Physiotherapy in the treatment of chronic bronchitis

Physiotherapy is used in patients with chronic bronchitis to suppress the inflammatory process, improve the drainage function of the bronchi.

In chronic bronchitis, inhalation aerosol therapy is widely prescribed. This method of treatment is carried out with the help of individual (home) inhalers (AIIP-1, Tuman, Musson, Geyser-6, TIR US-70, etc.) or in hospital and sanatorium inhalators.

The surface of the mucosa of the affected bronchial tree for chronic bronchial diseases is 10 to 25 m ², and the diameter of bronchial tubes of small and medium caliber is from 10 to 4 mm. Therefore, only sufficiently large volumes of aerosol with small particles are able to penetrate the hard-to-reach places of the respiratory tract and have a therapeutic effect on the bronchial mucosa.

The solution of this problem is only possible with the help of individual ultrasonic inhalers, which generate dense and highly dispersed (with a particle size of 5-10 microns) aerosols in large volumes in a short period of time.

According to VN Solopov, in the basis of correction of bronchial obstruction in bronchial obstructive diseases lie the inhalation of expectorant and powerful antiseptic drugs. Combinations of several expectorants are used, for example, first dilute sputum (acetylcisgein, mistabrone), and then stimulating it to cough (hypertonic solutions of potassium and sodium iodide, sodium bicarbonate, their mixture). The duration of one treatment course is -2-3 months. Inhalations are prescribed 2 times a day. VN Solopov proposes the following inhalation program for a patient with obstructive or pyo-obstructive bronchitis:

Bronchodilator mixture with adrenaline:

• solution of adrenaline 0.1% - 2 ml
• solution of atropine 0.1% - 2 ml
• solution of dimedrol 0.1% - 2 ml

20 drops per 10-20 ml of water.

You can also use another wording:

• solution of euphyllinum 2.4% - 10ml
• adrenaline solution 0.1% - 1 ml
• solution of diphenhydramine 1.0% - 1 ml
• solution of sodium chloride 0.9% - up to 20 ml

For 20 ml per 1 inhalation.

20% solution of acetylcysteine 5 ml per 20 ml isotonic sodium chloride solution.

Alkaline expectorant mixture:

• sodium bicarbonate - 2 g
• sodium tetraborate 1 g
• Sodium Chloride - 1 g
• distilled water - up to 100 ml

For 10-20 ml per 1 inhalation.

It is possible to use in words

• sodium bicarbonate - 4 g
• potassium iodide-3 g
• distilled water - up to 150 ml

10-20 ml per 1 inhalation

Or

• sodium bicarbonate 0.4 g
• sodium citrate - 0.1 g
• copper sulfate - 0.001 g

1 powder per 20 ml of water for 1 inhalation.

1% solution of dioxidine - 10 ml per inhalation.

You can also use it in words

• solution of furacilin 1: 5000-400 ml
• sodium citrate - 2 g
• sodium bicarbonate-16g
• copper sulphate 0.2 g

For 10-20 ml per 1 inhalation.

Criteria for the effectiveness of treatment are improved cough expectoration, absence of difficulty breathing, disappearance of purulent sputum. If purulent sputum continues to be allocated, you can try to inject antibiotics of a broad spectrum of action (aminoglycosides, cephalosporins) in the form of a fine powder instead of solutions of antiseptics in the respiratory tract.

Very useful is aeroionotherapy with negative ions.

In recent years, endobronchial ultrasonic nebulization of antibiotics has been developed with the help of low-frequency ultrasound.

Physiotherapeutic procedures recommended for exacerbation of chronic bronchitis:

• UHF currents for 10-12 minutes per area of the roots of the lungs every other day in an oligothermic dosage;
• microwave therapy (decimeter waves with the "Volna-2" device) on the lung roots every day or every other day, 10-15 procedures (improves patency of small bronchi);
• inductothermy or shortwave diathermy on the interscapular area for 15-25 minutes, daily or every other day (total 10-15 procedures);
• with abundant sputum - UHF in alternation with electrophoresis of calcium chloride on the chest, with a dry cough - electrophoresis of potassium iodide;
• in the presence of bronchospasm - electrophoresis of potassium iodide with inductothermia, electrophoresis of spasmolytic agents - papaverine, magnesium sulfate, euphyllinum;
• all patients are shown electrophoresis with heparin on the thorax;
• sinusoidal modulated currents (improve the patency of small bronchi).

With a ceasing exacerbation of chronic bronchitis, one can apply mud, ozocerite, paraffin to the thorax, UFO during the warm season in a phase close to remission; coniferous, oxygen baths; warming circular compresses.

Therapeutic exercise (LFK) is an obligatory component of the treatment of chronic bronchitis. They use traditional exercise therapy with the predominance of static and dynamic exercises against the background of general toning. In the presence of purulent bronchitis include drainage exercises.

LFK is contraindicated in acute respiratory and cardiovascular insufficiency.

O.F. Kuznetsov suggested in the middle of the basic period of exercise therapy, during the peak load periods, individual exercises should not be performed 3-6 times as usual, but repeated many times within 1-3 minutes at a rate of 12-18 movements per minute with deep inspiration and enhanced exhalation. After each such cycle, a pause of a fixed active rest of 1.5-2 minutes follows. The optimal load for chronic bronchitis is 2 cycles of exercise with two rest intervals. The duration of intensive gymnastics is 25-35 minutes. It is performed 2 times a week (4-8 times in total) against the background of daily sessions of conventional medical gymnastics.

The most preferred form of exercise for most patients is walking. Patients with chronic bronchitis may under the guidance of an instructor practice yoga gymnastics.

In severe breathing disorders caused by bronchial obstruction, exercises associated with deepening of breathing, prolongation of the exhalation phase after a deep inspiration (the ratio of the duration of inspiration and expiration 1: 3), with additional inspiratory resistance (slow exhalation, through compressed lips) at rest and at a load, and also training of a diaphragm and diaphragmatic respiration at deenergizing of auxiliary respiratory muscles of a neck and a humeral belt. For patients with bronchial obstruction necessarily include exercises that create positive exhalation pressure, which improves ventilation and bronchial drainage. For this purpose, breathing regulators are used.

Mandatory tempering of the body, which should start in July and August with a gradual increase in the cold load. Hardening allows to increase the resistance of the patient to sudden changes in temperature, supercooling.

Spa treatment

Sanatorium treatment improves nonspecific resistance of the body, has an immunocorrective action, improves the function of respiration and drainage function of the bronchi.

The main therapeutic factors of the spa treatment:

• purity and ionization of air by negative ions; bactericidal properties of ultraviolet irradiation;
• balneological factors;
• terrenkury;
• aerosol therapy;
• LFK, massage;
• breathing exercises;
• physiotherapy.

At the resorts, balneotherapy is actively used. Hydrogen sulfide baths have an anti-inflammatory effect, carbonic baths improve bronchial patency.

Recommended:

• resorts with seaside climate (Southern coast of Crimea, Anapa, Gelendzhik, Lazarevka);
• resorts with mountain climate (Kislovodsk, Issyk-Kul);
• local suburban resorts (Ivanteevka, Sestroretsk, Slavyanogore, etc.).
• in the Republic of Belarus - sanatorium "Belarus" (Minsk region), "Bug" (Brest region)

Patients are sent to the resorts in the phase of remission with initial manifestations of respiratory failure or without it.

Dispensary supervision

Chronic non-obstructive bronchitis with rare exacerbations (no more than 3 times a year) in the absence of pulmonary insufficiency.

Patients are examined by a therapist 2 times a year, an ENT doctor, a dentist once a year, a pulmonologist - according to the indications.

The general analysis of blood, sputum and sputum analysis for Koch bacilli is performed 2 times a year, ECG, bronchial examination - according to indications.

Anti-relapse therapy is performed 2 times a year, as well as with acute respiratory-viral infections. It includes:

• inhalation aerosol therapy;
• multivitamin therapy;
• reception of adaptogens;
• the use of expectorants;
• physiotherapeutic treatment;
• LFK, massage;
• hardening, playing sports;
• sanation of foci of infection;
• Spa treatment;
• to give up smoking;
• employment.

Chronic non-obstructive bronchitis with frequent exacerbations in the absence of respiratory failure.

Examinations of the therapist are recommended to be performed 3 times a year, general blood tests - 3 times a year, spirography - 2 times a year, fluorography and a biochemical blood test - once a year. Anti-relapse treatment is carried out 2-3 times a year, the volume is the same, but immunocorrective therapy is included.

Chronic obstructive bronchitis with respiratory failure.

Examinations of the therapist are conducted 3-6 times a year, other examinations are the same and at the same time as in the second group.

Anti-relapse treatment is carried out 3-4 times a year, the treatment program is the same, in the presence of purulent bronchitis is indicated endobronchial sanation, in addition, bronchodilators are used.

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