Bronchitis vs. Upper Respiratory Infections

Do you know the difference between bronchitis and an upper respiratory tract infection (URI)? With all the medical jargon and complex terminology out there, it’s easy to get mixed up about these common respiratory conditions—and the arrival of

COVID-19 certainly hasn’t helped to simplify things. To help clear up the confusion, let’s take a closer look at bronchitis, upper respiratory tract infections, and what sets them apart.

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The Basics of Bronchitis

Bronchitis (chest cold) is not an upper respiratory tract infection. Rather, it affects the air-transporting tubes of the lungs (bronchioles), which are a part of the lower respiratory tract. So, bronchitis is considered a lower respiratory infection—or an infection that impacts the lungs or structures below the voice box (larynx). Other lower respiratory tract infections include pneumonia, tuberculosis, and bronchiolitis.

Acute (short-term) bronchitis occurs when the bronchioles become inflamed and produce too much mucus. It is usually caused by a virus, although bacteria may also lead to bronchitis. Some of the most common symptoms of acute bronchitis include:

• Frequent coughing, with or without mucus
• A wheezing noise when coughing
• Fatigue
• Chest soreness, especially when coughing
• Sore throat
• Headache
• Mild body aches or fever

Symptoms of acute bronchitis typically last for 10 to 14 days, although some symptoms may linger for up to three weeks.

Treatment for acute bronchitis often involves plenty of rest, fluids, and over-the-counter medications to help control symptoms. Bacterial bronchitis may be treated with antibiotics. It’s also important to avoid smoking and exposure to airborne irritants while recovering from bronchitis. Individuals with symptoms that remain or worsen after three weeks should be evaluated by a medical professional.

While acute bronchitis is a contagious short-term infection, chronic bronchitis is a long-term condition that falls under the chronic obstructive pulmonary disease (COPD) umbrella. It is caused by smoking tobacco in most cases, although long-term exposure to air pollution, certain chemicals, and secondhand smoke may also contribute to chronic bronchitis.

Understanding Upper Respiratory Tract Infections

As you may have guessed, upper respiratory tract infections (URIs) are infections that impact the upper respiratory tract, which includes the nose, mouth, throat, and voice box.

Types of upper respiratory infections include:

• The common cold
• Sinusitis (sinus infection)
• Laryngitis
• Tonsillitis
• Epiglottitis

Influenza (flu) and

COVID-19 can impact both the lower and upper respiratory tracts, although COVID-19 typically begins in the upper respiratory tract and may spread to the lower.

Upper respiratory tract infections are caused by several types of viruses and bacteria that can travel through respiratory droplets or physical contact. These infections are incredibly widespread—in fact, the common cold is to blame for most routine doctor visits in the United States.

The signs of a upper respiratory tract infection will vary based on what type of condition is present, but a few hallmark URI symptoms include:

• Sore throat
• Cough
• Nasal congestion or runny nose
• Post-nasal drip
• Sneezing
• Fatigue
• Headache

Similar to lower respiratory infections, most upper respiratory tract infections can be treated at home by getting plenty of rest, drinking lots of water, and taking over-the-counter medications to reduce symptoms. Most infections resolve on their own within two weeks, although sinusitis may last longer. Individuals should consult with a medical professional if symptoms:

• Worsen or do not improve with self-care methods
• Go away and then return
• Include sinus pain or a severe sore throat
• Include a low-grade fever that persists for more than five days
• Include a fever higher than 101.3 degrees fahrenheit (for adults)

In-Home Treatment for Bronchitis, URIs & Other Common Illnesses

No matter if you’re battling bronchitis, the common cold, or any other type of respiratory infection, you’re probably not in the mood to trek to an urgent care center or physician’s office and sit in a bustling, germ-filled waiting room. Enter: DispatchHealth. Our fully equipped medical teams offer safe, convenient, and affordable medical care to patients in the comfort of their own home.

Ready to find relief from bothersome respiratory symptoms? If so, request a same-day visit from DispatchHealth by giving us a call, going on our website, or using our app. Our team is here to answer any questions you may have.

Sources

DispatchHealth relies only on authoritative sources, including medical associations, research institutions, and peer-reviewed medical studies.

Sources referenced in this article:

1. https://www.healthline.com/health/acute-upper-respiratory-infection
2. https://my.clevelandclinic.org/health/diseases/3993-bronchitis
3. https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/bronchitis.html
4. https://www.medicalnewstoday.com/articles/324413
5. https://www.mayoclinic.org/diseases-conditions/common-cold/symptoms-causes/syc-20351605

Bronchitis vs Upper Respiratory Infection: What’s the Difference?

Respiratory infections are common, especially during the colder months. Two of the most common respiratory infections are bronchitis and upper respiratory infections (URIs). While they share some similarities, there are also some key differences between the two.

What is Bronchitis?

Bronchitis is an inflammation of the bronchial tubes, which are the air passages that lead to the lungs. It can be acute or chronic, with acute bronchitis typically lasting for a few weeks and chronic bronchitis lasting for several months or longer.

The most common cause of acute bronchitis is a viral infection, such as the flu or a cold. Chronic bronchitis is often caused by smoking or exposure to air pollution.

What is an Upper Respiratory Infection?

An upper respiratory infection (URI) is a viral infection that affects the nose, throat, and sinuses. It is also known as the common cold. Symptoms of a URI include a runny or stuffy nose, sore throat, cough, and congestion.

What are the Differences Between Bronchitis and URIs?

While both bronchitis and URIs are respiratory infections, there are some key differences between the two:

• Location: Bronchitis affects the bronchial tubes, while URIs affect the nose, throat, and sinuses.
• Symptoms: Bronchitis typically causes a cough that produces mucus, while URIs cause a runny or stuffy nose, sore throat, and congestion.
• Duration: Acute bronchitis typically lasts for a few weeks, while URIs usually last for a week or two.
• Cause: Bronchitis is often caused by a viral infection, but can also be caused by smoking or exposure to air pollution. URIs are caused by viral infections.

When Should You See a Doctor?

If you are experiencing respiratory symptoms, it is important to see a doctor to get the right diagnosis and treatment. While most cases of bronchitis and URIs can be treated at home with rest and over-the-counter medications, some cases may require prescription medications or other treatments.

If you are experiencing severe symptoms, such as difficulty breathing or chest pain, seek medical attention immediately.

How Nao Medical Can Help

At Nao Medical, we offer a range of services to help diagnose and treat respiratory infections, including bronchitis and URIs. Our experienced healthcare providers can help you get the right diagnosis and treatment for your respiratory concerns.

We offer same-day appointments, minimal wait times, exceptional and empathetic staff, stunning clinic environments, a technologically driven approach with a comprehensive app, and extensive after-hours virtual care. Book an appointment with us today to get the care you need.

Frequently Asked Questions

What are the symptoms of bronchitis?

The most common symptom of bronchitis is a cough that produces mucus. Other symptoms may include chest discomfort, fatigue, and shortness of breath.

How is bronchitis treated?

Treatment for bronchitis depends on the cause and severity of the infection. Most cases can be treated at home with rest, over-the-counter medications, and plenty of fluids. In some cases, prescription medications may be necessary.

What are the symptoms of an upper respiratory infection?

The symptoms of an upper respiratory infection include a runny or stuffy nose, sore throat, cough, and congestion.

How is an upper respiratory infection treated?

Treatment for an upper respiratory infection typically involves rest, over-the-counter medications, and plenty of fluids. Antibiotics are not effective against viral infections, such as URIs.

When should I see a doctor for a respiratory infection?

If you are experiencing severe symptoms, such as difficulty breathing or chest pain, seek medical attention immediately. Otherwise, it is a good idea to see a doctor if your symptoms last for more than a week or if they are interfering with your daily activities.

Key Takeaways

• Bronchitis is an inflammation of the bronchial tubes, while upper respiratory infections (URIs) affect the nose, throat, and sinuses.
• Bronchitis typically causes a cough that produces mucus, while URIs cause a runny or stuffy nose, sore throat, and congestion.
• If you are experiencing respiratory symptoms, it is important to see a doctor to get the right diagnosis and treatment.
• Nao Medical offers a range of services to help diagnose and treat respiratory infections, including bronchitis and URIs.

External Links: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pulmonology, https://www.lung.org/

Disclaimer: The information presented in this article is intended for general informational purposes only and should not be considered, construed or interpreted as legal or professional advice, guidance or opinion.

Upper respiratory infections: symptoms, treatment, prevention

Content

• 1 Upper respiratory infections
  • 1.1 Upper respiratory infections
  • 1.2 Symptoms:
  • 1.3 Treatment
  • 1.4 Prevention
  • 1.5 Complications
  • 1.6 Colds
  • 1.7 Influenza
  • 1.8 Angina
  • 1.9 Bronchitis
  • 1.10 Sinusitis
  • 1.11 Rhinitis
  • 1.12 Laryngitis
  • 1.13 Tonsillitis
  • 1. 14 Related videos:
  • 1.15 Q&A:
    • • 1.15.0.1 What are upper respiratory tract infections?
      • 1.15.0.2 What are the symptoms of upper respiratory infections?
      • 1.15.0.3 How to treat upper respiratory infections?
      • 1.15.0.4 How can you protect yourself from upper respiratory infections?

Upper respiratory infections are common diseases that affect the nose, throat, larynx, and other organs. Symptoms include a runny nose, cough, sore throat, difficulty breathing, and fever. Learn about the main types of upper respiratory tract infections, their causes, diagnosis and treatment.

Upper respiratory tract infections are among the most common diseases affecting our health. They include a range of flare-ups such as a runny nose, sore throat and bronchitis, as well as more serious illnesses such as a sore throat and pneumonia. Upper respiratory tract infections are usually caused by viruses and bacteria that are spread through coughing, sneezing, or contact with contaminated surfaces.

The main symptoms of an upper respiratory tract infection include runny nose, nasal congestion, sore throat, cough and fever. These symptoms can last from several days to several weeks, depending on the severity of the disease. In the case of serious infections such as pneumonia, additional symptoms may occur, such as shortness of breath, feeling weak and tired.

Prevention of upper respiratory tract infections includes the following measures: washing hands regularly with soap and water, avoiding contact with infected people, avoiding touching the face with dirty hands, wearing masks when in contact with sick people, vaccination against certain types of infections, both by vaccination and stimulating the immune system with natural means, such as proper nutrition, exercise and daily routine.

Upper respiratory infections

Upper respiratory infections are a group of diseases that attack the respiratory system and cause various symptoms such as runny nose, cough, sore throat and headache. They are usually spread from person to person through airborne droplets that are expelled when coughing or sneezing.

One of the most common infections of the upper respiratory tract is the common cold. It usually presents with a runny nose, stuffy nose, sneezing, and a runny nose. This illness is usually caused by a virus and can last from a few days to two weeks. Treatment for a cold usually includes rest, hydration, and medication to relieve symptoms.

Prevention of upper respiratory tract infections includes hygiene measures such as regular handwashing, avoiding contact with sick people, and avoiding overheating or hypothermia. It is also recommended to be vaccinated against various viral infections such as the flu. Proper nutrition, getting enough vitamins and minerals, and strengthening the immune system can help prevent upper respiratory infections.

Symptoms:

Infections of the upper respiratory tract are characterized by a number of specific symptoms, primarily affecting the nasal cavity, throat and leading to a decrease in the general condition of the body.

1. Runny nose is one of the most common symptoms of upper respiratory infections. It is manifested by a stagnant state of the nasal cavity, the secretion of mucus or its blockage, as well as frequent sneezing.
2. Difficulty breathing may be due to obstruction of the nasal passages, as well as due to swelling of the mucous membrane of the upper respiratory tract.
3. Sore throat is also one of the main symptoms of upper respiratory tract infections. They can manifest as local discomfort in the throat, as well as more intense pain when swallowing.
4. Cough can be both dry and mixed, and is often accompanied by irritation of the larynx and an unpleasant sensation behind the chest.
5. Decreased general condition – upper respiratory tract infections often present with general weakness, fatigue, headache and loss of appetite.

Other symptoms, such as fever, dizziness, or skin rashes, may occur depending on the disease. If you have these symptoms, you should consult a doctor for qualified assistance and appropriate treatment.

Treatment

Treatment of upper respiratory infections depends on the cause of the infection. In most cases, viral infections are the main source of problems, and symptomatic treatment is the key approach. The main emphasis is on relieving symptoms and keeping the patient in good condition.

Most of the general recommendations include calmness, rest, hot drinks, air humidification, and regular ventilation of the premises. You should also refrain from smoking and avoid polluted or smoky places.

A range of symptoms can be alleviated by the use of traditional methods such as inhalations with herbal infusions or essential oils. Careful and regular intake of vitamins and minerals, as well as immune support, can also play a key role in the recovery process.

If the upper respiratory tract infection is due to a bacterial infection, antibiotics may be needed. However, it is worth remembering that antibiotics are not effective against viral infections, and their use may be inappropriate or even harmful.

Prevention

To prevent infections of the upper respiratory tract, it is recommended to follow a few simple rules:

• Wash your hands often. Washing your hands regularly with soap and warm water helps kill bacteria and viruses that can get on your hands.
• Use disposable wipes. Cover your mouth and nose with disposable tissues or your elbow when you cough or sneeze to prevent the spread of viruses.
• Avoid contact with sick people. Try to avoid contact with people who have symptoms of an upper respiratory tract infection, especially if you have an increased risk of complications.
• Maintain immunity. Proper nutrition, moderate exercise, adequate rest, and limiting stress will help strengthen the immune system and make it less vulnerable to infections.
• Get vaccinated. Vaccination can prevent many upper respiratory tract infections, including influenza and pneumococcal infections.

By following these tips, you can reduce your risk of getting upper respiratory infections and keep yourself healthy.

Complications

Infections of the upper respiratory tract can cause a number of complications, especially if treated incorrectly or late.

One possible complication is sinusitis. The infection can spread to the lining of the sinuses, causing inflammation. Symptoms of sinusitis can include difficulty breathing, facial pain, and headache.

Other complications may include laryngitis and tracheitis. With inflammation of the vocal cords or trachea, there are problems with the voice and hoarseness appears. It can be caused by a bacterial infection or a weakened immune system.

In addition, complications such as bronchitis or pneumonia may develop. They are the most serious complications in which inflammation spreads to the bronchi and lungs. Bronchitis is accompanied by a cough with phlegm, and pneumonia can present with severe chest pain, high fever, and shortness of breath.

In case of complications from upper respiratory tract infections, it is recommended to consult a doctor for an accurate diagnosis and appropriate treatment, as complications may require more serious and longer treatment than simple infections.

Colds

The common cold is one of the most common infections of the upper respiratory tract. It is caused by various viruses, including rhinoviruses, adenoviruses, and coronaviruses. Colds are spread from person to person through the air, especially when coughing, sneezing, or talking.

Common cold symptoms include runny nose, nasal congestion, cough, sore throat, muscle pain, fatigue and weakness. They usually appear a few days after infection and disappear within a week or two. However, in some cases, a cold can lead to complications such as sinusitis, bronchitis, or pneumonia.

Treatment of the common cold includes symptomatic therapy such as antiviral drugs, rich fluids, and rest. It is also recommended to take analgesics and suck on lozenges to relieve sore throats. It is important to remember good hygiene, including washing your hands regularly and wearing masks during a cold outbreak.

For the prevention of colds, it is recommended to strengthen the immune system through proper nutrition, physical activity and sufficient sleep. It is also helpful to avoid contact with sick people and to ventilate rooms frequently. Getting the flu vaccine can help prevent the spread of viruses that cause the common cold.

Influenza

Influenza is an acute infectious disease affecting the upper respiratory tract. The main symptoms of the flu are fever, runny nose, cough, headache, muscle and joint pain.

Influenza is caused by the influenza virus, which is transmitted from person to person through airborne droplets. The influenza virus can cause serious complications, especially in people with weakened immune systems or chronic illnesses.

Treatment for influenza includes taking antipyretics to reduce fever and relieve symptoms, as well as rest and humidify the room. To prevent influenza, vaccination, regular handwashing, and avoidance of contact with sick people are recommended.

Below is a list of recommendations for influenza prevention:

• Get influenza vaccine;
• Wash your hands regularly with soap and water;
• Avoid contact with sick people;
• Do not touch your face with dirty hands;
• Avoid crowded places during an influenza epidemic;
• Cover nose and mouth when coughing or sneezing;
• Ventilate the room;
• Maintain a healthy immune system through proper nutrition and physical activity.

As an acute and viral illness, influenza can lead to serious complications, so it is important to take preventive measures and seek medical attention if you get sick.

Angina

Angina is an acute infectious disease characterized by inflammation of the glands at the back of the throat. Angina is usually caused by bacteria such as streptococci or staphylococci. However, it can also be caused by viruses or fungi.

Symptoms of a sore throat include burning or sore throat, difficulty swallowing, swelling and redness of the glands, and swollen lymph nodes in the neck. People with angina may also experience fever, headache, and weakness.

Treating angina involves taking antibiotics to kill the bacteria causing the infection. It is important to take the full course of antibiotics, even if the symptoms have disappeared, to prevent possible complications. It is also recommended to rest and drink plenty of fluids to help the body fight infection.

Prevention of angina includes the following measures: avoid contact with sick people, wash hands regularly with soap and water, especially after visiting public places, do not smoke and avoid secondhand smoke, ventilate rooms where a sick person is, regularly strengthen the immune system through proper nutrition, physical activity and sleep.

In the event of symptoms of angina, it is necessary to consult a doctor for a correct diagnosis and treatment. Do not self-medicate or take antibiotics without consulting your doctor.

Bronchitis

Bronchitis is an inflammatory disease of the bronchi that is usually caused by a viral or bacterial infection. Most often, bronchitis develops after a cold or flu, when a virus or bacteria enters the bronchi and causes inflammation.

The main symptoms of bronchitis include a cough that may be dry or phlegm, shortness of breath, general weakness and fatigue, and fever. The cough may be accompanied by sputum production, which may be clear, white, or yellow.

Treatment of bronchitis includes antitussive drugs to relieve dry coughs and drugs that thin sputum. It is also important to drink plenty of fluids and rest to strengthen the immune system and normalize dehydration.

Prevention of bronchitis comes down to maintaining a healthy lifestyle, including regular exercise, a healthy diet and vaccinations. It is also important to avoid contact with sick people and reduce time spent in closed spaces with low ventilation.

In conclusion, bronchitis is an inflammation of the bronchi, which is manifested by coughing, shortness of breath and general weakness. It is important to follow preventive measures and seek medical help in a timely manner for the effective treatment of this disease.

Sinusitis

Sinusitis is an inflammation of the mucous membrane of one or more sinuses. It can occur as an independent disease, or be a complication of influenza, SARS or an allergic reaction. Sinusitis can affect various sinuses, including the posterior, anterior, superior, and inferior sinuses.

Symptoms of sinusitis may include a runny nose, nasal congestion, headache, pain in the forehead and cheekbones, fever, fatigue, general weakness and feeling unwell. However, symptoms can vary depending on the type of sinusitis and its severity.

Treatment for sinusitis may include antibiotics, anti-inflammatory drugs, symptomatic medications to relieve runny nose and pain, and topical treatments such as nasal sprays and drops. In some cases, surgery may be required to remove secretions or drain sinuses.

Prevention of sinusitis includes maintaining nasal hygiene, regularly moisturizing and rinsing the nose, maintaining a strong immune system, avoiding exposure to allergens, and good ventilation. In addition, it is desirable to avoid hypothermia, regularly ventilate the premises and avoid contact with patients with acute respiratory viral infections.

Rhinitis

Rhinitis is an inflammation of the nasal mucosa. It is accompanied by symptoms such as nasal congestion, discharge of mucous or purulent secretion, sneezing, itching and burning in the nose. Rhinitis can be caused by a variety of causes, including viruses, bacteria, allergens, chemical irritants, and mechanical damage.

Among the main types of rhinitis are viral, allergic and chronic rhinitis. Viral rhinitis will usually go away on its own within a few days. Allergic rhinitis is caused by allergens such as dust, pollen, and pets and can last for years if no treatment and prevention measures are taken. Chronic rhinitis can be caused by a variety of factors, including viruses, allergens, and improper medication.

Treatment of rhinitis depends on its cause and severity. For symptomatic relief, topical vasoconstrictors, hot drinks, inhalations, and heat application can be used. In the event of a bacterial infection, antibiotics may be required. For the prevention of rhinitis, it is recommended to avoid contact with infected people, observe hand hygiene and general hygiene, strengthen the immune system, and regularly clean and ventilate the premises.

• Symptoms of rhinitis:
  1. Nasal congestion
  2. Discharge of mucous or purulent secretion from the nose
  3. Sneezing
  4. Itching and burning in the nose

900 47

Types of rhinitis:

Viral	Will pass on its own in for several days
Allergic	Caused by allergens, lasts for years without treatment
Chronic	Can be caused by various factors, needs treatment

Laryngitis

Laryngitis is an inflammatory disease of the larynx that is most commonly caused by an infection such as a cold or flu virus. However, laryngitis can also be caused by other causes, such as allergies, trauma, or strain on the vocal cords.

Symptoms of laryngitis include hoarseness or loss of voice, reverse slight cough, sore or discomfort in the throat, difficulty breathing, and increased fatigue. Symptoms may be more severe in children than in adults.

Treatment of laryngitis is aimed at relieving symptoms and controlling the infection if it is caused by a virus. Recommendations include resting the vocal cords, avoiding irritants such as smoking or chemical fumes, hot drinks, and steam inhalations. Sometimes reflux medications and antibiotics may be prescribed if the laryngitis is caused by a bacterial infection.

Prevention of laryngitis includes strengthening the immune system, avoiding contact with infected people, and maintaining good hygiene practices such as regular handwashing. In the presence of allergies, contact with allergens should be avoided, and if necessary, allergy treatment should be carried out.

Tonsillitis

Tonsillitis is an inflammation of the tonsils (tonsilla) – paired organs of the lymphatic system located in the back of the throat. This disease is one of the most common and often occurs in children. Tonsillitis is usually caused by viruses or bacteria.

Symptoms of tonsillitis:

• Painful swallowing;
• Redness and swelling of the tonsils;
• Increased body temperature;
• Feeling weak and tired;
• Sore throat and headache;
• The appearance of a white coating on the tonsils.

Treatment for tonsillitis may include:

1. Taking antiviral or antibacterial drugs;
2. Washing the throat with antiseptic solutions;
3. Regular gargling with saline solutions;
4. Intake of liquid and nutritious food;
5. Recreation and health care;
6. In some cases, it may be necessary to remove the tonsils.

Prevention of tonsillitis includes:

• Hand hygiene;
• Avoidance of contact with sick people;
• Immunity strengthening;
• Regular ventilation of rooms;
• Proper nutrition and adequate drinking;
• Avoid hypothermia.

Seeing a doctor in time and following all the recommendations will help you quickly and effectively cope with tonsillitis and avoid complications.

Related videos:

Q&A:

What are upper respiratory tract infections?

Upper respiratory tract infections are diseases that affect the upper respiratory system, including the nose, throat, larynx, and trachea.

What are the symptoms of upper respiratory tract infections?

Symptoms of upper respiratory tract infections may include runny nose, nasal congestion, cough, sore throat, headache, fever, weakness, and muscle pain.

How to treat upper respiratory infections?

Treatment of upper respiratory tract infections usually includes taking rest, drinking plenty of fluids, taking pain and fever medications, rinsing the nose with saline solutions, hot drinks, and inhalations.

How can you protect yourself from upper respiratory infections?

To prevent upper respiratory tract infections, it is recommended to maintain good hand hygiene, avoid contact with sick people, ensure adequate nutrition and sleep, strengthen the immune system, do not smoke and avoid stressful situations.

Respiratory infections | Novikov Yu.K.

Respiratory tract infection

November 03, 2006

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• Novikov Yu.K.

For citation: Novikov Yu.K. Respiratory tract infection. breast cancer. 2006;22:1615.

Respiratory tract involvement is most often classified according to 2 criteria: temporary (acute or chronic) and topical (upper or lower airways). Otorhinolaryngologists deal with inflammation of the upper respiratory tract. In the lower respiratory tract section, pneumonia, bronchitis, and bronchiectasis are usually considered, although dysontogenetic bronchiectasis is classified as a developmental malformation. It combines lesions of the pharynx, larynx, trachea, bronchi with clinical symptoms: cough (dry or with varying degrees of hypercrinia, dyscrinia), sputum of different color and consistency, symptoms of intoxication and dyspnea (uncharacteristic for damage to large airways, but possible with tracheal dyskinesia and large bronchi).

Acute pharyngitis, tracheitis, bronchitis
If we do not consider toxic damage, then the main cause of acute bronchitis is infection, and among the infectious agents, viruses predominate, against which antibiotics are ineffective. However, in the United States, antibiotics are prescribed by doctors in 75% of cases, which, without a doubt, contributes to the sensitization of the macroorganism and the growth of microbial resistance. The list of nosologies for acute infectious inflammation of the upper respiratory tract includes pharyngitis, laryngitis, tracheitis and uncomplicated bronchitis. They are united by the nonspecific nature of inflammation, often associated with hypothermia, and viral etiology. The diagnostic algorithm for pharyngitis includes an assessment of clinical symptoms (pain, lymphadenopathy, inflammatory changes in the mucosa and tonsils) plus culture of throat swabs and serological testing. The appointment of antibiotics is indicated for purulent discharge and the severity of the condition.
Chronic bronchitis
The most well-known clinical definition of chronic bronchitis as a disease accompanied by a cough with sputum for 2 years at least 3 months a year, with the exclusion of other causes from the respiratory and cardiac systems, reflects the essence of the pathogenetic process with inflammation in the bronchi, accompanied by a violation mucociliary transport. In the presence of progressive airflow limitation and emphysema, one should speak of chronic obstructive pulmonary disease. The prevalence of chronic bronchitis in the US is 20% of the population. Deterioration in chronic bronchitis is associated with exposure to pollutants, including exposure to tobacco smoke, and acute infectious inflammation, 70% caused by bacterial flora and 30% by viruses and atypical pathogens M. pneumonia, Ch. pneumonia.
The most common bacteria are Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis.
H. influenzae is the most common pathogen isolated by sputum culture – 35-50%, S. pneumoniae – in 20%, Viruses and M. neumoniae take 3rd place as the cause of exacerbation, and C. pneumoniae – in 7%. The etiology of exacerbation of chronic bronchitis is presented in Table 1.
The most important clinical manifestations for determining an infectious exacerbation of chronic bronchitis are the classic symptoms:
• increased cough
• increase in sputum
• discoloration of sputum
• increase in dyspnea (if present)
Numerous clinical observations and rigorous multicenter studies have confirmed the role of infectious exacerbation both in aggravating the course of the disease and in its progression. Thus, a relationship was traced between the spectrum of microbial flora and the severity of bronchial obstruction. The more reduced the speed indicators, the more aggressive, virulent flora is detected (Tables 2, 3).
The degree of inoculation of microorganisms from sputum also depends on the characteristics of sputum. With mucosal sputum, the seeding rate is 38%, with colored sputum – 84%. The sensitivity of the method is 94%, the specificity is 77% for green sputum culture.
Treatment
Latest Research
In 2006, numerous studies continued on the comparative effectiveness of mainly III, IV generation of fluoroquinolones, macrolides, ketolides and b-lactam antibiotics in infectious exacerbation of chronic bronchitis. The indications for prescribing antibiotics are being clarified (for example, direct indications indicate the need for ventilation and concomitant cardiac pathology). The appointment of antibiotics in accordance with these criteria allows to achieve eradication of the microbial flora and prolong remission. Objective criteria for inflammation activity are impaired mucociliary transport, bronchial obstruction, viscoelastic properties of sputum, and sputum cytosis. A positive dynamics of these indicators was revealed during therapy with fluoroquinolones III-IV generation compared with therapy with macrolides and b-lactams. Treatment of infectious exacerbation of chronic bronchitis 200 mg cefditoren-pivoxil 2 times a day for 5 days was effective in 79.9% compared with treatment with cefuroxime axetil (250 mg 2 times a day for 10 days), effective in 82.7%. Comparative studies have shown high clinical efficacy of levofloxacin and moxifloxacin – 94 and 91%, respectively. In another study, moxifloxacin and azithromycin were clinically effective in 89% and 85%, respectively. A new fluoroquinolone – prurifloxacin 600 mg 1 time per day showed high clinical efficacy.
No one doubts the need for complex treatment of infectious exacerbation of chronic bronchitis:
• Bronchodilators
• Mucolytics
• Systemic corticosteroids, inhaled (as indicated)
• Oxygen therapy (for respiratory failure)
But these questions are beyond the scope of this article.
Indications for antibiotic therapy are clinical:
• increased cough
• increase in sputum
• discoloration of sputum
• the appearance or increase of shortness of breath
and laboratory-instrumental data:
• decrease in respiratory function
• increased sputum cytosis
• sputum culture with determination of cfu/ml
And when choosing an antibacterial drug, clinical and anamnestic criteria are mainly used.
So with simple bronchitis and rare exacerbations with a mucous character of sputum, azithromycin (Zitrocin and others), amoxicillin, amoxicillin with clavulanic acid are prescribed. With purulent bronchitis with colored sputum and frequent exacerbations, in the presence of concomitant, especially cardiovascular diseases, when taking corticosteroids, with FEV1 <50%, therapy includes amoxicillin, amoxicillin with clavulanic acid, cephalosporins II, III generation, fluoroquinolones III, IV generation. With constantly persistent infection, constant hypercrinia, there is a high probability of Pseudomonas aeruginosa, Acinetobacter, fungal flora, and therefore antipseudomonal antibiotics (ceftazidime, aminoglycosides, polymyxin) and the above-mentioned fluoroquinolones are used in the treatment of these patients.
Brochiectasis
The definition of bronchiectasis is based on pathoanatomical criteria that characterize this pathology as an irreversible expansion of the proximal and middle caliber of the bronchi as a result of damage to the muscular and connective tissue framework of the bronchial wall. Bronchiectasis may be limited to one lobe, may be widespread, but most often it is the result of acute or recurrent chronic inflammation. The most persistent clinical manifestations are chronic cough and, more often, profuse sputum production. Less common are variants of the so-called dry bronchiectasis. Shortness of breath appears depending on the presence of broncho-obstructive syndrome, emphysema and pneumofibrosis.
Etiology and pathogenesis
Bronchial obstruction:
– foreign body,
– tumor,
– enlarged lymph nodes,
– slime.
The occurrence of bronchiectasis after aspiration is possible after years, when the causal relationship is clearly lost, therefore, episodes of paroxysmal cough during meals, the state of anesthesia, and loss of consciousness are taken into account. An example of the formation of bronchiectasis that occurs during obstruction and violation of the sanitation of the bronchi can be the “middle lobe syndrome”, when it is possible to trace the relationship between obturation – pneumonia – bronchiectasis.
Malformations and hereditary diseases
Syndrome of primary ciliary dyskinesia, characterized by ultrastructural changes in the ciliary apparatus and leading to a decrease in the strength of the beating and dyskinesia of the cilia, clinically manifested by recurrent inflammation in the bronchi (bronchiectasis), infertility in men due to immobility of spermatozoa and infertility or ectopic pregnancies in women, chronic sinusitis. Sievert-Kartagener syndrome as a variant of primary dyskinesia, ciliary akinesia, is characterized by the listed symptoms and a mirror arrangement of internal organs (a consequence of the chaotic rotation of the fetus during the laying of internal organs) and is inherited in an autosomal recessive manner.
Cystic fibrosis. Hereditarily determined disease associated with dysfunction of the exocrine glands. The clinical picture depends on the location and degree of dysfunction of the glands. The defeat of the respiratory system is associated with a violation of the mucociliary apparatus, recurrence of infection with the formation of bronchiolobronchiectasis. The proportion of cystic fibrosis as a cause of bronchiectasis reaches 50%.
McLeod Syndrome
William-Campbell Syndrome
Young syndrome (in the absence of genetic pathology and normal sweat chlorides in young men with infertility, sinusitis and bronchiectasis).
The formation of bronchiectasis in these syndromes is noted after the first pneumonia, and not for many years as with cystic fibrosis.
Rheumatic diseases (rheumatoid arthritis and Sjögren’s syndrome may be accompanied by bronchiectasis. Sometimes bronchiectasis is detected earlier than articular syndrome).
Lung infections. This is mainly tuberculosis, possibly viral and mycoplasmal infections.
Smoking not as an etiological factor, but as a cause of recurrent respiratory tract infection
Abscessing, predominantly staphylococcal pneumonia
Pulmonary tuberculosis
Young Syndrome
Bronchopulmonary aspergillosis
Syndrome of “yellow nails” (lymphaedena, pleurisy, yellow nails, bronchiectasis)
Pathogenesis
The main pathogenetic mechanisms of formation of bronchiectasis are impaired bronchial patency and infectious inflammation. These interrelated processes are potentiated in the presence of certain defects in the mechanisms of lung protection (renichek dyskinesia, impaired mucus formation and mucus secretion, immunodeficiency in the humoral vein of immunity). More often, medium-sized bronchi are involved in the process, but more distal parts of the bronchial tree can also be affected. The expansion of the bronchi in the type of cylindrical or saccular bronchiectasis violates the mucociliary defense mechanism, contributes to the recurrence of infection and the progression of the process. Pus containing proteoitic enzymes (elastase, collagenase, cathepsin G) contribute to the destruction of proteins, which is accompanied by edema, ulceration, up to mucosal necrosis. Subsequent processes of granulation in themselves lead to a violation of bronchial patency, and the consequence of inflammation – metaplasia of the epithelium and sclerosis lead to irreversible changes in the bronchial wall. More often, the bronchi of the lower lobes of the left lung are involved in the process.
Clinical picture
• Cough is the main and most persistent symptom.
• Sputum is a mandatory symptom of bronchiectasis. Sputum is mucous or purulent during exacerbation with a predominant discharge in the morning. The amount of sputum can reach 500 ml / day. with uncontrolled bacterial inflammation. A rare variant of the so-called “dry” bronchiectasis is possible.
• Hemoptysis most often as evidence of active inflammation.
• Shortness of breath in the presence of broncho-obstructive syndrome, emphysema, pneumofibrosis.
• Intoxication syndrome, depending on the severity of bacterial inflammation.
• Non-pulmonary symptoms in the form of amyloidosis of the internal organs, “drum fingers” and “watch glasses” are not the most frequent and non-specific symptoms of bronchiectasis.
• Symptoms of hereditarily determined diseases (ciliary dyskinesia, cystic fibrosis, immune deficiency, MacLeod syndrome, Lewis Campbell syndrome).
Objective examination methods
X-ray examination. Able to detect bronchiectasis in 90% of cases. Rounded shadows, atelectasis, a symptom of “tram rails” are determined, with the progression of the disease – deformation of the pulmonary pattern and emphysema.
High-resolution computed tomography of the lungs reliably helps to determine the size and localization of bronchiectasis.
Brochoscopy to determine a foreign body, tumor, compression of the lymph nodes from the outside, for sanitation and bleeding.
The function of external respiration to determine the type of disorders (obstruction, emphysema, restriction) with subsequent correction of bronchial collapse on exhalation.
Bronchography (mainly as a preoperative study).
Additional research methods
Immunological studies: quantitative determination of Ig A, M, G, determination of antibodies of the IgG, E class to aspergillus, determination of total Ig E, polymerase chain reaction for CD, markers of autoimmune diseases, phagocytic activity of neutrophils, test with nitrosine tetrazole, a1-antitrypsin.
Morphological study of biopsy specimens of the bronchial mucosa (electron microscopy of cilia) with akinesia, cilia dyskinesia), determination of sperm motility, detection of carini pneumocystis.
Microbiological study for the determination of BC, Pseudomonas aeruginosa, staphylococcus aureus, culture of fungi and other pneumotropic pathogens.
Biochemical study of sweat chlorides (55–60 mev/l), blood gases.
Genetic study (genotype delta F508).
Ultrasound examination of internal organs (mirror arrangement, cor pulmonale).
Examination of ENT organs (sinusitis).
Complications
• Hemoptysis
• Pneumonia
• Abscesses
• Empyema
• Bronchopleural fistulas
• Amyloidosis of internal organs
• Respiratory failure
• Cor pulmonale
Complications in terms of severity and frequency of occurrence are more typical for patients with an early onset of the disease (with ciliary dyskinesia, cystic fibrosis, immunological deficiency) than for patients who acquired the disease in adulthood.
Treatment
• Restoration of mucociliary clearance (inhalation bronchodilators, including through a nebulizer, mucolytics of the acetylcysteine ​​and ambroxol groups, carbocysteine ​​in combination and combination of various routes of administration, hydration therapy, postural drainage, breathing exercises with positive expiratory pressure, vibration massage).
• Anti-inflammatory therapy with antibiotics (usually penicillin group), cephalosporins, co-trimoxazole, macrolides, ie. antibiotics used in uncomplicated chronic bronchitis. With the appearance of G-flora – fluoroquinolones, aminoglycosides, III-IV generation cephalosporins, with methicillin-resistant staphylococcus – clindamycin, vancomycin, with fungal flora – amphotericin B, etc. Courses of antibiotic therapy lasting 1-3 weeks parenterally, orally, inhalation – tobramycin for Gy flora. Inhaled tobramycin and intravenous antibiotics are needed for recurrent Pseudomonas aeruginosa. With the ineffectiveness of antibiotic therapy and clinical symptoms of bacterial inflammation, with new infiltrative changes on radiographs and a positive culture in 2 samples for CD, therapy is carried out: azithromycin 250 mg / day. or clarithromycin 500 mg twice daily, rifampin 600 mg daily, ethambutol 15 mg/kg/day, streptomycin 15 mg/kg 2 to 3 times weekly for the first 8 weeks as recommended by the American Thoracic Society and thereafter until 12 months, achieving abacilarity.
A feature of macrolides (azithromycin (Zitrocin), etc.) in the treatment of infectious diseases of the respiratory tract is their good penetration into many organs, tissues and body environments. Macrolide antibiotics accumulate in high concentrations in the tonsils, lungs, bronchial secretions, pleural fluid, middle ear cavity, paranasal sinuses, etc. The “tropism” of macrolides to the respiratory organs, along with high activity against the main pneumotropic pathogens, determines their high therapeutic efficacy in bacterial infections. respiratory tract infections. It should also be noted that almost all macrolides create concentrations in tissues that significantly exceed the level of drugs in serum.
Macrolides (azithromycin, clarithromycin, etc.) are reliably considered one of the safest antibiotics. When using macrolides, serious adverse reactions are extremely rare. Of the undesirable manifestations, nausea, vomiting, abdominal pain are more often noted, less often – diarrhea. As a rule, these side effects occur when using natural 14-mer macrolides. It has also been established that long-term use of “old” 14-mer macrolides may be accompanied by the development of cholestatic hepatitis, including due to the formation of hepatotoxic metabolites of the antibiotic (nitrosoalkane forms). Contraindications for the appointment of macrolides are pronounced violations of liver function, as well as increased individual sensitivity to these antibiotics.
Corticosteroids – oral in short courses up to 2 weeks 25-30 mg / day. or inhalation, especially in the presence of broncho-obstructive symptom and chronic bronchitis, atopy.
• Immunotherapy – vaccination against influenza and pneumococcal vaccine, immunoglobulin G, parenterally for immunodeficiency (with immunoglobulin levels below 10% of normal).
• Embolization of bronchial arteries in case of bleeding.
• Lung resection in case of local bronchiectasis and bleeding that cannot be stopped by other methods.
• Lung transplantation in the development of the terminal phase of the disease.
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