Chronic bronchitis in the elderly
Introduction
Introduction to chronic bronchitis in the elderly Chronic bronchitis (chronic bronchitis) is a chronic non-specific inflammation of the tracheal-bronchial mucosa and its surrounding tissues caused by infection or non-infectious factors. Its pathological features are bronchial mucosal hyperplasia and increased mucus secretion. Clinically, it is a cough, cough or asthma that lasts for more than 2 years and lasts for more than 3 months every year. The onset of the disease is insidious, and the early symptoms are mild. It is often in the winter and relieves after the warm spring. The symptoms are aggravated and perennial. presence. The course of the disease is repeated, often with emphysema and pulmonary heart disease. basic knowledge Probability ratio: 27% probability of illness in the elderly Susceptible people: the elderly Mode of infection: contagious Complications: emphysema obstructive emphysema bronchial pneumonia bronchodilation cough
Cause
Causes of chronic bronchitis in the elderly
Smoking (30%):
Smoking is the most important cause of chronic bronchitis. The incidence of chronic bronchitis in smokers is 4 to 5 times higher than that of non-smokers, and the incidence increases with the number of years of smoking and the amount of smoking. Harmful ingredients, such as tar, nicotine, carbon monoxide, furfural, etc., these harmful substances can directly or indirectly damage the bronchial mucosa epithelium, and even cause squamous metaplasia; inhibit or damage the bronchial mucociliary movement, make it fall, become shorter or even fall off Stimulate mucinous gland hyperplasia, excessive secretion of mucus, secretions are easy to secondary microbial infection; inhibit the phagocytic function of pulmonary macrophages; smoking can also cause bronchospasm.
Air pollution (20%):
Harmful gases in the atmosphere, such as nitrogen oxides, sulfur dioxide, chlorine, etc., have stimulating and cytotoxic effects on the bronchial mucosa, which can cause inflammation of the mucous membranes; harmful organic and inorganic dusts in the atmosphere, such as silica, coal powder, cotton chips, Sugarcane dust can also cause pulmonary fibrosis, which can damage lung clearance and create conditions for pathogenic microbial invasion.
Infection (10%):
Infection with pathogenic microorganisms is another important morbidity and aggravating factor for chronic bronchitis.
Allergic factors (10%):
Endogenous or exogenous antigens can cause delayed or immediate allergic reactions, causing bronchospasm and leading to tissue damage and inflammation, especially for asthmatic chronic bronchitis, an allergic factor is an important cause.
Meteorological factors (10%):
Climate change, especially cold, dryness, and high heat can damage the cilia function and respiratory mucosal blood circulation, and reduce the local barrier function and facilitate the infection of pathogenic microorganisms.
Other (10%):
Autonomic dysfunction may also be an internal cause of the disease; vitamin deficiency, especially vitamin C, A deficiency can reduce the body's resistance and is prone to chronic bronchitis; elderly gland and adrenal cortical function decline, throat reflex, respiratory Decreased defense function, declining function of mononuclear-macrophage system, malnutrition, etc. can increase the incidence of chronic bronchitis.
Pathogenesis
The main pathological change of chronic bronchitis is non-specific inflammation of tracheal-bronchial mucosa. Due to repeated attacks of inflammation, epithelial focal necrosis and squamous metaplasia are caused. Ciliated epithelial cells are damaged to varying degrees, cilia become shorter and sparse. Qi or shedding; mucous gland hyperplasia, ductal dilatation, serous gland and mixed gland decreased, goblet cells proliferated, Reid index (gland thickness / bronchial wall thickness) increased; bronchial wall inflammatory cell infiltration, congestion and edema, necrosis And fibrosis; mucosal tissue ulceration and granulation hyperplasia; severe cases can also be seen bronchial smooth muscle layer thickening and elastic fiber muscle, stenosis, bronchiole collapse, mucus plug in the lumen; alveolar wall can also be seen under electron microscopy I Type cells swelled and thickened, type II cells proliferated, capillary basement membrane thickened, endothelial cell injury, thrombosis, luminal occlusion, diffuse hyperplasia of alveolar wall fibrous tissue, and these changes were particularly significant in patients with emphysema and pulmonary heart disease.
Prevention
Elderly chronic bronchitis prevention
In view of the fact that chronic bronchitis is one of the most common diseases in the elderly, its global incidence is on the rise, which seriously affects the health of the elderly. It should pay full attention to its prevention. Smoking is the most important cause of chronic bronchitis. Passive smoking will also obviously damage health. Therefore, smoking should be advocated. Although smoking cessation can not completely restore the smoking of elderly chronic bronchitis, it can significantly delay the development of the disease, partially restore lung function damage, and eliminate or improve air pollution. A very important measure to prevent chronic bronchitis in the elderly. In addition, reasonable nutrition, physical exercise, physical fitness, and prevention of colds are also beneficial for the prevention of chronic bronchitis in the elderly.
Complication
Chronic bronchitis complications in the elderly Complications emphysema obstructive emphysema bronchial pneumonia bronchodilation cough
1. Emphysema is also the most common complication of chronic bronchitis in the elderly. Obstructive chronic bronchitis and obstructive emphysema are collectively called COPD.
2. Pulmonary heart disease is a common complication of chronic bronchitis in the elderly.
3. Bronchial pneumonia in elderly patients with chronic bronchitis, inflammation spread to the lung tissue around the bronchi, patients may have chills, fever, increased cough, increased sputum volume and purulent, frail elderly patients often have no chills, fever, only as Increased cough, shortness of breath, shortness of breath, palpitation; lungs or double lungs scattered in the wet voice.
4. Bronchiectasis is a recurrent episode of chronic bronchitis in the elderly, resulting in narrowing of the lumen and expansion of the distal end of the stenosis.
Symptom
Chronic bronchitis symptoms in the elderly Common symptoms Difficulty breathing Chronic cough Respiratory sounds Rough breath sounds Low wheezing Bronchospasm Airway hyperresponsive Shortness of breath snoring
Old people with chronic bronchitis onset, mostly onset in young and middle-aged, there are a few onset in old age, patients more than the cold season, cough, cough, especially in the morning, sputum is white mucus foam With the development of the disease, coughing all the time, coughing, and winter and spring aggravation, some patients with episodes of acute respiratory infections as a precursor, there may be fever, upper respiratory tract symptoms, and then cough, cough significantly increased Increased sputum volume, viscous viscous or yellow purulent, a small number can also be seen in the sputum with blood, wheezing chronic bronchitis patients with cough, often worse than cough after asthma attacks, elderly patients often have emphysema, often Shortness of breath is obvious.
Signs: There are many signs in the early stage of the disease, sometimes it can be heard that the breath sounds are rough, the dry or wet voice of the bottom of the lungs; the wheezing type has a wide wheezing sound; the obstructive breath sound is weak, and the exhalation time is prolonged.
X-ray signs: There is no abnormality in the early X-ray examination of the disease. The elderly with long-term disease can be seen with increased lung pattern, coarse and chaotic, with two lungs, sometimes showing "double track sign"; there are small patches around the bronchi during infection. .
The clinical manifestations and prognosis of chronic bronchitis are very different. Most of the domestic use of the 1979 national professional meeting staging, typing method:
1 acute attack period: sudden increase in severity within 1 week, cough, increased cough, increased sputum volume, purulent or mucopurus, or other inflammatory manifestations; or any symptom within 1 week Severe; or the symptoms of severely ill patients are significantly worse.
2 Chronic prolongation period: The patient's cough, phlegm, and asthma symptoms are delayed, or the seizure level has not recovered to the pre-onset level.
3 clinical remission period: after treatment or natural remission, the condition is stable, the symptoms are obviously reduced or disappeared, and the maintenance time is more than 2 months.
This meeting divided the chronic bronchitis into two types: simple type and wheezing type. Later, many foreign scholars divided it into three types:
1 simple type: this type of patient has no obvious airway obstruction performance, and there is no obvious airway hyperresponsiveness. The lesion mainly exists in the airway. The patient mainly presents with cough, cough, no breathing difficulty, wheezing, and lung function. The damage is small, there is no hypoxemia and carbon dioxide retention, this type is more common in adult males.
2 wheezing type: this type of patient has persistent airflow obstruction and obvious airway hyperresponsiveness. On the basis of chronic cough and cough, accompanied by episodic bronchospasm, bronchial wall edema, and increased mucus secretion, The type is more common in elderly smokers. Its discriminating point is the maximum expiratory peak flow (PEF) variability of 15% at 24h, or positive bronchodilation test, or positive anti-asthmatic treatment.
3 obstructive type: the airway of this type of patients has irreversible stenosis, and the stenosis is mostly in the small airway. The chronic bronchial inflammation, fibrosis, goblet cell hyperplasia, smooth muscle hypertrophy and other pathological changes are prominent, and the lung function is progressively damaged. , often accompanied by hypoxemia and hypercapnia, easy to complicated emphysema and pulmonary heart disease, this type is relatively small, but the prognosis is serious.
There is controversy about the classification of chronic bronchitis. Many scholars believe that the so-called wheezing type is chronic bronchitis complicated by asthma. It is not an independent disease and should be called COPD overlap syndrome. However, some scholars believe that it is different from the treatment of asthma in acute attacks, should be controlled mainly for infection, or should be retained as an independent type.
Examine
Examination of chronic bronchitis in the elderly
The total number of white blood cells may not be high, but neutrophils are increased.
X-ray examination, blurred shadows appear in the double lung field.
Diagnosis
Diagnosis and diagnosis of chronic bronchitis in the elderly
diagnosis
Older people with cough, cough or recurrent wheezing, at least 3 months a year, lasting 2 years or more, and rule out other diseases of heart and lung can be diagnosed.
Differential diagnosis
Elderly chronic bronchitis should be distinguished from the following diseases:
Tuberculosis
The toxic symptoms of senile pulmonary tuberculosis, such as fever, night sweats, weight loss, etc., are not obvious, such as cough, cough, heart palpitations, shortness of breath, fatigue, anorexia, weight loss, mild edema, X-ray chest radiographs are often atypical, easy to Chronic bronchitis, emphysema confusion, in recent years, elderly tuberculosis and COPD, the incidence rate has been increasing year by year, it often coexists with elderly chronic bronchitis, must not relax the tuberculosis because of the existence of chronic bronchitis in the elderly Suspicious cases should be X-ray, tuberculosis, tuberculin test, PCR test, to identify.
2. Lung cancer
Lung cancer is the same as chronic bronchitis in older male smokers. They often coexist. Don't relax the warning of lung cancer because of the presence of chronic bronchitis in the elderly. Anyone who has irritating cough, or sputum with blood and anti-infection Treatment for 1 week still does not disappear, or the same part of the lung tissue in the short-term inflammation, or the occurrence of atelectasis should be highly alert to the possibility of lung cancer, timely X-ray, CT, MRI, sputum exfoliated cells, fiberoptic bronchoscopy Clear diagnosis.
3. Bronchial dilation
Most of the disease occurs in children and young people, with chronic cough, coughing a lot of purulent sputum, repeated hemoptysis, clubbing, etc. It is generally difficult to identify with chronic bronchitis in the elderly; some cases can be recurrent in chronic bronchitis in old age Bronchiectasis occurs, and its pathological manifestations are stenosis and dilatation. It is clinically characterized by chronic cough, cough and purulent sputum, and sometimes can cause atelectasis. Bronchial iodized oil can be identified.
4. Bronchial asthma and heart disease asthma
Wheezing chronic bronchitis sometimes needs to be differentiated from bronchial asthma and heart disease, identifying points (Table 1).
