Prevention and treatment of chronic bronchitis
Chronic bronchitis, referred to as chronic bronchitis, is a common and frequently-occurring disease that seriously endangers people's health, especially the elderly, and the number of people over 50 years old is as high as 15%. Chronic bronchitis refers to chronic nonspecific inflammation of trachea, bronchial mucosa and its surrounding tissues, with the peak incidence in autumn and winter.
The etiology of chronic bronchitis is still not completely clear. According to the investigation and study at home and abroad, it is the result of long-term interaction of many factors. The infection caused by virus and bacteria is an important factor for the secondary infection and aggravation of chronic bronchitis. Dust, air pollution, irritating smoke and chronic irritation of long-term smoking are one of the main reasons, and cold climate and allergic factors are also the causes. The internal cause of chronic bronchitis is that the body's resistance is weakened and the local defense function of respiratory tract is reduced.
Chronic bronchitis has a slow onset and a long course of disease, and its recurrent attacks are gradually aggravated. The main symptoms are cough, expectoration, wheezing or shortness of breath, especially in the morning or at night, the amount of sputum increases. When complicated with emphysema, in addition to cough, excessive phlegm, asthma and other symptoms, breathing difficulties gradually appear. At first, I felt short of breath only when I was working. With the development of my illness, I feel short of breath when I rest.
In order to prolong the remission period, reduce the recurrence and prevent the further development of the disease, patients and their families should pay attention to prevention and nursing.
1. Actively control infection: choose effective antibacterial drugs according to doctor's advice in acute stage. Commonly used drugs are: compound sulfamethoxazole, potent toxin, erythromycin, penicillin and so on. When the treatment fails, you can also choose drugs that the patient has never used or used less, such as midecamycin, spiramycin and cephalosporin. After acute infection control, stop using antibacterial drugs in time to avoid side effects caused by long-term application.
2. Promote expectoration: Patients in acute phase should use antitussive and expectorant drugs while using antibacterial drugs. For elderly patients who are too weak to expectorate or patients with a large amount of sputum, expectoration should be the main treatment, and strong antitussive drugs should not be used, so as not to inhibit the central nervous system from aggravating respiratory inflammation and lead to the deterioration of the condition. Helping critically ill patients to change their posture regularly and gently massage their chest and back can promote the discharge of sputum.
3. Maintain good household hygiene, fresh indoor air circulation and a certain humidity, control and eliminate all kinds of harmful gases and smoke, quit smoking habits and pay attention to keep warm.
4, strengthen physical exercise, enhance physical fitness, improve cold tolerance and physical resistance. It is helpful to wash your face and hands with cold water in winter and massage your feet and palms before going to bed.
5. In the climate change and cold season, pay attention to add and subtract clothes in time to avoid colds and prevent influenza. Pay attention to observe the changes of the disease and master the law of the disease, so as to take measures in advance. If the patient has symptoms such as dyspnea, purple lips and nails, edema of lower limbs, trance and drowsiness, he should be sent to the hospital for treatment in time.
Chronic bronchitis is caused by many reasons. The main clinical symptoms are long-term cough, expectoration and wheezing. It often happens repeatedly in cold season and climate change. If the disease persists, it may be complicated with emphysema and even pulmonary heart disease.
Health guide:
1. Prevention of colds: Avoiding colds can effectively prevent the occurrence or acute attack of chronic bronchitis.
2. Diet adjustment: The diet should be light and avoid spicy meat. You should quit smoking and drink more tea, because smoking will cause an increase in respiratory secretions, reflex bronchospasm and difficulty in expectoration, which is conducive to the growth and reproduction of viruses and bacteria and further aggravate chronic bronchitis. Tea contains theophylline, which can excite sympathetic nerve, dilate bronchi and relieve cough and asthma symptoms.
Abdominal breathing: Abdominal breathing can keep respiratory tract unobstructed, increase vital capacity, reduce the attack of chronic bronchitis, and prevent emphysema and pulmonary heart disease. Specific methods: try to make the abdomen bulge when inhaling, and try to make the abdomen sag when exhaling. Exercise 2 ~ 3 times a day, each time 10 ~ 20 minutes.
4. Poison avoidance and desensitization: harmful gases and poisons, such as sulfur dioxide, carbon monoxide and dust. It will aggravate the condition, and the gas emitted by the coal stove at home will induce cough and asthma. Kitchen rooms should be ventilated or equipped with range hoods to keep the indoor air fresh. Parasites, pollen, fungi, etc. Can cause bronchial specific allergic reactions, so the indoor and outdoor environment should be kept clean and hygienic, and dirt should be removed in time to eliminate allergens.
5. Treatment of winter diseases in summer: Applying Xiaochuan ointment in summer can play a role in preventing and treating diseases. Specific method: Apply Xiaochuan ointment to Dazhui, Tiantu, Shu Fei and Zhongshan points. Apply for 2 days each time, change the dressing once every 3 ~ 5 days, apply for 3 times as a course of treatment, and apply continuously for 3 years in summer.
6. Proper rest: Be sure to stay in bed when you have a fever and cough, otherwise it will increase the burden on your heart and make your condition worse; When the fever and cough are relieved, you can get out of bed and exercise slightly. You should take part in appropriate activities or labor at ordinary times.
7. Insist on exercise: You can choose aerobics, Tai Ji Chuan, Wuqinxi and other items according to your physical fitness. Persisting in exercise can improve the body's disease resistance, and the amount of activity should be no obvious shortness of breath or rapid heartbeat. Do @ ass? Take?
Chronic bronchitis recurs all the year round, leading to hyperplasia and hypertrophy of glands, excessive secretion and phosphorylation, sparse and shedding of bronchial mucosa epithelium, destruction, collapse, distortion or expansion of bronchial wall, forming irreversible lesions. At the same time, the patient's respiratory function will also decline, showing airway stenosis, increased resistance and increased residual volume.
If chronic bronchitis is not well prevented, it may further develop into emphysema and even pulmonary heart disease.
Emphysema refers to the pathological state of airway elasticity, over-inflation, expansion and lung volume increase at the distal end of terminal bronchioles, or accompanied by airway wall destruction. Recurrence of chronic bronchitis narrows the tracheal cavity and forms incomplete obstruction. When inhaling, gas easily enters alveoli. When exhaling, due to the increase of pleural cavity pressure, trachea is blocked and alveoli are over-inflated. At the same time, chronic inflammation destroys the cartilage of the small bronchial wall, causing it to collapse, which also affects the gas discharge when exhaling. Chronic lung inflammation increases proteolytic enzymes released by some inflammatory cells, damages lung tissue and alveolar wall, and forms emphysema and bullae. The capillary of alveolar wall is compressed, the blood supply is reduced, the nutrition of lung tissue is poor, and the elasticity of alveolar wall is reduced, which promotes emphysema. It usually takes more than 6 years for chronic bronchitis to develop into emphysema.
Chronic bronchitis can also develop into pulmonary heart disease. From chronic bronchitis complicated with emphysema to pulmonary heart disease is a chronic process, which generally takes 6- 10 years. After the formation of emphysema, the pressure in alveoli increases, which leads to the compression of capillary lumen and the increase of pulmonary circulation resistance. At the same time, due to respiratory insufficiency and hypoxia, it can cause reflex spasm of pulmonary small vessels, further increase pulmonary artery pressure, and the increase of pulmonary artery pressure will aggravate the burden on the right ventricle. In order to overcome the increased resistance, the right ventricle will gradually thicken, and eventually the right ventricle will expand and eventually the right heart will fail. This is pulmonary heart disease.
Chronic bronchitis is characterized by repeated coughing, expectoration or wheezing. 1, Cough: The prominent feature of this disease is that cough is aggravated repeatedly for a long time. Mild patients have only a slight cough and a small amount of mucus. When the sudden change of climate or acute upper respiratory tract infection causes acute attack in autumn and winter, cough is frequent and aggravated, especially in the morning and at night. 2, expectoration: the amount of sputum varies, generally white mucus sputum and white foam-like sputum; When accompanied by acute infection, sputum becomes sticky or purulent, and the amount of sputum increases. When coughing badly, there are occasional bloodshot sputum. 3. Asthma: If the patient has excessive phlegm, bronchospasm and edema and stenosis of the tracheal wall, the patient will have asthma.
In terms of physical examination, there are no abnormal signs in the early stage of chronic bronchitis, and the lungs are often scattered with dry and wet rales during acute attacks. During the attack of chronic asthmatic bronchitis, wheezing and prolonged exhalation can be heard in the lungs. If accompanied by infection, rales increase.
Chest X-ray examination showed that the lung texture was thickened and increased, especially in the middle and lower fields. Secondary infection, lung texture disorder, rough or patchy shadow, and mostly located in the distal texture, irregular shape, about 2-3 mm in diameter, especially in the middle and lower lung fields of both lungs. This is caused by inflammation of bronchioles and obstruction of secretions in the cavity. There is generally no abnormal change in blood routine. Only in acute attack can the total number of white blood cells and neutrophils be high. Patients with chronic asthmatic bronchitis can have eosinophilia, sputum smear and culture examination, and pathogenic bacteria such as pneumococcus can be found. Chronic bronchitis is a disease that often recurs and is difficult to be completely cured. Comprehensive measures of combining prevention and treatment should be taken in treatment. In acute attack and chronic protracted period, infection control, expectorant and cough suppression should be the main methods, and spasmolytic and antiasthmatic treatment should be given when accompanied by wheezing. During the clinical remission period, we should strengthen exercise, increase physical fitness and improve resistance.
Acute attack: ⑴ Control infection: Antibiotics should be used in time, especially when fever, expectoration and wheezing get worse. Mild patients can take orally, and severe patients can use intramuscular injection or intravenous drip of antibiotics. Commonly used antibiotics are penicillin G, erythromycin and cephalosporin. ⑵ Eliminating phlegm and relieving cough: The application of expectorant and relieving cough drugs is mainly to improve symptoms. In particular, patients in protracted period should insist on taking medicine to eliminate symptoms. For those who are old and weak, unable to expectorate or have a large amount of sputum, expectoration should be the main method to keep the respiratory tract unobstructed, and strong antitussive drugs such as codeine should be avoided, so as not to inhibit the respiratory center, aggravate respiratory obstruction and aggravate the condition. Commonly used drugs such as brown amine mixture, expectorant, biscotrol, etc. ⑶ Antispasmodic and antiasthmatic: aminophylline, salbutamol, etc. Often used. Intravenous administration, oral administration and spray administration can relax bronchial smooth muscle, relieve spasm and make sputum easy to be discharged. ⑷ Aerosol therapy: For patients with sticky phlegm who are not easy to cough up, the aerosol can be humidified and inhaled to dilute the secretions in the trachea, which is beneficial to expectoration.
Treatment in remission: (1) Patients who smoke should quit smoking first. The incidence of chronic bronchitis is many times higher than that of non-smokers. After quitting smoking, patients' lung function has been greatly improved, and passive smoking should also be avoided. (2) Strengthen physical exercise and enhance physical resistance. The amount of exercise depends on your physical condition. Walking, boxing, jogging, etc. You can breathe fresh air every morning to promote blood circulation. Winter exercise can improve the adaptability of respiratory mucosa to cold air. ⑶ Adjust the room temperature reasonably to prevent colds. The indoor temperature should not be too high in winter, otherwise the temperature difference with the outdoor is large and it is easy to catch a cold. Summer should not be greedy and cool, and the air conditioning temperature should be moderate, otherwise it is easy to suffer from bronchitis caused by "cold" when going out. Go to the crowd as little as possible during the flu season, sweat a lot, don't take off your clothes suddenly to prevent colds, and pay attention to changing clothes with the seasons. The elderly can get flu shots to reduce the chance of catching the flu. (4) Eat more foods containing vitamin A, such as carotene. Vitamin A can enhance the resistance of tracheal mucosa epithelium, and play a certain role in preventing bacterial and viral infection and poison stimulation. Under the guidance of a doctor, oral Chinese medicine, such as Chinese medicine Huanghua, has a good effect. In western medicine, drugs such as Bistin and nuclear cheese can be taken orally, and thymosin can also be injected intramuscularly to improve immunity.
Referred to as chronic bronchitis, it refers to chronic nonspecific inflammation of trachea, bronchial mucosa and its surrounding tissues. Traditional Chinese medicine calls it "cough" and "drinking phlegm".
Symptoms include long-term repeated cough, expectoration, asthma and infection, which last for at least three months every year for two years or more, and can be diagnosed as chronic bronchitis after excluding cardiopulmonary diseases. Only those who cough and expectorate are simple chronic bronchitis, and those who gasp are wheezing. Simple chronic bronchitis is mostly asymptomatic, and wet or dry rales can be heard in auscultation of the lungs when there is infection. Asthmatic chronic bronchitis can hear wheezing. X-ray chest film display mode
The causes increase and become rough and disorderly. Complications include emphysema and bronchiectasis.
Prevent and strengthen physical exercise, improve disease resistance, prevent cold and keep warm, prevent colds, quit smoking, prevent dust, smoke, dust and irritating gases from visiting the respiratory tract.
(1) The treatment of chronic bronchitis at the attack stage focuses on anti-infection, which has expectorant, antitussive and antiasthmatic effects. Commonly used antibacterial drugs include compound sulfamethoxazole, penicillin and gentamicin. (2) The expectorant, antitussive and antiasthmatic drugs are: Bisupine, aminophylline and Shuchuanling 0. 1 ~ 0.2 mg, sprayed l ~ 2 times, inhaled/kloc-0 every 4 hours. (3) Adrenal cortical hormone can be used in patients with intractable diseases. (3) Fritillaria cirrhosa batch paste, Fritillaria cirrhosa cough syrup, expectorant cough, etc.
What is chronic bronchitis?
Chronic bronchitis is caused by physical and chemical factors, which leads to inflammatory changes in trachea and bronchus and increased mucus secretion. The clinical manifestations are cough, expectoration, shortness of breath and other symptoms. Early symptoms are mild, mostly in winter and relieved after warm spring; In the later stage, the inflammation is aggravated, and the symptoms exist for many years, regardless of the season. The progress of the disease can be complicated with emphysema, pulmonary hypertension and right ventricular hypertrophy, which seriously affects the labor force and health.
What are the causes of chronic bronchitis?
The etiology of this disease is not completely clear, and it is generally divided into external and internal causes.
(1) external cause
① Smoking: Studies at home and abroad have proved that smoking is closely related to the occurrence of chronic bronchitis. The longer you smoke, the more you smoke and the higher the prevalence rate. After quitting smoking, the symptoms can be alleviated or disappeared, and the condition can be alleviated or even cured.
② Infection factors: Infection is an important factor in the occurrence and development of chronic bronchitis, mainly viral and bacterial infections, especially rhinovirus, myxovirus, adenovirus and respiratory syncytial virus. Bacterial infection can be secondary to airway mucosal damage caused by virus or mixed infection of virus and mycoplasma. From the results of sputum culture, it was found that Haemophilus influenzae, pneumococcus, Streptococcus A and Neisseria were the most common. Although infection is closely related to the pathogenesis of chronic bronchitis, there is not enough evidence to show that it is the primary cause. It is only considered as a secondary infection of chronic bronchitis and an important factor to aggravate the development of the disease.
③ Physical and chemical factors: chronic stimuli such as irritating smoke, dust and air pollution (such as sulfur dioxide, nitrogen dioxide, chlorine and ozone) are often one of the inducing factors of chronic bronchitis. The prevalence rate of chronic bronchitis in workers exposed to industrial irritating dust and harmful gases is much higher than that in workers who are not exposed, so air pollution is also an important inducing factor of this disease.
④ Climate: Cold is often an important cause and inducement of chronic bronchitis. The attack and acute exacerbation of chronic bronchitis are common in cold winter, especially when the climate changes suddenly. Cold air stimulates respiratory tract, which not only weakens the defense function of upper respiratory tract mucosa, but also causes bronchial smooth muscle contraction, mucosal blood circulation disorder and secretion discharge difficulty through reflection, which is beneficial to secondary infection.
⑤ Allergic factors: According to the investigation, asthmatic bronchitis often has allergic history. The number of eosinophils and histamine content in patients' sputum have an increasing trend, indicating that some patients are related to allergic factors. Dust, dust mites, bacteria, fungi, parasites, pollen and chemical gases can all become allergic factors and cause diseases.
(2) Internal factors
① Decreased local defense and immune function of respiratory tract: The respiratory tract of normal people has perfect defense function, which can filter, warm and moisten the inhaled air; The mucociliary movement of trachea and bronchial mucosa, as well as cough reflex, can purify or eliminate foreign bodies and excessive secretions; The bronchioles and alveoli also secrete immunoglobulin (IgA), which has antiviral and bacterial effects. Therefore, under normal circumstances, the lower respiratory tract remains sterile. Weakening the defense and immune function of the whole body or respiratory tract can provide internal conditions for the onset of chronic bronchitis. The elderly often have a high prevalence rate because of the decline of respiratory immune function, immunoglobulin, respiratory defense function and mononuclear-phagocytic system function.
② Autonomic nerve dysfunction: When the parasympathetic response of respiratory tract is enhanced, the weak stimulation that has no effect on normal people can cause bronchospasm and increase secretion, resulting in symptoms such as cough, expectoration and asthma.
Based on the above factors, when the body's resistance is weakened, there are one or more external factors in the airway on the basis of different degrees of sensitivity (susceptibility), and long-term repeated action can develop into chronic bronchitis. If long-term smoking damages respiratory mucosa, coupled with repeated microbial infections, chronic bronchitis may occur, and even develop into chronic obstructive emphysema or chronic pulmonary heart disease.
Why is smoking closely related to the incidence of chronic bronchitis?
Tar and nicotine contained in cigarettes can increase the excitability of parasympathetic nerves and make bronchus contract and spasm; The ciliary movement of respiratory mucosa epithelial cells was inhibited; Bronchial goblet cells proliferate and mucosal secretion increases, which weakens the ability of airway purification and leads to congestion, edema and mucus accumulation in bronchial mucosa. The function of phagocytes in alveoli is weakened, which is easy to cause infection. Smokers are easy to cause squamous metaplasia, mucosal gland hyperplasia, hypertrophy and bronchospasm, and are easy to be infected.
What are the pathological changes of chronic bronchitis?
At the early stage, cilia of tracheal and bronchial epithelial cells adhered, fell off and lost, and epithelial cells became vacuolar degeneration, necrosis, proliferation and squamous metaplasia. If the course of disease is long and the condition is serious, the inflammation spreads to the tissues around the bronchial wall. Submucosal smooth muscle bundle breaks and shrinks; When the lesion develops to the late stage, the mucosa atrophy and the fibrous tissue around the trachea proliferates, which leads to the stiffness or collapse of the lumen. The lesions spread to bronchioles and alveolar walls, leading to the destruction of lung tissue structure or fibrous tissue proliferation, and then obstructive emphysema and interstitial fibrosis occur. Electron microscopic observation showed that type ⅰ alveolar epithelial cells swelled and thickened, and type ⅱ alveolar epithelial cells proliferated; Capillary basement membrane thickening, endothelial cell injury, thrombosis, lumen fibrosis and occlusion; Diffuse hyperplasia of fibrous tissue in alveolar wall. These changes are especially obvious in patients with emphysema, pulmonary hypertension and cor pulmonale.
What auxiliary examinations do patients with chronic bronchitis need?
(1)X-ray examination: there was no abnormality in the early stage. Repeated attacks of lesions lead to thickening of bronchial tube wall, infiltration or fibrosis of inflammatory cells in bronchioles or alveolar interstitium. The texture of both lungs is thickened and disordered, showing a net or strip shadow, which is more obvious in the lower lung field.
(2) Respiratory function examination: there was no abnormality in the early stage. If there is small airway obstruction, the maximum expiratory flow rate-volume curve is obviously reduced when the lung volume is 75% and 50%, which is more sensitive than the forced expiratory volume at 1 sec. The enclosed volume can be increased. When the airway is narrow or blocked, there will be pulmonary function manifestations of obstructive ventilation dysfunction, such as the ratio of forced expiratory volume to forced vital capacity decreases (< 70%) and the maximum ventilation volume decreases (