Bronchitis in the elderly

Bronchitis in the elderly is an inflammatory or dystrophic process in the bronchi that disrupts their structure and function. The disease can have acute or chronic course.

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

Acute bronchitis in the elderly

The disease, manifested by acute inflammation of the mucous membrane of the tracheobronchial tree, occurs with a cough and sputum or dyspnea in the lesions of small bronchi. Often acute bronchitis in the elderly is one of the manifestations of acute respiratory infection of the upper respiratory tract and occurs consecutively or simultaneously with the defeat of the nasopharynx, larynx, trachea. The process spreads downward along the respiratory tract leading to the development of laryngitis, tracheitis, bronchitis. In pulmonary tissue, the elderly often form sites of atelectasis as a result of occlusion of the secretion of the lumen of small bronchi. Often the inflammatory process extends to the terminal branching of the bronchi and causes the development of pneumonia.

[5], [6], [7], [8], [9], [10]

How is acute bronchitis manifested in the elderly?

In acute bronchitis patients experience malaise, there may be a burning sensation behind the sternum, a tightness behind the sternum. Cough sometimes occurs in the form of attacks accompanied by shortness of breath. With a strong cough, there may be pain in the lower parts of the chest, caused by cystic contractions of the diaphragm. Often after a few days, the cough becomes less painful, and mucus sputum is separated. The state of health gradually improves.

In physical examination from the lungs, dry whistling and buzzing rales are found. Percutary tone over the lungs is not changed. With X-ray examination, there is no abnormality.

The clinical course of acute bronchitis in the elderly and old people is largely determined by the state of the function of external respiration and impaired bronchial patency. Especially severe acute bronchitis occurs in elderly people with cardiovascular insufficiency, as well as in people who are forced to maintain a long-term bed rest.

A great danger for the elderly and old people is bronchiolitis.

The general condition of such patients deteriorates sharply. Intoxication is expressed. A sharp adynamy develops. There is excitement, anxiety, turning into apathy and drowsiness. These phenomena are caused by respiratory acidosis. The lack of external respiration (dyspnea, cyanosis) is sharply expressed. Unlike young patients, the symptoms of heart failure are often associated with the picture of pulmonary insufficiency in elderly patients. When the patient is examined, a large number of dry, moist small bubbling rales are revealed on the background of a weakening of breathing, in some places a changed percussion sound (tympanitis). Usually bronchiolitis is accompanied by numerous small pneumonic foci, in older people bronchiolitis occurs more often in the absence of a pronounced temperature response and changes in the blood. Thus, if during the acute bronchitis in elderly patients there are phenomena of severe pulmonary heart failure, general intoxication with the abundance of auscultatory changes in the lungs, one can think of acute bronchiolitis.

How is acute bronchitis treated in the elderly?

Treatment of acute bronchitis varies depending on the severity of the course of the disease. In mild forms, with a small cough, normal or subfebrile temperature, the regime is semi-bedded, and when the temperature is raised to febrile and the effects of severe intoxication - bed. In the treatment of bronchitis, possible etiological factors of the disease are taken into account. So, if it is a viral infection (influenza A or B), then in the first days of the disease remantadine is used according to the scheme.

Also, anti-influenza gammaglobulin is recommended for 5-7 days, irrigation of the nasal mucosa with interferon, nasopharyngeal irrigation with iodinol is advisable. In the treatment, acetylsalicylic acid with caffeine is used, an abundant drink is prescribed, mustard plasters, hot foot baths.

Treatment of severe forms of acute bronchitis includes: bed rest; abundant drinking; the appointment of expectorant and bronchospasmolytic drugs with viscous sputum - inhalation of 2% sodium hydrogen carbonate solution or inhalation with bronchospasmolytic agents; the use of antibiotics and sulfonamide drugs.

It is shown the appointment of vitamins: C, A and B group. In elderly people, even cardiovascular pathology is prescribed cardiotonic drugs (soupofacamphomacin, cordiamin). When signs of circulatory failure appear, cardiac glycosides, diuretics are shown.

With headaches accompanied by high fever, use antipyretic drugs (aspirin, paracetamol, phenacetin).

Only a serious condition of the patient is an indication for the appointment of bed rest. To avoid clogging of small bronchioles, to improve sputum discharge and improve breathing, active movement of patients in bed is necessary. Chest massage, respiratory gymnastics, a raised nose or a semi-sitting position of the patient in bed contribute to lung ventilation.

As is known, cough is a reflex act providing protective purificatory function of the lungs in response to irritation of the receptor zones of the trachea and bronchi. When coughing, the drainage function of the bronchi increases, the patency of the airways improves. The early stage of bronchitis is one of the few cases when old people benefit from the use of antitussive drugs, since during this period cough movements do not perform the function of protection, but, on the contrary, frequent non-productive cough causes pain in the chest, disturbs ventilation, hemodynamics, normal sleep sick. To suppress the cough reflex, codecs, glauvent, libexin are prescribed. At the same time, one should strive to dilute the bronchial secretion. In acute bronchitis, bronchospasm is always observed, which largely violates the ventilation of the lungs and thus contributes to the development of hypoxia. Purine derivatives (theophylline, euphyllin, diprofylline, etc.) are used as bronchodilators.

Chronic bronchitis in the elderly

Chronic bronchitis in the elderly is a chronic inflammation of the bronchial tree, which first affects the mucous membrane, then, with the progression of the process, deeper layers of the bronchial wall and peribronchial connective tissue.

They are more likely to have elderly men.

The greatest incidence of chronic bronchitis occurs in the sixth and seventh decades of life, and the highest mortality rate in this disease is observed in the eighth decade.

[11], [12], [13]

How is chronic bronchitis manifested in the elderly?

Among the main symptoms of chronic bronchitis include: cough, sputum, dyspnea, with auscultation - hard breathing and wheezing. Chronic bronchitis in the elderly develops gradually and is diagnosed late, because for a long time it can be of little concern to the patient. Clinical manifestations are associated with the level of damage to the bronchial tree.

With the so-called proximal bronchitis, the inflammatory process involves large and medium bronchi, a cough with a predominantly small sputum is observed, there is no dyspnea, dry rhonchuses of dry voices are heard against the background of hard breathing. Bronchial patency, as a rule, is not broken. This is a chronic non-obstructive bronchitis in the elderly or "bronchitis without shortness of breath."

When obstructive bronchitis is observed not only cough (with or without phlegm), but, most importantly, dyspnea ("bronchitis in elderly people with shortness of breath"). Inflammatory process is localized mainly in small bronchi ("distal bronchitis in elderly people"). Against the background of hard breathing, wheezing is heard. When examining the function of external respiration, violations of bronchial patency are determined.

Exacerbation of bronchitis often occurs with normal temperature, appears sweating of the upper body (head, neck), cough increases, and sputum increases. With a moderate exacerbation of sputum-purulent sputum, normal or subfebrile body temperature, the parameters of peripheral blood are changed little. With severe exacerbation of sputum mucopurulent, contains many leukocytes. With an increase in obstructive changes, dyspnea increases. Progression of chronic obstructive bronchitis leads to the development of respiratory and heart failure.

How is chronic bronchitis treated in the elderly?

With exacerbation of chronic bronchitis treatment is carried out according to the following scheme:

1. restoration of bronchial conductivity - draining with bronchospasmolytic agents, postural drainage, drainage at bronchoscopy - with purulent bronchitis);
2. antibacterial therapy taking into account the sensitivity of the microflora and the toxicity of the preparation;
3. antiallergic and detoxifying agents;
4. exercise therapy (breathing, drainage exercises);
5. restorative treatment (physiotherapy, vitamins, massage).

With severe cough, antitussive drugs are used. If there is a cough with sputum separation, then two-phase antitussive agents are used, which reduce cough, but do not reduce the separation of sputum (intussin, baltix, etc.). To remove bronchospasm with obstructive bronchitis, bronchodilators are used: antispasmodics (isadrin, salbutamol, terbutamine); inhibitors of phosphodiesterase (theophylline derivatives). For rapid relief of the spastic syndrome prescribed drugs: berotek, ventalin, atrovent, berodual. To improve the drainage function of the bronchi, the use of expectorants, liquefying phlegm is indicated. The use of these drugs is most effective if it is performed taking into account viscoelastic properties of sputum. At higher viscosity, thiol derivatives - acetylcysteine (mucosalvin) or proteolytic enzymes (trypsin, chymotrypsin) are used. At high adhesive values - preparations stimulating the formation of surfactant - bromhexine), secretion rehydrates, mineral salts, essential oils. If the rheological properties of sputum are not changed, but the rate of mucociliary transport is reduced, theophylline and beta-2-sympathomimetics derivatives - theolong, theopic, etc., are used. Patients with chronic bronchitis with prolonged stay in bed for other diseases often have a collapse of individual lung sites as a result violations of drainage function of the bronchi, Therefore, these patients need to turn in bed, give them a semi-sitting position, conduct respiratory gymnastics, metered exercise.

To combat hypoxia, it is necessary to assign oxygen - a mixture of moistened oxygen with air, an oxygen tent. Oxygenotherapy should be intermittent with a gradual increase in the dose of oxygen to 50% (to prevent dizziness, nausea, suffocation, inhibition of the respiratory center). It is expedient to carry it out against the background of taking bronchodilator drugs.

The appointment of cardiac glycosides is indicated when symptoms of circulatory failure appear.

With chronic bronchitis with abundant sputum, sanatorium-and-spa treatment in the steppe voice, in the pine forest, in the conditions of mountain climate (not higher than 1000-1200 m above sea level) is effective.