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Chronic non-obstructive bronchitis: diagnosis
Last reviewed: 23.04.2024
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Laboratory and instrumental diagnostics
Blood test
Catarrhal endobronchitis is usually not accompanied by a diagnostic change in the clinical blood test. Moderate neutrophilic leukocytosis with a shift of the leukocyte formula to the left and a slight increase in ESR, usually indicate an exacerbation of purulent endobronchitis.
Diagnostic value is the determination of the content of acute phase proteins (alpha-1-antitrypsin, alpha1-glycoprotein, a2-macroglobulin, haptoglobulin, ceruloplasmin, seromucoid, C-reactive protein) in the serum of blood, as well as total protein and protein fractions. An increase in the content of acute phase proteins, a-2 and beta-globulips, indicates the activity of the inflammatory process in the bronchi.
Sputum examination
With a low activity of inflammation in the sputum of a mucous character, the eliminated cells of the bronchial epithelium predominate (about 40-50%). The number of neutrophils and alveolar macrophages is relatively small (from 25% to 30%).
With a moderate activity of inflammation in the contents of the bronchi, in addition to the cells of the bronchial epithelium, there is a large number of neutrophils (up to 75%) and alveolar macrophages. Sputum, as a rule, has a mucus-purulent character.
Finally, pronounced inflammation is characterized by the presence in the bronchial content of a large number of neutrophils (about 85-95%), single alveolar macrophages and dystrophically altered cells of the bronchial epithelium. The sputum becomes purulent.
Retgenology research
The significance of X-ray examination of patients with chronic non-obstructive bronchitis is mainly in the ability to exclude the presence of other diseases similar in clinical manifestations (pneumonia, lung cancer, tuberculosis, etc.). Any specific changes, characteristic of chronic non-obstructive bronchitis, can not be detected on radiographs. Pulmonary pattern is usually little changed, pulmonary fields are transparent, without focal shadows.
External respiration function
The function of external respiration in patients with chronic non-obstructive bronchitis in most cases remains normal both in the phase of remission and in the phase of exacerbation. An exception is a small category of patients with chronic non-obstructive bronchitis who, during a severe exacerbation of the disease, can detect a slight decrease in FEV1 and other indicators compared to the proper values. These pulmonary ventilation disorders are transient and are caused by the presence of viscous sputum in the airway lumen, as well as the hyperreactivity of the bronchi and the tendency to moderate bronchoconstriction, which are completely eliminated after the activity of the inflammatory process in the bronchi subsides.
According to L.P. Kokosova et al. (2002) and HA Savinova (1995), such patients with functionally unstable bronchitis should be classified as at risk, since they develop obstructive pulmonary ventilation more often over time. It is not excluded that the persistent viral infection (influenza, PC-viral or adenovirus infection) lies at the heart of the described hyperreactivity of the bronchi and their functional destabilization during the exacerbation of bronchitis.
Bronchoscopy
The need for endoscopic examination in patients with chronic non-obstructive bronchitis can occur during a period of severe exacerbation of the disease. The main indication for reduced bronchoscopy in patients with chronic non-obstructive bronchitis is suspected for the presence of purulent endobronchitis. In these cases, the state of the bronchial mucosa is assessed, the nature and prevalence of the inflammatory process, the presence of bronchial mucopurulent or purulent contents in the luminaire, etc.
Bronchoscopy is also indicated in patients with a painful paroxysmal pertussis-like cough, which can be caused by hypotonic tracheobronchial dyskinesia of II-III degree accompanied by expiratory collapse of the trachea and large bronchi, which contributes to the development of obstructive ventilation disorders in a small part of patients with chronic obstructive bronchitis and supports purulent inflammation of the bronchi.
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