Chronic Bronchitis and Emphysema

The chronic bronchitis and emphysema are both lung diseases, but beside the similarities, they have many differences. Chronic bronchitis is a disease characterized by chronic or recurrent excessive mucus secretion in the bronchi, leading to a productive cough with annual exacerbations to 3 months or more in recent years. Emphysema is a disease caused by the increased airspace of the bronchioles as a result of the destructive changes in their walls.

Depending on different kinds of chronic bronchitis, it can be the catarrhal bronchitis which is accompanied by the formation of mucous sputum and the mucopurulent bronchitis where the intermittent or constant pus in the sputum is present. Chronic asthmatic bronchitis is characterized by recurrent attacks of breathlessness similar to asthma caused by various reasons. Emphysema causes loss of elasticity of the body and the increased resistance to the air flow. The same patient can suffer on both: chronic bronchitis and emphysema (Fletcher, 1976). Each of the diseases or any of them is characterized by chronic airway obstruction.

The term “chronic bronchitis” marks diffuse inflammation of the bronchial mucosa, grabbing the deeper layers of the bronchial wall development peribronchitis. It proceeds with the period changes of exacerbations and remissions. This is one of the most common respiratory diseases that occurs mostly over the age of 50 years. Men suffer 2-3 times more often than women. The clinical significance of chronic bronchitis is large, since it can be associated with the development of some chronic lung diseases such as emphysema, chronic pneumonia, asthma, and lung cancer. In the development of chronic bronchitis, various factors are important, but most significant is an infection. Chronic bronchitis is often a consequence of acute and long-term irritation of the bronchi by different physical and chemical factors (Leave, 1973). Therefore, chronic bronchitis may be an occupational disease among the workers at the flour, tobacco and woollen factories, among miners and workers at the chemical plants. However, especially often, chronic bronchitis occurs among the smokers.

The changes in the bronchi vary and depend largely on the nature of the inflammatory process and duration of disease. At the beginning, the bronchial mucosa is hyperaemic, cyanotic, sometimes brownish gray with the signs of hypertrophy. The bronchial glandules are in the state of functional hyperplasia; later the hypertrophic changes become atrophic. The process can extend to all layers of the wall of the bronchi and lead to its thickening/ the connective tissue develops, resulting in the deformed and dilated bronchi. In the process, the peribronchitis fabric can be drawn with advancing pneumonic sclerosis and emphysema. The clinic feature has basically one type and sometimes can be poor. The most frequent and constant symptom is a cough, which usually appears in cold and wet weather and can occur paroxysmal. The mucus of the sputum, mucopurulent or purulent character contains a variety micro flora. In some cases, it appears only in the morning, and the rest of the day, the dry whooping cough occurs. Some patients cough around the clock and sometimes vomit with painful chink and skin cyanosis. The body temperature is usually normal, but during the exacerbation period may rise to low-grade (Guerra, 2002). Progression of disease is accompanied by destructive changes in the bronchi, the development of bronchiectasis, pneumonic sclerosis and emphysema, respiratory failure, and syndrome of the pulmonary heart. The diagnosis of chronic bronchitis is based on the above characteristic symptoms, but there may be difficulties in the differential diagnosis of other chronic diseases: tuberculosis, chronic pneumonia, lung cancer, and asthma.

The treatment of the chronic bronchitis should be mixed. It is important to avoid contact with the external irritating factors, to reorganize foci of infection in the upper respiratory tract. By the exacerbation, the antibiotics, sulfanilamide medicines are usually prescribed. For dealing with the sputum, doctors prescribe expectorants, enzymes in the form of aerosols, in the presence of asthmatic phenomena – antispasmodic medicines (Fletcher, 1976). During the acute disease is used as distractions agents. In severe bronchitis can be applied therapeutic bronchoscope with the introduction of the bronchi medicines. In chronic bronchitis showed physiotherapy and spa treatment.

The prevention of the chronic bronchitis is to prevent the acute respiratory infections and acute bronchitis, as well as mixed treatment of the patient. Important meaning has the timely treatment of the patient with acute infectious diseases, hardening, eliminating of the relevant hazards and the rational employment of the patients with the professional bronchitis. The issue of employment can occur in the severe chronic bronchitis. It is contraindicated in work associated with the difficult physical activity, hypothermia, inhalation of dust and any irritants (Guerra, 2002). The patients with chronic bronchitis should be under medical supervision.

Emphysema is a term that refers to the various lung diseases, a common feature of which is the excess air content in them. To the development of chronic emphysema lead the various factors. A particularly important role play an obstructive mechanism involving a violation of the bronchial patency, as observed in chronic bronchitis and asthma (Fletcher, 1976). The violation of bronchial patency due to the incomplete obturation leads to the ultimately improved air content in the alveoli.

The development of emphysema may be associated with other chronic diseases of the bronchi such as tuberculosis, lung abscess, moved to childhood measles and whooping cough. It should also take into account the value of deformities of the spine and chest and the role of some professions. In the pathogenesis of emphysema plays a role also decrease of the lung elasticity. In the chronic inflammatory processes in the lungs, the changes are observed in preganglionic and postganglionic nerve fibers in, leading to disruption of the trophy lung tissue. The trophy disorders are aggravated by the fact that in the inflammatory processes precedes the development of emphysema, obliteration of blood vessels and perivascular changes. This leads to the malnutrition of the lung tissue and the development of atrophic changes, which play a significant role in the development of emphysema.

In recent years, the development of emphysema attaches the importance of heredity. Even in the last century was marked by the existence of family forms of emphysema. However, it did not find an explanation. Currently, the scientists distinguish the family form of emphysema, which is associated with the development of the innate antitrypsin deficiency.

During emphysema, the lungs are increasing. The microscopic examination marks the thinning of the alveolar walls, a clear boundary between neighbor alveoli is absent because they merge with each other, sometimes forming the air cavity. When the location of cavities on the peripheral area of the lung is possible, they split with the occurrence of spontaneous pneumonic thorax (Fletcher, 1976). The elastic fibers become dramatically thinned. At the same time, it can show the phenomenon of chronic bronchitis, bronchiectasis, and fibrosis.

One of the main symptoms of emphysema is shortness of breath. Initially, it appears only on exertion, later gradually increases and becomes constant. The shortness of the breath expiratory character in breathing involves supporting muscles (Leaver, 1973). Pretty typical appearance of patients: chest expanded, especially in the lower parts, often observed kyphosis and enlarged intercostal spaces. The thorax is limited in its mobility. The main feature of emphysema is an increasing residual volume of the lungs. There is a decrease in the rate of maximum expiratory flow and reduced forced vital lung capacity. For obstructive emphysema characteristic is the increase of breathing resistance. The violation of the lung ventilation function can be determined by simple tests proposed when the patient should be closing his mouth, blow out the candle burning, which is located at a distance of 15 cm from his mouth.
Later, it changes the flow velocity and height of the venous pressure. Ob the electro cardiogram, the dextrogram is observed. The increased lung transparency, low standing of the diaphragm, and limited respiratory excursions are determined radio graphically.

Emphysema is associated with the antitrypsin deficiency and occurs in a younger age of 20 – 40 years by type of primary “idiopathic”, occurs with equal frequency in women and men. The main symptom is the chink.

The flow of emphysema pronounces more or less progressive nature. The flow is defined by the degree of inflammatory changes in the bronchi and lungs, the development of pulmonary insufficiency and hypertension in the pulmonary circulation. With progression of the disease increased shortness of breath, frequent and aggravated cough, increases arterial hypoxemia, carbon dioxide accumulates in the blood. The lung lack has initially hidden nature, and then it turns out that the heart failure joins it.

The prognosis is determined by the severity of these phenomena, maybe a long course of severe emphysema without clinical manifestations and with preservation of efficiency (Fletcher, 1976). The diagnosis is based on characteristic signs of the disease such as dyspnea, barrel chest, short neck, voltage of the auxiliary respiratory muscles, boxed shade of the percussion sound, the limited mobility of the lower edges of lung, weakened breath, and wheezing (Guerra, 2002). The treatment is advisable to use first of all the methods to combat the infection, especially antibiotics, including in the form of aerosols. The bronchodilator agents such as ephedrine, atropine, etc. improve the patency of the bronchi, especially the tendency to the bronchospasm. They are useful before prescribing antibiotics in the form of aerosols, and increases their efficiency. By the suspect on the allergic nature of the bronchospasm prescribe corticosteroids. The assigned physical therapy aims at restoring the most effective diaphragmatic breathing type. Thus, the most important task of physiotherapy is to increase the amplitude of respiration through the exhalation deepening and reduction of residual volume (Guerra, 2002). At the ending of the disease process, it is recommended to use the respirators. Against the symptoms of pulmonary insufficiency helps the oxygen therapy. Oxygen must be sufficiently moist. When oxygen therapy via an oxygen tent should let low oxygen concentration approximately 50-60% (Leave, 1973). The sessions should gradually lengthen from 10 to 30 minutes under the supervision of a physician who should monitor the depth of breathing. By the heart failure help the cardiac glycosides and diuretics.

The prevention is the timely diagnosis and treatment of chronic diseases of the bronchi and lungs, especially chronic bronchitis. The great importance has sanitation of the epipharynx. The preventive measures include also the hardening of the patient, starting with the dry sponging of the whole body with a gradual transition to wet, washing the feet with the gradual cooling of water.

The chronic bronchitis and emphysema are the similar lung diseases. Both of them need the good prevention and efficient treatment. Emphysema is harder than the chronic bronchitis. However, they both make harm to the human health.

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