development of their functional blockade, which can lead to exacerbation of the disease and a sharp decrease in the effectiveness of previously treated chronic obstructive bronchitis. Therefore, in patients with COPD, it is recommended, if possible, only sporadic (not regular) use of drugs in this group.

Long-acting beta2-agonists include formoterol, salmeterol (Sereven), saltos (slow-release salbutamol), and others. The prolonged effect of these drugs (up to 12 hours after inhalation or oral administration) is due to their accumulation in the lungs.

In contrast to short-acting beta2-agonists, the effect of these long-acting drugs occurs slowly, so they are used primarily for long-term constant (or course) bronchodilator therapy to prevent the progression of bronchial obstruction and exacerbations of the disease. According to some researchers, long-acting beta2-agonists also have anti-inflammatory properties action, as they reduce vascular permeability, prevent activation of neutrophils, lymphocytes, and macrophages inhibiting the release of histamine, leukotrienes and prostaglandins from mast cells and eosinophils. A combination of long-acting beta2-agonists with the use of inhaled glucocorticoids or other anti-inflammatory drugs is recommended.

Formoterol has a significant duration of bronchodilator action (up to 8-10 hours), including when used inhaled. The drug is prescribed by inhalation in doses of 2 times a day or in tablet form of 20, 40 and 80 mcg.

Volmax (salbutamol SR) is a long-acting preparation of salbutamol intended for oral administration. The drug is prescribed 1 tablet (8 mg) 3 times a day. Duration of action after a single dose of the drug is 9 hours.

Salmeterol (Serevent) is also a relatively new long-acting beta2-sympathomimetic drug with a duration of action of 12 hours. Its bronchodilatory effect exceeds the effects of salbutamol and fenoterol. A distinctive feature of the drug is its very high selectivity, which is more than 60 times higher than that of salbutamol, which ensures a minimal risk of developing side systemic effects.

Salmeterol is prescribed at a dose of 50 mcg 2 times a day. In severe cases of broncho-obstructive syndrome, the dose can be increased by 2 times. There is evidence that long-term therapy with salmeterol leads to a significant reduction in the occurrence of exacerbations of COPD.

Tactics for the use of selective beta2-agonists in patients with COPD

When considering the advisability of using selective beta2-agonists for the treatment of chronic obstructive bronchitis, several important circumstances should be emphasized. Despite the fact that bronchodilators of this group are currently widely prescribed in the treatment of patients with COPD and are regarded as drugs for the basic treatment of these patients, it should be noted that in real clinical practice their use encounters significant, sometimes insurmountable, difficulties associated primarily with the presence of significant side effects in most of them. In addition to cardiovascular disorders (tachycardia, arrhythmias, a tendency to increase systemic blood pressure, tremor, headaches, etc.), these drugs, with long-term use, can aggravate arterial hypoxemia, since they help increase the perfusion of poorly ventilated parts of the lungs and further impair ventilation-perfusion relationships. Long-term use of beta2-agonists is also accompanied by hypocapnia, caused by the redistribution of potassium inside and outside the cell, which is accompanied by an increase in weakness of the respiratory muscles and deterioration of ventilation.

However, the main disadvantage of long-term use of beta2-adrenoceptors in patients with broncho-obstructive syndrome is the natural formation of tachyphylaxis - a decrease in the strength and duration of the bronchodilator effect, which over time can lead to rebound bronchoconstriction and a significant decrease in functional parameters characterizing the patency of the airways. In addition, beta2-adrenergic agonists increase bronchial hyperreactivity to histamine and methacholine (acetylcholine), thus worsening parasympathetic bronchoconstrictor effects.

Several important practical conclusions follow from the above.

  1. Considering the high effectiveness of beta2-adrenergic agonists in relieving acute episodes of bronchial obstruction, their use in patients with COPD is indicated primarily at the time of exacerbations of the disease.
  2. It is advisable to use modern, long-acting, highly selective sympathomimetics, for example, salmeterol (Serevent), although this does not at all exclude the possibility of sporadic (not regular) use of short-acting beta2-adrenergic agonists (such as salbutamol).
  3. Long-term regular use of beta2-agonists as monotherapy for patients with COPD, especially elderly and senile patients, cannot be recommended as permanent basic therapy.
  4. If in patients with COPD there remains a need to reduce the reversible component of bronchial obstruction, and monotherapy with traditional M-anticholinergics is not entirely effective, it is advisable to switch to modern combined bronchodilators, including M-cholinergic inhibitors in combination with beta2-adrenergic agonists.

Combined bronchodilators

In recent years, combined bronchodilator drugs are increasingly used in clinical practice, including for long-term therapy of patients with COPD. The bronchodilating effect of these drugs is achieved by stimulating beta2-adrenergic receptors in the peripheral bronchi and inhibiting cholinergic receptors in the large and medium bronchi.

Berodual is the most common combined aerosol drug containing the anticholinergic ipratropium bromide (Atrovent) and the beta2-adrenergic stimulant fenoterol (Berotec). Each dose of Berodual contains 50 mcg of fenoterol and 20 mcg of atrovent. This combination allows you to obtain a bronchodilator effect with a minimal dose of fenoterol. The drug is used both for the relief of acute attacks of asthma and for the treatment of chronic obstructive bronchitis. The usual dose is 1-2 aerosol doses 3 times a day. The onset of action of the drug is after 30 s, the maximum effect is after 2 hours, the duration of action does not exceed 6 hours.

Combivent is the second combination aerosol preparation containing 20 mcg. anticholinergic ipratropium bromide (Atroventa) and 100 mcg salbutamol. Combivent is used 1-2 doses of the drug 3 times a day.

In recent years, positive experience has begun to accumulate in the combined use of anticholinergics with long-acting beta2-agonists (for example, Atrovent with salmeterol).

This combination of bronchodilators of the two described groups is very common, since the combined drugs have a more powerful and persistent bronchodilator effect than both components separately.

Combination drugs containing M-cholinergic inhibitors in combination with beta2-adrenergic agonists have a minimal risk of side effects due to the relatively small dose of the sympathomimetic. These advantages of combined drugs allow us to recommend them for long-term basic bronchodilator therapy in patients with COPD when monotherapy with Atrovent is insufficiently effective.

Methylxanthine derivatives

If taking anticholiolytics or combined bronchodilators is not effective, methylxanthine drugs (theophylline, etc.) can be added to the treatment of chronic obstructive bronchitis. These drugs have been successfully used for many decades as effective drugs for the treatment of patients with broncho-obstructive syndrome. Theophylline derivatives have a very wide spectrum of action, going far beyond just the bronchodilator effect.

Theophylline inhibits phosphodiesterase, resulting in the accumulation of cAMP in the smooth muscle cells of the bronchi. This promotes the transport of calcium ions from myofibrils to the sarcoplasmic reticulum, which is accompanied by relaxation of smooth muscles. Theophylline also blocks purine receptors in the bronchi, eliminating the bronchoconstrictor effect of adenosine.

In addition, theophylline inhibits the degranulation of mast cells and the release of inflammatory mediators from them. It also improves renal and cerebral blood flow, enhances diuresis, increases the strength and frequency of heart contractions, lowers pressure in the pulmonary circulation, and improves the function of the respiratory muscles and diaphragm.

Short-acting drugs from the theophylline group have a pronounced bronchodilator effect; they are used to relieve acute episodes of bronchial obstruction, for example, in patients with bronchial asthma, as well as for long-term therapy of patients with chronic broncho-obstructive syndrome.

Euphylline (a compound of theophyllip and ethylenediamine) is available in ampoules of 10 ml of 2.4% solution. Eufillin is administered intravenously in isotonic sodium chloride solution over 5 minutes. With rapid administration, a drop in blood pressure, dizziness, nausea, tinnitus, palpitations, facial flushing and a feeling of heat may occur. Aminophylline administered intravenously lasts for about 4 hours. With intravenous drip administration, a longer duration of action can be achieved (6-8 hours).

Long-acting theophyllines have been widely used in recent years for the treatment of chronic obstructive bronchitis and bronchial asthma. They have significant advantages over short-acting theophyllines:

  • the frequency of taking medications is reduced;
  • the accuracy of drug dosing increases;
  • provides a more stable therapeutic effect;
  • prevention of asthma attacks in response to physical activity;
  • drugs can be successfully used to prevent night and morning asthma attacks.

Long-acting theophyllines have a bronchodilator and anti-inflammatory effect. They significantly suppress both the early and late phases of the asthmatic reaction that occurs after inhalation of the allergen, and also have an anti-inflammatory effect. Long-term treatment of chronic obstructive bronchitis with long-acting theophyllines effectively controls the symptoms of bronchial obstruction and improves lung function. Since the drug is released gradually, it has a longer duration of action, which is important for the treatment of nocturnal symptoms of the disease that persist despite treatment of chronic obstructive bronchitis with anti-inflammatory drugs.

Long-acting theophylline preparations are divided into 2 groups:

  1. 1st generation drugs last 12 hours; they are prescribed 2 times a day. These include: theodur, theotard, teopec, durophylline, ventax, theogard, theobid, slobid, aminophylline SR, etc.
  2. 2nd generation drugs act for about 24 hours; they are prescribed once a day. These include: theodur-24, unifil, dilatran, eufilong, filocontin, etc.

Unfortunately, theophyllines act within a very narrow therapeutic concentration range of 15 mcg/mL. When the dose is increased, a large number of side effects occur, especially in elderly patients:

  • gastrointestinal disorders (nausea, vomiting, anorexia, diarrhea, etc.);
  • cardiovascular disorders (tachycardia, rhythm disturbances, up to ventricular fibrillation);
  • dysfunction of the central nervous system (hand tremors, insomnia, agitation, convulsions, etc.);
  • metabolic disorders (hyperglycemia, hypokalemia, metabolic acidosis, etc.).

Therefore, when using methylxanthines (short and long-acting), it is recommended to determine the level of theophylline in the blood at the beginning of treatment of chronic obstructive bronchitis, every 6-12 months and after changing doses and medications.

The most rational sequence of use of bronchodilators in patients with COPD is as follows:

Sequence and volume of bronchodilator treatment of chronic obstructive bronchitis

  • With mild and unstable symptoms of broncho-obstructive syndrome:
    • inhaled M-anticholinergics (Atrovent), mainly in the phase of exacerbation of the disease;
    • if necessary - inhaled selective beta2-adrenergic agonists (sporadic - during exacerbations).
  • For more persistent symptoms (mild to moderate):
    • inhaled M-anticholinergics (Atrovent) constantly;
    • in case of insufficient effectiveness - combined bronchodilators (Berodual, Combivent) continuously;
    • if the effectiveness is insufficient, additional methylxanthines are used.
  • With low effectiveness of treatment and progression of bronchial obstruction:
    • consider replacing Berodual or Combivent with a highly selective long-acting beta2-adrenergic agonist (salmeterol) and combination with an M-anticholinergic;
    • modify methods of drug delivery (spensers, nebulizers),
    • Continue taking methylxanthines and theophylline parenterally.

Mucolytic and mucoregulatory agents

Improving bronchial drainage is the most important task in the treatment of chronic obstructive bronchitis. For this purpose, any possible effects on the body, including non-drug treatment methods, should be considered.

  1. Drinking plenty of warm fluids helps reduce the viscosity of sputum and increase the sol layer of bronchial mucus, resulting in easier functioning of the ciliated epithelium.
  2. Vibration chest massage 2 times a day.
  3. Positional bronchial drainage.
  4. Expectorants with an emetic-reflex mechanism of action (thermopsis herb, terpin hydrate, ipecac root, etc.) stimulate the bronchial glands and increase the amount of bronchial secretion.
  5. Bronchodilators that improve bronchial drainage.
  6. Acetylcysteine ​​(fluimucin) viscosity of sputum due to the rupture of disulfide bonds of mucopolysaccharides of sputum. Has antioxidant properties. Increases the synthesis of glutathione, which takes part in detoxification processes.
  7. Ambroxol (lazolvan) stimulates the formation of low-viscosity tracheobronchial secretions due to the depolymerization of acidic mucopolysaccharides of bronchial mucus and the production of neutral mucopolysaccharides by goblet cells. Increases the synthesis and secretion of surfactant and blocks the breakdown of the latter under the influence of unfavorable factors. Enhances the penetration of antibiotics into bronchial secretions and the bronchial mucosa, increasing the effectiveness of antibacterial therapy and reducing its duration.
  8. Carbocisteine ​​normalizes the quantitative ratio of acidic and neutral sialomucins in bronchial secretions, reducing the viscosity of sputum. Promotes regeneration of the mucous membrane, reducing the number of goblet cells, especially in the terminal bronchi.
  9. Bromhexine is a mucolytic and mucoregulator. Stimulates the production of surfactant.

Anti-inflammatory treatment of chronic obstructive bronchitis

Since the formation and progression of chronic bronchitis is based on the local inflammatory reaction of the bronchi, the success of treatment of patients, including patients with COPD, is primarily determined by the possibility of inhibiting the inflammatory process in the respiratory tract.

Unfortunately, traditional nonsteroidal anti-inflammatory drugs (NSAIDs) are not effective in patients with COPD and cannot stop the progression of clinical manifestations of the disease and the steady decline in FEV1. It is believed that this is due to the very limited, one-sided effect of NSAIDs on the metabolism of arachidonic acid, which is a source of the most important inflammatory mediators - prostaglandins and leukotrienes. As is known, all NSAIDs, by inhibiting cyclooxygenase, reduce the synthesis of prostaglandins and thromboxanes. At the same time, due to the activation of the cyclooxygenase pathway of arachidonic acid metabolism, the synthesis of leukotrienes increases, which is probably the most important reason for the ineffectiveness of NSAIDs in COPD.

The mechanism of the anti-inflammatory effect of glucocorticoids, which stimulate the synthesis of a protein that inhibits the activity of phospholipase A2, is different. This leads to a limitation in the production of the very source of prostaglandins and leukotrienes - arachidonic acid, which explains the high anti-inflammatory activity of glucocorticoids in various inflammatory processes in the body, including COPD.

Currently, glucocorticoids are recommended for the treatment of chronic obstructive bronchitis in which other treatments have been ineffective. However, only 20-30% of patients with COPD can improve bronchial patency with the help of these drugs. Even more often it is necessary to abandon the systematic use of glucocorticoids due to their numerous side effects.

To resolve the issue of the advisability of long-term continuous use of corticosteroids in patients with COPD, it is proposed to conduct a trial therapy: mg/day. at the rate of 0.4-0.6 mg/kg (prednisolone) for 3 weeks (oral corticosteroids). The criterion for the positive effect of corticosteroids on bronchial patency is an increase in the response to bronchodilators in a bronchodilator test by 10% of the required FEV1 values ​​or an increase in FEV1 of at least 200 ml. These indicators may be the basis for long-term use of these drugs. At the same time, it should be emphasized that currently there is no generally accepted point of view on the tactics of using systemic and inhaled corticosteroids for COPD.

In recent years, a new anti-inflammatory drug, fenspiride (erespal), which effectively acts on the mucous membrane of the respiratory tract, has been successfully used to treat chronic obstructive bronchitis and some inflammatory diseases of the upper and lower respiratory tract. The drug has the ability to suppress the release of histamine from mast cells, reduce leukocyte infiltration, reduce exudation and the release of thromboxanes, as well as vascular permeability. Like glucocorticoids, fepspiride inhibits the activity of phospholipase A2 by blocking the transport of calcium ions necessary for the activation of this enzyme.

Thus, fepspiride reduces the production of many inflammatory mediators (prostaglandins, leukotrienes, thromboxanes, cytokines, etc.), providing a pronounced anti-inflammatory effect.

Fenspiride is recommended for use both during exacerbation and for long-term treatment of chronic obstructive bronchitis, being a safe and very well tolerated drug. In case of exacerbation of the disease, the drug is prescribed at a dose of 80 mg 2 times a day for 2-3 weeks. In case of stable COPD (stage of relative remission), the drug is prescribed in the same dosage for 3-6 months. There are reports of good tolerability and high effectiveness of fenspiride with continuous treatment for at least 1 year.

Correction of respiratory failure

Correction of respiratory failure is achieved through the use of oxygen therapy and respiratory muscle training.

Indications for long-term (up to hours per day) low-flow (2-5 liters per minute) oxygen therapy both in hospital and at home are:

  • decrease in arterial blood PaO2

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