Violation of the drainage function of the body. Age-related changes in the tracheo-bronchial tree

Violation drainage function of the airways is one of the links in the pathogenesis of many respiratory diseases. Therefore, in recent years, sanitation of the trachea and bronchi has become important in the complex treatment of patients with lung diseases.

Sanitation of the airways is indicated for chronic bronchitis and pneumonia, atelectasis, bronchiectasis, lung abscesses, tuberculosis, suppurating cysts, bronchial asthma, etc. Various medications can be used for tracheobronchial sanitation:

• antiseptic (solutions of furacillin, chlorophyllipt, potassium permanganate, etc.),
• enzymatic (chymotrypsin, chymopsin, trypsin, ribonuclease, deoxyribonuclease, streptokinase, etc.),
• substances with high surface activity (tergitol, adegon, etc.),
• bronchodilators (aminophylline, ephedrine, isadrine, naphthyzine, adrenaline, etc.),
• desensitizing (diphenhydramine, suprastin, pipolfen), corticosteroids (prednisolone, hydrocortisone),
• anti-inflammatory (dimexide, antipyrine, etc.),
• antimicrobial (streptomycin, penicillin, kanamycin, sulfonamides, etc.),
• phytoncides (garlic, lingonberries, onions, etc.),
• sulfhydryl (acetylcysteine, thiamphenitol, etc.),
• antifungal (nystatin, levorin, etc.),
• stimulants (pentoxyl, metacil, etc.),
• hemostatic (thrombin, etc.),
• cauterizing (solutions of trichloroacetic acid, silver nitrate, etc.).

Methods for sanitation of the bronchial tree include: postural drainage, administration of expectorants, aerosol therapy, tracheobronchial infusions and other methods of administering drugs into the trachea and bronchi, therapeutic bronchoscopy.

• Therapeutic bronchoscopy - an effective method of sanitizing air ducts. When carrying out it, it is possible to examine the tracheobronchial tree, aspiration of pathological contents (mucus, secretions, pus, blood) with subsequent diagnostic examination, washing (lavage) of the airways.
• Intratracheal infusions of medicinal solutions . The procedure is performed using a laryngeal syringe under the control of indirect laryngoscopy without anesthesia or under local anesthesia. The course of treatment is 15-20 sessions, repeated courses are possible.
• Transnasal endotracheal and endobronchial infusions performed using catheters such as Nelaton, a syringe (5-10 ml) under local anesthesia.
• Physiotherapy . Infrared irradiation promotes the resorption of chronic inflammatory processes and reduces pain. Ultraviolet irradiation has an anti-inflammatory and desensitizing effect and is indicated for chronic nonspecific lung diseases in remission.
• Thermotherapy . Ozocerite treatment improves blood circulation in the affected area of ​​the lung and has an anti-inflammatory effect. Paraffin treatment and ozokerite treatment are indicated for chronic pneumonia in the acute phase.
• Electrophoresis . Electrophoresis is indicated for patients with chronic bronchitis, chronic pneumonia, bronchial asthma and is used in the form of medicinal electrophoresis, electrophoresis with therapeutic mud.
• High and ultra-high frequency currents . Diathermy and inductothermy promote the formation of heat inside tissues and can be used for chronic pneumonia in the acute phase of the process. The UHF electric field promotes deep tissue heating. The microwave electromagnetic field improves tissue nutrition, local blood circulation, and promotes the resorption of inflammatory changes in the bronchi and lung tissue. The method is indicated for acute and chronic pneumonia. Decimeter microwave therapy has a high therapeutic effect.
• Ultrasound - the use of ultrasonic vibrations (20,000 per 1 s) for therapeutic purposes. Indications: pleurisy. Phonophoresis is the administration of medicinal substances using ultrasound.
• Electroaerosol inhalation - introduction into the respiratory tract of charged medicinal substances mainly negative sign for medicinal purposes. Indications: bronchitis, pneumonia, bronchiectasis, bronchial asthma, etc.
• Aeroionotherapy - treatment with ionized air. Indications: chronic bronchial diseases of a nonspecific nature.
• Therapeutic breathing exercises helps restore or improve lung ventilation, improve the function of all organs and systems. Indications: chronic bronchitis, chronic pneumonia, bronchiectasis, condition after surgery on the lungs, chest and other organs, pulmonary tuberculosis, bronchial asthma. Special breathing exercises stimulate the respiratory center, improve ventilation and gas exchange in the lungs, tone the central nervous system, increase general tone and activate protective body strength, improve blood and lymph circulation, promote the resorption of exudate, prevent the development of pleural adhesions, emphysema and pneumosclerosis, and form spontaneous compensation processes.
• Massage , helps to improve the respiratory function of the lungs, strengthen the respiratory muscles, increase the mobility of the ribs and diaphragm, and improve blood flow in the lungs. Indicated for chronic bronchitis and pneumonia, bronchial asthma and bronchiectasis, after operations on the chest organs. The duration of the procedure is 15-30 minutes, the course of treatment is 16-20 procedures.
• Diet therapy . For focal pneumonia (bronchopneumonia), a diet with a high content of protein, calcium, phosphorus and a somewhat limited content of carbohydrates is prescribed.
• Psychotherapy . The doctor’s encouraging, calming, regular conversations, instilling faith in the treatment, demonstrating cases of successful therapy, and placing convalescent patients in the ward often make it possible to improve or restore the patient’s mental balance, which is the key to successful treatment.
• Artificial respiration - a therapeutic method that allows you to restore or improve breathing. Indications: respiratory arrest, acute respiratory failure, condition clinical death. Technique: restore airway patency, bring forward lower jaw victim, start breathing mouth to mouth, mouth to nose, mouth into the mouth through a mask or pharyngeal tube.
• Assisted breathing - mechanical assistance in case of inadequate spontaneous breathing of the patient, carried out at the moment of inhalation by squeezing the fur or bag of the anesthesia or breathing apparatus. Exhalation is passive.
• Guided breathing(ventilator, forced breathing) - breathing using an anesthesia machine can be done with passive or active exhalation.
• Oxygen therapy - treatment by inhaling oxygen. Indications: arterial or venous hypoxia. Oxygen is supplied to the patient through a catheter inserted into the nose, larynx, trachea, using a mask or oxygen tent.
• Hyperbaric oxygenation - treatment with compressed air or oxygen under high pressure in special pressure chambers. The method is based on the fact that an increased content of 02 in the blood (25-26 vol%) can satisfy the tissue needs for 02 even with a decrease in blood flow by 50%. Indications: acute poisoning, cardiogenic, traumatic and hemorrhagic shock, anaerobic sepsis, acute cerebrovascular accidents, surgical interventions in persons with increased operational risk. -%
• Oxyheliotherapy - use of helio-oxygen mixture for inhalation to improve respiratory mechanics. Respiratory is a medical room in which artificial ventilation of the lungs is carried out using oxygen-aerosol mixtures. Indications: chronic bronchitis, chronic pneumonia, bronchial asthma.
• Tracheal intubation - insertion of a breathing (intubation) tube into the trachea. Indications: endotracheal anesthesia, resuscitation measures.
• Tracheotomy - sore throat. It comes in top, middle and bottom. Indication: laryngeal stenosis.
• Coniotomy- opening the larynx by dissecting the thyroid-cricoid membrane.
• Isotope treatment - radioactive iodine therapy (J131). Indications: chronic respiratory failure that is not amenable to conventional treatment methods. Introduction radioactive iodine into the body reduces metabolism and reduces the tissue need for oxygen. Treatment can improve respiratory function and the general condition of the patient in cases where other methods have been ineffective.
• Percutaneous intrapulmonary puncture . Transcutaneous intrapulmonary puncture - puncture chest wall, pleura and lung for the purpose of administering drugs into lung tissue. Indications: inflammatory infiltrate of the lung (staphylococcal). Contraindications: severe emphysema, pulmonary bulla, abscess adjacent to the infiltrate. Technique. The puncture site is marked using fluoroscopy. The puncture is carried out with the patient sitting or lying down under aseptic conditions; under local anesthesia. Complications: hemoptysis, pneumothorax, pyopneumothorax.
• Cervical vagosympathetic blockade according to Vishnevsky - administration of a solution of novocaine to block the vagus and sympathetic nerves in the neck, and sometimes the phrenic nerve. Indications: chest injuries, spontaneous pneumothorax, lung surgery. Blockade of the vagus nerve in the neck and intradermal injection of novocaine solution in the area of ​​reflexogenic zones are also used.

_______________________________

ECOLOGY OF HUMAN EXISTENCE

Dina Tarasova

Constant cleansing of the subtle bodies and physical

guide, is the key to spiritual and

physical health of a person.

Alice A. Bailey

"Treatise on Cosmic Fire"

Blood is life, blood is Soul.

Alice A. Bailey

"The Soul and Its Mechanism"

The word ecology has Greek origin and is associated with the state environment. All living things, including humans, are constantly in certain living conditions, and therefore in certain environmental conditions. But, unfortunately, the state of the environment has changed a lot recently in an unfavorable direction. The animal and plant worlds suffer, and humans also suffer. Evolutionary processes do not stand still; they tend to develop in both living and inanimate nature. However, in living nature, more and more often, attention is drawn to the occurrence of some “failure” in the program, leading to serious consequences - to mutations. Mutation (from lat. mutation - "change") is an abrupt change in hereditary cellular structures, leading to changes in hereditary characteristics. Mutation has become a principle that goes beyond the control of the laws of evolutionary development of living nature, which means the process is not sufficiently controlled. This is the trend of evolutionary development today. What could this lead to in the near future? What else is there to know than the emergence of mutants as a result of these poorly controlled processes.

During the evolutionary processes of development of all living things, mutual adaptation of some forms of existence to others occurred. This means that they have been in symbiosis for millions of years (Greek: symbiosis - "cohabitation"). But unauthorized changes or mutations of some forms of existence inevitably entail changes in symbiotic forms, which is what is observed in nature today.

If we talk about the ecology of human existence, then it first of all bears all the signs of the modern process of civilization. And today it is the subject of study by many scientists looking for ways to overcome and get out of this deadlock. Today, as never before topical issues human health in its environment and survival processes in these conditions. The development of even the simplest adaptive processes takes a very long time, sometimes thousands of years. In the context of this developing environmental crisis, that time simply does not exist. This is another great feature of the modern period of existence. Humanity has nowhere to rush anymore; it is forced to stop and understand what is really happening and begin to change its attitude towards the environment.

Human ecology today can be considered in two aspects: medical and social. The peculiarities of the medical ecological approach are that a person is considered from the point of view of the classical formula “organism and environment”. That is, the features of the impact of the environment on the human body and its health are considered. Therefore, more attention is paid to the consideration of factors leading to impaired health status of people:

TO exogenous factors include:

1. Exposure to toxic substances:

Poor quality and unhealthy diet

Untreated and undisinfected drinking water

Bad habits

Toxic effect of drugs

Any acute and chronic poisoning

Unfavorable living conditions, air pollution

Atmospheric emissions from chemical plants

Harmful working conditions

2. Exposure to harmful radiation:

Electrosmog

Geopathogenic radiation of the earth

Radioactivity

3. Acute and chronic stress

TO endogenous factors include:

1. Exposure to toxic substances – formation and accumulation of toxic metabolites in the body (toxins)

2. Exposure to pathogenic microflora - bacteria, viruses, fungi

Noteworthy is the fact that almost all of the above environmental factors, with the exception of stress, have a toxic effect on the body. It is clear that when exposed to such factors or substances, certain reaction reactions develop in the body, which will be called acute or chronic poisoning or acute or chronic intoxication. As for the impact of exogenous factors, their content in the environment is different, so it is always necessary to take into account the maximum permissible concentrations of toxic substances - MAC. But it is also necessary to take into account the maximum permissible concentrations not only of one substance, but also of their combination. In this case, we have to talk about the total dose of toxic substances.

Today, exo- and endogenous causes balance each other and equally cause the development of pathology within the body. The recent decline in immunity, sharp increase various allergic reactions and others serious illnesses are a consequence of the increasing pollution of the human environment and especially internal environment body.

It is clear that medical scientists are closely studying these problems. And since the middle of the last century, several scientific works that deserve attention have been devoted to these problems.

One of such works is the work of Yu.M. Levina. He created a new direction in the ecology of the internal environment of the body, which he called endoecology. The applied task of endoecology is the creation and implementation of methods for cleansing the habitat of cells and the entire organism from exo- and endotoxins. The term “endoecological rehabilitation” was used to refer to detoxification (neutralization of toxins) in the body at the cellular level. What led to the further use of this term as “endoecological rehabilitation according to Lewin”, the abbreviated name is ERL. The author placed the main emphasis in cleansing the body of exo- and endotoxins on cleansing the intercellular space (matrix, mesenchyme) and the lymphatic system of the body.

The first origin of life on Earth at the level of a single-celled organism occurred in an aquatic environment, which simultaneously nourished the cell and also cleansed it of waste products. At all subsequent stages of evolution multicellular organism retained the water mechanism for maintaining the existence of cells. Despite the specificity of cells, they all live according to the same bioenergetic and biochemical laws, they all live in the same environment: in the intercellular fluid, in the intercellular space called interstitium, one of the main functions of which is to protect cells from toxic aggression of exogenous and endogenous nature.

The human body is 90% water, which accounts for up to 2/3 of the total body weight - it is found in cells and surrounding tissues. Distribution of water in the body:

1. Extracellular fluid – 38%

2. Intracellular fluid – 26%

3. Thick fabrics – 26%

4. Blood – 7%

5. Lymph – 3%

The aqueous environment in the body carries out its main function– transport. It would be appropriate here to compare it with “water arteries” called rivers or other bodies of water. As a rule, the degree of cleanliness of a reservoir depends on its flow, how quickly a particular reservoir changes its water; if the reservoir is not flowing, then the water in it will stagnate, sour, and then generally turn into a swamp. It’s the same with water in the body: the degree of purity of the intercellular space depends on the speed of flow or exchange of water in the body. If a person drinks enough water and has good diuresis, then the rate of fluid exchange in the body will be good enough to keep the body clean. Another thing is when the excretory (drainage) systems of the body for some reason do not work, they are clogged with toxins, and then problems begin in the internal water environments of the body: they are filled with toxic products of both endo- and exogenous origin. And here it is appropriate to compare them with swamp water, which is unlikely to be able to effectively perform its transport function and ensure proper cleanliness in the body.

Where do toxins accumulate in the human body:

1. Intercellular space – 83%

2. In cells – 7%

3. Blood – 7%

4. Lymph – 3%

If the accumulation of toxins does occur, then problems begin in the body called intoxication, which has its own clinical manifestations, and if measures to cleanse the drainage systems were not taken in time, then a clinical picture appears various symptoms and syndromes, the description of which is devoted to entire volumes and encyclopedias. And the correct understanding lies in a very simple answer: the body needs to unload the drainage systems and cleanse it of toxic substances that poison it. And people, as a rule, in such a state seek medical help and receive completely different medical advice and recommendations. Most likely, they urgently receive massive drug therapy, which further aggravates the patient’s condition, leading to the state of the body’s aqueous media becoming even more polluted from the layered toxic effects of drugs. The use of such tactics does not lead to unloading of drainage systems, cleaning of the interstitium and removal of toxins, and therefore does not lead to the restoration of impaired body functions. Prescribing drug therapy is appropriate if the drainage systems are open, working well, and the intercellular fluid is properly performing its transport function. Then you can achieve a positive effect from traditional methods treatment.

Also, since the mid-twentieth century, another similar direction has been formed and exists - homotoxicology (from the Latin homo - human). In 1948-1949, the German physician G. Reckeweg (1905-1985) formulated the basic principles of homotoxicology. He first introduced the concept of homotoxins. By homotoxins he understood substances that can be of exogenous and endogenous origin. Moreover, when they enter the body, they activate the body’s defense systems. From the point of view of homotoxicology, a healthy body is free from homotoxins and is in a state of dynamic equilibrium - homeostasis. Everything that enters the body must either be absorbed in the body or neutralized in the intercellular space and excreted through various excretory systems of the body in the form of various excrements: urine, feces, sweat, saliva, tear fluid, pus, mucus, sputum. If this does not happen, then homotoxin accumulates in the human body, and this condition is considered a disease - homotoxicosis. According to Leriche, “illness is a drama in two acts, the first of which is played out in the gloomy silence of our tissues, with the candles extinguished. When pain or other symptoms appear, it is almost always the second act.” Today we can say with confidence that the whole drama plays out in the intercellular space, where the fate of cell damage, and therefore organs, systems, and the entire organism as a whole, is decided.

G. Reckeweg identified six progressive stages (phases) of body contamination, resulting in illness:

First phase – allocation, this is the removal of homotoxins through the excretory (drainage) systems of the body in the form of various excrements: urine, feces, sweat, saliva, tear fluid, nasal mucus, bile, gastric juice, menstruation, sperm, earwax, etc., and so on activation of the body’s defense systems - blood, lymph, immune system, formation of antibodies, and if the body does not cope with this task, then the process goes into

Second phase – reaction and inflammation when homotoxins begin to be excreted in a pathological way: vomiting, diarrhea, pus, sputum, runny nose, skin rashes, boils, abscesses, phlegmon, neuralgia, myositis, pharyngitis, laryngitis, tonsillitis, lymphadenitis, pleurisy, pneumonia, endocarditis, pericarditis, peritonitis, sepsis , enteritis, colitis, appendicitis, hepatitis, cholangitis, polyarthritis, osteomyelitis, cystitis, pyelitis, nephritis, adnexitis, prostatitis. In this phase, there is already inflammation and tension in the body’s defense systems. These are also allergic reactions in the body. If the elimination of homotoxins did not take place fully, and most often it was suppressed by various therapeutic methods, then comes

Third phase – deposition - deposition: accumulation and isolation of homotoxins in various tissues. Its meaning is that toxins are isolated from the general circulation in the tissues, so that later, when the supply of toxins from the outside stops, they can be tried to remove them from the body. This phase, compared to the second, is more protracted. This is how atheromas, warts, calluses, nasal polyps, adenoid growths, cysts, benign tumors, polyps of the stomach and intestines, gout, heel spurs, stone formation in the biliary and urinary systems, obesity, hypertrophy of the mucous membranes and endocrine glands, varicose veins. All the action actively takes place in the intercellular space, to which the cells react with increased division.

These first three phases are called humoral. They do not pose a particular threat to the body; they develop in reverse; the body itself is able to eliminate the damaging factor or the consequences of its influence.

Important Feature of these three phases is that they are aimed at the principle of releasing (excreting) toxins at any cost. But an even greater feature of the course of these phases is the preservation of enzymatic systems with a general tendency towards recovery. If the body fails to avoid the intake of toxins from the outside or the formation of endotoxins and also neutralize them, then the disease moves to the so-called cellular level, when the body's defenses are depleted and it is unable to cope with the toxic effects: homotoxins penetrate into the cell. The cellular phases are separated from the humoral phases by a biological barrier, which is considered a kind of boundary line, after which the cells lose the ability to function normally.

The peculiarity of the next three phases lies in the principle of accumulation of toxins in the body, as a result of which enzymatic systems necessarily suffer, which leads to various kinds of enzymopathies. Clinically, this looks like the border between a treatable and an incurable (theoretically) disease or, in other words, between acute and chronic diseases.

Fourth phase – saturation: cells are isolated from the intercellular space, which in turn can no longer cope with its filtering and protective functions. And in the cell there is an accumulation of products of intracellular metabolism, which entails damage to its cellular structures. This phase is manifested by damage to various enzymatic systems: glycogenosis, lipidosis, mucopolysaccharidosis, amyloidosis, hemosiderosis, and manifests itself in the form of pigmentation, leukoplakia, migraine, nervous tics, asthma, stomach ulcers and 12- duodenum, chronic hepatitis, pancreatitis, angina pectoris, myocarditis, lymphostasis of the extremities, hydronephrosis, pneumoconiosis, silicosis, rheumatic and gouty nodes.

Fifth phase – degeneration: begin structural changes cells and tissues, clinically manifested by dysfunction of organs and systems. These are collagenosis, arthrosis deformans, fibrosis, sclerosis, cirrhosis, atheromatosis, mucosal atrophy, demyelination, liver cirrhosis, hyperthyroidism, pulmonary edema and emphysema, spondylosis, pernicious anemia, lymphogranulomatosis, wrinkled kidney, progressive muscular dystrophy, chronic tuberculosis, leprosy.

Sixth phase – neoplasm or malignancy of previous processes.

The development of the disease according to G. Reckweg should be considered as a holistic process of protecting the body from homotoxins, which can develop moving from one phase to another, or from one organ to another without damage to enzymatic systems, or with their damage.

What is the sequence of damage to certain body systems in the ideas of traditional Chinese medicine?

According to them, the excretory systems of the LUNGS and GASTROINTESTINAL tract begin to suffer first of all.

THE LUNGS have an energetic connection with the KIDNEYS, hence the renal system is strained compensatory (dysuric manifestations - frequent urination, pain, burning without pathological changes in urine). When the renal system is decompensated, clinical symptoms from the pulmonary system appear (cough, pneumonia, asthma attacks). From the gastrointestinal tract - diarrhea, enteritis, colitis.

Intoxication in the body cannot remain constantly tense, so the body looks for compensatory ways to “dump” toxins in the most safe places. There are several such places and options for “reset” in the body. The most common way is the formation of “discharges” through the SKIN - various allergic rashes, the formation of papillomas, warts, age spots. Or in the subcutaneous fat - the formation of cellulite.

Another way is the formation of stones in the excretory organs and systems: kidneys, gallbladder, prostate, salivary glands etc. These organs, as a rule, are initially functionally tense, then move into the stage of inflammation and then into the stage of stone formation. Places of “discharges” are an extremely beneficial phenomenon for the body; they compensate for deficiencies in organ function. When such places are eliminated, the process loses the ability to compensate at their expense, and the disease begins to progress.

The disease “wanders” throughout the body and looks for weak points, an organ or a system. In this case, the target organ or target system can be hereditarily determined or predetermined, that is, genetically weakened. Such a system is called a LIMITING SYSTEM (Locus minoris resistenсia) – it is most often affected.

But there are also energy connections between different organs and systems, and it is there, most often, that pathology is discharged from the limiting system: these are the so-called SHUNT TRANSITIONS.

Example of a limiting system/organ:	Shunt junction:
Pancreas/spleen	- to gynecology
CNS	- head, nasopharynx, skin, gastrointestinal mucosa
HEART	- pharyngeal tonsils
Hypothalamic-pituitary system	- posterior wall of the pharynx
KIDNEYS	- lungs

According to traditional Chinese medicine, there are many such places, because organs and systems have different energetic connections based on different principles and different hierarchical levels. As the compensatory capabilities of the systems decrease more and more, the emissions become more and more aggressive - ulcerations appear on the skin and mucous membranes, and bleeding occurs. If such foci begin to be intensively treated, then the pathological processes are driven further and further into the cell. And then at this stage enzymopathies arise and intoxication increases. The body overcomes the biological barrier that separates it from the fourth phase of homotoxicosis according to G. Reckweg and enters it. In this case, the greatest burden of neutralizing toxic effects falls on the hepatobiliary system - liver, gall bladder, ducts. Enzymeopathy and hepatic cell failure impair liver function as a whole, causing disruption of all types of metabolism and a decrease in the detoxification function of the LIVER. Thus, metabolic products - endotoxins - begin to accumulate in the body. Although the central nervous system (CNS) is separated from the body by the blood-brain barrier, it is also subject to acute and chronic intoxication. The basal parts of the brain have a common circulatory network with the nasopharynx and therefore, first of all, it is here that the “discharge” of toxins from the central nervous system occurs. This “reset” is a salvation for the central nervous system and a compensation process until intensive treatment of acute and especially chronic diseases of the nasopharynx and ENT organs begins. Suppression of these processes by drugs leads to the fact that toxic substances again begin to accumulate in the central nervous system, and then this condition is expressed by the following clinical manifestations:

First stage:

1. Dysregulation of the autonomic nervous system, namely tension of the sympathetic-adrenal system. Vegetative crises appear.

2. Dysregulation of the hypothalamic-pituitary system and, as a result,

– endocrine disorders at the level of the endocrine glands:

thyroid gland, parathyroid glands, pancreas, ovaries, prostate;

– adrenal glands:

There is an increase in the cortical layer, the release of adrenaline, an increase in the amount of hormones (glucocorticoids) and a decrease in the mineralocorticoid fraction.

3. An increase in the content of glucocorticoids causes depression of the thymic-lymphatic system and, as a result, a decrease in immunity, i.e. immunosuppression, and this is a further predisposition to infectious diseases, allergic, autoimmune, and oncological.

Second stage:

1. Continuation of disturbances in the regulation of the autonomic nervous system, namely:

tension appears in the vagoinsular part of the system, which causes unauthorized cell division, tumor growth, and at the same time depletion of the sympatho-adrenal system occurs:

2. Development of stomach and duodenal ulcers, bleeding.

3. Development of chronic vasculitis:

generalized inflammation at the microvascular level with the subsequent process of sclerosis in the vascular wall, impaired microcirculation in tissues and organs and, as a result, impaired trophism with the formation of ulcers, bleeding, etc.

4. The development of type II diabetes mellitus is caused by

damage to the enzymatic system of the pancreas and manifests itself in the late stages of chronic intoxication.

The pancreas (Pancreas) suffers:

Normally, insulin is produced metabolically and proliferatively. When the proliferative insulin fraction begins to predominate, neoplasms begin to grow - polyps, condylomas, etc. Then it is necessary to increase the production of metabolic insulin - this is achieved by the practice of fasting and dosed glucose load.

Pathological processes in the body develop according to certain laws and are devoid of any spontaneity. Sometimes these patterns are almost mathematical in nature.

Some scientists are trying to approach the problems of chronic intoxication at earlier stages of preventing the entry of harmful substances into the human body, which often occurs with the consumption of food and various drinks, such as carbonated drinks or alcohol. Today, there are many different theories and teachings about proper healthy, rational nutrition and each has its own characteristics. One of these teachings is macrobiotics. It arose in Japan under the influence of Eastern philosophical views. The authors of the modern concept are George Osawa and his students Evilin and Michio Kushi and Alex Jack. The essence of the concept is that proteins, fats and carbohydrates consumed with food, when broken down in the body, produce a large amount of various acids, which are endotoxins and pollute the body, which leads to chronic intoxication.

Especially a lot of acids are formed as a result of the breakdown of animal proteins and animal fats, so they are initially classified as acidic foods. Macrobiotic teaching recommends reducing the consumption of such foods. But they recommend eating more alkaline foods of plant origin (grains, vegetables) and using only certain types of cooking.

In contrast to the homotoxicology of G. Reckweg, macrobiotics identifies seven stages of “contamination” of the body.

First stage:

The first symptoms are general fatigue, cervical osteochondrosis.

Second phase:

Added to fatigue headache, aches in joints and muscles. At this stage, all problems can still be corrected with proper nutrition.

Third stage:

The emergence of various allergic diseases. Symptoms appear in the respiratory tract, lungs, gastrointestinal tract, skin, and gynecology.

Fourth stage:

Benign tumors appear - cysts, fibromas, fibromyomas, papillomas, polyps, adenomas, thrombophlebitis.

Fifth stage:

Symptoms of degeneration appear connective tissue– rheumatism, polyarthritis, gout.

Sixth stage:

Symptoms appear from the autonomic nervous system, endocrine glands and central nervous system.

Seventh stage:

The appearance of neoplasms or malignancy of previous processes.

With just a small difference, this scheme and G. Reckeweg’s scheme are very similar to each other. This indicates the truth of the observations and the correctness of the conclusions made by various authors.

Human blood is the aqueous medium of the body. One liter of human blood plasma contains 900-910 g. water, 65-80 gr. protein and 20 gr. low molecular weight compounds. The composition of plasma and interstitial fluid differ significantly only in the concentration of proteins, since their large molecules cannot freely pass through the walls of capillaries, but which remain highly permeable to water and ions.

The acid-base state of human blood is within a fairly narrow range of physiological constants or norms:

Arterial blood – 7.37-7.45;

Venous blood – 7.32-7.42.

Therefore, when we talk about the “acidification” of arterial blood, these indicators remain within the physiological norm between 7.37-7.45, but shift closer to the side – 7.37. Hence, the morpho-functional properties of such blood change: it becomes more viscous, red blood cells (red blood cells that deliver oxygen from the lungs to the tissues) stick together into garlands or “coin columns” and can no longer circulate freely through the bloodstream, penetrate into small microvessels in diameter, enriching tissues with oxygen. This is how tissue hypoxia develops and cells switch from aerobic (in the presence of oxygen) to anaerobic (without oxygen) enzymatic oxidation pathway, i.e. glycolysis In terms of energy, glycolysis is significantly inferior to aerobic oxidation: glycolysis produces 2 molecules of ATP (adenosine triphosphate), and aerobic oxidation produces 34 ATP molecules. ATP is the main source of energy in red blood cells, ensuring that these cells maintain the desired shape and their deformability. If there is not enough ATP, energetic suffering begins in cells, tissues, organs and the entire body.

One red blood cell lives in the blood for an average of 120 days, then it dies. But this is his normal life expectancy normal conditions existence - acid-base state, etc. And if its habitat becomes “acidified,” toxic, aggressive, then the red blood cells die within 120 days. And this is an additional load on the liver, where they are “utilized.”

A prosaic question: will fish live in an aquarium containing stale, sour water? No, they will not do. So red blood cells do not live long in such conditions.

To such premature death of red blood cells, the hematopoietic organs, and in particular Bone marrow and spleen, react with increased production of new red blood cells, which need to be produced in urgently and as quickly as possible. Thus, immature forms of red blood cells may appear in the blood, and then such a patient is referred to an appointment with a hematologist with suspicion of a severe hematological disease.

Where does the answer lie? It is necessary to purify the blood.

It is also noteworthy that the number of patients suffering from chronic diseases has recently increased. In addition, the number of people suffering from various allergic diseases and, most importantly, both of them are difficult to treat and often these diseases are combined together.

The immune system plays the main protective role in the body. The immune system human provides specific protection of the body from genetically foreign molecules and cells, including infectious agents - bacteria, viruses, fungi, protozoa. About 85% of human lymphoid tissue is concentrated in the intestinal wall, where secretory immunoglobulin “A” is produced and B and T lymphocytes are located. The role of the intestinal mucosa is diverse and complex. But from a protection point of view, it plays the role of a barrier, just like the mucous membrane of the respiratory tract. Therefore, scientists pay great attention to the work of the intestinal mucosa.

Problems of “bad” ecology also affect this organ, all of the above environmental factors affect it, including the quality of nutrition - the presence of preservatives, dyes, poor sanitary condition of food, as well as uncontrolled consumption of medications, including antibiotics. All this has led to more and more people talking about some mysterious disease called dysbiosis.

Normally, there are over 500 different types of microbes in the intestines. The upper part of the small intestine is practically sterile, but the number of microorganisms in the intestine increases in the distal direction, i.e. in the direction of the large intestine, where their number reaches 10 14, which is an order of magnitude greater than the total number of cellular composition of the human body. Most of the bacteria in the large intestine are normal, 95-97% are strict anaerobes Bifidus and Bacteroides (gram-positive and gram-negative bacteria that do not form spores). Aerobic bacteria E. coli, enterococci and lactobacilli make up 1-2% of the total number of bacteria in the large intestine, fungi and proteus - less than 1%. Escherichia coli, enterococci, bifidobacteria and acidophilus bacilli are capable of suppressing the growth of pathogenic microorganisms under conditions of a normally functioning intestine. Toxic products that can be produced as a result of human activity and microorganisms are excreted in feces and urine and should not normally have an effect on the body.

The gastrointestinal tract is designed to digest food eaten, absorb all the nutrients necessary for the body and remove waste material - waste. This means that everything we eat plays a big role in maintaining the body’s vital functions and metabolism. Therefore, nutritionists always pay attention to the fact that nutrition must be properly balanced and consist of proteins, fats and carbohydrates. Carbohydrates can be divided into quickly digestible and slowly digestible. Quickly digestible products include refined products - sugar, starch, white flour, etc., they are considered harmful because. sharply increase the level of glucose (sugar) in the blood, increase appetite and “acidify” the body. Moreover, white flour contains the substance gluten (Latin for “glue”) in the form of gluten, which is of great importance in baking industry and its high content in wheat flour is a criterion for the quality of flour. This gluten (gluten), under certain conditions, can destroy the villi of the small intestine, which can lead to disruption of absorption processes and the development of diseases. This phenomenon can also be hereditary in nature - so-called celiac disease, which is a complete intolerance to gluten. This disease requires a lifelong diet with the complete exclusion of all foods containing gluten.

But slowly digestible carbohydrates are considered healthy - these are cereals, vegetables, fruits and especially their coarse fiber part - fiber. This is a substance that is not broken down by pancreatic and bile enzymes, but is broken down intestinal bacteria. Anaerobic bacteria break down plant fibers into short-chain fibers fatty acids, which are very useful for the intestines, they improve the trophism of the mucous membrane and the energy state of its structures, including lymphoid tissue, and therefore immunity. Coarse fibers are mechanically cleaned gastrointestinal tract and enhance its activity, which as a result has a beneficial effect on almost all digestive disorders and is an integral part of a healthy diet.

If the conditions for a healthy diet are not met or due to any other of the above environmental reasons, the biocenosis (a certain ratio of microorganisms) in the intestine may be disrupted and then dysbiosis will begin to develop - qualitative and quantitative changes in the normal bacterial microflora of the intestine. As a result, the protective function of the mucous membrane is disrupted, the permeability of the intestinal barrier changes, and intestinal microflora and toxins enter the blood. This condition corresponds to the decompensated stage of dysbiosis, is accompanied by inflammation and manifests itself in certain clinical symptoms and is very clearly visible during microscopic examination of a living drop of blood.

Blood is the medium of the body that, like a mirror, is capable of reflecting all the processes occurring in the body. It is believed that blood consists of plasma, blood cells and substances dissolved in it. Two were made everywhere clinical studies– general blood test (quantitative) and biochemical analysis blood (quality). Recently, scientific research in this direction has moved forward and another fairly informative method of blood research has appeared to help doctors - hemoscanning of a living drop of blood in order to determine its morpho-functional state.

This method allows you to:

1. Determine the mobility of red blood cells in the blood: how they move in the plasma,

Loosely or glued together into garlands - “coin columns” or form

Slag phenomen , literally “slag phenomenon”.

Based on the mobility of red blood cells, one can draw conclusions about its acidification or slagging.

2. Assume the degree of dehydration of the body (in parallel with questioning the patient about his water and drinking regime).

3. Determine the degree of hypoxemia in the blood:

The acid-base balance is normal, blood oxygen saturation (blood oxygenation) is up to 100%.

Red blood cell aggregation - blood oxygenation is reduced by 10-15%.

- “coin columns” – blood oxygenation is reduced by 25-30%.

Slag phenomen – blood oxygenation is reduced by 45-50%.

4. Assume the degree of hypoxia in the tissues (questioning the patient - complaints, medical history).

5. Visually determine the quality of erythrocytes, leukocytes, platelets.

6. Determine the presence of chronic intoxication.

7. Determine the state of the immune system.

8. Determine the degree of blood viscosity by the rate of fibrin spicule loss in plasma.

9. Determine the state of metabolic processes - protein, fat, carbohydrate.

10. Determine the presence of enzymopathies and salt crystalloids in the blood.

12. Determine the degree of cancer susceptibility.

This method also allows you to monitor the development of any processes in the blood over time, adjust the correctness of treatment, determine the speed and effectiveness of the effects of medications; evaluate the effects on the body of other treatments or any other influence.

This diagnostic method has been used for many years in Europe and America.

Thus, summarizing all of the above and based on modern theories chronic intoxication, several reasons for the development of pathology in the body can be identified:

1. Dysfunction of the body’s drainage systems, and, as a result, aggression acidic foods metabolism in the body's environments and the development of chronic intoxication.

2. Chronic intoxication of the central nervous system and disruption of neuroendocrine regulation of homeostasis.

3. Development of enzymatic deficiency and disruption of all types of metabolism.

4. Immunosuppression.

Measures for the prevention and treatment of chronic intoxication should pursue two goals: firstly, to prevent further entry of toxins into the body, and secondly, to eliminate existing intoxication.

This can be represented schematically like this:

Adverse environmental factors - prevention of their entry into the body:	HUMAN	Drainage systems of the body and their cleansing (therapy):
With food With water With air Chem. Connections Radiation Stress Viruses, bacteria, fungi		Blood Lymphatic system Gastrointestinal tract Liver + gallbladder Leather Kidneys Respiratory system

In a healthy person, drainage systems work 100%. But this is the ideal option. In modern environmental conditions and with increasing biological age of a person, the body’s ability to cleanse itself decreases, and then it needs additional measures to cleanse the body of toxins and preventive protection body from toxins.

Scientific ideas created over the years, today, more than ever, find their confirmation in the logical chain of these mutually influencing concepts:

Ecology of the environment – human organism –blood – intercellular space – cells – intercellular space – lymph – blood – human organism – environmental ecology.

But is it possible today, in the current conditions for the survival of all living things, not to say anything about the most important thing: the state of the biofield and subtle bodies of man? There are people who completely deny the existence of such, but there are people who admit it. They recognize themselves as a separate energy system, which is, nevertheless, part of the whole energy space. And if you think about what has been said, then the influence of the environment cannot affect only the physical conductor, it will also spread to the subtle bodies of a person. Therefore, they, just like the body, need to be prevented and cleansed from harmful energy influences: these can be any energy influences produced by people themselves - most often these are negative emotions and thought forms that pollute the corresponding subtle bodies, but they can also be targeted sending negative charges - “evil eye”, “spoilage”, “love spell”, “lapel”. But in our civilized society, most often this is the energy impact of harmful radiation: electrosmog, radiation, geopathogenic radiation of the earth, which is additionally superimposed on the unfavorable environmental energy background. And then the question arises: what to do? And the answer lies in a simple one: you need to protect and cleanse the biofield. Return to the beginning of the article and read the epigraph again. These are not empty words, this is the truth, which may not yet be clear to everyone. But it is precisely behind these words - the purification of subtle bodies - that lies the future of humanity.

Spiritual and religious cleansing can work wonders and produces a very good cleansing effect, but, unfortunately, it cannot help protect against harmful radiation and, therefore, it will again destroy the human biofield.

Prevention of “pollution” and cleansing of the subtle bodies – etheric, emotional and metallic – is a necessity today, which cannot be ignored today and which can be an unforgivable negligence towards the human body. Although there are such irresponsible “comrades” who strive to wishful thinking and dissuade everyone from the safety of at least mobile phones. And where are they leading everyone? To even greater consumption of electrosmog in all its modern forms.

Why, you ask, cleanse the subtle bodies? Yes, to be healthy.

In this case, the above diagram should look like this:

Ecology of the environment –human body + BIOFIELD (subtle bodies)–environmental ecology.

As mentioned above, in the human body it is water that is the necessary nutrient medium for cells, a universal solvent and a vehicle for the transfer of dissolved substances. For effective cleaning The body needs to perform three tasks: improve humoral transport in the intercellular space - interstitium (IGT), improve lymphatic drainage (LD) and cleanse the blood. Nature was concerned about this before people and created the necessary medicinal herbs for this purpose, which can be used to cleanse the body’s drainage systems:

1. Brown rosehip: 100 gr. infusion of fruits 2 times a day after meals - affects IHT, LD, affects the myocardium, intestines, liver, muscles.

2. Badan: 1 tbsp. a spoonful of crushed roots per 1 cup of boiling water; take 1 tbsp. spoon 2 times a day – affects IHT.

3. Lingonberries: 100g. decoction 2 times a day - cleanses blood vessels, choleretic.

4. Ivan tea: 1 tbsp. a spoonful of leaves and flowers in 0.5 cups of boiling water; leave for 12 hours in a thermos, take 100 g. 2 times a day – cleanses lymph.

5. Calendula: 100g. infusion of flowers 2 times a day – enhances LD, immunomodulator.

6. Dandelion: 1 tbsp. spoon of crushed roots per 1 cup of boiling water, take 100 g. 1 time a day before meals, 7 days – blood cleansing.

7. Parsley: 2 tbsp. spoons of root decoction 2 times a day, cleanses the kidneys and gynecology.

8. Wormwood: grind dried leaves and shoots into powder, pour a pinch of powder into 0.5 cups of boiling water, leave for 10 seconds and drink in small sips. A very good product for cleansing the blood and gastrointestinal tract.

9. Black currant: 100g. decoction of leaves or fruits 2 times a day - cleanses the liver, myocardium, blood and lymphatic vessels.

Take all infusions for 21 days, unless there are special instructions in the text!

Pharmaceutical drugs to improve IHT and LD:

1. Ginkgo Biloba leaf extract.

2. Glycyrrhiza roots.

3. Detralex.

1. Various plant bitters.

2. Garlic preparations.

3. Paudarka - ant tree bark

4. Black (walnut) leaves.

In advanced cases, pharmaceutical chemicals should be taken under medical supervision.

Plan preventive measures:

1. Sufficient daily consumption of good purified, drinking, still water. Healthy body should consume up to 1.5-2 liters of water per day.

2. Wearing a protective device such as ATOX or QUINTESS , or water stickers (see information on the website) to cleanse the subtle bodies of the biofield.

3. Healthy image life and proper healthy eating.

4. Blood purification once a year.

5. Cleaning the gastrointestinal tract - 2 times a year.

7. Liver cleansing once a year.

1. Elimination of etiological factors of chronic bronchitis.
2. Inpatient treatment and bed rest for certain indications.
3. Medical nutrition.
4. Antibacterial therapy during exacerbation of purulent chronic bronchitis, including methods of endobronchial administration of drugs.
5. Improving the drainage function of the bronchi: expectorants, bronchodilators, positional drainage, chest massage, herbal medicine, heparin therapy, calcitrin treatment.
6. Detoxification therapy during exacerbation of purulent bronchitis.
7. Correction of respiratory failure: long-term low-flow oxygen therapy, hyperbaric oxygenation, extracorporeal membrane blood oxygenation, humidified oxygen inhalation.
8. Treatment of pulmonary hypertension in patients with chronic obstructive bronchitis.
9. Immunomodulatory therapy and improvement of the function of the local bronchopulmonary defense system.
10. Increased nonspecific resistance of the body.
11. Physiotherapy, exercise therapy, breathing exercises, massage.
12. Spa treatment.

Elimination of etiological factors

Elimination of etiological factors of chronic bronchitis largely slows down the progression of the disease, prevents exacerbation of the disease and the development of complications.

First of all, you must categorically stop smoking. Great importance is attached to the elimination of occupational hazards (various types of dust, fumes of acids, alkalis, etc.), thorough sanitation of foci of chronic infection (in ENT organs, etc.). It is very important to create an optimal microclimate in the workplace and at home.

In the case of a pronounced dependence of the onset of the disease and its subsequent exacerbations on unfavorable weather conditions, it is advisable to move to a region with a favorable dry and warm climate.

Patients with the development of local bronchiectasis are often indicated for surgical treatment. Elimination of the focus of purulent infection reduces the frequency of exacerbations of chronic bronchitis.

Inpatient treatment of chronic bronchitis and bed rest

Inpatient treatment and bed rest are indicated only for certain groups of patients in the presence of the following conditions:

• severe exacerbation of chronic bronchitis with increasing respiratory failure, despite active outpatient treatment;
• development of acute respiratory failure;
• acute pneumonia or spontaneous pneumothorax;
• manifestation or worsening of right ventricular failure;
• the need for certain diagnostic and therapeutic procedures (in particular, bronchoscopy);
• the need for surgical intervention;
• significant intoxication and severe deterioration general condition patients with purulent bronchitis.

The rest of the patients with chronic bronchitis undergo outpatient treatment.

Therapeutic nutrition for chronic bronchitis

In chronic bronchitis with the release of large amounts of sputum, protein loss occurs, and in decompensated cor pulmonale, there is an increased loss of albumin from vascular bed into the intestinal lumen. These patients are prescribed a protein-enriched diet, as well as intravenous drip transfusion of albumin and amino acid preparations (polyamine, neframin, alvesin).

For decompensated cor pulmonale, diet No. 10 is prescribed with restriction energy value, salts and liquids and increased (potassium content.

With severe hypercapnia, a carbohydrate load can cause acute respiratory acidosis due to increased formation of carbon dioxide and reduced sensitivity of the respiratory center. In this case, it is suggested to use a hypocaloric diet of 600 kcal with carbohydrate restriction (30 g carbohydrates, 35 g protein, 35 g fat) for 2-8 weeks. Positive results noted in patients with excess and normal body weight. Subsequently, a diet of 800 kcal per day is prescribed. Dietary treatment for chronic hypercapnia appears to be quite effective.

Antibiotics for chronic bronchitis

Antibacterial therapy is carried out during the period of exacerbation of purulent chronic bronchitis for 7-10 days (sometimes with severe and prolonged exacerbation for 14 days). In addition, antibacterial therapy is prescribed for the development of acute pneumonia against the background of chronic bronchitis.

When choosing an antibacterial agent, the effectiveness of previous therapy is also taken into account. Criteria for the effectiveness of antibacterial therapy during an exacerbation:

• positive clinical dynamics;
• mucous nature of sputum;

reduction and disappearance of indicators of an active infectious-inflammatory process (normalization of ESR, leukocyte count, biochemical indicators of inflammation).

For chronic bronchitis, the following groups can be used: antibacterial agents: antibiotics, sulfonamides, nitrofurans, trichopolum (metronidazole), antiseptics (dioxidin), phytoncides.

Antibacterial drugs can be prescribed in the form of aerosols, orally, parenterally, endotracheally and endobronchially. The last two methods of using antibacterial drugs are the most effective, as they allow the antibacterial substance to penetrate directly into the site of inflammation.

Antibiotics are prescribed taking into account the sensitivity of the sputum flora to them (sputum must be examined using the Mulder method or sputum obtained during bronchoscopy should be examined for flora and sensitivity to antibiotics). To prescribe antibiotic therapy until results are available bacteriological research Sputum microscopy with Gram stain is useful. Typically, an exacerbation of the infectious-inflammatory process in the bronchi is caused not by one infectious agent, but by an association of microbes, often resistant to most drugs. Often the pathogens include gram-negative flora and mycoplasma infection.

The correct choice of antibiotic for chronic bronchitis is determined by the following factors:

• microbial spectrum of infection;
• sensitivity of the infectious pathogen to infection;
• distribution and penetration of the antibiotic into sputum, the bronchial mucosa, bronchial glands, and lung parenchyma;
• cytokinetics, i.e. the ability of the drug to accumulate inside the cell (this is important for the treatment of infections caused by “intracellular infectious agents” - chlamydia, legionella).

Yu. B. Belousov et al. (1996) provide the following data on the etiology of acute and exacerbation of chronic bronchitis:

• Haemophilus influenzae 50%
• Streptococcus pneumoniae 14%
• Pseudomonas aeruginosas 14%
• Moraxella (Neiseria or Branhamella) catarrhalis 17%
• Staphylococcus aureus 2%
• Other 3%

According to Yu. Novikov (1995), the main pathogens during exacerbation of chronic bronchitis are:

• Streptococcus pneumoniae 30.7%
• Haemophilus influenzae 21%
• Str. haemolitjcus 11%
• Staphylococcus aureus 13.4%
• Pseudomonas aeruginosae 5%
• Mycoplasma 4.9%
• Unidentified pathogen 14%

Quite often, in chronic bronchitis, a mixed infection is detected: Moraxella catairhalis + Haemophilus influenzae.

According to 3. V. Bulatova (1980) specific gravity mixed infections in exacerbation of chronic bronchitis are as follows:

• microbes and mycoplasma - in 31% of cases;
• germs and viruses - in 21% of cases;
• microbes, imicoplasma viruses - in 11% of cases.

Infectious agents secrete toxins (for example, N. influenzae - peptidoglycans, lipooligosaccharides; Str. pneumoniae - pneumolysin; P. aeruginosae - pyocyanin, rhamnolipids), which damage the ciliated epithelium, slow down ciliary fluctuations and even cause death of the bronchial epithelium.

When prescribing antibacterial therapy after identifying the type of pathogen, the following circumstances are taken into account.

H. influenzae is resistant to beta-lacgam antibiotics (penicillin and ampicillin), which is due to the production of the TEM-1 enzyme, which destroys these antibiotics. Inactive against N. influenzae and erythromycin.

Recently, a significant spread of Str. strains has been reported. pneumoniae, resistant to penicillin and many other beta-lactam antibiotics, macrolides, and tetracycline.

M. catarrhal is a normal saprophytic flora, but quite often it can cause exacerbation of chronic bronchitis. A feature of Moraxella is its high ability of adhesion to oropharyngeal cells, and this is especially typical for people over the age of 65 with chronic obstructive bronchitis. Moraxella most often causes exacerbation of chronic bronchitis in areas with high air pollution (metallurgical and coal industry). Approximately 80% of Moraxella strains produce beta-lactamases. Combined preparations of ampicillin and amoxicillin with clavulanic acid and sulbactam are not always active against beta-lactamase-producing strains of moraxella. This pathogen is sensitive to Septrim, Bactrim, Biseptol, and is also highly sensitive to 4-fluoroquinolones and erythromycin (however, 15% of Moraxella strains are not sensitive to it).

For a mixed infection (Moraxella + Haemophilus influenzae) that produces β-lactamases, ampicillin, amoxicillin, and cephalosporins (ceftriaxone, cefuroxime, cefaclor) may not be effective.

When choosing an antibiotic in patients with exacerbation of chronic bronchitis, you can use the recommendations of P. Wilson (1992). He proposes to distinguish the following groups of patients and, accordingly, groups of antibiotics.

• Group 1 - Previously healthy individuals with post-viral bronchitis. These patients, as a rule, have viscous purulent sputum; antibiotics do not penetrate well into the bronchial mucosa. This group of patients should be recommended to drink plenty of fluids, expectorants, and herbal mixtures that have bactericidal properties. However, if there is no effect, antibiotics amoxicillin, ampicillin, erythromycin and other macrolides, tetracyclines (doxycycline) are used.
• Group 2 - Patients with chronic bronchitis, smokers. These include the same recommendations as for people in group 1.
• Group 3 - Patients with chronic bronchitis with concomitant severe somatic diseases and a high probability of having resistant forms of pathogens (Moraxella, Haemophilus influenzae). This group is recommended beta-lactamase-resistant cephalosporins (cefaclor, cefixime), fluoroquinolones (ciprofloxacin, ofloxacin, etc.), amoxicillin with clavulanic acid.
• Group 4 - Patients with chronic bronchitis with bronchiectasis or chronic pneumonia, producing purulent sputum. The same drugs are used that were recommended for patients in group 3, as well as ampicillin in combination with sulbactam. In addition, active drainage therapy and physiotherapy are recommended. In bronchiectasis, the most common pathogen found in the bronchi is Haemophylus influenzae.

In many patients with chronic bronchitis, exacerbation of the disease is caused by chlamydia, legionella, and mycoplasma.

In these cases, macrolides are highly active and, to a lesser extent, doxycycline. Special attention highly effective macrolides ozithromycin (sumamed) and roxithromycin (rulid), rovamycin (spiramycin) deserve. After oral administration, these drugs penetrate well into the bronchial system, remain in tissues for a long time in sufficient concentration, and accumulate in polymorphonuclear neutrophils and alveolar macrophages. Phagocytes deliver these drugs to the site of the infectious and inflammatory process. Roxithromycin (rulid) is prescribed 150 mg 2 times a day, azithromycin (sumamed) - 250 mg 1 time a day, rovamycin (spiramycin) - 3 million IU 3 times a day orally. The duration of the course of treatment is 5-7 days.

When prescribing antibiotics, individual tolerance to the drugs should be taken into account, this especially applies to penicillin (it should not be prescribed for severe bronchospastic syndrome).

Antibiotics in aerosols are currently rarely used (an antibiotic aerosol can provoke bronchospasm, and in addition, the effect of this method is not great). Antibiotics are most often used orally and parenterally.

When identifying gram-positive coccal flora, the most effective is the administration of semi-synthetic penicillins, mainly combined (ampiox 0.5 g 4 times a day intramuscularly or orally), or cephalosporins (kefzol, cephalexin, claforan 1 g 2 times a day intramuscularly), with gram-negative coccal flora - aminoglycosides (gentamicin 0.08 g 2 times a day intramuscularly or amikacin 0.2 g 2 times a day intramuscularly), carbenicillin (1 g intramuscularly 4 times a day) or the latest generation cephalosporins (fortum 1 g 3 times a day intramuscularly).

Antibiotics may be effective in some cases wide range actions macrolides (erythromycin 0.5 g 4 times a day orally, oleandomycin 0.5 g 4 times a day orally or intramuscularly, ericycline - a combination of erythromycin and tetracycline - in capsules 0.25 g, 2 capsules 4 times a day orally), tetracyclines, especially long-acting (methacycline or rondomycin 0.3 g 2 times a day orally, doxycycline or vibramycin capsules 0.1 g 2 times a day orally).

Thus, according to modern concepts, first-line drugs for the treatment of exacerbation of chronic bronchitis are ampicillin (amoxicillin), including in combination with beta-lactamase inhibitors (clavulanic acid augmentin, amoxiclav or sulbactam unasin, sulacillin), oral cephalosporins of the second or third generation , fluoroquinolone drugs. If you suspect the role of mycoplasmas, chlamydia, legionella in exacerbation of chronic bronchitis, it is advisable to use macrolide antibiotics (especially azithromycin - sumamed, roxithromycin - rulide) or tetracyclines (doxycycline, etc.). It's also possible combined use macrolides and tetracyclines.

Sulfonamide drugs for chronic bronchitis

Sulfonamide drugs are widely used for exacerbation of chronic bronchitis. They have chemotherapeutic activity against gram-positive and non-negative flora. Long-acting medications are usually prescribed.

Biseptol in tablets of 0.48 g. Prescribed orally, 2 tablets 2 times a day.

Sulfatone in tablets of 0.35 g. On the first day, 2 tablets are prescribed in the morning and evening, on subsequent days, 1 tablet in the morning and evening.

Sulfamonomethoxine in tablets of 0.5 g. On the first day, 1 g is prescribed in the morning and evening, on subsequent days 0.5 g in the morning and evening.

Sulfadimethoxine is prescribed in the same way as sulfamonomethoxine.

Recently, the negative effect of sulfonamides on the function of ciliated epithelium.

Nitrofuran drugs

Nitrofuran drugs have a wide spectrum of action. Preferably furazolidone is prescribed 0.15 g 4 times a day after meals. Metronidazole (Trichopolum), a broad-spectrum drug, can also be used in tablets of 0.25 g 4 times a day.

Antiseptics

Among broad-spectrum antiseptics, dioxidin and furatsilin deserve the greatest attention.

Dioxidin (0.5% solution of 10 and 20 ml for intravenous administration, 1% solution in ampoules of 10 ml for abdominal and endobronchial administration) is a drug with broad antibacterial action. Slowly inject intravenously 10 ml of a 0.5% solution in 10-20 ml of isotonic sodium chloride solution. Dioxidin is also widely used in the form of aerosol inhalations - 10 ml of a 1% solution per inhalation.

Phytoncidal preparations

Phytoncides include chlorophyllipt, a preparation made from eucalyptus leaves that has a pronounced antistaphylococcal effect. A 1% alcohol solution is used internally, 25 drops 3 times a day. You can administer intravenously slowly 2 ml of a 0.25% solution in 38 ml of sterile isotonic sodium chloride solution.

Garlic (in inhalation) or for oral administration also belongs to phytoncides.

Endobronchial sanitation

Endobronchial sanitation is performed by endotracheal infusions and fibrobronchoscopy. Endotracheal infusions using a laryngeal syringe or rubber catheter are the simplest method of endobronchial sanitation. The number of infusions is determined by the effectiveness of the procedure, the amount of sputum and the severity of its suppuration. Usually, 30-50 ml of isotonic sodium chloride solution heated to 37 °C is first poured into the trachea. After coughing up sputum, antiseptics are administered:

• furatsilin solution 1:5000 - in small portions of 3-5 ml during inhalation (total 50-150 ml);
• dioxidine solution - 0.5% solution;
• Kalanchoe juice diluted 1:2;
• in the presence of bronchoecgases, 3-5 ml of antibiotic solution can be administered.

Fibrobronchoscopy under local anesthesia is also effective. To sanitize the bronchial tree, the following are used: furatsilin solution 1:5000; 0.1% furagin solution; 1% solution of rivanol; 1% solution of chlorophyllipt in a 1:1 dilution; dimexide solution.

Aerosoltherapy

Aerosol therapy with phytoncides and antiseptics can be performed using ultrasonic inhalers. They create homogeneous aerosols with optimal particle sizes that penetrate to the peripheral parts of the bronchial tree. The use of drugs in the form of aerosols ensures their high local concentration and uniform distribution of the drug in the bronchial tree. Using aerosols, you can inhale the antiseptics furatsilin, rivanol, chlorophyllipt, onion or garlic juice (diluted with a 0.25% novocaine solution in a ratio of 1:30), fir infusion, lingonberry leaf condensate, dioxidine. After aerosol therapy, postural drainage and vibration massage are performed.

In recent years, the aerosol drug bioparoxocobtal has been recommended for the treatment of chronic bronchitis. It contains one active component, fusanfungin, a drug of fungal origin that has antibacterial and anti-inflammatory effects. Fusanfungin is active against predominantly gram-positive cocci (staphylococci, streptococci, pneumococci), as well as intracellular microorganisms (mycoplasma, legionella). In addition, it has antifungal activity. According to White (1983), the anti-inflammatory effect of fusanfungin is associated with the suppression of the production of oxygen radicals by macrophages. Bioparox is used in the form of dosed inhalations - 4 breaths every 4 hours for 8-10 days.

Improving the drainage function of the bronchi

Restoring or improving the drainage function of the bronchi is of great importance, as it contributes to the onset of clinical remission. In patients with chronic bronchitis, the number of mucus-forming cells and sputum in the bronchi increases, its character changes, it becomes more viscous and thick. A large amount of sputum and an increase in its viscosity disrupts the drainage function of the bronchi, ventilation-perfusion relationships, and reduces the activity of the local bronchopulmonary defense system, including local immunological processes.

To improve the drainage function of the bronchi, expectorants, postural drainage, bronchodilators (in the presence of bronchospastic syndrome), and massage are used.

Expectorants, herbal medicine

According to the definition of B.E. Votchal, expectorants are substances that change the properties of sputum and facilitate its discharge.

There is no generally accepted classification of expectorants. It is advisable to classify them according to their mechanism of action (V. G. Kukes, 1991).

Classification of expectorants

1. Remedies for expectoration:
   • drugs that act reflexively;
   • resorptive drugs.
2. Mucolytic (or secretolytic) drugs:
   • proteolytic drugs;
   • derivatives of amino acids with an SH group;
   • mucoregulators.
3. Mucus secretion rehydrators.

Sputum consists of bronchial secretions and saliva. Normally, bronchial mucus has the following composition:

• water with sodium, chlorine, phosphorus, calcium ions dissolved in it (89-95%); The consistency of sputum depends on the water content; the liquid part of sputum is necessary for the normal functioning of mucociliary transport;
• insoluble macromolecular compounds (high and low molecular weight, neutral and acidic glycoproteins - mucins), which determine the viscous nature of the secretion - 2-3%;
• complex plasma proteins - albumins, plasma glycoproteins, immunoglobulins of classes A, G, E;
• antiproteolytic enzymes - 1-antichymotrilsin, 1-a-antitrypsin;
• lipids (0.3-0.5%) - surfactant phospholipids from alveoli and bronchioles, glycerides, cholesterol, free fatty acids.

Bronchodilators for chronic bronchitis

Bronchodilators are used for chronic obstructive bronchitis.

Chronic obstructive bronchitis is a chronic diffuse non-allergic inflammation of the bronchi, leading to a progressive impairment of pulmonary ventilation and gas exchange of the obstructive type and manifested by cough, shortness of breath and sputum production, not associated with damage to other organs and systems (Consensus on chronic obstructive bronchitis of the Russian Congress of Pulmonologists, 1995) . As chronic obstructive bronchitis progresses, pulmonary emphysema forms, among the reasons for this are exhaustion and impaired production of protease inhibitors.

The main mechanisms of bronchial obstruction:

• bronchospasm;
• inflammatory edema, infiltration of the bronchial wall during exacerbation of the disease;
• hypertrophy of the bronchial muscles;
• hypercrinia (increase in the amount of sputum) and discrinia (change in the rheological properties of sputum, it becomes viscous, thick);
• collapse of small bronchi during exhalation due to a decrease in the elastic properties of the lungs;
• fibrosis of the bronchial wall, obliteration of their lumen.

Bronchodilators improve bronchial patency by eliminating bronchospasm. In addition, methylxanthines and beta2-agonists stimulate the function of the ciliated epithelium and increase sputum production.

Bronchodilators are prescribed taking into account the daily rhythms of bronchial patency. Sympathomimetic agents (beta-adrenergic receptor stimulants), anticholinergic drugs, purine derivatives (phosphodiesterase inhibitors) - methylxanthines - are used as bronchodilators.

Sympathomimetic drugs stimulate beta-adrenergic receptors, which leads to an increase in adenyl cyclase activity, the accumulation of cAMP and then a bronchodilator effect. Use ephedrine (stimulates beta-adrenergic receptors, which provides bronchodilation, as well as alpha-adrenergic receptors, which reduces swelling of the bronchial mucosa) 0.025 g 2-3 times a day, the combination drug theophedrine 1/2 tablet 2-3 times a day, broncholithin (combined preparation, 125 g of which contains glaucine 0.125 g, ephedrine 0.1 g, sage oil and citric acid 0.125 g each) 1 tablespoon 4 times a day. Broncholithin causes a bronchodilator, antitussive and expectorant effect.

It is especially important to prescribe ephedrine, theophedrine, and broncholithin in the early morning hours, since this is the time when bronchial obstruction peaks.

When treated with these drugs, side effects associated with stimulation of both beta1 (tachycardia, extrasystole) and alpha-adrenergic receptors (arterial hypertension) are possible.

In this regard, the greatest attention is paid to selective beta2-adrenergic stimulants (selectively stimulate beta2-adrenergic receptors and have virtually no effect on beta1-adrenergic receptors). Typically used are Solbutamol, Terbutaline, Ventolin, Berotec, and also partially the beta2-selective stimulant Asthmopent. These drugs are used in the form of metered aerosols, 1-2 puffs 4 times a day.

With long-term use of beta-adrenergic receptor stimulants, tachyphylaxis develops - a decrease in the sensitivity of the bronchi to them and a decrease in the effect, which is explained by a decrease in the number of beta2-adrenergic receptors on the membranes of the smooth muscles of the bronchi.

In recent years, long-acting beta2-adrenergic stimulants have begun to be used (duration of action is about 12 hours) - salmeterol, formaterol in the form of metered aerosols 1-2 puffs 2 times a day, spiropent 0.02 mg 2 times a day orally. These drugs are less likely to cause tachyphylaxis.

Purine derivatives (methylxanthines) inhibit phosphodiesterase (this promotes the accumulation of cAMP) and bronchial adenosine receptors, which causes bronchodilation.

In case of severe bronchial obstruction, euphylline is prescribed 10 ml of a 2.4% solution in 10 ml of isotonic sodium chloride solution intravenously very slowly, intravenously by drip to prolong its action - 10 ml of 2.4% solution of euphylline in 300 ml of isotonic sodium chloride solution.

For chronic bronchial obstruction, you can use aminophylline preparations in tablets of 0.15 g 3-4 times a day orally after meals or in the form of alcohol solutions, which are better absorbed (eufillin - 5 g, ethyl alcohol 70% - 60 g, distilled water - up to 300 ml, take 1-2 tablespoons 3-4 times a day).

Of particular interest are extended-release theophylline preparations, which act for 12 hours (taken 2 times a day) or 24 hours (taken once a day). Theodur, teolong, teobilong, theotard are prescribed 0.3 g 2 times a day. Uniphylline ensures a uniform level of theophylline in the blood throughout the day and is prescribed 0.4 g 1 time per day.

In addition to the bronchodilator effect, extended-release theophyllines for bronchial obstruction also cause the following effects:

• reduce pressure in the pulmonary artery;
• stimulate mucociliary clearance;
• improve the contractility of the diaphragm and other respiratory muscles;
• stimulate the release of glucocorticoids by the adrenal glands;
• have a diuretic effect.

The average daily dose of theophylline for non-smokers is 800 mg, for smokers - 1100 mg. If the patient has not previously taken theophylline preparations, then treatment should be started with smaller doses, gradually (after 2-3 days) increasing them.

Anticholinergic drugs

Peripheral M-anticholinergics are used; they block acetylcholine receptors and thereby promote bronchodilation. Preference is given to inhaled forms of anticholinergics.

Arguments in favor of wider use of anticholinergics in chronic obstructive bronchitis are the following circumstances:

• anticholinergics cause bronchodilation to the same extent as beta2-adrenergic receptor stimulants, and sometimes even more pronounced;
• the effectiveness of anticholinergics does not decrease even with prolonged use;
• with increasing age of the patient, as well as with the development of pulmonary emphysema, the number of beta2-adrenergic receptors in the bronchi progressively decreases and, consequently, the effectiveness of beta2-adrenergic receptor stimulants decreases, and the sensitivity of the bronchi to the bronchodilatory effect of anticholinergics remains.

Ipratropium bromide (Atrovent) is used - in the form of a dosed aerosol 1-2 breaths 3 times a day, oxytropium bromide (oxyvent, ventilate) - a long-acting anticholinergic, prescribed in a dose of 1-2 breaths 2 times a day (usually in the morning and before bedtime) , if there is no effect - 3 times a day. Preparations are practically devoid side effects. They exhibit a bronchodilator effect after 30-90 minutes and are not intended to relieve an attack of suffocation.

Anticholinergics can be prescribed (in the absence of a bronchodilator effect) in combination with beta2-agonists. The combination of Atrovent with the beta2-adrenergic stimulant fenoterol (Berotec) is produced in the form of a dosed aerosol of Berodual, which is used in 1-2 doses (1-2 puffs) 3-4 times a day. The simultaneous use of anticholinergics and beta2-agonists enhances the effectiveness of bronchodilator therapy.

In case of chronic obstructive bronchitis, it is necessary to individually select basic therapy with bronchodilator drugs in accordance with the following principles:

• achieving maximum bronchodilation throughout the entire day, basic therapy is selected taking into account the circadian rhythms of bronchial obstruction;
• when selecting basic therapy are guided by both subjective and objective criteria for the effectiveness of bronchodilators: forced expiratory volume in 1 s or peak expiratory flow in l/min (measured using an individual peak flow meter);

With moderately severe bronchial obstruction, bronchial obstruction can be improved with the combination drug theophedrine (which, along with other components, includes theophylline, belladonna, ephedrine) 1/2, 1 tablet 3 times a day or by taking powders of the following composition: ephedrine 0.025 g, platifimine 0.003 g, aminophylline 0.15 g, papaverine 0.04 g (1 powder 3-4 times a day).

The first-line drugs are ipratrotum bromide (Atrovent) or oxytropium bromide; if there is no effect from treatment with inhaled anticholinergics, beta2-adrenergic receptor stimulants (fenoterol, salbutamol, etc.) are added or the combination drug berodual is used. In the future, if there is no effect, it is recommended to sequentially add prolonged theophyllines to the previous steps, then inhaled forms of glucocorticoids (inhacort (flunisolide hemihydrate) is the most effective and safe), in its absence, becotide is used, and, finally, if the previous stages of treatment are ineffective, short courses of oral glucocorticoids are used. O. V. Alexandrov and Z. V. Vorobyova (1996) consider the following scheme effective: prednisolone is prescribed with a gradual increase in dose to 10-15 mg over 3 days, then the achieved dose is used for 5 days, then it is gradually reduced over 3-5 days Before the stage of prescribing glucocorticoids, it is advisable to add anti-inflammatory drugs (Intal, Tailed) to bronchodilators, which reduce swelling of the bronchial wall and bronchial obstruction.

The administration of glucocorticoids orally is, of course, undesirable, but in cases of severe bronchial obstruction in the absence of effect from the above bronchodilator therapy, it may be necessary to use them.

In these cases, it is preferable to use drugs short acting, i.e. prednisolone, urbazone, try to use small daily doses (3-4 tablets per day) for a short time (7-10 days), with a subsequent transition to maintenance doses, which are advisable to prescribe in the morning in an intermittent manner (double the maintenance dose every other day). Part of the maintenance dose can be replaced by inhalation of Becotide, Ingacort.

It is advisable to carry out differentiated treatment of chronic obstructive bronchitis depending on the degree of dysfunction of external respiration.

There are three degrees of severity of chronic obstructive bronchitis depending on the forced expiratory volume in the first second (FEV1):

• mild - FEV1 is equal to or less than 70%;
• average - FEV1 within 50-69%;
• severe - FEV1 less than 50%.

Positional drainage

Positional (postural) drainage is the use of a certain body position for better discharge of sputum. Positional drainage is performed in patients with chronic bronchitis (especially when purulent forms) when the cough reflex is reduced or the sputum is too viscous. It is also recommended after endotracheal infusions or administration of expectorants in aerosol form.

It is performed 2 times a day (morning and evening, but it can be done more often) after preliminary intake of bronchodilators and expectorants (usually infusion of thermopsis, coltsfoot, wild rosemary, plantain), as well as hot linden tea. 20-30 minutes after this, the patient alternately takes positions that promote maximum emptying of sputum from certain segments of the lungs under the influence of gravity and “draining” to the cough reflexogenic zones. In each position, the patient first performs 4-5 deep, slow breathing movements, inhaling air through the nose and exhaling through pursed lips; then, after a slow deep breath, makes 3-4 shallow coughs 4-5 times. A good result is achieved by combining drainage positions with various methods of vibration of the chest over the drained segments or compression with the hands while exhaling, massage done quite vigorously.

Postural drainage is contraindicated in cases of hemoptysis, pneumothorax, and significant shortness of breath or bronchospasm during the procedure.

Massage for chronic bronchitis

Massage included complex therapy chronic bronchitis. It promotes the removal of sputum and has a bronchial relaxant effect. Classic, segmental, acupressure massage is used. The latter type of massage can cause a significant bronchial relaxation effect.

Heparin therapy

Heparin prevents degranulation of mast cells, increases the activity of alveolar macrophages, has an anti-inflammatory effect, antitoxic and diuretic effect, reduces pulmonary hypertension, and promotes sputum discharge.

The main indications for heparin in chronic bronchitis are:

• the presence of reversible bronchial obstruction;
• pulmonary hypertension;
• respiratory failure;
• active inflammatory process in the bronchi;
• ICE syndrome;
• significant increase in sputum viscosity.

Heparin is prescribed 5000-10,000 units 3-4 times a day under the skin of the abdomen. The drug is contraindicated in hemorrhagic syndrome, hemoptysis, peptic ulcer.

The duration of heparin treatment is usually 3-4 weeks, followed by gradual withdrawal by reducing the single dose.

Use of calcitonin

In 1987, V.V. Namestnikova proposed treatment of chronic bronchitis with colcitrin (calcitrin is an injectable dosage form of calcitonin). It has an anti-inflammatory effect, inhibits the release of mediators from mast cells, and improves bronchial patency. It is used for obstructive chronic bronchitis in the form of aerosol inhalation (1-2 units in 1-2 ml of water per 1 inhalation). The course of treatment is 8-10 inhalations.

Detoxification therapy

For detoxification purposes, during the period of exacerbation of purulent bronchitis, intravenous drip infusion of 400 ml of hemodez (contraindicated in cases of severe allergization, bronchospastic syndrome), isotonic sodium chloride solution, Ringer's solution, 5% glucose solution is used. In addition, it is recommended to drink plenty of fluids (cranberry juice, rosehip infusion, linden tea, fruit juices).

Correction of respiratory failure

The progression of chronic obstructive bronchitis and pulmonary emphysema leads to the development of chronic respiratory failure, which is the main cause of deterioration in the quality of life and disability of the patient.

Chronic respiratory failure is a condition of the body in which, due to damage to the external respiratory system, either the maintenance of normal blood gas composition is not ensured, or it is achieved primarily by turning on the compensatory mechanisms of the external respiratory system itself, cardio vascular system, blood transport system and metabolic processes in tissues.

CHRONIC BRONCHITIS- diffuse progressive inflammation of the bronchi, not associated with local or generalized damage to the lungs and manifested by cough. It is customary to speak of the chronic nature of the process if the cough continues for at least 3 months in 1 year for 2 years in a row. Chronic bronchitis is the most common form of chronic nonspecific lung diseases (CNLD), which tends to become more frequent.
Etiology, pathogenesis. The disease is associated with prolonged irritation of the bronchi by various harmful factors (smoking, inhalation of air contaminated with dust, smoke, carbon monoxide, sulfur dioxide, nitrogen oxides and other chemical compounds) and recurrent respiratory infection (the main role is played by respiratory viruses, Pfeiffer's bacillus, pneumococci), occurs less frequently in cystic fibrosis, alpha(one)-antitrypsin deficiency. Predisposing factors are chronic inflammatory and suppurative processes in the lungs, chronic foci of infection in the upper respiratory tract, decreased body reactivity, hereditary factors. The main pathogenetic mechanisms include hypertrophy and hyperfunction of the bronchial glands with increased mucus secretion, a relative decrease in serous secretion, a change in the composition of the secretion - a significant increase in acidic mucopolysaccharides in it, which increases the viscosity of sputum. Under these conditions, the ciliated epithelium does not ensure emptying of the bronchial tree and the normal renewal of the entire layer of secretion (emptying of the bronchi occurs only when coughing). Long-term hyperfunction leads to depletion of the mucociliary apparatus of the bronchi, dystrophy and atrophy of the epithelium. Violation of the drainage function of the bronchi contributes to the occurrence of bronchogenic infection, the activity and recurrence of which largely depend on the local immunity of the bronchi and the development of secondary immunological failure.
A severe manifestation of the disease is the development of bronchial obstruction due to hyperplasia of the epithelium of the mucous glands, edema and inflammatory infiltration of the bronchial wall, fibrous changes in the wall with stenosis or obliteration of the bronchi, obstruction of the bronchi with excess viscous bronchial secretions, bronchospasm and expiratory collapse of the walls of the trachea and bronchi. Obstruction of the small bronchi leads to overstretching of the alveoli during exhalation and disruption of the elastic structures of the alveolar walls, as well as the appearance of hypoventilated and completely unventilated zones that function as an arteriovenous shunt; due to the fact that the blood passing through them is not oxygenated, arterial hypoxemia develops. In response to alveolar hypoxia, spasm of the pulmonary arterioles occurs with an increase in total pulmonary and pulmonary arteriolar resistance; precapillary pulmonary hypertension occurs. Chronic hypoxemia leads to polycythemia and increased blood viscosity, accompanied by metabolic acidosis, which further increases vasoconstriction in the pulmonary circulation.
Inflammatory infiltration, superficial in large bronchi, in medium and small bronchi, as well as bronchioles, can be deep with the development of erosions, ulcerations and the formation of meso- and panbronchitis. The remission phase is characterized by a decrease in inflammation in general, a significant decrease in exudation, proliferation of connective tissue and epithelium, especially with ulceration of the mucous membrane. The outcome of the chronic inflammatory process of the bronchi is sclerosis of the bronchial wall, peribronchial sclerosis, atrophy of glands, muscles, elastic fibers, and cartilage. Possible stenosis of the lumen of the bronchus or its expansion with the formation of bronchiectasis.
Symptoms, course. The beginning is gradual. The first symptom is a cough in the morning with mucous sputum. Gradually, the cough begins to occur both at night and during the day, worsening in cold weather, and becomes constant over the years. The amount of sputum increases, it becomes mucopurulent or purulent. Shortness of breath appears and progresses. There are 4 forms of chronic bronchitis. In a simple, uncomplicated form, bronchitis occurs with the release of mucous sputum without bronchial obstruction. With purulent bronchitis, purulent sputum is constantly or periodically released, but bronchial obstruction is not expressed. Obstructive chronic bronchitis is characterized by persistent obstructive disorders. Purulent-obstructive bronchitis occurs with the release of purulent sputum and obstructive ventilation disorders. During an exacerbation of any form of chronic bronchitis, bronchospastic syndrome may develop.
Frequent exacerbations are typical, especially during periods of cold, damp weather: cough and shortness of breath intensify, the amount of sputum increases, malaise, night sweats, and fatigue appear. Body temperature is normal or subfebrile, hard breathing and dry wheezing over the entire surface of the lungs can be detected. The leukocyte count and ESR often remain normal;
a slight leukocytosis with a band shift in the leukocyte formula is possible. Only with exacerbation of purulent bronchitis do the biochemical indicators of inflammation change slightly ( C-reactive protein, sialic acids, seromucoid, fibrinogen, etc.). In diagnosing the activity of chronic bronchitis, sputum examination is of relatively great importance: macroscopic, cytological, biochemical. Thus, with a severe exacerbation, a purulent nature of sputum is detected, predominantly neutrophilic leukocytes, an increase in the content of acidic mucopolysaccharides and DNA fibers that increase the viscosity of sputum, a decrease in the content of lysozyme, etc. Exacerbations of chronic bronchitis are accompanied by increasing disorders of respiratory function, and in the presence of pulmonary hypertension - by disorders blood circulation
Bronchoscopy provides significant assistance in recognizing chronic bronchitis, in which the endobronchial manifestations of the inflammatory process (catarrhal, purulent, atrophic, hypertrophic, hemorrhagic, fibrinous-ulcerative endobronchitis) and its severity are visually assessed (but only to the level of the subsegmental bronchi). Bronchoscopy allows you to perform a biopsy of the mucous membrane and histologically clarify the nature of the lesion, as well as identify tracheobronchial hypotonic dyskinesia (increased mobility of the walls of the trachea and bronchi during breathing, up to expiratory collapse of the walls of the trachea and main bronchi) and static retraction (change in configuration and reduction of the lumens of the trachea and bronchi) ), which can complicate chronic bronchitis and be one of the causes of bronchial obstruction.
However, in chronic bronchitis, the main lesion is most often localized in the smaller branches of the bronchial tree; Therefore, bronchial and radiography are used in the diagnosis of chronic bronchitis. In the early stages of chronic bronchitis, there are no changes in bronchograms in most patients. With long-term chronic bronchitis, bronchograms may reveal breaks in medium-sized bronchi and lack of filling of small branches (due to obstruction), which creates a picture of a “dead tree”. In the peripheral parts, bronchiectasis can be found in the form of small cavity formations filled with contrast with a diameter of up to 5 mm, connected to small bronchial branches. Radiographs may reveal deformation and intensification of the pulmonary pattern, similar to diffuse reticular pneumosclerosis, often with concomitant pulmonary emphysema.
Important criteria for diagnosis, selection of adequate therapy, determination of its effectiveness and prognosis for chronic bronchitis are symptoms of bronchial obstruction (bronchial obstruction): 1) the appearance of shortness of breath with physical activity and leaving a warm room into the cold; 2) sputum production after a long, tiresome cough; 3) the presence of whistling dry rales during forced exhalation; 4) prolongation of the expiratory phase;
5) data from functional diagnostic methods. Improvement in ventilation and respiratory mechanics when using bronchodilators indicates the presence of bronchospasm and the reversibility of bronchial obstruction. In the late period of the disease, disturbances in ventilation-perfusion ratios, diffusion capacity of the lungs, and blood gas composition occur.
Often there is a need to differentiate chronic bronchitis from chronic pneumonia, bronchial asthma, tuberculosis and lung cancer. Unlike chronic pneumonia, chronic bronchitis is always a diffuse disease with the gradual development of widespread bronchial obstruction and often emphysema, respiratory failure and pulmonary hypertension (chronic cor pulmonale); X-ray changes are also diffuse in nature: peribronchial sclerosis, increased transparency of the pulmonary fields due to emphysema, expansion of the branches of the pulmonary artery. Chronic bronchitis is distinguished from bronchial asthma by the absence of asthma attacks. Differential diagnosis chronic bronchitis and pulmonary tuberculosis is based on the presence or absence of signs of tuberculosis intoxication, mycobacteria and uberculosis in sputum, X-ray and bronchoscopic examination data, and tuberculin tests. Early recognition of lung cancer against the background of chronic bronchitis is very important. A hacking cough, hemoptysis, chest pain are signs that are suspicious for a tumor, and require urgent X-ray and bronchological examination of the patient; The most informative ones are tomography and bronchography. A cytological examination of sputum and bronchial contents for antipyretic cells is necessary.
Treatment, prevention. In the phase of exacerbation of chronic bronchitis, therapy should be aimed at eliminating the inflammatory process in the bronchi, improving bronchial patency, and restoring impaired general and local immunological reactivity. Antibiotics and sulfonamides are prescribed in courses sufficient to suppress the activity of the infection. The duration of antibacterial therapy is individual. The antibiotic is selected taking into account the sensitivity of the microflora of sputum (bronchial secretions), prescribed orally or parenterally, sometimes combined with intratracheal administration. Inhalation of garlic or onion phytoncides is indicated (garlic and onion juice is prepared before inhalation, mixed with a 0.25% solution of novocaine or isotonic sodium chloride solution in the proportion
1 part juice to 3 parts solvent). Inhalations are carried out
2 times a day; for a course of 20 inhalations. Simultaneously with the treatment of active bronchial infection, conservative sanitation of foci of nasopharyngeal infection is carried out.
Restoring or improving bronchial patency is an important link in the complex therapy of chronic bronchitis, both during exacerbation and in remission; use expectorants, mucolytic and bronchospasmolytic drugs, and drink plenty of fluids. Potassium iodide, infusion of thermopsis, marshmallow root, coltsfoot leaves, plantain, as well as mucolytics and cysteine ​​derivatives have an expectorant effect. Proteolytic enzymes (trypsin, chymotrypsin, chymopsin) reduce the viscosity of sputum, but are now used less and less due to the threat of hemoptysis and the development of allergic reactions. Acetylcysteine ​​(mucomist, mucosolvin, fluimucil, mistabrene) has the ability to break the disulfide bonds of mucus proteins and causes strong and rapid liquefaction of sputum. Apply as an aerosol 20% solution, 3-5 ml 2-3 times a day. Bronchial drainage is improved with the use of mucoregulators that affect both the secretion and synthesis of glycoproteins in the bronchial epithelium (bromhexine, or bisolvone). Bromhexine (bisolvone) is prescribed 8 mg (2 tablets) 3-4 times a day for 7 days orally, 4 mg (2 ml) 2-3 times a day subcutaneously or inhaled (2 ml of bromhexine solution diluted with 2 ml distilled water) 2-3 times a day. Before inhalation of expectorants in aerosols, bronchodilators are used to prevent bronchospasm and enhance the effect of the drugs used. After inhalation, positional drainage is performed, which is mandatory for viscous sputum and inability to cough (2 times a day with prior administration of expectorants and 400-600 ml of warm tea).
In case of insufficient bronchial drainage and the presence of symptoms of bronchial obstruction, bronchospasmolytics are added to therapy: aminophylline rectally (or intravenously) 2-3 times a day, anticholinergic blockers (atropine, latifilline orally, subcutaneously; atrovent in aerosols), adrenergic stimulants ( ephedrine, isadrine, novodrine, euspiran, alupent, perbutalin, albutamol, berotec). In a hospital setting, intratracheal lavages for purulent bronchitis are combined with sanitation bronchoscopy (3-4 sanitation bronchoscopy with a break of 3-7 days). The restoration of the drainage function of the bronchi is also facilitated by physical therapy, chest massage, and physiotherapy. If allergic syndromes occur, calcium chloride is prescribed orally and intravenously with antihistamines; if there is no effect, it is possible to carry out a short (until the allergic syndrome is relieved) course of glucocorticoids (the daily dose should not exceed 30 mg). The danger of infection activation does not allow us to recommend long-term use of glucocorticoids.
If a patient with chronic bronchitis develops bronchial obstruction syndrome, etimizol (0.05-0.1 g 2 times a day orally for 1 month) and heparin (5000 units 4 times a day subcutaneously for 3-4 weeks) with gradual withdrawal of the drug. In addition to the antiallergic effect, heparin at a dose of 40,000 units/day has a mucolytic effect. In patients with chronic bronchitis, complicated by respiratory failure and chronic cor pulmonale, the use of veroshpiron (up to 150-200 mg/day) is indicated.
The diet of patients should be high-calorie and fortified. Ascorbic acid is prescribed in a daily dose of 1 g, B vitamins, nicotinic acid; if necessary - levamisole, aloe, methyluracil. Due to the known role in the pathogenesis of chronic bronchitis of a number of biologically active substances(histamine, acetylcholine, kinins, serotonin, prostaglandins) indications for inclusion of inhibitors of these systems in complex therapy are being developed. When the disease is complicated by pulmonary and pulmonary-heart failure, oxygen therapy and auxiliary artificial ventilation are used. Oxygen therapy includes inhalation of 30-40% oxygen mixed with air, it should be intermittent. This position is based on the fact that with a pronounced increase in carbon dioxide concentration, the respiratory center is stimulated by arterial hypoxemia. Eliminating it by intense and prolonged inhalation of oxygen leads to a decrease in the function of the respiratory center, an increase in alveolar hypoventilation and hypercapnic coma. For stable pulmonary hypertension, long-acting nitrates and calcium ion antagonists (verapamil, phenigidine) are used for a long time. Cardiac glycosides and saluretics are prescribed for congestive heart failure.
Anti-relapse and maintenance therapy begins in the phase of subsiding exacerbation, can be carried out in local and climatic sanatoriums, and is also prescribed during medical examination. It is recommended to distinguish 3 groups of dispensary patients. The first group includes patients with severe respiratory failure, cor pulmonale and other complications of the disease, with loss of ability to work; patients need systematic maintenance therapy, which is carried out in a hospital or by a local doctor. The goal of therapy is to combat the progression of pulmonary heart failure, amyloidosis and other possible complications of the disease. These patients are examined at least once a month. The second group consists of patients with frequent exacerbations of chronic bronchitis and moderate respiratory dysfunction. Patients are examined by a pulmonologist 3-4 times a year, anti-relapse courses are prescribed in spring and autumn, as well as after acute respiratory diseases. A convenient method of administering drugs is inhalation; according to indications, the bronchial tree is sanitized by intratracheal lavage and sanitary bronchoscopy. For active infection use antibacterial drugs. An important place in the complex of anti-relapse drugs is occupied by measures aimed at normalizing the body’s reactivity: referral to sanatoriums, dispensaries, exclusion of occupational hazards, bad habits etc. The third group consists of patients in whom anti-relapse therapy led to the subsidence of the process and the absence of relapses for 2 years. They are indicated for seasonal preventive therapy, including agents aimed at improving bronchial drainage and increasing reactivity.