Syndromes in bronchitis

Main clinical manifestations and auscultation

Physical examination plays a key role in the diagnosis of bronchitis. The purpose of the examination is to identify signs of respiratory tract inflammation, detect bronchoobstructive syndrome, or rule out local changes characteristic of focal pneumonia.

In uncomplicated cases, the respiratory rate (RR) and blood oxygen saturation (SpO2) remain within normal limits. Lung auscultation serves as the primary diagnostic tool. In bronchitis, harsh vesicular breathing is classically auscultated. Against this background, isolated dry rales are often determined. Depending on the nature of the secretion in the bronchial lumen, moist rales may also appear.

An important aspect is the differentiation of the nature of the disease by its timeline. In the first 3–4 days of the disease, respiratory tract damage is usually viral in nature. If symptoms persist or worsen starting from the 5th day, this highly likely indicates the accession of a predominantly bacterial flora.

Assessment of severity and detection of complications

All patients with symptoms of respiratory tract damage mandatorily undergo a comprehensive assessment to rule out respiratory failure. The list of mandatory clinical parameters includes:

• Measurement of the respiratory rate.
• Performing pulse oximetry (SpO2).
• Detailed lung auscultation.
• Assessment of the severity of cough and shortness of breath.

If the course of the disease is complicated, the clinical picture changes rapidly. The patient's respiratory rate increases, and a decrease in SpO2 levels directly indicates the development of acute respiratory failure. During auscultation, additional pathological respiratory noises appear. Among rare but severe complications are primary viral or secondary bacterial pneumonia, as well as acute respiratory distress syndrome (ARDS). In extremely severe forms of infections (for example, HFRS), "congestive lungs" can form with characteristic plethora, perivascular infiltration, decreased aeration, and alveolar edema.

Chronic processes and developmental anomalies

In a number of cases, bronchitis takes on a recurrent or chronic course against the background of congenital anomalies. A striking example is immotile cilia syndrome (primary ciliary dyskinesia). Its pathogenesis is based on impaired mucociliary clearance. This inevitably leads to the formation of a widespread purulent bronchopulmonary process, as well as concomitant upper respiratory tract damage (rhinitis, sinusitis).

The disease can occur either in isolation or be accompanied by the transposition of internal organs (situs inversus). Objectively, in such patients, against the background of chronic hypoxia, specific deformities gradually form. The distal phalanges of the fingers become thickened (clubbing), and the nail plates acquire a convex shape (watch-glass nails).

Identified clinical syndromes

Depending on the extent of the respiratory system damage and the presence of concomitant factors, the clinical picture exhibits polymorphism. Several typical variants of the course are distinguished:

• Latent (asymptomatic) course: characteristic of uncomplicated simple cysts or extra-lobar sequestration. Manifestation of the inflammatory bronchopulmonary process occurs only when a secondary infection joins.
• Obstructive syndrome: characterized by a pronounced impairment of airway patency. It manifests with asthma attacks and stridor (especially in the presence of tracheal stenosis).
• Infectious-inflammatory syndrome: the formation of persistent recurrent or chronic inflammation of the bronchial tree.
• Respiratory failure syndrome: accompanied by dyspnea, cyanosis, and hypoxemia. With long-term existence, it leads to physical changes: lag in physical development, asymmetry and deformation of the chest, as well as local changes in percussion sound.

Instrumental diagnostics

To verify the diagnosis and assess the structure of the respiratory tract, a comprehensive approach is used. The basic method is chest X-ray, which allows for the detection of additional shadows, organ transposition, or mediastinal shift. For direct visualization of the bronchial tree structure, identification of stenoses, and fistulas, bronchological studies (bronchoscopy and bronchography) are used. If pathological shunts between the arteries and veins of the lesser circulation (arteriovenous aneurysms) leading to hypoxemia and pulmonary hemorrhage are suspected, angiopulmonography is considered the gold standard.

Class and exam questions

What else to study on this topic

• Pathogenesis and manifestations of Kartagener syndrome (situs inversus)
• Radiological signs of pulmonary artery agenesis and hypoplasia
• Mechanism of hypoxemia development in arteriovenous aneurysms
• Formation of "congestive lungs" in severe viral infections

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