Bronchitis in bronchial asthma

When two diseases of the respiratory system are combined - inflammation of the bronchial mucosa of infectious etiology (bronchitis) and narrowing of their lumens due to sensitization (bronchial asthma) - bronchitis can be diagnosed in bronchial asthma.

When patients with bronchial asthma develop infectious bronchitis, bronchial hyperreactivity to allergens and other irritants affects the severity of the inflammatory process, increasing the likelihood of airway obstruction. And this requires a balanced approach to the choice of therapeutic agents.

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Epidemiology

Bronchial asthma is a serious global health problem. This chronic respiratory disorder affects 5-10% of people of all ages. According to WHO, there are almost 235 million people diagnosed with bronchial asthma in the world, and according to The Global Asthma Reports (2014), there are 334 million.

Experts from the Belgian UCB Institute of Allergy note that in Western Europe the number of people with bronchial asthma has doubled over the past ten years. In Switzerland, about 8% of the population suffers from asthma, in Germany – about 5%, in Great Britain there are 5.4 million asthmatics, that is, every eleventh Briton has this chronic disease.

Chronic bronchitis affects 4.6% of French residents, while among asthma sufferers this figure is 10.4%.

The American National Center for Health Statistics notes the presence of bronchial asthma in 17.7 million adults (7.4% of citizens over 18 years of age). There are also 8.7 million adults (3.6%) diagnosed with chronic bronchitis. The fatal outcome of chronic diseases of the lower respiratory tract (including asthma) reaches 46 cases per 100 thousand population.

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Causes bronchitis in bronchial asthma.

According to clinical data, in nine cases out of ten, acute inflammation of bronchitis in bronchial asthma is caused by a viral respiratory infection. In other cases, acute bronchitis is caused by bacteria (Staphylococcus spp., Streptococcus spp., Mycoplasma pneumoniae, etc.). However, given the atopic state characteristic of asthma, it is not always possible to verify the types of pathogen.

Long-term exposure to exogenous irritants (tobacco smoke, dust, various chemicals, etc.) can cause chronic bronchitis, which lasts a long time and often recurs.

Bronchial asthma, which is associated with genetic and environmental factors that cause an allergic reaction to a specific antigen with the production of antibodies (IgE) by B cells, develops in the same way. That is, chronic respiratory pathology develops with periodic spasms of the surrounding muscles and tissue edema, narrowing of the bronchi and cough - with allergic bronchitis (asthmatic or atopic) typical for patients with asthma.

Some specialists, despite the terminological ambiguity, also distinguish a cough form of asthma, but experienced pulmonologists consider these to be simply clinical cases where the predominant symptom of bronchial asthma is cough.

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Risk factors

Risk factors for bronchitis in the presence of a history of bronchial asthma are common and include hypothermia, seasonal epidemics of acute respiratory viral infections and flu, air pollution, smoking (including passive smoking), weakened immunity, childhood or old age. And the increased sensitivity of bronchial tissue receptors to non-specific triggers significantly increases the risk of various respiratory diseases.

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Pathogenesis

The pathogenesis of bronchitis in asthmatic patients is associated with the release of inflammatory mediators from lymphoid cells, reticular fibroblasts of the bronchial connective tissue and mast cells of the endothelium of their blood and lymphatic vessels: interleukins, proinflammatory eicosanoids (prostaglandins and leukotrienes), histamine, eosinophils. The result of their effect on the membrane receptors of bronchial mucosa cells is the activation of T-lymphocytes and the mobilization of other immune factors that cause edema of the respiratory tract, narrowing of the bronchial lumen and hypersecretion of bronchial mucin surfactant. This pathophysiological combination leads to wheezing, shortness of breath and cough with difficult to remove viscous sputum.

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Symptoms bronchitis in bronchial asthma.

Symptoms of bronchial asthma in the active stage are manifested by tightness and wheezing in the chest (most often on exhalation), shortness of breath (especially at night and in the morning) and periodic dry cough. The addition of a viral or bacterial infection causes such symptoms of bronchitis in bronchial asthma as bilateral wheezing and chest pain, fever and chills, headaches, night hyperhidrosis, increased fatigue. And, of course, bronchitis aggravates the existing cough and shortness of breath, which is noted not only on exhalation, but also on inhalation.

The first signs of bronchitis manifest themselves in attacks of abrupt coughing, which is somewhat different from the characteristic cough of asthma. Bronchitis with a dry cough is more common when the mucous membranes are affected by viruses. With bronchitis of bacterial origin, the volume of sputum increases significantly, so the cough quickly becomes productive, and the expectorated mucus may be greenish in color, that is, include purulent impurities.

There is also pronounced spasm of the bronchi, which – in combination with the accumulation of excess bronchial mucus and increasing difficulty breathing – indicates a narrowing of the bronchi, that is, obstructive bronchitis in asthma.

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Complications and consequences

Viral and bacterial infections that cause bronchitis in bronchial asthma have a toxic effect on the respiratory tract, thereby increasing the frequency of asthma attacks.

Also, the severity of asthma manifestations can significantly increase with the deterioration of the respiratory system functions and the general condition of patients. Frequent consequences and complications of bronchitis of viral etiology are manifested by the development of chronic asthmatic bronchitis, which requires constant treatment.

Chronic obstructive bronchitis can result in irreversible heart failure.

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Diagnostics bronchitis in bronchial asthma.

Diagnosis of bronchitis in bronchial asthma begins with listening to patients’ complaints, studying their medical history and determining breathing characteristics using a phonendoscope.

Blood tests are done - general, biochemical, immunological (for IgE), for the presence of eosinophilia.

A serological examination of sputum is also required, although, according to pulmonologists, bronchial surfactant secreted during coughing is not a prognostic parameter for the presence of infection, since viruses are practically impossible to detect.

Instrumental diagnostics are used in the form of:

• spirometry;
• chest x-ray;
• bronchography (contrast X-ray of the bronchi);
• ultrasonography (ultrasound) of the bronchi and lungs;
• electrocardiography (ECG).

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Differential diagnosis

Differential diagnostics of bronchitis is carried out to determine similar symptoms of tracheitis, laryngitis, pneumonia, obstructive pulmonary disease (a common complication of asthma), stenosis of the larynx or trachea, pneumofibrosis, reflux esophagitis with chronic aspiration, enlarged cervical lymph nodes, congestive heart failure (in elderly patients), lung tumor, and some psychosomatic diseases.

Treatment bronchitis in bronchial asthma.

Acute bronchitis is traditionally treated with antibiotics, although there is insufficient evidence to support the effectiveness of such treatment. Therefore, antibiotics for bronchitis in asthma (Amoxicillin, Azithromycin, Ofloxacin) are prescribed in courses lasting 5-7 days - only if a bacterial infection is detected or if there is a high temperature and a risk of complications. See also - Antibiotics for cough

In essence, treatment of bronchitis in bronchial asthma is carried out in the same way as treatment of asthma and bronchitis, and may include medications used for bronchial asthma (to relieve its attacks), as well as bronchodilators - to thin thick sputum and better remove it from the respiratory tract.

The latter include drugs based on such pharmacologically active substances as acetylcysteine, carbocysteine, bromhexine, ambroxol: ACC, Acestin, Acetal, Fluimucil, Mukobene, Bronchocod, Mukopront, Bromhexine, Bronchosan, Ambrogeksal, Ambrobene, etc. The dosage, contraindications and possible side effects of the listed drugs are described in detail in the publications - Severe cough with phlegm and Treatment of cough with phlegm

A good therapeutic effect is provided by cough drops Bronchipret, Bronchicum, Gedelix, Lizomucil; syrups Brontex, Mucosol, Lazolvan, Flavamed.

The dilation of the bronchi during asthmatic asphyxiation is facilitated by the use of β2-sympathomimetics in the form of a spray - Salbutamol (Albuterol, Astalin, Ventolin) or Fenoterol (Berotek, Aerum, Aruterol), one or two sprays at a time (daily dose - three inhalations). Among the side effects of these drugs are tachycardia, headache, tremor of the limbs, convulsions, and psychoneurological disorders.

Seretide (Tevacomb), which also contains the corticosteroid fluticasone, is a group of drugs that expand the lumen of the bronchi (bronchodilators). The doctor determines the dosage individually, depending on the severity of asthma. Side effects of this drug include irritation of the mucous membranes of the throat, nausea, increased heart rate, tremor, as well as all the side effects of GCS, including decreased adrenal function and Cushing's syndrome. Therefore, it is not prescribed to children under five years of age, as well as pregnant women, patients with cardiac problems, thyroid disease and diabetes.

Clenbuterol (Contraspazmin, Spiropent), which relieves bronchospasm and thins mucus (in the form of syrup it can be prescribed to children from 6 months), is taken orally - twice a day, one tablet (0.02 mg). Side effects may occur in the form of dry mouth, nausea, increased heart rate, decreased blood pressure.

More useful information can be found in the material - Treatment of bronchitis, as well as in the article - Treatment of obstructive bronchitis

It is necessary to take into account the indisputable need to take vitamins (A, C, E) and increase water consumption. But physiotherapy treatment for a combination of bronchial asthma and bronchitis is prescribed with caution: steam inhalations, which help well with bronchitis, can cause an asthma attack.

Breathing exercises for asthma and bronchitis can alleviate the condition, especially diaphragmatic breathing, but performing exercises that force exhalation or require forward bends can provoke an increase in coughing.

Manual massage of the chest should be postponed until the acute inflammatory process has ceased; acupressure for asthma and bronchitis is better - shiatsu: at points in the middle of the subclavian region, on the back of the neck at the base of the skull and above the upper lip (immediately below the nasal septum).

Folk remedies

Asthmatics are advised to eat fresh garlic (a couple of cloves a day) for viral bronchitis; garlic not only kills the infection, but also helps to cough up phlegm.

Also, folk treatment consists of drinking grape juice mixed with honey (a teaspoon per 200 ml); in addition to grape juice, you can use cranberry juice and black elderberry juice (diluted with water 1:1). Or a decoction of elder flowers with honey and lemon. You can also make ginger for coughs

If medicinal plants do not cause allergies, herbal treatment can be used as an adjunct. Phytotherapy suggests drinking herbal teas and decoctions using peppermint, coltsfoot, oregano, thyme; licorice roots or elecampane; anise fruits. Pharmaceutical chest collection for cough can also be used.

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Prevention

It is most likely impossible to eliminate all risk factors for the development of bronchitis in bronchial asthma. Therefore, prevention consists of quitting smoking, hygiene (personal and household), and strengthening the immune system.

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Forecast

Viral or bacterial bronchitis can be cured, bronchial asthma can only be controlled. And the prognosis of all respiratory diseases in asthmatics depends on the quality of this control.

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