What Is Involved in Making a Diagnosis of Bronchitis?

Bronchitis is a chronic, non-specific inflammation of the trachea, bronchial mucosa, and surrounding tissues. The main cause of bronchitis is the chronic non-specific inflammation of the bronchus caused by repeated infection of viruses and bacteria. When temperature drops, respiratory vasospasm, ischemia, and decreased defense function are conducive to disease; chronic irritation such as smoke, dust, and polluting the atmosphere can also cause disease; smoking causes bronchospasm, mucosal variation, decreased ciliary movement, and increased mucus secretion, which are beneficial to infection; Factors also have a certain relationship.

Basic Information

English name: bronchitis
Visiting department: Respiratory

Common causes: Common bacteria, viruses, etc. caused by upper respiratory tract infections
Common symptoms: Obvious cough, expectoration, asthma, recurrent respiratory infections

Clinical manifestations of bronchitis

Acute bronchitis

Acute bronchitis often manifests as symptoms of upper respiratory tract infection in the early stages of the disease. Patients usually have clinical symptoms such as nasal congestion, runny nose, sore throat and hoarseness. The systemic symptoms are mild, but low fever, chills, fatigue, itchiness in the throat, irritating cough, and pain behind the sternum can occur. There is not much sputum in the early stage, but the sputum is not easy to cough. After 2 to 3 days, the sputum can be changed from mucous to mucopurulent. Chilling or inhaling cold air or irritating gas can make the cough worse or induce cough. Patients often have significant coughing in the morning or at night. Cough can also be paroxysmal and sometimes persistent. A severe cough is often accompanied by nausea, vomiting, and pain in the chest and abdominal muscles. If accompanied by bronchospasm, there may be wheezing and shortness of breath. In general, the course of acute bronchitis has a certain self-limiting nature. Systemic symptoms can resolve within 4 to 5 days, but cough can sometimes extend for several weeks.

On examination, dry rales can sometimes be found, which disappear after coughing; occasionally wet rales can be heard at the bottom of the lungs, and wheezing can be heard with bronchospasm. Usually, the white blood cell count is normal, and no abnormality is found on the chest X-ray.

2. chronic bronchitis

Chronic bronchitis refers to patients with chronic cough and sputum for more than three months each year for two consecutive years after various other causes except chronic cough. It is not necessarily accompanied by persistent airflow limitation.

(1) Cough recurring and gradually worsening is a prominent manifestation of the disease. The mild cases only occur in the winter and spring season, especially before and after getting up in the morning, and have less cough during the day. In summer and autumn, the cough eases or disappears. Severe patients have cough all seasons, intensified in winter and spring, cough day and night, especially severe morning and evening.

(2) Sputum Generally, the sputum is a white mucus foam, which rises frequently in the morning, and is often difficult to spit out because of stickiness. After infection or cold, symptoms rapidly intensified, sputum volume increased, viscosity increased, or yellow purulent sputum or accompanied by wheezing. Occasionally, there was blood in the sputum due to severe cough.

(3) Asthma When there is a respiratory infection, asthma (wheezing) symptoms can occur due to bronchiole mucosal congestion and edema, sputum obstruction and bronchial lumen stenosis. The patient developed wheezing in the throat while breathing and wheezing in the auscultation of the lungs.

(4) Repeated infections In cold seasons or sudden changes in temperature, repeated respiratory infections are prone to occur. At this time, the patient's asthma worsened, the sputum volume increased significantly and was purulent, accompanied by general weakness, chills, and fever. Wet sounds in the lungs, increased blood white blood cell count, and so on. Repeated respiratory infections are particularly likely to worsen the condition of elderly patients and must be given full attention.

There are no special signs in the early stage of the disease, and a few wet or dry murmurs can be heard at the bottom of the lung in most patients. Sometimes it disappears temporarily after coughing or sputum. Signs of emphysema can be found in chronic attacks.

The relationship between chronic bronchitis and chronic obstructive pulmonary disease (COPD), emphysema, and bronchial asthma: Chronic bronchitis is closely related to COPD and emphysema, and patients have clinical symptoms such as cough and sputum COPD cannot be diagnosed immediately. If the patient only has the clinical manifestations of "chronic bronchitis" and / or "emphysema" and there is no persistent airflow limitation, the diagnosis of COPD cannot be made. The patient can only be diagnosed as "chronic bronchitis" and / or "Emphysema". However, COPD is diagnosed if the patient's lung function indicates persistent airflow limitation. In some patients, while suffering from bronchial asthma, chronic bronchitis and emphysema can be complicated. Such as bronchial asthma patients are often exposed to irritating substances, such as smoking, cough and sputum also occur, and cough and sputum is an important feature of chronic bronchitis. Such patients can be diagnosed as "wheezing bronchitis".

Bronchitis examination

The diagnosis of acute bronchitis mainly depends on the history and clinical manifestations. There is no abnormality on X-ray examination or only deepening of lung texture. The white blood cell count did not increase in the virus-infected patients, and the lymphocytes increased relatively slightly. The total number of white blood cells and the proportion of neutrophils increased during bacterial infection. Sputum smears, sputum cultures, serological tests, etc. can sometimes detect pathogenic pathogens.

Differential diagnosis of bronchitis

A variety of acute infectious diseases such as tuberculosis, pulmonary abscess, mycoplasma pneumonia, measles, pertussis, acute tonsillitis, etc., as well as postnasal drip syndrome, cough variant asthma, gastroesophageal reflux disease, interstitial lung disease, Acute pulmonary embolism and lung cancer often have a cough at the time of onset, similar to the cough symptoms of acute bronchitis, so it should be examined in depth, and it needs to be identified in clinical practice.

The symptoms of influenza are similar to those of acute bronchitis, but it is not difficult to distinguish from the widespread epidemic of influenza, rapid onset, obvious symptoms of poisoning throughout the body, fever, and muscle soreness in the whole body. The virus isolation and complement-combination tests can confirm the diagnosis.

Bronchitis treatment

1. When the patient has systemic symptoms, pay attention to rest and keep warm

The purpose of treatment is to reduce symptoms and improve body function. Patients often need fluids and antipyretics. Antitussive drugs can be used appropriately. When the amount of sputum is heavy or sticky, expectorants can be applied.

2. Patients with acute bronchitis

There is no obvious therapeutic effect on antibacterial drugs, and abuse of antibacterial drugs should be avoided when treating patients with acute bronchitis. However, patients with fever, purulent sputum, and severe cough are indications for antimicrobial use. For patients with acute bronchitis, antibacterial drugs are used for treatment. Antibacterial drugs for Chlamydia pneumoniae and Mycoplasma pneumoniae, such as erythromycin, can also be used. During the influenza epidemic, anti-flu treatment should be applied if there are signs of acute bronchitis.

3. Treatment of acute exacerbation of chronic bronchitis

(1) Control of infection Select antibacterial drugs according to the main pathogenic bacteria and the severity of infection or according to the susceptibility results of pathogenic bacteria. If the patient has purulent sputum, it is an indication of antimicrobial use. It can be taken orally in mild cases, and the heavier patients can be injected intramuscularly or intravenously with antibacterial drugs. Commonly used are penicillin G, erythromycin, aminoglycosides, quinolones, and cephalosporins.

(2) Expectorant and antitussive For anti-infective treatment of patients with acute attack, apply expectorant and antitussive to improve symptoms. Commonly used drugs are ammonium chloride mixture, bromhexine, ambroxol, carboxymethylcysteine, and potent dilute mucin. Chinese patent medicine also has a certain effect on cough. For the elderly who are weak and sputum-sputum or who have a large amount of sputum, they should help sputum discharge and open the airway. The use of antitussives should be avoided in order to prevent central and aggravated airway obstruction and complications.

(3) Antispasmodic and antiasthmatic drugs Aminophylline and terbutaline are usually taken orally or inhaled with short-acting bronchodilators such as salbutamol. If airflow persistence persists, lung function tests are required. If the diagnosis of COPD is clear, use long-acting bronchodilator inhalation or glucocorticoid plus long-acting bronchodilator inhalation if necessary.

(4) Atomization therapy Atomization inhalation can dilute the secretions in the trachea, which is good for sputum excretion. If the sputum is sticky and difficult to cough, inhalation can help.

4. Treatment of chronic bronchitis during stable phase

Attaching importance to the prevention and treatment of colds: Colds can make patients with relapses relapse. For a long period of time (at least 1 year), it is important to take preventive treatments for colds regularly. You can use flu vaccine or take Chinese herbs to prevent colds.

Bronchitis prevention

Quit smoking

In order to reduce the irritation of the respiratory tract by smoking, patients must quit smoking. Avoid contact with other irritating gases, such as kitchen fumes.

2. Promote expectoration

For elderly patients with weak and weak sputum or patients with large sputum, expectorants should be mainly used, and antitussives should not be used to prevent the central nervous system from aggravating respiratory inflammation and worsening the condition. Help critical patients to change their position regularly and gently massage the patient's chest and back, which can promote sputum discharge.

3. Maintain good family environmental hygiene

The indoor air circulation is fresh and has a certain humidity, which controls and eliminates various harmful gases and soot. Improving environmental hygiene, doing dust and air pollution prevention work, and strengthening personal protection to avoid the effects of smoke, dust and irritating gases on the respiratory tract.

4. Proper physical exercise

Strengthening the physique, increasing the resistance of the respiratory tract, preventing upper respiratory tract infections, avoiding inhalation of harmful substances and allergens, can prevent or reduce the occurrence of this disease. Exercise should be gradual and gradually increase the amount of activity.

5. Pay attention to climate change and cold seasons

In the severe winter season or when the climate suddenly becomes cold, you should pay attention to your clothes to be warm and cold, and increase your clothes in time to avoid causing colds due to cold. The indoor temperature in the cold season of winter should be 18 20 .