Dyspnoea with obstructive and acute bronchitis: treatment with drugs and alternative means

Different forms of the inflammatory process in the bronchi are usually accompanied by dyspnoea (dyspnea). And in children, dyspnea with this disease develops much more often than in adults. Sensation of acute oxygen deficiency, which threatens to leak into choking, causes not only considerable discomfort, but also a danger to health, and sometimes to the life of the patient.

[1], [2], [3]

Causes of the dyspnoea with bronchitis

Subjective feeling of lack of air appears as a result of a violation of its patency in the bronchi with their spasms or strictures and is aggravated by the accumulation of a viscous secretion (sputum) in narrower places.

Risk factors for dyspnea in bronchitis are pain in the chest on inhalation, which does not allow breathing deeply, the development of complications (pneumonia, pleurisy), chronic inflammation, the presence of cardiovascular pathologies, pulmonary hypertension, emphysema, pulmonary heart and other complications.

In the group at risk of developing respiratory diseases, smokers do not give the first place to anyone. Allergy sufferers are also a weak link, as well as people with reduced immunity and a hereditary predisposition to respiratory diseases.

The reason that children with bronchitis almost always has shortness of breath is the small diameter of the bronchi, which is quickly filled with a viscous secret, insufficient development of the elastic tissue in the walls of the bronchi, weakness of the respiratory musculature.

[4]

Pathogenesis

In the mechanism of the appearance of dyspnea, the main pathogenetic links are the decrease in the blood of the partial pressure of oxygen and its content (hypoxemia) that occur in bronchitis due to the difficult passage of air through spasmodically contracted or blocked by viscous secretion of the bronchi. The threat of hypoxia causes reactive excitation of the respiratory center. Lack of oxygen, the body tries to compensate for more frequent and deep breathing, that is, shortness of breath. As a result, the frequency of contractions of the heart and the systolic volume of blood, the rate of blood flow, the level of erythrocytes and hemoglobin increase, entailing other functional disorders.

In acute bronchitis in the pathogenesis of dyspnea, the main role belongs to bronchial spasms, the accumulation of a viscous secretion and pain in the chest, with chronic processes - obstructions, organic and functional stenoses, obstructions of the bronchus lumen, pulmonary heart and hypertension, heart failure.

In the inflammatory process in the large bronchi, the reflex regulation of respiration in the inspiratory (inhaling regulating) department of the respiratory center is usually violated.

Expiratory dyspnea (shortness of breath) develops with changes in the small bronchi and lung parenchyma in chronic bronchitis, and mixed (with neglected diseases) also occurs, when the regulation of respiration is impaired in both departments.

[5], [6], [7], [8]

Epidemiology

Acute bronchitis is most often affected by a young (up to 40 years) male population. About 5% of adults turn to a doctor about this every year. Among children, the incidence is up to 100 cases per 1000 children, especially children of the first three years of life. The disease is characterized by pronounced seasonality - more than 80% of cases occur in the cold season.

Chronic bronchitis, which, in general, is accompanied by shortness of breath, affects about 10% of the population. Among them, more than half are over 50 years old, male patients are five to six times more than women, which is explained by such a harmful habit as smoking, which is more common among men. However, if you compare smoking men and women, then the incidence of bronchitis among them is the same.

[9], [10], [11],

Symptoms

The first signs of dyspnea in patients appear usually under the influence of unusual physical exertion (running, fast walking, climbing the stairs). Subjectively, this is expressed in a lack of air, it seems to the person that he suffocates.

Dyspnea with acute bronchitis in adults is rare. Its appearance should alert the patient, as, most likely, it signals the spread of the inflammatory process to the pulmonary or pleural tissues. At the child dyspnea develops at an acute bronchitis quickly enough. This is facilitated by the anatomical and physiological characteristics of the children's respiratory tract.

Classical development of clinical symptoms of acute bronchitis-suddenly a violent cough begins, usually it is dry at first; when inhaling and exhaling, rales and / or gurgling sounds are heard; it becomes difficult to breathe (shortness of breath); fever, weakness, sweating, hyperthermia.

Chronic forms of the disease are characterized by a long (at least three months a year for two years) cough, the patient quickly tired, sweats at the slightest effort, he can hold or rise to the evening subfebrile temperature.

Dyspnea with chronic bronchitis occurs very often. Patients can test it periodically (under loads) or permanently (even at rest). The frequency of exacerbations adversely affects the quality of breathing, the more frequent the recurrence of the disease, the worse the patient breathes. Sometimes dyspnea does not stop and during remission.

Dyspnea with obstructive bronchitis always develops. This is facilitated by edema of the bronchi, narrowing their lumen and contributing to the clogging up of his phlegm, as well as spasms of their musculature. For this type of bronchitis is characterized by expiratory dyspnea. Harsh and whistling sounds accompany the air outlet from the respiratory tract. With obstructive bronchitis, wheezing is often well audible to others. Especially severe shortness of breath in the morning, when the bronchi are clogged with sputum accumulated overnight. Relief occurs after a cough.

Dyspnea with chronic form of the disease can progress, in advanced cases appears mixed dyspnea, it is difficult both for inhaling and exhaling. In this case, severe shortness of breath with bronchitis accompanies the patient and at rest. With the long course of the disease, hypertension develops in the pulmonary artery, which eventually leads to an increase in the right ventricle of the heart and its insufficiency (pulmonary heart). The development of pulmonary hypertension often goes unnoticed, especially against the backdrop of chronic bronchitis, as its symptoms are shortness of breath and cough, weakness and fatigue at physical exertion, hoarseness, tachycardia, dizziness and loss of consciousness. Symptoms of the pulmonary heart are crossed with symptoms of chronic bronchitis and pulmonary hypertension are the same shortness of breath, which increases not only with physical exertion, but in lying or cold. There are heart pains, cyanosis, hepatomegaly, peripheral edema.

With bronchitis of allergic genesis, dyspnea develops from contact with the substance that caused the reaction. Difficulty breathing can be, both minor and serious, down to choking. It is possible to get rid of this type of bronchitis only when an allergen is detected and eliminated.

Atrophic bronchitis is also accompanied by shortness of breath, especially during periods of exacerbations. At bronchial atrophy, their mucous membrane is replaced by scar tissue. Early symptoms of an atrophic form of the disease - sore throat, cough, hoarse voice, intense sweating, weakness, tenderness in the muscles of the back, dyspnoea with exertion. At the stage of exacerbation, shortness of breath accompanies the most simple and usual movements, there is a headache, weakness and pains in the sternum and abdominal region increase, body temperature can rise.

Dyspnea with bronchitis in an adult arises necessarily and is one of the first signs if it is asthmatic bronchitis. It differs from asthma by the absence of attacks of suffocation and is considered a pre-asthmatic condition. However, children of preschool and primary school age are most prone to this form of bronchitis.

Dyspnoea with bronchitis in a child develops much more often and faster than in adults, since even a small lump of viscous secretion can clog the narrow lumen. The younger the child, the more dangerous the consequences of procrastination may be.

Symptoms that require urgent care for adults and children:

• the occurrence of sudden severe dyspnea with increasing symptoms;
• pain in the chest;
• expiratory dyspnea with signs of suffocation.

Sometimes after the treatment of bronchitis remains dyspnea, accompanied by pain and raspiranie in the chest. These sensations usually indicate recovery processes and eventually pass independently.

[12], [13], [14],

Diagnostics of the dyspnoea with bronchitis

The examination of patients complaining of cough and shortness of breath begins by collecting information for the medical history and visual inspection. The age, heredity, appearance, working conditions and bad habits of the patient are taken into account.

Assign blood tests (clinical, biochemical, for coagulation), urine, sputum. Instrumental diagnostics is carried out: X-ray examination of chest organs, which allows to detect bronchitis and its complications, in particular, pneumonia, pleural effusion, pneumosclerosis and others; computer or magnetic resonance imaging of the thorax; scintigraphy of blood supply and ventilation of respiratory organs; pulse oximetry (to determine the degree of respiratory failure); spirometry (to determine the volume of exhalation and inspiration). The internal surface of the bronchi is examined using bronchoscopy (endoscopic examination of the mucous membranes of the trachea and bronchi). If you suspect a pleurisy, ultrasound examination of the lungs may be prescribed.

[15], [16], [17]

Differential diagnosis

Differential diagnosis of dyspnea in bronchitis is performed with dyspnea with diseases of parenchymal tissues or lung vessels, with pathologies of respiratory muscles, chest. Excludes tumor diseases, neurotic states, organic lesions of the respiratory center of the brain, heart pathology.

[18], [19],

Treatment of the dyspnoea with bronchitis

When developing a series of acute dyspnoea attacks, especially those that are expiratory and accompanied by pain, it is necessary to call an ambulance team. Until she arrived, you can alleviate the condition of the patient as follows:

• at an attack of an allergic etiology, first of all, it is necessary to eliminate an irritant and give an antihistamine medication recommended by a doctor and available in the medicine cabinet of any allergic person;
• if the provoking factor is unknown, arrange the patient in a semi-sitting position, creating an eminence from pillows, blankets;
• to facilitate breathing, unbuttoning the pulling clothes (tight collar, corsetry);
• Ensure access to the premises of fresh air, if possible - to humidify the air;
• if the patient has an aerosol with a drug (inhaler) - to help him apply it.

Dyspnea with bronchitis may appear periodically, but may be of a permanent nature. An ambulance is called in an emergency. Basically, with seizures cope on their own. Than to remove a dyspnea or short wind at a bronchitis?

Currently, there is a large selection of conventional inhalers and nebulizers in which the drug is sprayed into minute particles and, getting into the respiratory tract, acts quickly and efficiently.

With spasmodic contraction of the muscular layer of the bronchi,  inhalation with  Fenoterol is used.  This product is available in aerosol containers. The drug by inhibiting the transport of calcium ions through the cell membranes lowers its concentration in the muscle tissue, relaxing the muscles of the bronchi and promoting their expansion. Spasmolytic action occurs quickly, arresting attacks of suffocation of the most diverse etiology, and lasts up to eight hours. Contraindications to its use are severe atherosclerotic lesions of the heart vessels, disturbances of the heart rhythm. It can cause side effects in the form of tahikradia, anxiety, the appearance of trembling in the fingers, and also - there is increased sweating, fatigue, migraine.

Dosage the drug individually, with acute dyspnea, patients with a six-year-old age are recommended a one-time inhalation of 0.2 mg of the drug or twice in 0.1 mg. If the first attempt is ineffective, the drug may be reused after five minutes. The next inhalation is carried out with an interval of six hours (not earlier!).

Prophylactic dosage is 0.2 mg. Adult patients do inhalations three times a day, children 6-18 years - twice.

The age group of patients 4-5 full years is recommended aerosol in a dosage of 0.1 mg of active substance up to four times a day.

The largest permissible daily number of aerosol applications for patients of all age categories is four.

You can do inhalations with a preparation based on herbal ingredients -  Solutan. It can also be used orally. Not recommended for insomnia, high blood pressure, increased thyroid function, organic pathologies of the heart muscle and coronary arteries. In childhood, from five to ten drops are dosed and taken three times a day. Adult patients with bronchitis are recommended to take from 10 to 30 drops. The number of receptions is similar. The drug is taken after a meal.

Anticholinergic  Atrovent  may also be designated as a means cupping bonhospazm occurring on a background of colds and infectious diseases, bronchial obstruction and reducing the secretory activity of the bronchial mucous glands. This drug is available in aerosol form and in drops for inhalation. Aerosol can be used in patients older than five years, and the solution is older than four. Pregnant women can be prescribed by a doctor from the second trimester.

Aerosol Atrovent H, as a means of preventing shortness of breath, is recommended to use two or three inhalations three times a day, as a therapeutic - up to five times. Children 6-12 years old are given up to two inhalations with a break of at least six hours as needed.

In the inhaler for adults, from 20 to 40 drops of the solution are added and three or four inhalations per day are administered. The daily dose should not be more than 2 mg.

In pediatric practice, patients between five and 12 years of age are given inhalations with 10 or 20 drops of solution. Perform the procedure as needed under the supervision of medical staff. The daily dose should not be more than 1 mg.

When using nebulizer, the required dose is diluted with physiological solution to a capacity of 4 ml. A fresh solution is prepared before each inhalation.

Quite often prescribed pills for dyspnoea with bronchitis -  Theophylline. Its ability to dilate the bronchi helps to stop attacks of dyspnea. This drug is not recommended to take for a long time, since it can provoke cramps. Tablets are prescribed from the age of two, they can cause dyspeptic side effects. You can avoid this by applying the drug in the form of rectal suppositories. Sometimes this form is more effective.

Children's dosage: from two to four years - a single dose of 10-40mg, from five to six - 40-60mg, from seven to nine - 50-75mg, from ten to 14 years - 50-100mg. Adult patients take 100-200 mg each. Multiplicity of admission - twice or four times a day. The daily dose for adults should not exceed 15 mg per kilogram of body weight, in childhood - 20 mg.

The drug  Salbutamol is  available in a variety of forms: in tablets of usual and prolonged action, syrup, in powders and solution for the inhaler, in solution for injections. Eliminates spasms of the bronchi for a long time (from five to eight hours), without having a significant impact on the cardiovascular system. Has no absolute contraindications, requires caution when prescribing to pregnant women, patients with toxic goiter and attacks of strong palpitations, hypertensive patients.

Orally, patients older than 12 years may take a daily dose of 6 to 16 mg divided into three or four doses. The maximum permissible daily dose is 32 mg. For children, the drug is dosed as follows: from two to six years 3-6 mg per day, divided into three doses; older than six, but younger than 12 years - 6-8mg per day, divided into three or four receptions.

The aerosol form is dosed at 0.1 mg in childhood, 0.1-0.2 mg for adult patients - three to four inhalations per day.

The powder form is also used three times or four times a day, 0.2 mg for children and 0.2-0.4 for adults.

The solution can be dosed at 2.5 mg (if necessary - you can increase the single dosage, but not more than 5 mg) in the same scheme.

These drugs facilitate the patient's condition and are included in the therapeutic regimen if the patient has dyspnea.

In the treatment of bronchitis, the patient is prescribed vitamins to support the immune system and prevent the development of complications. Vitamin therapy is prescribed by a doctor based on the patient's condition. Vitamin-mineral complexes can be prescribed, in their composition should be vitamin C and A, vitamins of group B, to exclude the development of anemia.

Often it happens that people who have been ill with bronchitis for a long time are tormented by shortness of breath. It should be noted that the recovery period takes a long time. It is not necessary after the disease to return to bad habits, in particular, to smoking. It is necessary to conduct a fairly active lifestyle, including walking on fresh air, feasible physical exercises. As a rehabilitation, a good effect is given by massage, special physical therapy, physiotherapy. Thermal procedures can be useful - mud, paraffin, ozocerite applications; impact of pulses of low-frequency current; amplipulse therapy; ultrahigh-frequency therapy; halotherapy.

Alternative treatment

To get rid of dyspnea, it is possible and with the help of prescriptions of alternative medicine, supplementing them with the permission of the attending physician scheme of therapy of bronchitis. In the rehabilitation period with residual effects in the form of dyspnea, it is also possible to fight with the help of alternative means.

It is recommended to use a regular turnip: finely chop or grate on a large grater one root, pour water (400ml), boil a quarter of an hour, strain. To drink before going to bed a glass of broth from turnip to the disappearance of dyspnea.

People suffering from shortness of breath of any etiology should drink tea from cranberry leaves.

Virtually everyone probably had to inhale boiled potatoes in their uniform, covering themselves with a towel over the pan.

At a dyspnea, arising at a physical pressure accompanying chronic diseases it is possible to accept courses (three times in day before meal during a month) the following mixture: two dots of garlic cloves grind with a blender or on a grater and fill with unrefined vegetable oil. Stir and refrigerate - the mixture is ready for use. Take, mixing a teaspoon of a mixture and freshly squeezed juice from a lemon. After a month of taking, you need to make the same break in time. During the year, you can spend four wellness courses.

Treatment with herbs: from dyspnea with bronchitis get rid of by the next infusion. Prepare the herbal mixture, taking one part of oregano for two of the same parts of the marshmallow and mother-and-stepmother, mix. A tablespoon of a mixture of herbs brew with boiling water (½ liter), insist for 20 minutes, strain. Daily to drink half a glass after breakfast, lunch and dinner.

In spring, drink infusion of young birch leaves, two teaspoons of which are brewed with a glass of boiling water, insist 30 minutes and eat once a day.

You can take a tablespoon of lilac flowers and pour it with the same amount of boiling water. Infuse four hours. Take infusion for shortness of breath for three weeks, with an interval of a week to repeat the course.

Dyspnoea with allergic bronchitis: mix eight tablespoons of flowers of viburnum, five - sage herbs and turns, three - flowers of chamomile and mint leaves. To fill in a thermos a tablespoon of the collection, to boil with boiling water in volume of 250ml, to leave for the night. Strain and drink before eating during the day, dividing into four divided doses.

Recipe for adults: dry shredded flowers of horse chestnut (a teaspoon) insist on medical alcohol (50ml). The tincture is kept for a week in a cool place without access to light. Finished product, filtered, take 30 drops, diluted in 150 ml of water, before breakfast and dinner.

Homeopathy

Treatment of dyspnea with bronchitis homeopathic remedies requires medical prescription of the drug. The choice of drugs for treatment is wide enough. Patients are assigned both constitutional and symptomatic means. One of the drugs used in acute dyspnea Antimonium tartaricum (vomiting stone, complex antimony and potassium salt), this medicine is one of the constitutional means for patients with bronchopneumonia. Kalium carbonicum (potassium carbonate) is prescribed for dyspnea, accompanied by severe pain syndrome, dry cough and tachycardia. Arsenicum album (white arsenic) is prescribed for nighttime dyspnoea attacks. Curare (curare) - with bronchitis, complicated by emphysema of the lungs.

Of the drugs that can be purchased at any pharmacy, for the treatment of dyspnea in bronchitis are intended Bronhalis-Heel and Tartuffeldel N. These drugs directly act on the bronchial tree, relieving spasms, stopping the inflammatory process, facilitating the excretion of phlegm. Preparations in homeopathic dilutions, included in their composition, activate their own protective forces of the patient's body, opposing diseases.

Bronchalis-Heel is a  multicomponent drug with the ability to cure acute and chronic inflammatory processes in the respiratory system.

Atropa belladonna (krasavka) - a first aid for acute respiratory inflammatory processes;

Lobaria pulmonaria (pulmonary lobaria) - stops coughing attacks, hemoptysis;

Cephaelis ipecacuanha (vomiting root), Kreosotum (forest beech tar tar) - contribute to alleviating acute attacks of cough in chronic processes of any etiology;

Lobelia inflata (lobelia inflated) - it stops dyspnea, facilitates breathing, helps relax the muscles of the bronchi and other organs of the respiratory system, eliminates vegetative disorders accompanying acute respiratory symptoms;

Hyoscyamus niger (black henbane) - especially effective at night paroxysms of cough, eliminates dryness in the throat, larynx;

Bryonia (white transgression) - used as an expectorant, effective for pleurisy;

Antimonium tartaricum (emetic stone) - clears the respiratory tract from the viscous secretion of the bronchial glands, eliminates the dyspnea caused by its congestion, inflammation and hoarseness of the voice;

It is produced in tablet form for resorption under the tongue. Patients over six years of age are prescribed one tablet three times a day for a quarter of an hour before meals or an hour after.

For small patients aged 3-6 years, the tablet is crushed to a powdery mass, which is dissolved in 20 ml of cool boiled water. Dosage at one time 10ml solution.

For relief of acute symptoms, the drug is taken at intervals of 15 or 20 minutes, but not more than two consecutive hours.

Duration of admission is individual (from two weeks to a month). Repeated course appoints a doctor.

In case of sensitization to the components of the drug, an allergic reaction may be observed. Children under the age of three, pregnant and lactating women are not recommended to use without medical appointment. Contraindicated to persons sensitized to ingredients and with a deficiency of lactase. Can be taken in combination with other medicines.

The composition of oral homeopathic drops  Tartefedrelle N  echoes the composition of the previous remedy - Antimonium tartaricum, Atropa belladonna, Lobelia inflata, Cephaelis ipecacuanha is also in its composition.

Also in the composition of drops include:

Natrium sulfuricum (Glauber's salt or sodium sulfate) - is prescribed for asthmatic bronchitis and attacks of suffocation, especially in the morning, coughing and pains in the chest;

Arsenum iodatum (arsenic iodide) is an expectorant for bronchitis, pneumonia, tuberculosis, pleurisy, and also for respiratory manifestations of allergy;

Blatta orientalis (black cockroach) - a constitutional remedy for diseases of the respiratory system in people with a dense build;

Naphthalinum (naphthalene) - dyspnea, shortness of breath with bronchitis, infectious, cold and allergic, antispasmodic and expectorant, is prescribed for emphysema of lungs, bronchial asthma;

Illicium verum (anis stellate) - antispasmodic.

It should be noted that the medicine contains ethyl alcohol.

Contraindicated with intolerance of one or more ingredients of the drug. Persons with thyroid disorders should be admitted only as prescribed by the doctor.

Before taking ten drops, dissolve in ½ cup of water, drink, holding a mouthful in your mouth, three times during the day. For relief of acute conditions take a single dose at intervals of a quarter of an hour for the first two hours, then switch to the usual reception.

A long course of treatment (more than a month) is carried out according to the prescription and under the supervision of the attending physician.

Surgery

For the treatment of dyspnea with bronchitis, conservative treatment is used in most cases. In cases of complications of long-term chronic bronchitis that have spread to the parenchymal lung tissue, operations are performed to excise atrophied tissue sites.

Complications and consequences

Difficulty breathing in bronchitis is a common symptom, however, it should not be ignored. In acute process, shortness of breath usually indicates the spread of inflammation to the lung parenchyma and the development of complications, the flow of the disease into a chronic form.

Prolonged chronic processes affect not only the bronchi. The disease is progressing. A prolonged inflammatory process irritates the mucous membrane of the bronchi, causing irreversible changes in it. Most often chronic bronchitis is complicated by pneumonia, which does not last long and can also be chronic. Parenchymal lung tissues undergo irreversible sclerotic changes.

The development of asthmatic syndrome or bronchial asthma often becomes a consequence of the unfair treatment of obstructive bronchitis. The risk of asthmatic complications is the presence of allergies.

Expiratory or mixed dyspnoea may be a sign of the development of emphysema - irreversible stretching of the pulmonary alveoli and an increase in lung size in these areas. Gas exchange in the lungs is disrupted, the main signs of respiratory failure appear - dyspnea increases, cyanosis appears, the distance between the ribs increases and a so-called barrel chest arises.

Vessels and the heart muscle are also involved in this process. Chronic pulmonary heart leads to the development of severe heart failure. Emphysema is also complicated by severe respiratory failure, pneumothorax may develop.

With prolonged chronic bronchitis, the immune system suffers. Launched diseases are not amenable to treatment, can lead to disability and death.

[20], [21], [22], [23],

Prevention

Preventing the disease is much easier than curing it. A healthy lifestyle - physical activity, nutrition, hardening, exclusion of bad habits will keep the immune system in working order, and timely treatment of viral infections, allergic and colds will not contribute to the development of chronic respiratory diseases.

In the presence of chronic bronchitis, timely treatment of exacerbations, special breathing exercises, other rehabilitation measures, and most importantly - the efforts and desire of the patient to get rid of shortness of breath and cure the underlying disease will necessarily be effective.

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

Forecast

Dyspnoea with bronchitis, especially in children, should cause caution in parents and encourage them to seek medical help. Aggravated seizures in adults, accompanied by pain and suffocation, also require emergency measures. Time provided help will help to maintain health, relieve serious complications and development of respiratory failure. In general, the outlook is favorable.

[27], [28], [29], [30],