Chronic non-obstructive bronchitis: symptoms

The clinical course of chronic non-obstructive bronchitis in most cases is characterized by long periods of persistent clinical remission and comparatively rare exacerbations of the disease (not more often 1-2 times per year).

The stage of remission is characterized by poor clinical symptoms. Most people with chronic non-obstructive bronchitis generally do not consider themselves to be sick, and a recurring cough with sputum is explained by the habit of smoking tobacco (smoker's cough). In this phase, cough, in fact, is the only symptom of the disease. It often occurs in the morning, after sleep and is accompanied by a mild mucous or mucopurulent sputum. Cough in these cases is a kind of protective mechanism that allows you to remove excess bronchial secretion accumulating overnight in the bronchi and reflects the already existing in the patient's morphofunctional disorders - hyperproduction of bronchial secretion and a decrease in the effectiveness of mucociliary transport. Sometimes such a periodic cough is provoked by inhalation of cold air, concentrated tobacco smoke or considerable physical exertion.

Other symptoms in the phase of persistent clinical remission are usually not found. The working capacity and physical activity in the life of patients with chronic non-obstructive bronchitis, as a rule, are fully preserved.

At an objective research of such patients in a phase of remission of visible deviations from norm, except for a rigid respiration, usually it is not revealed. Only occasionally with auscultation of the lungs can be detected single dry low-tonal rales, especially when forced exhalation. Chryps are very fickle and quickly disappear after a small cough.

The phase of exacerbation is marked by a more vivid clinical symptomatology. Exacerbations of bronchitis usually provoke ARVI, often during epidemics of a viral infection, to which the bacterial infection quickly joins. In other cases, the provoking factor may be expressed by overcooling ("cold"), excessive smoking or exposure to irritants of domestic or industrial nature, as well as acute laryngitis, pharyngitis, tonsillitis or significant physical exhaustion, affecting the immune system and the general resistance of the body .

Typical seasonality of exacerbations, which often occur in late autumn or early spring, during pronounced differences in weather and climate factors.

When questioning a patient with exacerbation of chronic non-obstructive bronchitis, there are basically three clinical signs:

• cough with phlegm;
• fever (optional);
• intoxication syndrome.

In most cases, in the clinical picture of an exacerbation, cough is much more important, much more intense and painful than during the period of remission of the disease. The cough worries the patient not only over the rams, on and during the day and especially tobacco smoke, volatile pollutants, respiratory viral infection

Chronic exposure to the bronchial mucosa at night, when the patient occupies a horizontal position in the bed, which contributes to the receipt of sputum in the larger bronchi and trachea containing, as is known, a large number of cough receptors.

Cough is more often productive and is accompanied by separation of mucopurulent and purulent sputum, which becomes more viscous and poorly separated. Nevertheless, the daily amount significantly increases compared with the phase of remission.

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

As a rule, in patients with exacerbation of chronic non-obstructive bronchitis, working capacity decreases, there is pronounced sweating, weakness, headache, myalgia. Particularly expressed symptoms of intoxication against a background of significant fever. Nevertheless, it should be remembered that the deterioration of the general condition and individual symptoms of intoxication can be detected even in patients with normal body temperature.

With objective research, in most cases very meager changes are also detected on the part of the respiratory organs. The shape of the chest is usually not changed. Percutally determined clear pulmonary sound, the same over the symmetrical areas of the lungs.

The greatest diagnostic value is given by auscultation. For patients with exacerbation of chronic non-obstructive bronchitis, hard breathing is most characteristic, which is heard over the entire surface of the lungs and is caused by uneven lumen and "roughness" of the inner surface of large and medium bronchi.

As a rule, scattered dry rales, more often lowtonal (bass), are also heard, which indicates the presence of large amounts of viscous sputum in large and medium bronchi. The movement of air during inhalation and exhalation causes low-frequency oscillations of the filaments and strands of viscous sputum, which leads to the appearance of prolonged lingering sounds - buzzing and buzzing dry wheezes, which are usually heard in both phases of breathing. The peculiarity of bass rales is their inconstancy: they are listened to, then disappear, especially after coughing. In some cases, you can listen to wet and small bubbles or medium bubbling silent rales, which is associated with the appearance in the lumen of the bronchi more liquid secret.

It should be emphasized that in a relatively small proportion of patients with chronic non-obstructive bronchitis during a period of severe exacerbation, certain symptoms of bronchial obstructive syndrome can be detected, mainly due to the reversible component of obstruction-the presence of a large amount of viscous sputum in the bronchus and a moderate spasm of the smooth muscles of the bronchi. Often this situation occurs when exacerbation of chronic non-obstructive bronchitis is triggered by an acute respiratory viral infection - influenza, adenovirus or RS virus infection. Clinically, this is expressed by a certain difficulty in breathing, which occurs during physical exertion or at the time of an attack of unproductive cough. Often, respiratory discomfort occurs at night, when the patient takes a horizontal position in bed. At the same time auscultative, against the background of severe breathing, high-tonnous (dissentant) dry wheezes begin to be heard. They are best identified during a rapid forced exhalation. This method helps to recognize even the latent bronchial obstruction syndrome, which sometimes develops in chronic non-obstructive bronchitis patients in the phase of exacerbation of the disease. After relief of exacerbation of chronic non-obstructive bronchitis, signs of moderate bronchial obstruction completely disappear.

• The most characteristic clinical symptoms of exacerbation of chronic non-obstructive bronchitis are:
  • cough with mucous membrane or mucopurulent sputum;
  • increase in body temperature to low-grade figures;
  • Intense intoxication;
  • dry scattered low-tone wheezing in the lungs against the background of hard breathing.
• Only a part of patients with chronic non-obstructive bronchitis in the phase of acute exacerbation can be detected moderate signs of bronchial obstructive syndrome (shortness of breath, high treble rales, fits of unproductive cough) caused by a reversible component of bronchial obstruction - the presence of viscous sputum and bronchospasm.
• In the phase of remission of chronic non-obstructive bronchitis, cough with sputum is detected in patients, while dyspnea and other signs of bronchial obstructive syndrome are completely absent.

[1], [2], [3], [4], [5], [6], [7], [8],