Chronic bronchitis: symptoms

The main symptoms of chronic bronchitis - cough with separation of sputum, general weakness, sweating (with exacerbation of the disease and purulent nature of bronchitis).

According to WHO definition, the main symptoms of chronic bronchitis are cough with sputum separation for at least 3 months a year for 2 or more years. At the onset of the disease of chronic bronzitis, coughing worries patients usually in the morning immediately or soon after waking, while the amount of sputum is small. The appearance of a cough mainly in the morning is due to the daily rhythm of functioning of the ciliated epithelium. His activity is small at night and most expressed in the morning. In addition, morning morning physical activity of the patient plays an important role in the appearance of a cough and an increase in the tone of the sympathetic nervous system. Cough usually increases in the cold and damp season, and in warm and dry weather, patients feel much better, cough worries them less often and may even completely stop.

At the beginning of the disease, cough worries patients only in the period of exacerbation, during the period of remission it is almost not expressed. As chronic bronchitis progresses, cough becomes more regular, almost constant, and worries not only in the morning, but also during the day, and also at night. Cough at night in the horizontal position of the patient is associated with the receipt of phlegm from the small bronchi.

Cough is caused by irritation of the vagal nerve receptors in the cough reflex zones (larynx, vocal cords, tracheal bifurcation, division of large bronchi). In small bronchi, there are no cough receptors, therefore cough may be absent in the predominantly distal bronchitis and the main complaint of patients is shortness of breath.

In the period of exacerbation of chronic bronchitis, the sensitivity of cough receptors rises sharply, which leads to a sharp increase in the cough, it becomes an exasperating, painful, sometimes "barking." It should be taken into account that the cough acquires a tinge of barking and paroxysmal attacks with a pronounced expiratory collapse of the trachea and large bronchi, with bronchial obstruction. Nasty "barking" cough with bronchial obstruction differs from coughing with coughing in case of hypersensitivity of cough zones in that during bronchial obstruction you have to cough longer, while cough becomes painful, the patient's face turns red, veins of neck tighten, swell, cough accompanied by wheezing. During the day, bronchial patency improves and cough becomes less pronounced and worries less often.

Attacks of an excruciating painful cough may be caused by hypotonic tracheobronchial dyskinesia by prolapse into the lumen of the trachea or large bronchi of the posterior membrane part of these organs. Cough with this can be accompanied by a gasp of asthma, with stridor breathing, anxiety of the patient, often loss of consciousness at the height of cough (cough-and-fainting syndrome).

Coughing attacks with chronic bronchitis can be provoked by cold, frosty air; return in cold weather from the street to a warm room; tobacco smoke; exhaust gases; the presence in the air of various irritants and other factors.

In the late stage of the disease, the cough reflex can fade away, coughing worries little, and draining the bronchi is severely impaired.

Separation of sputum is the most important symptom of chronic bronchitis. Sputum can be mucous, purulent, mucopurulent, sometimes with veins of blood. In the early stages of the disease, sputum can be mucous, light. However, in patients working for a long time in conditions of a dusty atmosphere, sputum may acquire gray or black color (for example, "black" sputum of miners). As the progression of chronic bronchitis, sputum becomes mucopurulent or purulent, especially in the period of exacerbation of the disease. Purulent sputum is more viscous and is separated with great difficulty. With exacerbation of chronic bronchitis, the amount of sputum increases, however, in damp weather and after drinking alcohol may decrease. In most patients, the daily amount of sputum is 50-70 ml, with the development of bronchiectasises - significantly increases.

There are cases of chronic bronchitis, which proceeds without sputum ("dry catarrh of the bronchi") - not to be confused with swallowing sputum! In 10-17% of cases with chronic bronchitis hemoptysis is possible. It can be caused by damage to the blood vessels of the bronchial mucosa during an exacerbation cough (especially this is typical of atrophic bronchitis). The appearance of hemoptysis requires careful differential diagnosis with pulmonary tuberculosis, lung cancer, bronchiectasis. Hemoptysis is also possible with pulmonary embolism, mitral stenosis, congestive heart failure, hemorrhagic diathesis.

With uncomplicated chronic bronchitis, shortness of breath does not bother the patients. However, with the development of bronchial obstruction and emphysema of the lungs, shortness of breath becomes a characteristic sign of the disease.

The general condition of patients in the initial stages of chronic bronchitis is satisfactory. It is significantly impaired as the disease progresses and bronchial obstruction develops, emphysema and respiratory failure appear.

When external examination of patients with chronic non-obstructive bronchitis, no significant changes are detected. In the period of exacerbation of the disease, especially with purulent bronchitis, sweating can be observed, possibly raising the body temperature to subfebrile digits.

With percussion of the lungs with chronic non-obstructive bronchitis, the percussion sound remains clear. Voice tremor and bronchophonia are usually not changed. The most typical are the auscultative data. With auscultation of the lung, prolonged exhalation is noted (normal ratio of duration of inspiration and expiration is 1: 1.2). Chronic bronchitis is characterized by severe breathing ("roughness", "unevenness" of vesicular breathing).

Usually, in chronic bronchitis dry rales are also heard, due to the presence of viscous sputum in the lumen of the bronchi. The smaller the caliber of bronchi, the higher the tonality of wheezing. In the large bronchi, bass, low-tonal rales appear, in middle-sized bronchial tubes - buzzing rales, in fine bronchi - high-tonal (wheezing, hissing) wheezing. Low-tonal rales are better audible on inspiration, high-toned - on exhalation. High-tonal rales (wheezing), especially those that occur when forced exhalation, are characteristic of obstructive bronchitis.

In the presence of liquid sputum in the bronchi, wet wheezing is heard, the character of which depends on the caliber of bronchi. In large-caliber bronchi, large bubbles are formed, medium-sized medium-bubbles, and small-sized rales are small-sized. If large bubbling rales are heard over the peripheral parts of the lungs, where there are no large bronchi, this may be a sign of bronchiectasis or cavity in the lung. A characteristic feature of both dry and wet wheezing is their instability - they can disappear after vigorous coughing and sputum discharge.

Any significant changes in the study of other organs and systems in patients with chronic non-obstructive bronchitis, as a rule, is not detected. When expressed purulent bronchitis may develop myocardial dystrophy, which is manifested by muffled heart tones, unintentional systolic murmur in the region of the apex of the heart.

[1], [2], [3], [4], [5]