Bronchitis chronic - the diffusive progressing inflammation of the bronchuses which have been not bound with local or a lesion of lungs and shown tussis. It is accepted to speak about chronic character of process, if the productive tussis which has been not bound to any other disease, proceeds not less than 3 months in a year within 2 years on end.

Etiology, pathogenesis. Disease is bound to a long boring of bronchuses various harmful factors (smoking, inhalation of air polluted by a dust, a smoke, oxides of Carboneum, a sulfurous anhydrase, oxides of nitrogen and other chemical compounds) and a recurring respiratory infection (the leaging role belongs to respiratory viruses, pneumococcuses).

Signs, current. The beginning gradual. The first sign is tussis in the mornings with unit of a mucous sputum. Gradually tussis starts to arise both at night and in the afternoon, amplifying in cold weather, in the course of time becomes to constants. The quantity of a sputum is enlarged, it becomes mucous and purulent or purulent. The dyspnea appears and progresses. Allocate 4 forms of a chronic bronchitis. The simple (catarral) bronchitis proceeds with allocation of a small amount of a mucous sputum without bronchial obstruction. At a purulent bronchitis constantly or the purulent sputum is periodically allocated, but the bronchial obstruction is not expressed. The chronic obstructive bronchitis is characterized by proof obstructive disturbances, together with an emphysema of lungs and a bronchial asthma concerns to chronic obstructive illnesses of lungs. The purulent obstructive bronchitis proceeds with allocation of a purulent sputum and obstructive disturbances of ventilation. During an exacerbation at any form of a chronic bronchitis the spastic syndrome can develop. Frequent exacerbations, especially during the periods of cold crude weather are typical: tussis and a dyspnea amplify, the quantity of a sputum is enlarged, there is a malaise, sweat at night, fast fatigability. A body temperature normal or subfebrile, rigid respiration and dry rhonchuses above all surface of lungs can be defined. The leukocytic formula remain normal is more often; the small leukocytosis with band shift in the leukocytic formula is possible. In diagnostics of activity of a chronic bronchitis rather the great value has research of a sputum: macroscopical, the cytologic, biochemical. So, at the expressed exacerbation find out purulent character of a sputum, mainly leucocytes, rising of the maintenance of acidic mucopolysaccharides and fibers of DNA strengthening viscosity of a sputum, depression of the maintenance of a lysozyme, etc. Exacerbations of a chronic bronchitis are accompanied by accrueing frustration of function of respiration, and at presence of a pulmonary hypertensia - and circulatory disturbances. Considerable aid in recognition of a chronic bronchitis is rendered with a bronchoscopy at which visually estimate endobronchial displays of inflammatory process (a catarral, purulent, atrophic, hypertrophic, hemorrhagic, fibrinous ulcerative endobronchitis) and its expression (but only up to a level of subsegmental bronchuses). The bronchoscopy allows to make a biopsy of a mucosa and to specify character of a lesion, and also to tap a bronchial hypotonic dyskinesia (augmentation of mobility of walls of a trachea and bronchuses during respiration down to expiratory fall of walls of a trachea and primary bronchuses) and a static retraction (change of a configuration and decrease of lumens of a trachea and bronchuses) which can complicate a chronic bronchitis and to be one of the reasons of bronchial obstruction. However at a chronic bronchitis the basic lesion is localized more often in fineer branches of a bronchial tree; therefore in diagnostics of a chronic bronchitis use a bronchography and roentgenography. At early stages of a chronic bronchitis of change on bronchograms at the majority of patients are absent. At it is long a current chronic bronchitis on bronchograms breakages of bronchuses of average calibre and absence of filling of fine bifurcations (owing to obstruction) can be taped, that frames a picture of a dead tree. In peripheric departments bronchiectasias in the form of the fine cavitary formations filled by contrast in diameter up to 5 mm, bridged with fine bronchial branches can be found out.