Obstructive bronchitis

Obstructive bronchitis (bronchitis obstructiva, spastic) is acute bronchitis with expressed obstructive component due to the tissue edema, bronchial hypersecretion and smooth muscle spasm of the airways. It is invoked by the inflammatory process in lower respiratory tract, usually in medium and large bronchi. Typically occurs in newborns and infants. Higher frequency in allergic patients. Sometimes might be difficult to differ from asthma.

Etiology
Obstructive bronchitis is invoked typically by RS-viruses, adenoviruses, influenza viruses and parainfluenza or rhinoviruses.

Patogenesis
Infectious agens (virus) replicates in tracheobronchial tissue and therefore invokes necrosis of epithelium. New epithelium cells proliferate, they are however without cilia and therefore there is a worsened clearance of the tissue. Secretion obstructs the lumen of airways with inflammatory edema and spasm.

Clinical signs
Expiratory dyspnoa dominates with difuse obstruction sounds such as wheezing, prolonged expirium, tachypnoa and dyspnoa, we can see inflating jugulum and subcostal region. In severe cases also inspiration figure of thorax and cyanosis. Lung X-ray shows more intense bronchovascular parts, sometimes also emphysema.

Diagnosis
Based on the clinical signs of expiratory dyspnoa with wheezing and prolonged expirium.

Differential diagnosis
In differential diagnosis consider bronchiolitis, asthma bronchiale, foreign object aspiration, hoarseness, barking cough and inspiration dyspnoa which is typical in upper respiratory tract disorders, cystic fibrosis, tracheobronchial anomalies.

Therapy
Symptomatic – inhalation of bronchodilatans via spacer or nebulized (selective beta-2-sympatomimetics = salbutamol, parasympatolytics = ipratropium bromid), warm nebulization, in severe cases oxygen therapy is indicated with corticosteroids (per os or i.v.). We don't treat with mucolytics (secretion of phlegm is increased and leads to worsened state) or antitussics (cough reflex is stronger) or sedation (except for ICU).

Prognosis
In children may be even lethal. Obstructive bronchitis in infants is a common cause of respiratory failure that needs ICU therapy and artificial ventilation. Problematic situation is in allergic patients, where recurrent bronchitis may lead to asthma.

Other articles

 * Akutní bronchitida • Recidivující bronchitida • Astma • Bronchiolitida • Akutní laryngitida