Bronchitis in the elderly

Bronchitis in the elderly is an inflammatory or degenerative process in the bronchi, disrupting their structure and function. The disease can be acute or chronic.

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Acute bronchitis in the elderly

A disease manifested by acute inflammation of the mucous membrane of the tracheobronchial tree, occurring with cough and sputum production or shortness of breath when small bronchi are affected. Acute bronchitis in the elderly is often one of the manifestations of an acute respiratory infection of the upper respiratory tract and occurs sequentially or simultaneously with damage to the nasopharynx, larynx, trachea. The process spreads downward along the respiratory tract, leading to the development of laryngitis, tracheitis, bronchitis. In the lung tissue of the elderly, areas of atelectasis often form as a result of blockage of the lumen of small bronchi with secretions. Often, the inflammatory process spreads to the terminal branches of the bronchi and causes the development of pneumonia.

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How does acute bronchitis manifest itself in the elderly?

With acute bronchitis, patients feel unwell, there may be a burning sensation behind the breastbone, tightness behind the breastbone. Cough sometimes occurs in attacks, accompanied by shortness of breath. With a strong cough, pain in the lower parts of the chest may be observed, caused by spasmodic contractions of the diaphragm. Often, after a few days, the cough becomes less painful, abundant mucous sputum is released. The state of health gradually improves.

Physical examination of the lungs reveals dry whistling and buzzing rales. Percussion tone over the lungs is unchanged. X-ray examination reveals no abnormalities.

The clinical course of acute bronchitis in elderly and old people is largely determined by the state of the external respiratory function and the obstruction of the bronchi. Acute bronchitis is especially severe in elderly people with cardiovascular insufficiency, as well as in people who are forced to stay in bed for a long time.

Bronchiolitis poses a great danger to the elderly and old people.

The general condition of such patients deteriorates sharply. Intoxication is expressed. Severe adynamia develops. Excitement, anxiety, turning into apathy and drowsiness are observed. The above phenomena are caused by respiratory acidosis. External respiration failure (dyspnea, cyanosis) is sharply expressed. Unlike young patients, in elderly patients, symptoms of heart failure often join the picture of pulmonary failure. When examining the patient, a large number of dry, moist small bubbly rales are revealed against the background of weakening of breathing, in places an altered percussion sound (tympanitis). Usually, bronchiolitis is accompanied by numerous small pneumonic foci; in elderly people, bronchiolitis occurs more often in the absence of a pronounced temperature reaction and changes in the blood. Thus, if during acute bronchitis in elderly patients there are signs of severe pulmonary-cardiac insufficiency, general intoxication with an abundance of auscultatory changes in the lungs, one can think about acute bronchiolitis.

How is acute bronchitis treated in the elderly?

Treatment of acute bronchitis varies depending on the severity of the disease. In mild forms, accompanied by a slight cough, normal or subfebrile temperature, a semi-bed regimen is prescribed, and if the temperature rises to febrile and there are signs of severe intoxication, bed rest is prescribed. When treating bronchitis, possible etiological factors of the disease are taken into account. Thus, if it is a viral infection (flu A or B), then in the first days of the disease, rimantadine is used according to the scheme.

Also recommended is anti-flu gamma globulin for 5-7 days, irrigation of the nasal mucosa with interferon, irrigation of the nasopharynx with iodinol is advisable. Acetylsalicylic acid with caffeine is used in treatment, plenty of fluids, mustard plasters, hot foot baths are prescribed.

Treatment of severe forms of acute bronchitis includes: bed rest; plenty of fluids; prescription of expectorants and bronchospasmolytics for viscous sputum - inhalation of 2% sodium bicarbonate solution or inhalation with bronchospasmolytics; use of antibiotics and sulfonamides.

Vitamins C, A and B group are prescribed. Cardiotonic drugs (sulfokamphokamn, cordiamine) are prescribed to elderly people even in the absence of cardiovascular pathology. When signs of circulatory failure appear, cardiac glycosides and diuretics are prescribed.

For headaches accompanied by high temperature, antipyretic drugs (aspirin, paracetamol, phenacetin) are used.

Only a serious condition of the patient is an indication for bed rest. To avoid blockage of small bronchioles, to improve the discharge of sputum and improve breathing, active movement of patients in bed is necessary. Chest massage, breathing exercises, elevated nose or a semi-sitting position of the patient in bed promote ventilation of the lungs.

As is known, cough is a reflex act providing a protective cleansing function of the lungs in response to irritation of the receptor zones of the trachea and bronchi. When coughing, the drainage function of the bronchi increases, the patency of the airways improves. The early stage of bronchitis is one of the few cases when it is useful to prescribe antitussives in old people, since during this period coughing movements do not perform a protective function, but, on the contrary, frequent unproductive cough causes chest pain, disrupts ventilation, hemodynamics, and normal sleep of patients. To suppress the cough reflex, codecs, glauvent, and libexin are prescribed. At the same time, it is necessary to strive to liquefy bronchial secretions. In acute bronchitis, bronchospasm is always observed, which significantly disrupts ventilation of the lungs and thereby contributes to the development of hypoxia. Purine derivatives (theophylline, euphylline, diprophylline, etc.) are used as bronchodilators.

Chronic bronchitis in the elderly

Chronic bronchitis in the elderly is a chronic inflammation of the bronchial tree, in which the mucous membrane is affected first, then, as the process progresses, the deeper layers of the bronchial wall and peribronchial connective tissue.

It most often affects older men.

The highest incidence of chronic bronchitis occurs in the sixth and seventh decades of life, and the highest mortality from this disease is observed in the eighth decade.

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How does chronic bronchitis manifest itself in the elderly?

The main symptoms of chronic bronchitis include: cough, sputum, shortness of breath, and harsh breathing and wheezing upon auscultation. Chronic bronchitis in the elderly develops gradually and is diagnosed late, as it may cause little concern to the patient for a long time. Clinical manifestations are related to the level of damage to the bronchial tree.

In so-called proximal bronchitis, the inflammatory process involves large and medium bronchi, there is a cough with mostly small sputum production, there is no shortness of breath, and dry wheezing of a low pitch is heard against the background of harsh breathing. Bronchial patency is usually not impaired. This is chronic non-obstructive bronchitis in the elderly or "bronchitis without shortness of breath."

Obstructive bronchitis is characterized not only by cough (with or without sputum), but mainly by dyspnea ("bronchitis in the elderly with dyspnea"). The inflammatory process is localized mainly in the small bronchi ("distal bronchitis in the elderly"). Wheezing sounds are heard against the background of harsh breathing. When examining the function of external respiration, bronchial patency disorders are determined.

Exacerbation of bronchitis often occurs with normal temperature, sweating of the upper body (head, neck) appears, cough intensifies, the amount of sputum increases. With moderate exacerbation, sputum is of a purulent type, body temperature is normal or subfebrile, peripheral blood indices are slightly changed. With severe exacerbation, sputum is mucopurulent, contains many leukocytes. With the increase in obstructive changes, dyspnea increases. The progression of chronic obstructive bronchitis leads to the development of respiratory and cardiac failure.

How is chronic bronchitis treated in the elderly?

In case of exacerbation of chronic bronchitis, treatment is carried out according to the following scheme:

1. restoration of bronchial conductivity - drainage with the help of bronchospasmolytic agents, postural drainage, drainage during bronchoscopy - for purulent bronchitis);
2. antibacterial therapy taking into account the sensitivity of microflora and toxicity of the drug;
3. antiallergic and detoxifying agents;
4. therapeutic exercise (breathing, drainage exercises);
5. general health treatment (physiotherapy, vitamins, massage).

In case of severe cough, antitussives are used. If there is a cough with sputum production, then two-phase antitussives are used, which reduce the cough, but do not reduce the production of sputum (intussin, baltix, etc.). To relieve bronchospasm in obstructive bronchitis, bronchodilators are used: antispasmodics (isadrin, salbutamol, terbutamine); phosphodiesterase inhibitors (theophylline derivatives). For rapid relief of spastic syndrome, the following drugs are prescribed: berotek, ventalin, atrovent, berodual. To improve the drainage function of the bronchi, the use of expectorants, sputum-thinning agents is indicated. The use of these drugs is most effective if it is carried out taking into account the viscoelastic properties of sputum. In case of increased viscosity, thiol derivatives are used - acetylcysteine (mucosalvin) or proteolytic enzymes (trypsin, chymotrypsin). In case of high adhesive indices - preparations stimulating formation of surfactant - bromhexine), secretion rehydrants, mineral salts, essential oils. If rheological properties of sputum are not changed, but the speed of mucociliary transport is reduced, derivatives of theophylline and beta-2-sympathomimetics are used - theolong, teopec, etc. In patients with chronic bronchitis, with prolonged stay in bed due to other diseases, collapse of individual sections of the lungs often occurs as a result of impaired drainage function of the bronchi. Therefore, such patients should be turned in bed, given a semi-sitting position, breathing exercises, and dosed physical exercises should be performed.

To combat hypoxia, oxygen must be administered - a mixture of humidified oxygen with air, an oxygen tent. Oxygen therapy must be intermittent with a gradual increase in the oxygen dose to 50% (to prevent dizziness, nausea, suffocation, inhibition of the respiratory center). It is advisable to conduct it against the background of taking bronchodilators.

The administration of cardiac glycosides is indicated when symptoms of circulatory failure appear.

For chronic bronchitis with abundant sputum, spa treatment in the steppe, in a pine forest, in a mountain climate (no higher than 1000-1200 m above sea level) is effective.