Respiratory tract retching, coughing, chest congestion

The environment has a great impact on the body, especially in heavily polluted weather. It is recommended that everyone wear a mask to avoid respiratory diseases and drink more water. But some people say that sometimes the symptoms occur together, such as dry heaving, coughing, chest congestion, etc. These symptoms make it difficult for people to work or live normally, so it is necessary to find the cause and treat it symptomatically to prevent the disease from becoming more serious.

Under normal circumstances, the respiratory tract has a complete defense function and can filter, heat and humidify the inhaled air. The ciliary movement on the surface of the airway mucosa and the cough reflex can clear foreign matter and pathogenic microorganisms in the airway. There is also secretory IgA in the lower respiratory tract, which has an anti-pathogenic effect, so the lower respiratory tract can generally remain in a purified state. People with weakened systemic or respiratory defense and immune functions (especially the elderly) are very likely to suffer from chronic bronchitis, which can recur repeatedly without recovery.

Smoking

Smoking is the main factor causing this disease. Cigarettes contain chemicals such as tar, nicotine and hydrocyanic acid, which can damage airway epithelial cells, reduce ciliary motility and macrophage phagocytic function, leading to decreased airway purification function and stimulating submucosal receptors, causing parasympathetic nerve hyperfunction, causing bronchial smooth muscle contraction, leading to increased airway resistance and increased glandular secretion. Goblet cell hyperplasia, bronchial mucosal congestion and edema, and mucus accumulation can easily induce infection. In addition, cigarette smoke can increase the production of toxic oxygen free radicals, induce neutrophils to release proteases to inhibit the anti-protease system, destroy lung elastic fibers, and induce the occurrence of emphysema. Studies have shown that the prevalence of chronic bronchitis in smokers is 2 to 8 times higher than that in non-smokers, and the longer the smoking period and the more cigarettes smoked, the higher the prevalence.

Air pollution

Harmful gases such as sulfur dioxide, nitrogen dioxide, chlorine and ozone have irritating and cytotoxic effects on the airway mucosal epithelium. It is reported that when the smoke or sulfur dioxide in the air exceeds 1000μg/m3, the acute attacks of chronic bronchitis will increase significantly. Other dusts such as silica, coal dust, sugarcane dust, cotton dust, etc. can also irritate and damage the bronchial mucosa, impair the lung clearance function, and create conditions for bacterial infection.

Infectious factors

Infection is one of the important factors in the occurrence and development of chronic bronchitis. Viral mycoplasma and bacterial infections are the main causes of acute attacks of this disease. The most common viral infections are influenza virus, rhinovirus, adenovirus and respiratory syncytial virus, while the most common bacterial infections are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus. Bacterial infections often occur secondary to viral or mycoplasma infections or damage to the airway mucosa.

Allergic factors

Patients with asthmatic chronic bronchitis often have a history of allergies, and the positive rate of skin tests stimulated by various allergens is also high. The number of eosinophils and histamine content in sputum and IgE in blood tend to increase. Some patients have positive rheumatoid factor in serum and abnormal distribution of T lymphocyte subpopulations. Therefore, it is believed that atopy and immune factors are related to the occurrence of this disease. However, some people believe that atopy should be a factor in the pathogenesis of asthma. In fact, such patients should belong to the category of asthma or chronic bronchitis combined with asthma.

other

Acute attacks of chronic bronchitis are more common in winter, so meteorological factors should be considered as one of the important factors causing the disease. Cold air can stimulate the glands to secrete more mucus and increase ciliary movement, weakening and weakening the airway's defense function. It can also cause bronchial smooth muscle spasm, mucosal vasoconstriction, and local blood circulation disorders through reflex, which is conducive to secondary infection. Most patients with this disease have autonomic dysfunction; some patients have hyperfunction of the parasympathetic nervous system and higher airway reactivity than normal people; in addition, adrenal cortex dysfunction, impaired cellular immune function, reduced lysozyme activity, malnutrition, and vitamin AC deficiency in the elderly can all increase airway mucosal vascular permeability and reduce epithelial repair function. There is no definite evidence as to whether genetic factors are related to the onset of chronic bronchitis.

The decline of gonadal and adrenal cortical function, weakened laryngeal reflex, degeneration of respiratory defense function, and decline of mononuclear phagocyte system function in the elderly can also increase the incidence of chronic bronchitis.

Nutrition also has a certain impact on bronchitis. Vitamin C deficiency, reduced resistance to infection, increased vascular permeability, and vitamin A deficiency can weaken the repair function of the columnar epithelial cells and mucosa of the bronchial mucosa, reduce lysozyme activity, and make one susceptible to chronic bronchitis.

It has not been confirmed whether genetic factors are related to the onset of chronic bronchitis. Severe deficiency of α1-antitrypsin can cause emphysema, but there are no symptoms of airway lesions, suggesting that it has no direct relationship with chronic bronchitis.

Clinical manifestations

1. Cough and sputum production or wheezing are the main symptoms, occurring for a total of 3 months each year and lasting for 2 years or more.

2. Exclude other diseases with symptoms of cough, sputum, and wheezing, such as tuberculosis, pneumoconiosis,

Lung abscess, heart disease, heart failure, bronchiectasis, bronchial asthma, chronic nasopharyngeal disease, etc.

Clinical classification

1. The simple type is characterized by repeated coughing and sputum production.

2. The wheezing type is characterized by chronic cough and sputum accompanied by wheezing, and wheezing sounds are often heard.

Clinical staging

1. During the acute exacerbation period, there is a respiratory tract infection within the past week, the amount of sputum increases, mucus and purulent sputum appears, or the symptoms are significantly aggravated.

2. Chronic persistent cough, sputum, and wheezing last for more than 1 month.

3. During the remission period, the symptoms basically disappear and last for more than 2 months.

Testing

1. Sputum bacterial examination: During the acute exacerbation period, sputum smear Gram staining, bacterial culture, and drug sensitivity test should be performed.

2. Chest X-ray examination: There are no abnormalities in the early stage. In patients with recurrent disease, the lung texture may be thickened and disordered, presenting as reticular, cord-like or spotted shadows, which are more obvious in the lower lung field.

3. The peripheral blood white blood cell count is normal, but may increase when bacterial infection occurs. The eosinophil count may increase in patients with wheezing type.

4. Pulmonary function test: In the early stage, the closed air volume may increase, and severe cases with repeated attacks may present with obstructive ventilation dysfunction.