Chronic bronchitis

Causes and mechanism of development

The disease occurs due to prolonged exposure of the bronchial mucosa to triggers. These include chronic inflammation, inhalation of pollutants (dust), and smoking—both active in adolescents and passive within the family.

Under the influence of these factors, structural remodeling of the bronchial wall begins:

• Cellular level: the number of goblet cells and the size of mucous glands increase, leading to excessive secretion production.
• Macroscopic level: the bronchial walls thicken, and mucus accumulates in the lumen.
• Progression: when defense mechanisms are depleted, the submucosal and muscular layers become involved in the process. This leads to irreversible sclerosis (scarring) and bronchial deformation.

Clinical presentation and diagnostics

Symptoms include persistent cough with mucopurulent sputum production and, during exacerbations, signs of intoxication with subfebrile temperature. Auscultation reveals dry and moist (medium- and coarse-bubbling) rales. Interestingly, rales may be heard for months even during remission, while their number simply increases during an exacerbation.

The diagnosis is established using:

• Time criterion: presence of at least 2–3 exacerbations per year for two or more years.
• Laboratory tests: during an exacerbation, the complete blood count shows neutrophilia and an elevated ESR.
• Chest X-ray: reveals accentuation and deformation of the bronchovascular pattern without localized foci of pneumosclerosis.
• Bronchoscopy: allows visualization of the mucosa and retrieval of biological material for bacterial culture and cytology.

Treatment approaches

The treatment of chronic bronchitis is comprehensive and includes several areas:

1. Medical treatment:
2. Antibiotics: prescribed only during exacerbation. Initially empirical, then adjusted based on sputum culture results.
3. Mucolytics: (ambroxol, acetylcysteine, carbocisteine, dornase alfa) help thin viscous sputum.
4. Bronchodilators: administered via nebulizer inhalations (salbutamol, fenoterol, ipratropium bromide) when bronchial obstruction occurs.
5. Instrumental and non-pharmacological methods:
6. Therapeutic bronchoscopy: for aspiration of sputum, lavage, and local administration of antibiotics.
7. Kinesiotherapy: includes postural drainage (e.g., Quincke position), vibratory massage, and breathing exercises.
8. Surgical treatment:
9. Used as a backup method for localized lesions and purulent bronchitis unresponsive to conservative therapy.

Prevention and rehabilitation

A paramount task is preventing the chronization of the process. Primary prevention includes environmental improvement, smoking cessation, prevention of aspiration, and timely treatment of atelectasis.

To maintain remission in children who have already developed the disease, the following are necessary:

• Sanation of chronic infection foci (e.g., ENT organs).
• Vaccination against pneumococcus, Haemophilus influenzae, and influenza.
• Regular exercise therapy (physical therapy) and postural drainage.

Sanatorium-resort treatment helps stabilize the condition after exacerbations and prepares the patient for potential surgeries.

Class and exam questions

What else to study on this topic

• Pathogenesis of scarring in the bronchial tree
• Microbiological spectrum during exacerbations
• Methodology of postural drainage
• Peculiarities of mucolytic use (dornase alfa)
• Differences in auscultatory findings between acute and chronic bronchitis

Other topics in "Chapter 4. Respiratory Diseases"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.