Bronchitis in bronchial asthma

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

When patients with bronchial asthma develop infectious bronchitis, bronchial hyperreactivity to allergens and other irritating factors 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.

[1], [2], [3]

Epidemiology

Bronchial asthma is a serious global health problem. From this chronic disorder of the respiratory system, 5-10% of people of all ages suffer. According to the WHO, there are almost 235 million people worldwide diagnosed with bronchial asthma, and according to the calculations of The Global Asthma Reports (for 2014) - 334 million.

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

Chronic bronchitis has 4.6% of France, among asthmatic patients 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 100,000 population.

[4], [5], [6], [7], [8], [9]

Causes of the bronchitis in bronchial asthma

According to clinical data, in the acute form of inflammation in nine cases out of ten causes of bronchitis in bronchial asthma - a viral respiratory infection. In other cases, acute bacteria are provoked by bacteria (Staphylococcus spp., Streptococcus spp., Mycoplasma pneumoniae, etc.). However, taking into account the state of atopy 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 for a long time and often recurs.

In the same way, bronchial asthma also occurs, which is associated with genetic and environmental factors that cause an allergic reaction to a certain antigen with the production of B-cell antibodies (IgE). That is, the chronic pathology of the respiratory tract develops with periodic spasms of the surrounding muscles and swelling of the tissues, narrowing of the bronchi and coughing - with allergic bronchitis typical for patients with asthma   (asthmatic or atopic).

Some specialists, despite the terminological fuzziness, also distinguish between a cough-type asthma, but experienced pulmonologists consider it simply clinical cases when the predominant symptom of bronchial asthma is cough.

[10], [11], [12], [13], [14]

Risk factors

Risk factors for bronchial inflammation in the history of bronchial asthma are usual and include hypothermia, seasonal epidemics of ARVI and influenza, air pollution, smoking (including "passive"), weakening of immunity, children or advanced age. And the very sensitivity of the receptors of bronchial tissues to nonspecific triggers significantly increases the risk of various respiratory diseases.

[15], [16], [17]

Pathogenesis

The pathogenesis of bronchitis in asthmatics patients is associated with the release from the lymphoid cells, the reticular fibroblasts of the bronchial connective tissue and the mastoid endothelial cells of their blood and lymphatic vessels of inflammatory mediators: interleukins, pro-inflammatory eicosanoids (prostaglandins and leukotrienes), histamine, eosinophils. The result of their action on the membrane receptors of bronchial mucosa cells is activation of T-lymphocytes and mobilization of other immune factors that cause swelling of the respiratory tract, narrowing of the bronchial lumen and hypersecretion of the bronchial mucin surfactant. Such a pathophysiological combination leads to wheezing, shortness of breath and cough with a difficultly excreted sputum viscous consistency.

[18], [19], [20], [21], [22], [23]

Symptoms of the bronchitis in bronchial asthma

Symptomatic of bronchial asthma in the active stage is 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. Attachment of a viral or bacterial infection causes such symptoms of bronchitis in bronchial asthma, as bilateral rales and chest pain, fever and chills, headaches, nocturnal hyperhidrosis, increased fatigue. And, of course, bronchitis exacerbates the already existing cough and shortness of breath, which is noted not only with exhalation, but also with inspiration.

In this case, the first signs of bronchitis manifest with attacks of an abrupt cough, which differs somewhat from the characteristic  cough in asthma. Bronchitis with a dry cough often occurs when the mucous membranes are affected by viruses. With bronchitis of bacterial origin, the volume of sputum is significantly increased, so the cough quickly becomes productive, and the cough to be cleansed can be greenish, that is, include purulent impurities.

Also expressed spasm of the bronchi, which - in combination with the accumulation of excess bronchial mucosa secretion and increasing difficulty in breathing - indicates a narrowing of the bronchi, that is, obstructive bronchitis with asthma.

[24], [25], [26],

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 asthmatic attacks.

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

Chronic obstructive bronchitis can result in irreversible heart failure.

[27], [28], [29], [30], [31], [32], [33]

Diagnostics of the bronchitis in bronchial asthma

Diagnosis of bronchitis in bronchial asthma begins with listening to patient complaints, studying their medical history and finding out the features of breathing - using a phonendoscope.

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

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

Instrumental diagnostics is used in the form of:

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

[34], [35], [36], [37], [38]

Differential diagnosis

Differential diagnosis of bronchitis is performed to determine a similar tracheitis, laryngitis, pneumonia, obstructive pulmonary disease (frequent 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 tumors, some psychosomatic diseases.

Treatment of the bronchitis in bronchial asthma

Acute bronchitis is traditionally treated with antibiotics, although evidence supporting the effectiveness of such treatment is not enough. Therefore, antibiotics from bronchitis in asthma (Amoxicillin, Azithromycin, Ofloxacin) are prescribed courses lasting 5-7 days - only if a bacterial infection is detected or at a high temperature and the threat of a complicated course of the disease. See also -  Antibiotics for coughing

In essence, the treatment of bronchitis in bronchial asthma is conducted in the same way as the treatment of asthma and bronchitis, and can include medications used for bronchial asthma (to stop her attacks), as well as bronchodilators - to dilute thick sputum and better excretion of it respiratory tract.

The latter include preparations based on such pharmacological active substances as acetylcysteine, carbocysteine, bromhexine, ambroxol: ATSTS, Acestin, Acetal, Fluimutsil, Mucobene, Bronhokod, Mukoprint, Bromhexin, Bronhosan, Ambrogexal, Ambrobene, etc. Dosage, contraindications and possible side effects the effects of these agents are described in detail in publications -  Strong cough with phlegm  and  cough treatment with phlegm

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

Expansion of the bronchi during asthmatic asphyxia is facilitated by the use of β2-sympathomimetics in the form of a spray - Salbutamol (Albuterol, Astalin, Ventolin) or Fenoterol (Beroteka, Aerum, Arutterol), one or two injections at a time (daily dose - three inhalations). Among the side effects of these drugs are tachycardia, headache, extremity tremors, convulsions, and psychoneurological disorders.

To the group of drugs that expand the lumen of the bronchi (bronchodilators), is Seretid (Tevacomb), also containing a corticosteroid fluticasone. The doctor determines the dosage individually - depending on the intensity of the manifestation 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 side effects of SCS, including a decrease in adrenal function and Cushing's syndrome. Therefore, children under five years of age are not assigned to it, nor to pregnant women, patients with cardiological problems, thyroid disorders and diabetes mellitus.

Clenbuterol (Contraspazmin, Spiropent), removing bronchospasm and diluting sputum (in the form of a syrup can be prescribed to children from 6 months), is taken orally - twice a day on a tablet (0.02 mg). There may be side effects in the form of dry mouth, nausea, frequent heart rate, lower 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 necessity to take vitamins (A, C, E) and increase water consumption. But physiotherapy treatment with a combination of bronchial asthma and bronchitis is prescribed with caution: steam inhalations, which are good for bronchitis, can cause an asthmatic attack.

Breathing exercises with asthma and bronchitis can alleviate the condition, especially diaphragmatic breathing, but doing exercises where forced exhalation or needing forward inclinations can provoke an increase in coughing.

It is necessary to postpone manual inflammation of the thorax until the inflammatory acute process ceases, it is better to use acupressure for asthma and bronchitis-shiatsu: at the points in the middle of the subclavian area, behind the neck at the base of the skull and above the upper lip (immediately under the nasal septum).

Alternative treatment

Asthmatics recommend using fresh garlic (a couple of denticles a day) in case of viral bronchitis, garlic not only kills the infection, but also helps cough up phlegm.

Also, an alternative treatment is to use grape juice mixed with honey (200 ml teaspoon); In addition to grape, you can use cranberry juice and juice from black elderberries (diluted 1: 1 with water). Or a decoction of elderberry blossoms with honey and lemon. You can also cook  ginger from a cough

If medicinal plants do not cause allergies, as an auxiliary, you can treat herbs. Phytotherapy offers drinking herbal teas and decoctions using peppermint, coltsfoot, marjoram, thyme; the roots of licorice are bare or elecampane; fruit anise. Can be used and pharmacy  chest of cough

[39], [40], [41]

Prevention

It is probably impossible to exclude all risk factors for the development of bronchitis in bronchial asthma. Therefore, prevention consists in the refusal of smoking, hygiene (personal and household), strengthening of immunity.

[42], [43], [44], [45], [46], [47]

Forecast

Bronchitis is viral or bacterial 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.

[48], [49]