Chronic obliterating bronchiolitis

Chronic bronchiolitis.

Acute obliterating bronchiolitis is most often caused by an infection caused by adenoviruses 1.7 and 21 types. Sometimes the appearance of the disease occurs due to acute respiratory diseases. With obliterating bronchiolitis, terminal bronchioles and small bronchi suffer( up to 1 mm in diameter), complete mucosal disruption occurs, followed by darkening of bronchioles clearance with fibrous tissue. When untimely treatment of obliterating bronchiolitis in affected areas, endarteritis and complete obliteration of arterioles can develop. Complication of the disease is the sclerosis of tissues, or increased airiness against the background of complete atrophy of the alveolar tissues. Pathological changes in tissues lead to impairment of pulmonary blood flow and contribute to the development of an emphysema.

The clinical picture of the disease with obliterating bronchiolitis is as follows: the patient has severe respiratory failure developing against the background of acute adenovirus infection, febrile fever, conjunctivitis, early vaginitis. Due to internal processes, severe mixed dyspnea, wheezing, cyanosis, tachypnea develop. When listening to the lungs, there are antisymmetric, small bubbling and wheezing rales. In the case of developing more severe forms of obliterating bronchiolitis, bacterial pneumonia joins the disease, and with the increase in acute respiratory failure, the disease is accompanied by frequent deaths.

In most cases, the above symptoms increase over a long period of time with a constant increase in body temperature. Even with the right and timely treatment, acute signs of the disease can persist for 2 weeks, sometimes they may not pass within a month. With a prolonged progressive obliterating bronchiolitis, a "super-transparent" lung can form, in medical terminology this symptom is usually called the McLeodon syndrome, after the name of the scientist who revealed it. With this form of the disease, the obliterating bronchiolitis passes into a chronic form, hard to treat.

Chronic bronchiolitis obliterans are diagnosed by laboratory and instrumental methods. First of all, this is the procedure for radiography. On radiographs of chest organs obliterating bronchiolitis manifests itself in the form of a characteristic total darkening of the organs of lung tissue. As a rule, the affected areas of reduced transparency alternate with airy tissue regions, the so-called "cotton lung".To confirm the diagnosis, blood sampling is done to study its gas composition. With a positive diagnosis, the gas composition of the blood reveals hypoxemia and hypercapnia. The increase in ESR and neutrophilic leukocytosis is revealed in the analysis of peripheral blood.

The risk factors for developing obliterating bronchiolitis are:

• smoking( 80-90% of cases);
• the effect of air pollution;
• is a professional risk faced by people of the following professions: miners, construction workers, metallurgical workers, workers - railway workers, workers. Employed on the processing of grain, paper, cotton. Office workers associated with printing on a laser printer.

First of all, all the risk factors associated with breathing harmful substances: powders, dust, poisonous gases, fumes, soot.

Treatment of obliterating bronchiolitis is not always positive, the disease reacts very poorly to any methods of medical treatment, in this regard, the predictions of doctors in the formulation of this diagnosis are extremely disappointing. No anti-inflammatory therapy can cause the reverse process of the disease, since the obliterating chronic bronchiolitis phenomenon is late diagnosed, and the purpose of restorative therapy is not a recovery process, but a supporting and preventing further development of pathological processes in tissues. Only aggressive therapy can achieve at least some fact of regression of the process.

Treatment of the disease.

The most effective is the early treatment of the disease, with the mandatory appointment of glucocorticoids( prednisolone), with a smooth decrease in the daily dose and the subsequent addition of bronchodilators, vibrating massage, postural drainage and strong antibiotics( prescribed by the doctor, depending on the patient's condition).

In medicine, single cases of successful treatment with obliterating bronchiolitis with cyclophosphamide are described. A promising direction in the treatment is the use of immunosuppressive drugs, but the field of their application and effects in medicine is not yet sufficiently studied, and therefore their use is extremely limited.

In some situations inhalations with glucocorticosteroids are of great importance, their special effectiveness is observed with postvirus bronchiolitis obliterans in children.

In very rare cases, as a method for controlling bronchiolitis obliterans, surgery is used, which involves lung transplantation, and does not exclude the possibility of repeated transplantation. However, the operation of lung transplantation is rather complicated, and involves a high degree of risk, then it should be resorted to only in extreme cases. It should be noted that with repeated lung transplantation, the mortality rate of patients is very high.

Obliterating bronchiolitis is familiar with symptomatic therapy. For example, with the development of hypoxemia, oxygen therapy is used, infectious complications often use antibiotics and antifungal drugs, and often use inhaled sympathomimetics, although their effectiveness in treating this kind of bronchiolitis is not very high.

Prevention.

Because of the special complexity of treatment and high mortality in cases of obliterating bronchiolitis, disease prevention should be undertaken. At the first symptoms of lung disease, you need to turn to a specialist without delaying the inflammatory process. It is also necessary to have an annual preventive examination by a pulmonologist with mandatory radiography, especially for people at risk.