Chronic bronchitis - Symptoms.

The main symptoms of chronic bronchitis are cough with sputum, general weakness, sweating (during exacerbation of the disease and purulent nature of bronchitis).

According to the WHO definition, the main symptoms of chronic bronchitis are cough with sputum production for at least 3 months a year for 2 or more years. At the onset of chronic bronchitis, cough usually bothers patients in the morning immediately or soon after waking up, while the amount of sputum is small. The appearance of cough mainly in the morning is due to the daily rhythm of the functioning of the ciliated epithelium. Its activity is low at night and is most pronounced in the morning. In addition, the appearance of cough in the morning is greatly influenced by the morning physical activity of the patient and an increase in the tone of the sympathetic nervous system. Cough usually increases in cold and damp weather, and in warm and dry weather, patients feel much better, the cough bothers them less often and may even stop completely.

At the beginning of the disease, cough bothers patients only during the period of exacerbation, during the period of remission it is almost not expressed. As chronic bronchitis progresses, cough becomes more regular, almost constant and bothers not only in the morning, but also during the day, as well as at night. Cough at night in a horizontal position of the patient is associated with the flow of sputum from the small bronchi.

Cough is caused by irritation of the vagus nerve receptors in cough reflex zones (larynx, vocal cords, tracheal bifurcation, division area of large bronchi). In small bronchi, cough receptors are absent, therefore, with predominantly distal bronchitis, cough may be absent and the main complaint of patients is shortness of breath.

During an exacerbation of chronic bronchitis, the sensitivity of cough receptors increases sharply, which leads to a sharp increase in coughing, it becomes straining, painful, sometimes "barking". It should be noted that the cough acquires a barking tone and paroxysmal onset with pronounced expiratory collapse of the trachea and large bronchi, with bronchial obstruction. A straining "barking" cough with bronchial obstruction differs from a straining cough with hypersensitivity of the cough zones in that with bronchial obstruction you have to cough longer, while the cough becomes painful, the patient's face turns red, the veins of the neck tense up, swell, the cough is accompanied by wheezing. During the day, bronchial patency improves and the cough becomes less pronounced and bothers less often.

Attacks of a painful, excruciating cough may be caused by hypotonic tracheobronchial dyskinesia, prolapse of the posterior membranous part of these organs into the lumen of the trachea or large bronchi. The cough may be accompanied by an attack of suffocation, stridor breathing, anxiety of the patient, and often loss of consciousness at the height of the cough (cough-syncope syndrome).

Coughing attacks in chronic bronchitis can be provoked by cold, frosty air; returning from the street to a warm room in cold weather; tobacco smoke; exhaust fumes; the presence of various irritants in the air and other factors.

In the late stages of the disease, the cough reflex may fade, coughing bothers patients little and bronchial drainage is sharply impaired.

Sputum production is the most important symptom of chronic bronchitis. Sputum may be mucous, purulent, mucopurulent, sometimes with streaks of blood. In the early stages of the disease, sputum may be mucous and light. However, in patients who work for a long time in dusty conditions, sputum may acquire a gray or black color (for example, the "black" sputum of miners). As chronic bronchitis progresses, sputum acquires a mucopurulent or purulent character, this is especially noticeable during an exacerbation of the disease. Purulent sputum is more viscous and is separated with great difficulty. During an exacerbation of chronic bronchitis, the amount of sputum increases, however, in damp weather and after drinking alcohol, it may decrease. In most patients, the daily amount of sputum is 50-70 ml, with the development of bronchiectasis, it increases significantly.

There are known cases of chronic bronchitis occurring without sputum production ("dry bronchial catarrh") - not to be confused with swallowing sputum! In 10-17% of cases of chronic bronchitis, hemoptysis is possible. It can be caused by damage to the blood vessels of the bronchial mucosa during a hard cough (this is especially typical for atrophic bronchitis). The appearance of hemoptysis requires careful differential diagnosis with pulmonary tuberculosis, lung cancer, bronchiectasis. Hemoptysis is also possible with pulmonary embolism, mitral stenosis, congestive heart failure, hemorrhagic diathesis.

In uncomplicated chronic bronchitis, dyspnea does not bother patients. However, with the development of bronchial obstruction and pulmonary emphysema, dyspnea becomes a characteristic symptom of the disease.

The general condition of patients in the initial stages of chronic bronchitis is satisfactory. It is significantly impaired as the disease progresses and bronchial obstruction, pulmonary emphysema and respiratory failure develop.

During external examination of patients with chronic non-obstructive bronchitis, no significant changes are detected. During an exacerbation of the disease, especially with purulent bronchitis, sweating may be observed, and body temperature may rise to subfebrile levels.

During percussion of the lungs in chronic non-obstructive bronchitis, the percussion sound remains clear. Vocal fremitus and bronchophony are usually unchanged. Auscultatory data are most characteristic. During auscultation of the lungs, an extension of exhalation is noted (normally, the ratio of the duration of inhalation and exhalation is 1:1.2). Chronic bronchitis is characterized by harsh breathing ("roughness", "unevenness" of vesicular breathing).

Usually, dry wheezing caused by the presence of viscous sputum in the lumen of the bronchi is also heard with chronic bronchitis. The smaller the caliber of the bronchi, the higher the tone of the wheezing. In large bronchi, bass low-tone wheezing appears, in medium-caliber bronchi - buzzing wheezing, in small bronchi - high-tone (whistling, hissing) wheezing. Low-tone wheezing is better heard on inhalation, high-tone - on exhalation. High-tone wheezing (whistling), especially appearing during forced exhalation, is characteristic of obstructive bronchitis.

If there is liquid sputum in the bronchi, moist rales are heard, the nature of which depends on the caliber of the bronchi. Large-caliber bronchi produce large-bubble rales, medium-caliber bronchi produce medium-bubble rales, and small-caliber bronchi produce small-bubble rales. If large-bubble rales are heard over the peripheral parts of the lungs, where there are no large bronchi, this may be a sign of bronchiectasis or a cavity in the lung. A characteristic feature of both dry and moist rales is their instability - they may disappear after vigorous coughing and expectoration.

As a rule, no significant changes are detected when examining other organs and systems in patients with chronic non-obstructive bronchitis. With severe purulent bronchitis, myocardial dystrophy may develop, which is manifested by muffled heart sounds and a low-intensity systolic murmur in the apex of the heart.

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