Bronchitis chronicJ42

Persistent inflammation of the bronchial tree over a period of at least 3 consecutive months in 2 consecutive years with coughing and sputum (WHO definition).

Of prognostic importance is the distinction between

• Chronic bronchitis without bronchial obstruction
• Chronic bronchitis with bronchial obstruction (chronic obstructive bronchitis (COPD).

m:w=3:1

prevalence:

• About 20% of adult men suffer from chronic bronchitis. Mostly male smokers are affected who are > 40 years old and have a long smoking history.
• In the Federal Republic of Germany there are about 400,000 cases of incapacity to work due to chronic bronchitis every year.
• The prevalence is rising in the industrialised countries.

Multifactorial; different environmental factors such as SO2, nitrogen oxides, fine dust pollution, etc. are frequent triggers. Inhalation smoking promotes respiratory tract infections via mucous membrane irritation and paralysis of the ciliary transport. Furthermore, viral and bacterial infections as well as endogenous factors such as lack of or low mucociliary clearance, so-called dyskinetic cilia syndromes (Cartagener syndrome - rare), immunodeficiencies such as IgA and IgG deficiency, alpha1-antitrypsin deficiency, cellular immune deficiencies.

Chronic bronchitis can be symptomatically accompanied by various cardiac and pulmonary diseases such as silicosis, left heart failure, tuberculosis, bronchiectasis.

Chronic bronchitis is a "smoker's disease". Smoking causes repeated and continuous damage to the mucous membrane of the respiratory tract. Inflammations occur, which in the long term lead to the proliferation of mucus-producing cells and thus to a continuous increase in mucus production. The combination of an increase in mucus production and damage to mucus drainage is typical of chronic bronchitis.

Chronic bronchitis is characterized by a productive or non-productive cough, which occurs more frequently in the morning. Characteristic are repeated complicating exacerbations of the symptoms by an overlying acute bronchitis. Often chronic bronchitis and emphysema with obstruction of the airways are present simultaneously.

In "simple" chronic bronchitis, the general condition is usually good and hardly or only rarely affected by respiratory distress. However, if the chronic bronchitis progresses, those affected more often complain of shortness of breath and morning headaches. The difficulty in breathing can lead to weight loss and a considerable reduction in performance. During physical exertion tachypnea and shortness of breath.

Increasing strain on the right heart. Symptoms of right heart strain in late stages are peripheral oedema and influence congestion (congested neck vessels).

X-ray or CT examination of the thoracic organs

Inflammation parameters, IgE, ECP, DD blood count, hematocrit

Medical history, type of symptoms (stress dyspnea, dyspnea at rest, sputum, cough). If the symptoms persist for a longer period of time, a barrel-shaped dilated thorax (barrel thorax) is formed. Smoking habits ("pack-years = product of the number of smoking years X of smoked cigarette packs/day).

bronchial carcinoma, pulmonary tuberculosis, bronchiectasis, bronchial asthma, emphysema

Elimination and control of the noxious agents that cause the disease.

While chronic obstructive bronchitis usually requires medication, chronic bronchitis therapy can initially be planned much more cautiously.

The general susceptibility to infection increases significantly as a result of chronic bronchitis. With every incipient respiratory tract infection, a short-term high-dose antibiotic administration must be carried out immediately.

In the case of significant airway obstruction, antibiotic/anti-inflammatory treatment.

Beta2 sympathomimetics and theophylline stimulate the mucociliary clearing function and reduce bronchial obstruction

Chronic bronchitis can develop into chronic obstructive pulmonary disease (COPD), a frequently irreversible damage to the lungs and lower airways.

In the course of a "simple" chronic bronchitis, acute attacks (exacerbations) can occur again and again, triggered, for example, by infections, air pollution or heart problems. The existing symptoms then become acutely worse, especially the symptoms coughing, shortness of breath and sputum.

Auscultation: rales, wheezing.

Percussion: Hypersonic head sound

Pulmonary function testing: Spirometry/full body body plethysmography

Peak-flow measurements can be used to indicate the extent of chronic bronchitis and to assess the response to therapy.

Chronic bronchitis, non-productive cough.

Medicinal drugs are proven in practice when antitussive and broncholytic therapy is necessary.

Strongly effective antitussives are the pure alkaloids codeine and noscapine derived from opium. They may be used only for short periods.

The following medicinal drugs are indicated for nonproductive cough:

• Dry spasmodic cough: Hedera fol ium (= ivy leaves: example: Prospan 20-20-20 tr.).
• Acute coughing attacks with incipient mucus formation: Primulae radix/ Thymi herba = primrose root/thyme herb: Example: Bronchipret TP 1-1-1 Filmtabl.)
• Persistent irritating cough, low mucus production: Plantaginis lanceolatae herba = ribwort herb (Broncho Sern Syrup 1-1-1 Tbl)
• Cramping coughs with little mucus production: sundew herb (Makatussin drops Drosera 20-20-20Tr)

The following medicinal drugs are indicated for productive cough:

• Spasmodic cough with phlegm: ivy leaves, thyme herb (example: Bronchipret 40-40-40 Tr.).
• Acute coughing attacks with strong mucus formation: primrose root/thyme herb/chickweed (example: Bronchicum Elexier Saft 1-1-1 teaspoon)
• Persistent cough, with tenacious mucus formation: thyme herb (Aspecton 20-20-20 tr.)
• Persistent cough, with thick mucus and fever: nasturtium, horseradish root (Angocin Anti-Infekt 4-4-4 tbl.)

Medicines for inhalation and rubbing:

These cause a sustained stimulation of blood flow in the chest. This can promote secretion. In addition, a warm chest compress can be applied.

In case of persistent cough, with viscous mucus formation

• Eucalyptus oil, spruce needle oil, peppermint oil: (Bronchoforton® ointment, rub into chest and back several times a day)
• Eucalyptus oil, pine needle oil, levomenthol (Pinimenthol® N cold ointment, rub into chest and back several times daily)
• Camphor, eucalyptus oil, levomenthol (Tumrol-N-Balsam®, rub into chest and back several times a day).

Note: When using essential oils externally, a relatively high sensitization rate of the ingredients must be taken into account. In this respect, attention should be paid to redness and itching in the area of application. Essential oils can also be used internally to promote secretolysis. Preparations containing Myrtol (e.g. Gelomyrtol) have proven effective.

However, the step-by-step therapy plan for chronic obstructive and chronic non-obstructive bronchitis is identical in severe cases.

• Patient education and cooperation is essential
• Smoking is the most important factor influencing chronic bronchitis. Meaningful treatment is only possible with consistent withdrawal from smoking.
• Patients should be trained in how to deal with their disease. This includes the correct use of inhalations, tapping massages and learning and maintaining special breathing exercises. Through these measures the mucus can be coughed up better.