Physiotherapy in the treatment of chronic bronchitis

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

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

The surface area of the mucous membrane of the affected bronchial tree in chronic bronchial diseases is from 10 to 25 m2 ^, and the diameter of small and medium-sized bronchi is from 10 to 4 mm. Therefore, only sufficiently large volumes of aerosol with small particles are able to penetrate into hard-to-reach places of the respiratory tract and have a therapeutic effect on the bronchial mucous membrane.

The solution to this problem is only possible through therapy using individual ultrasonic inhalers that 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 V. N. Solopov, the correction of bronchial obstruction in broncho-obstructive diseases is based on inhalations of expectorants and powerful antiseptic drugs. In this case, combinations of several expectorants are used, for example, first liquefying sputum (acetyl cisgein, mistabron), and then stimulating its expectoration (hypertonic solutions of potassium and sodium iodide, sodium bicarbonate, their mixtures). The duration of one course of treatment is 2-3 months. Inhalations are prescribed 2 times a day. V. N. Solopov suggests the following inhalation program for a patient with obstructive or purulent-obstructive bronchitis:

Bronchodilator mixture with adrenaline:

• adrenaline solution 0.1% - 2 ml
• atropine solution 0.1% - 2 ml
• diphenhydramine solution 0.1% - 2 ml

20 drops per 10-20 ml of water.

You can also use another spelling:

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

20 ml per 1 inhalation.

20% acetylcysteine solution 5 ml per 20 ml of 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

10-20 ml per 1 inhalation.

You can use the written form

• 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 handwriting

• furatsilin solution 1:5000-400 ml
• sodium citrate - 2 g
• sodium bicarbonate - 16g
• copper sulfate - 0.2 g

10-20 ml per 1 inhalation.

The criteria for the effectiveness of treatment are improved expectoration of sputum, absence of breathing difficulties, and disappearance of purulent sputum. If purulent sputum continues to be secreted, one can try to introduce broad-spectrum antibiotics (aminoglycosides, cephalosporins) into the respiratory tract in the form of finely dispersed powder instead of antiseptic solutions.

Aeroionotherapy with negative ions is also very useful.

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

Physiotherapeutic procedures recommended for exacerbation of chronic bronchitis:

• UHF currents for 10-12 minutes on the 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 area of the roots of the lungs daily or every other day, 10-15 procedures (improves the patency of small bronchi);
• inductothermy or short-wave diathermy on the interscapular region for 15-25 minutes, daily or every other day (10-15 procedures in total);
• in case of large amounts of sputum - UHF alternating with calcium chloride electrophoresis on the chest, in case of dry cough - potassium iodide electrophoresis;
• in the presence of bronchospasm - electrophoresis of potassium iodide with inductothermy, electrophoresis of antispasmodics - papaverine, magnesium sulfate, euphyllin;
• All patients are shown electrophoresis with heparin on the chest;
• sinusoidal modulated currents (improves the patency of small bronchi).

When the exacerbation of chronic bronchitis is fading, you can use mud, ozokerite, paraffin applications on the chest, UV radiation in the warm season in a phase close to remission; coniferous, oxygen baths; warming circular compresses.

Therapeutic exercise (TE) is a mandatory component of chronic bronchitis treatment. Traditional TE is used with a predominance of static and dynamic exercises against the background of general tonic ones. In the presence of purulent bronchitis, drainage exercises are included.

Physical therapy is contraindicated in cases of acute respiratory and cardiovascular failure.

O. F. Kuznetsov suggested that in the middle of the main period of exercise therapy, during the peak load period, individual exercises should be performed not 3-6 times, as usual, but repeated many times for 1-3 minutes at a rate of 12-18 movements per minute with a deep inhalation and an increased exhalation. After each such cycle, there should be a pause of fixed active rest for 1.5-2 minutes. The optimal load for chronic bronchitis is 2 exercise cycles 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 classes of generally accepted therapeutic gymnastics.

The most preferred form of exercise for most patients is walking. Patients with chronic bronchitis can do yoga exercises under the guidance of an instructor.

In severe respiratory disorders caused by bronchial obstruction, exercises are advisable that involve deepening breathing, lengthening the exhalation phase after a deep inhalation (inhalation and exhalation duration ratio 1:3), with additional resistance during inhalation (slow exhalation, through pursed lips) at rest and under load, as well as training the diaphragm and diaphragmatic breathing while turning off the auxiliary respiratory muscles of the neck and shoulder girdle. For patients with bronchial obstruction, exercises that create positive pressure during exhalation are mandatory, which improves ventilation and bronchial drainage. Breathing regulators are used for this purpose.

Hardening of the body is mandatory, which should begin in July-August with a gradual increase in cold load. Hardening allows increasing the patient's resistance to sudden temperature changes and hypothermia.

Sanatorium and resort treatment

Sanatorium and spa treatment increases the body's non-specific resistance, has an immunocorrective effect, improves respiratory function and bronchial drainage function.

The main therapeutic factors of spa treatment:

• air purity and ionization with negative ions; bactericidal properties of ultraviolet radiation;
• balneological factors;
• terrain cures;
• aerosol therapy;
• Physical therapy, massage;
• breathing exercises;
• physiotherapy.

Balneotherapy is widely used at resorts. Hydrogen sulphide baths have an anti-inflammatory effect, carbon dioxide baths improve bronchial patency.

Recommended:

• resorts with a seaside climate (South Coast of Crimea, Anapa, Gelendzhik, Lazarevka);
• resorts with a mountain climate (Kislovodsk, Issyk-Kul);
• local suburban resorts (Ivanteyevka, Sestroretsk, Slavyanorok, etc.).
• in the Republic of Belarus - sanatorium "Belarus" (Minsk region), "Bug" (Brest region)

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

Outpatient observation

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 general practitioner twice a year, an ENT specialist, a dentist once a year, and a pulmonologist as indicated.

A general blood test, sputum analysis and sputum analysis for Koch's bacilli are performed twice a year, ECG, bronchological examination - as indicated.

Anti-relapse therapy is carried out twice a year, as well as in acute respiratory viral infections. It includes:

• inhalation aerosol therapy;
• multivitamin therapy;
• taking adaptogens;
• use of expectorants;
• physiotherapy treatment;
• Physical therapy, massage;
• hardening, sports;
• sanitation of infection foci;
• spa treatment;
• quitting smoking;
• employment.

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

It is recommended to conduct examinations by a therapist 3 times a year, general blood tests - 3 times a year, spirography - 2 times a year, fluorography and biochemical blood test - 1 time per 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 by a therapist are carried out 3-6 times a year, other examinations are the same and at the same time as in the 2nd group.

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

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