Diagnosis and treatment of acute bronchitis

How to treat bronchitis?

August 6, 2022
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Content

• Symptoms of bronchitis
• Symptoms of acute bronchitis
• Symptoms of chronic bronchitis
• Why does bronchitis occur?
• Top 6 best medicines for bronchitis
• Bromhexine
• Dr. MOM
• ACC
• Ascoril
• Atrovent
• Salbutamol

With bronchitis, the inner lining of the bronchi becomes inflamed, causing a person to have a cough and breathing problems. Bronchitis is treated by a pulmonologist or otolaryngologist.

Symptoms of bronchitis

The main sign of bronchitis is a cough, and at first it is dry, unproductive, and later it becomes wet and sputum begins to come out. The bronchial mucosa is swollen, the lumen of the respiratory tract narrows - hence the cough and difficulty breathing. The swollen mucous membrane begins to secrete more secretions - a cough with sputum appears. Bronchitis in adults and children can be acute or chronic, with symptoms varying in different cases.

Read also How to treat dry cough: top 5 drugs The best drugs for dry cough in adults.

List of effective medicines for bronchitis and cough

Below is a sample list of medications for the treatment of acute bronchitis and its symptoms. It is for reference only; if the onset of the disease is suspected, self-medication is unacceptable.

In the case of chronic bronchitis and obstructive pulmonary disease, therapy is selected individually for each patient, depending on the medical history and examination results.

Symptoms of acute bronchitis

The doctor makes the diagnosis of “acute bronchitis” based on the following symptoms:

• severe coughing attacks;
• chest pain when breathing;
• wheezing;
• shortness of breath during physical activity, and sometimes even at rest;
• fatigue, apathy and weakness;
• increased sweating;
• chills and increased body temperature (within 38-38.5 degrees).

  
  Symptoms of bronchitis
  Photos from open sources

Acute bronchitis is usually easy to catch in winter, when the immune system is weakened. Often acute bronchitis at the onset of the disease is similar to a cold. When a dry cough turns into a wet one, with the release of a large amount of sputum, bronchitis can be suspected. If bronchitis is catarrhal, the sputum is usually yellowish or whitish. If purulent inflammation actively develops in the bronchi, the sputum will be green.

Sometimes acute bronchitis also affects the upper respiratory tract: the mucous membranes of the trachea, pharynx or nose - an inflammatory process also develops here. Typically, the peak of acute bronchitis occurs on the 3-4th day of illness and over time the symptoms of bronchitis subside. If adequate treatment for uncomplicated acute bronchitis is started in time, the patient will fully recover within 7-10 days.

Diagnosis and treatment of acute bronchitis

Acute bronchitis (AB) is one of the most frequently documented diseases encountered in clinical practice. OB is an acute or subacute disease, the leading clinical sign of which is cough (productive or non-productive), lasting no more than 2-3 weeks and, as a rule, accompanied by general symptoms of an upper respiratory tract infection (URTI) [1]. The annual incidence of OB ranges from 20 to 40% or more. The true prevalence of OB is evidenced by the fact that in 1997 in the United States, of the 30 million patients who consulted a doctor for cough, almost half were diagnosed with OB. Another problem is the prescription of antibacterial (AB) therapy to a patient with OB. The majority of the disease is viral in etiology. In this regard, it is in patients with OB that the share of various iatrogenic effects from unjustified prescription of antibiotics is high [2–4]. The etiological spectrum of pathogens leading to the development of OB is represented by influenza A and B viruses, parainfluenza, as well as respiratory syncytial virus and human metapneumovirus [2, 5], less often - coronaviruses, adenoviruses, rhinoviruses. According to the results of studies during which the identification of actual pathogens of OB was carried out (cultural, serological, molecular genetic and other methods were used, the study included patients without concomitant pulmonary pathology [6, 7]) - verification of the pathogen was successful only in a small number of patients (29 % of 42 examined in one study [7] and, accordingly, 16% when examining 113 patients in another [8]). It was found that viruses were the most common identifiable cause of OB. The long-standing hypothesis about acute bacterial bronchitis caused, for example, by Streptococcus (Str.) pneumoniae, Haemophilus (H.) influenzae, Staphylococcus (S.) aureus, Moraxella (Mor.) catarrhalis or even gram-negative bacteria, has not been confirmed; The exception is for patients who have undergone surgical procedures, such as tracheotomy, or who have undergone endotracheal intubation. In cases where microbiological and serological examinations are carried out in patients with OB outside of seasonal epidemic outbreaks of viral respiratory infections, with varying frequencies, but not more than 5–10%, it is possible to obtain evidence of the participation of Bordatella (B.) pertussis and B in the development of the disease parapertussis, Mycoplasma (M.) pneumoniae and Chlamydophila (C.) pneumoniae.

M. pneumoniae is a relatively common infection in young patients (16–40 years old), which is characterized by pharyngitis, constitutional disorders in the form of malaise, weakness, sweating and is accompanied by a long-term persistent cough (from 4 to 6 weeks) [9]. In cases of acutely developed cough lasting more than 5 days, M. pneumoniae as a verified causative agent of the resulting respiratory tract infection was documented in less than 1% of cases [10]. According to serological diagnostics (proven M. pneumoniae infection), the number of patients with OB significantly exceeds the number of patients with community-acquired pneumonia [11].

C. pneumoniae is detected in 5% of young patients diagnosed with OB [12]. Its clinical picture includes pharyngitis, laryngitis and bronchitis; patients most often report hoarseness, hoarseness, low-grade fever, sore throat, persistent unproductive cough, subsequently with the discharge of mucous sputum [10, 13].

The causative agents of whooping cough and parapertussis B. bordetella and B. parapertussis manifest with the main complaint of patients is a barking cough. Thus, among the selected 153 adult patients from San Francisco with complaints of cough lasting at least 2 weeks, it was proven that 12% of patients had whooping cough - and, most importantly, during the assessment of the clinical picture, a differential diagnosis with whooping cough was not made due to the absence typical clinical symptoms. [14].

From the clinician's perspective, OB is characterized by inflammation of the bronchi and clinical manifestations in the form of a hacking cough, usually with signs of URTI. Differential diagnosis should be carried out primarily in relation to community-acquired pneumonia.

Doctors, conducting differential diagnostics, believe that an acute cough, accompanied by low-grade fever, symptoms of URTI (sore throat, runny nose), in the absence of tachycardia, tachypnea and local physical symptoms, corresponds to the clinical picture inherent in OB of viral etiology. If the patient has febrile fever and/or chills, purulent sputum, chest pain that worsens with inhalation/coughing, tachypnea, as well as local physical symptoms (shortened percussion sound, bronchial breathing, crepitation phenomenon, moist rales, etc. ) one should lean in favor of the diagnosis of community-acquired pneumonia. Nevertheless, the vast majority of patients demonstrate a certain average clinical picture, and they are almost always prescribed AB therapy. However, according to the results of recent multicenter studies, it is known that purulent bronchial secretions are a poor predictor of bacterial infection [4].

Diagnosis of acute bronchitis

Most patients with an acute cough require no more than a medical examination and symptomatic treatment. Indications for an X-ray examination for complaints of acute cough in order to exclude the diagnosis of pneumonia are the identification during examination of the patient of tachycardia (> 100 beats per minute), shortness of breath (> 24 per minute), or body temperature > 38 ° C, or auscultation upon auscultation of moist small and large bubbling rales during inhalation and exhalation, as well as crepitating rales during inhalation on the affected side (pleural friction noise) [16, 17]. Recently, patients with clinical signs of infection and living in epidemiologically unfavorable regions with respect to severe acute respiratory syndrome were added to the list of patients requiring X-ray examination. X-ray examination may be necessary for patients with influenza, as well as for elderly and senile patients.

Typically, in 3/4 of cases of patients with colds, the cough disappears within 14 days [18]. Prolonged cough in patients with diagnosed OB can be caused by the development of a viral infection, as well as M. pneumoniae-, C. pneumoniae- or B. pertussis-infection. But if there are complaints of cough paroxysms with or without vomiting, the diagnostic examination algorithm should first of all be aimed at excluding whooping cough, even despite the presence of a history of immunization.

Diagnostic procedures aimed at identifying M. pneumoniae involve the determination of mycoplasma by culture from pharyngeal lavages of nasopharyngeal epithelial cells, as well as an increase in the titer of immunoglobulin M, usually noted after 7 days of illness [19]; it is possible to identify the antigen using polymerase chain reaction (PCR diagnostics) [20] and, finally, determine the antibody titer in the cold agglutination reaction ≥ 1:64 (nonspecific titer). It is worth noting that to date, none of the above tests have been recognized as the standard for diagnosing mycoplasma infection during the American Center for Disease Control (CDC) expert meeting [21].

The CDC has defined the following diagnostic criteria for C. pneumoniae infection: ≥ 4-fold increase in microimmunofluorescence (MIF) titer (the study uses samples obtained from the patient at presentation and ≥ 3 weeks later), or a positive PCR diagnostic result, and an important is the use of reagents during one of the four studies - completely prepared at the study site - without purchased reagents [22, 23].

Diagnosis of whooping cough is based on a culture technique using a sample of expectorated sputum, nasopharyngeal aspirates [24] followed by culture, or on the results of PCR diagnostics [25]. However, culture diagnostics is a relatively low-sensitivity technique, and PCR testing is not always available.

To date, there are rapid diagnostic tests for the influenza virus. The sensitivity of these tests is approximately comparable to clinical diagnosis, based on the detection of fever during examination, “typical symptoms”, and knowledge of the epidemiological situation in the region. The three proposed test systems (the average cost of one test is 10–15 USD) allow you to obtain results in the range from 10 to 20 minutes, with a sensitivity of the method of 70% [26].

In connection with the above, today doctors quite often encounter difficulties in diagnosing whooping cough, mycoplasma, chlamydia - as etiological agents of OB. A similar situation is observed with regard to the influenza virus. Culture studies of sputum in patients in the absence of radiological signs of pneumonic infiltration are not performed, since the bacterial flora is not a pathogenetically significant agent of OB.

Diagnostic tests to exclude postnasal drip, asthma, and esophagogastric reflux should be carried out in cases where the results of a medical examination reveal features of the clinical picture of the disease or if the patient has a cough lasting more than 15 days.

Treatment of acute bronchitis

Antiviral therapy. Influenza viruses A and B are among the most important causative agents of OB, and therefore antiviral therapy is required. It should be noted that it is advisable to prescribe antiviral drugs in cases where no more than 48 hours have passed since the onset of symptoms of the disease.

Currently, two groups of antiviral drugs are used - M2 channel blockers (amantadine, rimantadine) and neuroaminidase inhibitors (zanamivir, oseltamivir); in addition, in certain situations, it is possible to use ribavirin, which is active against respiratory syncytial virus (Table 1).

M2 channel blockers (adamantanes) include amantadine and rimantadine. Both drugs are active against influenza virus type A and inactive against influenza type B. Amantadine is not used in Russia, but rimantadine, created on its basis, is widely used: it is more active and less toxic. The antiviral effect is realized by blocking the ion channels (M2) of the virus, accompanied by a violation of its ability to penetrate cells and release ribonucleoprotein. This inhibits the stage of viral replication. When used prophylactically, the effectiveness of rimantadine is 70–90%. However, it is necessary to note a significant increase in the resistance of the influenza virus to these drugs over the past 3 years (from 1.9% in 2004 to 91% in 2006 in the United States), which caused the limitation of their use as means of prevention and treatment of infection . The disadvantages of rimantadine also include the risk of severe adverse events from the central nervous system (irritability, impaired concentration, insomnia), which occur in 3–6% of patients. In addition, undesirable reactions from the gastrointestinal tract (nausea, loss of appetite) were noted. The drug should be used with caution in the elderly, with severe liver dysfunction, as well as in people with increased convulsive readiness (epilepsy).

For therapeutic purposes, the drug is prescribed no later than 2 days from the appearance of the first symptoms of the disease. The duration of the course should not exceed 5 days to avoid the emergence of resistant forms of the virus.

Neuroamindase inhibitors. Neuroaminidase (sialidase) is one of the key enzymes involved in the replication of influenza viruses types A and B. When neuroamindase is inhibited, the ability of viruses to penetrate healthy cells is impaired, their resistance to the protective effect of respiratory tract secretions is reduced, and thus the further spread of the virus in the body is inhibited. In addition, neuroaminidase inhibitors are able to reduce the production of cytokines (interleukin-1 and tumor necrosis factor), preventing the development of a local inflammatory reaction and weakening systemic manifestations of a viral infection such as fever, pain in muscles and joints, and loss of appetite.

Oseltamivir (75 mg capsules) is used for the treatment and prevention of influenza in adult patients (over 18 years of age). According to the results of controlled clinical studies, the drug significantly reduces the duration of symptoms of the disease, the severity of its course, and the frequency of complications. When administered prophylactically, the effectiveness of oseltamivir is 75%. Most often (10–12% of cases) when taking the drug, nausea and vomiting are observed, less often (1–2.5% of cases) headaches, dizziness, weakness, insomnia, abdominal pain, diarrhea, nasal congestion, sore throat, cough. In most cases, adverse reactions do not require discontinuation of the drug. Oseltamivir is prescribed 75–150 mg 2 times a day for 5 days. In patients with creatinine clearance less than 30 ml/min, the dose is reduced by 2 times.

Zanamivir is a structural analogue of sialic acid, a natural substrate of influenza virus neuroamidase, and, therefore, has the ability to compete with it for binding to the active sites of the enzyme. Due to its low bioavailability when taken orally, zanamivir is used by inhalation, in which case its bioavailability is about 20%. Zanamivir is recommended for the treatment of uncomplicated influenza in people over 12 years of age with the onset of clinical symptoms no more than 36 hours. The drug significantly reduces the duration of the disease, improves the condition of patients, and prevents the development of complications in patients with influenza caused by both type A and type B viruses The effectiveness of prophylactic use of zanamivir is 70–80%. In most cases, zanamivir is well tolerated by patients. Adverse reactions are observed only in 1.5% of cases. The most typical of them are headache, dizziness, nausea, diarrhea, sinusitis, sore throat, bronchospasm.

Certain prospects were associated with the appearance of the drug pleconaril [26]. However, in 2002, the antiviral drug committee of the US Food and Drug Administration (FDA) rejected the approval of pleconaril for a number of reasons [27].

Antibacterial therapy. Considering the fact that pneumonia accounts for approximately 5% of the structure of all lower respiratory tract infections (about 70% for acute respiratory tract infections), the prescription of AT to patients with acute respiratory infection is unjustified from both a clinical and economic point of view. It is also necessary to remember about the increasing level of resistance of microorganisms to antibiotics.

Currently, the only clinical situation in which it is justified to prescribe antibiotics to a patient with an acute cough is suspected pertussis. It is recommended to prescribe erythromycin 0.25-0.5 g 4 times a day for 14 days or new macrolides - azithromycin and clarithromycin [35].

Other areas of therapy. Currently, the results of studies have been published demonstrating the effectiveness of salbutamol and fenoterol in the treatment of patients with OB. It has been proven that the use of these drugs is accompanied by a decrease in the duration of cough.

In cases of intense cough that affects the quality of life, symptomatic treatment is indicated. The choice of an antitussive drug should be made individually, taking into account the mechanism of action, antitussive activity of the drug, the risk of side effects, the presence of concomitant pathologies and possible contraindications. It should be noted that in case of acute and short-term cough as part of an acute viral respiratory infection, the antitussive effect of dextromethorphan and drugs containing codeine is minimal. And, on the contrary, the effect of these drugs is obvious in case of prolonged cough or OB that has developed against the background of chronic bronchopulmonary diseases.

Classification of antitussive drugs

• Centrally acting agents: morphine-like compounds (codeine);
• non-narcotic antitussives (prenoxdiazine, oxeladin, butamirate, glaucine).

When coughing with the discharge of viscous sputum, mucolytic agents are used: ambroxol, acetylcysteine ​​(Table 2). The mechanism of action of these drugs is based on the removal of bronchial secretions from the respiratory tract by reducing its viscosity, but with an increase in the volume of sputum. Expectorants increase mucus secretion due to reflex irritation of the glands of the bronchial mucosa. In particular, ambroxol has, in addition to bronchosecretolytic, a secretomotor effect. Iodides and a number of herbal preparations (thyme, sundew, thermopsis, etc.) have a direct effect on secretory bronchial cells and are released into the lumen of the bronchial tree, thereby enhancing the secretion of mucus and increasing its volume. In addition, they activate the motor function of bronchioles and ciliated epithelium of the bronchial mucosa.

Typically, taking mucolytics for OB is no more than 3–4 days [36].

Herbal preparations that have both secretolytic and bronchodilator effects (Bronchipret) are also used. The most commonly used medicinal plant for coughs is licorice. In addition to antitussive, it has expectorant and antispasmodic effects, and enhances the secretion of protective mucus. Licorice is included in breast mixtures No. 2–4, Propolis tablets with licorice, breast elixir, etc. It is also possible to use non-medicinal interventions, such as steam inhalations.

Literature

1. Sinopalnikov A.I. Acute bronchitis in adults // Atmosphere. Pulmonology and allergology. 2005. No. 3. pp. 15-20.
2. Gonzales R., Sande M. What will it take to stop physicians from prescribing antibiotics in acute bronchitis? // Lancet. 1995; 345:665.
3. Gonzales R., Steiner JF, Sande MA Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians [see comments] // JAMA. 1997; 278:901.
4. Gonzales R., Steiner JF, Lum A., Barrett PH Jr. Deccreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults // JAMA. 1999; 281:1512.
5. Falsey AR, Erdman D., Anderson LJ, Walsh EE Human metapneumovirus infections in young and elderly adults // J. Infect. Dis. 2003; 187:785.
6. Boldy DA, Skidmore SJ, Ayres JG Acute bronchitis in the community: Clinical features, infectious factors, changes in pulmonary function and bronchial reactivity to histamine // Respir. Med. 1990; 84:377.
7. Jonsson JS, Sigurdsson JA, Kristinsson KG et al. Acute bronchitis in adults. How close do we come to its aetiology in general practice? // Scand J. Prim Health Care. 1997; 15:156.
8. MacKay DN Treatment of acute bronchitis in adults without underlying lung disease // J. Gen. Intern. Med. 1996; 11:557.
9. Denny FW, Clyde WA Jr, Glezen WP Mycoplasma pneumoniae disease: clinical spectrum, pathophysiology, epidemiology, and control // J. Infect. Dis. 1971; 123:74.
10. Wadowsky RM, Castilla EA, Laus S. et al. Evaluation of Chlamydia pneumoniae and Mycoplasma pneumoniae as etiologic agents of persistent cough in adolescents and adults // J. Clin. Microbiol. 2002; 40:637.
11. Foy HM, Kenny GE, Cooney MK, Allan ID Long-term epidemiology of infections with Mycoplasma pneumoniae // J. Infect. Dis. 1979; 139:681.
12. Grayston JT, Kuo CC, Wang SP, Altman J. A new Chlamydia psittaci strain, TWAR, isolated in acute respiratory tract infections // N. Engl. J. Med. 1986; 315:161.
13. Grayston JT, Diwan VK, Cooney M. et al. Community- and hospital-acquired pneumonia associated with Chlamydia TWAR infection demonstrated serologically // Arch. Intern. Med. 1989; 149:169.
14. Nennig ME, Shinefield HR, Edwards KM et al. Prevalence and incidence of adult pertussis in an urban population // JAMA. 1996; 275:1672.
15. Gonzales R., Sande MA // Ann. Intern. Med. 2000; 133:981.
16. Snow V., Mottur-Pilson C., Gonzales R. Principles of appropriate antibiotic use for the treatment of acute bronchitis in adults // Ann. Inter Med 2001; 134:518.
17. Gonzales R, Bartlett JG, Besser RE et al. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background // Ann. Intern. Med. 2001; 134:521.
18. Dingle JH, Badger GF, Jordan WS Jr. Illness in the home: A study of 25,000 illnesses in a group of Cleveland families. The Press of Western Reserve University. Cleveland. 1964; P. 68.
19. Uldum SA, Jensen JS, Sondergard-Anderson J. et al. Enzyme immunoassay for detection of immunoglobulin M (IgM) and IgG antibodies to Mycoplasma pneumoniae // J. Clin. Microbiol. 1992; 30:1198.
20. Dular R., Kajioka R., Kasatiya S. Comparison of Gen-Probe commercial kit and culture technique for the diagnosis of Mycoplasma pneumoniae infection // J. Clin. Microbiol. 1988; 26:1068.
21. Bartlett JG, Dowell SF, Mandell LA et al. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America // Clin. Infect. Dis. 2000; 31:347.
22. Dowell SF, Peeling RW, Boman J. et al. Standardizing Chlamydia pneumoniae assays: recommendations from the Centers for Disease Control and Prevention (USA) and the Laboratory Center for Disease Control (Canada) // Clin. Infect. Dis. 2001; 33:492.
23. Gaydos CA, Quinn TC, Eiden JJ Identification of Chlamydia pneumoniae by DNA amplification of the 16S rRNA gene // J. Clin. Microbiol. 1992; 30: 796.
24. Hoppe JE Methods for isolation of Bordetella pertussis from patients with whooping cough // Eur. J. Clin. Microbiol. Infect.Dis. 1988; 7: 616.
25. Meade BD, Bollen A. Recommendations for the use of the polymerase chain reaction in the diagnosis of Bordetella pertussis infections // J. Med. Microbiol. 1994; 41:51.
26. The new drug pleconaril can become one of the main means for the treatment and prevention of acute respiratory viral infections. Available at: https://www.antibiotic.ru/index.php?article=334
27. The FDA has declared pleconaril unsuitable for the treatment of colds. Available at: https://www.antibiotic.ru/index.php?article=398
28. Ershov F.I., Kasyanova N.V., Polonsky V.O. Is rational pharmacotherapy of influenza and other acute respiratory viral infections possible? // Infection and antimicrobial therapy. 2003. No. 6. T. 5. P. 56-59.
29. Strachunsky L. S., Kozlov S. N. Antiviral drugs used for respiratory infections // RMZh. 2001. T. 3. No. 1-2. 6. Breast cancer. T. 9. No. 16-17.
30. Belshe RB, Burk B, Newman F et al. Resistance of influenza A virus to amantadine and rimantadine: results of one decade of surveillance // J. Infect. Dis. 1989; 159: 430-435.
31. Calfee DP, Hayden FG New approaches to influenza chemotherapy. Neuraminidase inhibitors. Drugs. 1998; 56: 537-553.
32. Romero JR. Pleconaril: a novel antipicornaviral drug. Expert Opin Investig Drugs. 2001 Feb;10(2): 369-79.
33. Lee PY, Matchar DB, Clemens DA, Huber J, Hamilton JD et al. Economic analysis of influenza vaccination and antiviral treatment for healthy working adults // Annals of Internal Medicine. 2002; 137: 225-231.
34. Pevear DC, Tull TM, Siepel ME, Groarke JM Activity of pleconaril against enteroviruses // Antimicrob. Agents Chemother. 1999; 43: 2109-2115
35. Snow V., Mottur-Pilson C., Gonzales R. Principles of appropriate antibiotic use for the treatment of acute bronchitis in adults // Ann. Intern. Med. 2001; 134: 518-20.
36. Sinopalnikov A.I., Klyachkina I.L. Mucolytics and expectorants // Rational pharmacotherapy of respiratory diseases. M.: Literra, 2004.

M. B. Mironov , Candidate of Medical Sciences A. A. Zaitsev , Candidate of Medical Sciences A. I. Sinopalnikov , Doctor of Medical Sciences, Professor of the State Institute of Internal Medicine of the Ministry of Defense of the Russian Federation, Moscow

Symptoms of chronic bronchitis

Chronic bronchitis is a long-term disease, with exacerbations occurring from time to time. Chronic bronchitis can be provoked by the same factors as acute bronchitis. The clinical manifestations of chronic bronchitis are similar to those of acute bronchitis. During remission, a person may experience shortness of breath, even if he exerts little physical activity. Such shortness of breath during bronchitis is caused by the fact that the bronchial mucosa is constantly inflamed - they allow less air to pass through than healthy ones. This condition is called chronic obstructive bronchitis (COB).

COB is dangerous for young children whose lung capacity is physiologically small. Problems with air flow in a child provoke a deterioration in gas exchange throughout the body. This provokes a lack of oxygen in organs and tissues, resulting in organ malformations, cardiopulmonary failure and disability. The body tries to establish normal gas exchange in the lungs by expanding the end sections of the respiratory tree - emphysema develops. Therefore, if a child has a similar pathology, it is necessary to urgently begin treatment.

Medicines for chronic bronchitis

Medicines Ascoril and Codelac Broncho

Chronic bronchitis most often affects those who abuse smoking. Also, the development of the disease can be influenced by living and working conditions - prolonged exposure to places where smoke, dust, toxic fumes accumulates provokes chronic inflammation of the respiratory tract.

The diagnosis of chronic bronchitis is established if the patient suffers from a wet cough for at least three months a year for more than three years. The disease often causes poor ventilation of the lungs and a decrease in the body's oxygen supply. In some cases, chronic bronchitis causes acidosis associated with congestion in the lungs and the accumulation of carbon dioxide in them.

It is important to treat chronic bronchitis, since its development can lead to obstructive pulmonary damage, leading to serious consequences for the patient.

Treatment of chronic bronchitis consists of eliminating risk factors and drug therapy aimed at improving symptoms of the disease.

It has been noted that quitting smoking contributes to a positive prognosis of acute bronchitis.

Pharmacological agents prescribed to treat acute bronchitis may include corticosteroids to reduce inflammation and swelling of the bronchial mucosa, bronchodilators to reduce bronchospasm, and anticholinergic drugs such as tiotropium bromide. These medications for acute bronchitis are taken in the form of inhalations.

Mucalytics promote the removal of sputum, easing the patient's condition.

Antibiotics work well as a cure for chronic bronchitis in children, in the case of bacterial etiology of the disease.

As maintenance therapy, patients are prescribed oxygen inhalations to saturate the blood with oxygen, the content of which is reduced in obstructive pulmonary disease.

Why does bronchitis occur?

There are three main groups of causes for the development of bronchitis

.

Infections:

• viruses (influenza, adenovirus);
• bacteria (streptococci, pneumococci, staphylococci);
• atypical microorganisms (chlamydia or mycoplasma);
• fungal infections.

Chemical irritants:

• polluted air of industrial cities;
• smoke or dust in the air;
• fumes hazardous to health;
• smoking.

Internal reasons

First of all, these are allergic reactions to various substances, which cause inflammation of the bronchial mucosa. Cardiovascular diseases and lung diseases, infections of the nasopharynx, oral cavity and tonsillitis can also cause the development of bronchitis.

Causes of acute bronchitis

Photos from open sources

Acute bronchitis advice from a pulmonologist

One of the common causes of cough in childhood is bronchitis. This is an inflammatory process of the mucous membrane of the bronchial tree, accompanied by swelling. Despite the apparent simplicity and supposed clarity of the understanding of this disease, parents still do not know much and make serious mistakes. Today we’ll talk to a pulmonologist about bronchitis from the perspective of evidence-based medicine.

Causes and mechanisms

The term “Bronchitis” only emphasizes the localization of the pathological process (bronchi), but does not say anything about the nature of the inflammation. It is often caused by viruses and much less often by bacteria. Moreover, it is impossible to determine the etiology just by the color and nature of the sputum.

Bronchitis is characterized by an increase in the volume of secretions produced by the bronchi. This is where the cough comes from. This is a reflex mechanism aimed at removing sputum, dust particles, viruses and other foreign substances from the bronchi.

Symptoms of bronchitis

Typical symptoms of bronchitis are cough with phlegm. The latter can have a different character - transparent, yellow or green.

With bronchitis there may also be additional manifestations:

• temperature increase;
• general weakness;
• discomfort behind the sternum.

Usually the symptoms are most pronounced in the first 3-4 days, then gradually subside. With a smooth course, recovery occurs by about 7-10 days. By the way, residual cough can last up to 3-4 weeks and in most cases it does not require therapy.

Treatment

A big misconception is the prescription of antibiotics for bronchitis. These drugs are indicated only in one case, when it is proven that bacteria are the cause of the inflammation.

The basic principles of treating bronchitis are the following:

1. Air humidification. It should also be cool. Ventilate the room - this makes breathing easier and improves coughing.

2. Drink plenty of fluids at room temperature or slightly cool. This improves sputum discharge.

3. Reducing high (!) temperature. For this, ibuprofen or paracetamol can be used in accordance with age-specific dosages. Ibuprofen and paracetamol are calculated based on the child’s weight. There is no single figure for when to lower the temperature. We focus not on the number on the thermometer, but on the child’s well-being. But it is worth remembering that a passion for non-steroids can erase the true clinical picture and prevent timely diagnosis of pneumonia.

4. Performing breathing exercises and vibration massage of the chest. These exercises improve bronchial drainage and help remove mucus from them. For the same purpose, children with bronchitis are allowed and even recommended to run, jump, play and have fun.

Pitfalls in treatment

It is worth mentioning mucolytics - drugs that thin out sputum. These medications are contraindicated for bronchitis in children under 3 years of age. The fact is that until this age, children's bronchi are narrow, and the mucous membrane contains a large number of goblet cells that produce mucus. And with all this, the cough reflex is minimally developed up to 3 years of age. Therefore, using mucolytics for bronchitis before the age of 3, we can aggravate the situation - the amount of liquid sputum increases, but it cannot be fully removed from the bronchi.

Expectorants of plant origin also require separate lighting. This group of drugs does not have reliable evidence of effectiveness. In addition, there is a risk of developing an allergic reaction to any of the components of the herbal mixture.

And some information about the use of a nebulizer, it is only needed for obstruction. And in this case, only bronchodilators are needed; there is no need to breathe mineral water, saline solution or antibiotics.

Conclusion

A clear understanding of the mechanisms and causes of the development of bronchitis helps to quickly get rid of this disease. It is important that not everything can be treated only with medications. The main place in stopping inflammation in the bronchi is given to general measures, the organization of which falls on the shoulders of the parents. Evidence-based medicine to protect your child's health!

Bromhexine

The main advantages of this remedy for bronchitis are its affordable price, complex effects and the absence of side effects. "Bromhexine" copes well with a productive, wet cough. The drug for bronchitis can be bought at the pharmacy in the form of tablets and syrup. "Bromhexine" reduces the viscosity of sputum and improves its discharge. But do not expect an immediate effect from the drug - the therapeutic effect occurs on the second to fifth day from the start of treatment with Bromhexine. This medicine for bronchitis is prescribed to adults and children over six years of age. Contraindications include pregnancy and breastfeeding. The maximum course of treatment with Bromhexine is 28 days. The drug acts comprehensively for acute and chronic bronchitis and other bronchopulmonary diseases. "Bromhexine" has a strong expectorant effect and a minimal list of contraindications. But you should remember that this medicine should not be taken together with drugs that contain codeine.

Bromhexine

OJSC Pharmstandard-Leksredstva, Russia

Diseases of the respiratory tract accompanied by the formation of difficult-to-discharge viscous secretions: tracheobronchitis, chronic bronchitis with a broncho-obstructive component, bronchial asthma, cystic fibrosis, chronic pneumonia.
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The best antibiotics

• Azithromycin. It can be found in pharmacies under other names. For example, Azitral Sumamed and others. The advantage is a short course of treatment (3 days), you need to take it once a day. Has a rapid effect on viral disease. Side effects included loose stools, insomnia, and dizziness. There are no more serious negative consequences.
• Amoxiclav. One of the most common antibiotics prescribed by doctors. Typically suitable for acute and chronic bronchitis. That is, it is not necessary to use it in the initial stages. Side effects are the same as the previous remedy. You can drink it from the age of 12, but the dosage must be determined by a doctor based on the person’s age and weight.
• Pantsef. It also has a strong effect on the causative agents of bronchitis. It can be used by pregnant women, children and the elderly. In this case, you need to carefully monitor the body’s reactions and use the medicine only on the recommendation of a doctor.

Dr. MOM

This drug for bronchitis has a unique composition: it contains extracts from 10 medicinal plants that help remove mucus from the lungs and are excellent mucolytics. "Doctor MOM" is available in the form of syrup, lozenges and ointment. The basis of the drug is not alcohol, but water, so the medicine for bronchitis is prescribed to children from three years of age. “Doctor MOM” not only soothes the bronchial mucosa, but also reduces inflammation well. The drug makes sputum less viscous and helps it pass more easily, while it is not so painful for a person to cough. Prohibitions include pregnancy and breastfeeding. The composition contains sugar, so patients with diabetes should take this into account. This remedy for bronchitis has almost no contraindications, it tastes good, can be taken for a long time, and is even prescribed as a preventive measure for colds.

Doctor Mom syrup

Unique Pharmaceutical Laboratories, India

Doctor Mom is a bronchodilator (dilates the lumen of the bronchi), expectorant, anti-inflammatory, decongestant.
from 161

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ACC

Of all expectorants in the treatment of bronchitis, ACC is considered the best. This drug quickly removes phlegm and at the same time has an antioxidant effect. "ACC" is prescribed not only for bronchitis, but also for other diseases of the respiratory system: bronchiectasis, cystic fibrosis, etc. You can buy "ACC" at a pharmacy in tablets (100 and 200 mg), as well as in the form of syrup. There are also granules and “ACC” powder with orange flavor (the powder is used to prepare a hot cough drink). "ACC" is prescribed for bronchitis in adults and children over two years of age. Contraindications include pregnancy and breastfeeding. This drug for bronchitis perfectly thins thick sputum (even purulent) and eases coughing attacks.

ACC

Hermes Pharma, Germany; Wernigerode Pharma, Germany; Lindopharm, Germany

Respiratory diseases accompanied by the formation of viscous, difficult to separate sputum (acute and chronic bronchitis, obstructive bronchitis, tracheitis, laryngotracheitis, pneumonia, lung abscess, bronchiectasis, bronchial asthma, COPD, bronchiolitis, cystic fibrosis);
acute and chronic sinusitis; Otitis media from 102

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Ascoril

"Ascoril" is prescribed for both dry and wet coughs - this drug for bronchitis reduces coughing attacks and helps you breathe easier. Ascoril is usually taken in the complex treatment of bronchitis. The remedy helps with chronic obstructive bronchitis, asthma and even some forms of tuberculosis. "Ascoril" relieves attacks of suffocation and restores normal breathing. You can buy Ascoril in the form of tablets, which are taken three times a day, one at a time. There is also “Ascoril” syrup in the pharmacy, but it is not as popular as tablets because it does not taste very pleasant. The course of treatment for bronchitis with Ascoril is determined by the doctor, taking into account the individual characteristics of each patient. Do not take the drug during pregnancy and breastfeeding, as well as in children under 6 years of age. The only disadvantage of Ascoril is that it contains flavorings and dyes.

Ascoril

Glenmark Pharmaceuticals, India

As part of combination therapy for acute and chronic bronchopulmonary diseases, accompanied by the formation of difficult-to-separate viscous secretions: bronchial asthma;
tracheobronchitis; obstructive bronchitis; pneumonia; emphysema; whooping cough; pneumoconiosis; pulmonary tuberculosis. from 113

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Atrovent

This drug helps well with chronic bronchitis, especially if attacks of suffocation and bronchospasms occur suddenly (for example, when a person is in the cold). You can buy Atrovent in the form of an aerosol or solution for inhalation. Aerosol is a more convenient option, especially if you do not know how to use an inhaler. Judging by patient reviews, Atrovent is well tolerated and is not absorbed into the blood. This eliminates side effects such as increased blood pressure and tachycardia. Very rarely, allergic reactions may occur when using Atrovent. Contraindications include individual intolerance. This remedy for bronchitis is prescribed to adults and children over 6 years of age. The effect of taking Atrovent lasts 6-7 hours, but this drug cannot be used constantly.

Atrovent

Boehringer Ingelheim, Germany

— COPD (including chronic obstructive bronchitis, pulmonary emphysema);
- bronchial asthma of mild to moderate severity. from 184

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Antibiotics for bronchitis

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What does the word "antibiotic" mean? Translated from Greek, “anti” means “against”, and the word “bios” means “life”. So the word “antibiotic” can be literally translated as “against life.” Despite such a menacing name, antibiotics only threaten the life of bacteria. But still, they can seriously affect the metabolism in the human body and therefore can lead to numerous side effects. These medications are considered potentially dangerous and most are prohibited for pregnant women and young children.

Bronchitis is a very common disease, which in recent years has become chronic among the population of our country, and the signs of bronchitis in adults are varied and depend on many factors. Before treating bronchitis, it is necessary to find out the cause of the disease.

Unfortunately, today antibiotics for bronchitis in adults are prescribed at random, and in some conditions the prescription of antibiotics is completely inappropriate.

It is known that bronchitis without antibiotics is easily treated if the inflammation is of viral origin, since the virus is not treated with antiseptics. If you treat viral bronchitis, antibiotics only interfere with the body's defense mechanisms to fight the virus, suppress the immune system, lead to the development of dysbacteriosis, allergies, and develop resistance of microorganisms to the drug.

Sometimes antibiotics are simply necessary. For example, in the treatment of bronchitis in elderly people over 60 years of age. At this time, a person’s immune system is not strong enough to quickly overcome the infection, and as a result, even banal bronchitis can result in unpleasant complications.

If symptoms of bronchitis persist for quite a long period, your doctor may recommend antibiotics. After all, if the body cannot cope with the infection on its own, it needs help.

There is such a disease as bronchial asthma. It is based on an allergic reaction, which manifests itself in response to various causes. With so-called infection-dependent asthma, allergies occur as a reaction to the presence of pathogenic microbes in the body. Therefore, each episode of bronchitis entails an increase in asthma attacks. To avoid this, patients are prescribed antibacterial drugs from the very beginning of the disease.

If you suffer from chronic obstructive bronchitis (smoker's bronchitis, chronic obstructive pulmonary disease), then during an exacerbation, when you have a cough with yellow or green sputum, you should also take a course of antibiotics.

Sometimes these drugs are prescribed for chemical bronchitis, which occurs when inhaling aggressive volatile substances (vapors of acids and alkalis). It would seem that if there are no manifestations of infection, then antibiotics are not needed. However, with chemical bronchitis there is a high risk of bacterial complications. Any injury is always easily accompanied by infection, so such patients also need antibiotics.

About half of cases of acute bronchitis are caused by viruses, and the effect of antibacterial drugs, as is known, applies only to bacteria. Therefore, only a doctor can decide on prescribing a course of antibiotics after a thorough examination. Never make this decision on your own!

Contact the Pulmonology Center, they will definitely help you, conduct the necessary examination and tell you whether you should take antibiotics and in what quantity.

Trust your health only to professionals, contact us at the Pulmonology Center!

Salbutamol

"Salbutamol" is an "emergency" remedy for bronchitis. This drug relaxes the smooth muscles of the bronchi. The positive effect of the drug occurs literally in five minutes, and the effect lasts five hours. “Salbutamol” is an aerosol for inhalation, therefore, before using this remedy for bronchitis, you must consult a doctor and then strictly follow the instructions. One of the disadvantages of Salbutamol is the possible development of a “ricochet effect”, in which each subsequent attack can become more intense. That is why “Salbutamol” is exclusively an “ambulance” for an attack of suffocation: the drug quickly relieves the spasm. The medicine has many contraindications and side effects, so it is prescribed only by a doctor.

Salbutamol