Chronic nonobstructive bronchitis - Symptoms

The clinical course of chronic non-obstructive bronchitis in most cases is characterized by long periods of stable clinical remission and relatively rare exacerbations of the disease (no more than 1-2 times a year).

The remission stage is characterized by scanty clinical symptoms. Most people suffering from chronic non-obstructive bronchitis do not consider themselves ill at all, and periodically occurring cough with sputum is explained by the habit of smoking tobacco (smoker's cough). In this phase, cough is essentially the only symptom of the disease. It most often occurs in the morning, after sleep and is accompanied by moderate separation of mucous or mucopurulent sputum. Cough in these cases is a kind of protective mechanism that allows removing excess bronchial secretion that accumulates in the bronchi overnight, and reflects the patient's already existing morphofunctional disorders - hyperproduction of bronchial secretion and decreased efficiency of mucociliary transport. Sometimes such periodic cough is provoked by inhalation of cold air, concentrated tobacco smoke or significant physical exertion.

Other symptoms in the phase of stable clinical remission usually cannot be detected. The working capacity and physical activity in everyday life of patients with chronic non-obstructive bronchitis are, as a rule, completely preserved.

During an objective examination of such patients in the remission phase, no visible deviations from the norm are usually detected, except for harsh breathing. Only occasionally, during auscultation of the lungs, can isolated dry low-pitched wheezing be detected, especially during forced exhalation. The wheezing is very inconstant and quickly disappears after a slight cough.

The exacerbation phase is characterized by more vivid clinical symptoms. Exacerbations of bronchitis are usually provoked by acute respiratory viral infections, often during epidemics of a viral infection, to which a bacterial infection quickly joins. In other cases, the provoking factor may be severe hypothermia ("cold"), excessive smoking or exposure of the bronchi to irritants of a household or industrial nature, as well as acute laryngitis, pharyngitis, tonsillitis or significant physical fatigue, which affect the immune system and the body's overall resistance.

Seasonality of exacerbations is typical, most often occurring in late autumn or early spring, during significant changes in weather and climate factors.

When questioning a patient with an exacerbation of chronic non-obstructive bronchitis, three clinical signs are mainly revealed:

• cough with sputum production;
• increased body temperature (optional symptom);
• intoxication syndrome.

In most cases, in the clinical picture of exacerbation, cough comes to the fore, much more intense and painful than during the period of remission of the disease. Cough bothers the patient not only because of acne, but also during the day and especially tobacco smoke, volatile pollutants, respiratory viral infection

Chronic exposure to the bronchial mucosa at night, when the patient is in a horizontal position in bed, which facilitates the flow of sputum into the larger bronchi and trachea, which are known to contain a large number of cough receptors.

The cough is often productive and is accompanied by the separation of mucopurulent and purulent sputum, which becomes more viscous and is difficult to separate. However, the daily amount increases significantly compared to the remission phase.

An increase in body temperature to subfebrile numbers is observed quite often, but not always. Higher fever is typical for exacerbations of chronic non-obstructive bronchitis caused by an acute viral infection.

As a rule, patients with exacerbation of chronic non-obstructive bronchitis experience decreased performance, severe sweating, weakness, headache, and myalgia. Symptoms of intoxication are especially pronounced against the background of significant fever. However, it should be remembered that deterioration of the general condition and individual symptoms of intoxication can be detected even in patients with normal body temperature.

In most cases, objective examination also reveals very scant changes in the respiratory organs. The shape of the chest is usually unchanged. Percussion reveals a clear pulmonary sound, identical over symmetrical areas of the lungs.

Auscultation data have the greatest diagnostic value. For patients with exacerbation of chronic non-obstructive bronchitis, the most characteristic feature is harsh breathing, heard over the entire surface of the lungs and caused by the unevenness of the lumen and the "roughness" of the inner surface of the large and medium bronchi.

As a rule, scattered dry wheezing is also heard, often low-pitched (bass), which indicates the presence of a large amount of viscous sputum in the large and medium bronchi. Air movement during inhalation and exhalation causes low-frequency vibrations of the threads and strands of viscous sputum, which leads to the appearance of long drawn-out sounds - humming and buzzing dry wheezing, which are usually heard in both phases of breathing. A feature of bass wheezing is their inconstancy: they are heard and then disappear, especially after coughing. In some cases, moist fine-bubble or medium-bubble silent wheezing can also be heard, which is associated with the appearance of a more liquid secretion in the lumen of the bronchi.

It should be emphasized that in a relatively small proportion of patients with chronic non-obstructive bronchitis, individual symptoms of broncho-obstructive syndrome may be detected during a severe exacerbation, mainly due to the reversible component of obstruction - the presence of a large amount of viscous sputum in the bronchial lumen, as well as moderate spasm of the smooth muscles of the bronchi. Such a situation often occurs when an exacerbation of chronic non-obstructive bronchitis is provoked by an acute respiratory viral infection - influenza, adenovirus or RS-virus infection. Clinically, this is expressed by some difficulty in breathing that occurs during physical exertion or during an attack of unproductive cough. Respiratory discomfort often occurs at night, when the patient assumes a horizontal position in bed. In this case, high-pitched (treble) dry wheezing is heard auscultatively, against the background of harsh breathing. They are best detected during rapid forced exhalation. This technique helps to recognize even the latent syndrome of bronchial obstruction, which sometimes develops in patients with chronic non-obstructive bronchitis in the phase of exacerbation of the disease. After stopping the exacerbation of chronic non-obstructive bronchitis, the signs of moderate bronchial obstruction completely disappear.

• The most characteristic clinical symptoms of exacerbation of chronic non-obstructive bronchitis are:
  • cough with the separation of mucous or mucopurulent sputum;
  • increase in body temperature to subfebrile levels;
  • mild intoxication;
  • dry, scattered, low-pitched wheezing in the lungs against the background of harsh breathing.
• Only in some patients with chronic non-obstructive bronchitis in the phase of severe exacerbation can moderate signs of broncho-obstructive syndrome be detected (difficulty breathing, high-pitched wheezing, attacks of unproductive cough), caused by the reversible component of bronchial obstruction - the presence of viscous sputum and bronchospasm.
• In the remission phase of chronic non-obstructive bronchitis, patients develop a cough with sputum, while shortness of breath and other signs of broncho-obstructive syndrome are completely absent.

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