The main subjective manifestations of chronic bronchitis are cough with sputum, weakness, sweating (during exacerbation of the disease and the nature of purulent bronchitis). According to the WHO definition for chronic bronchitis characterized by cough with phlegm at least 3 months per year for 2 years or more.
At the beginning of the disease cough bothers patients usually in the morning immediately or soon after awakening, while the number of small detachable sputum. This is due to circadian rhythm functioning ciliated epithelium. Its activity is most pronounced in the morning and low at night. In addition, the appearance of cough morning play an important role of physical activity and improving the patient tone of the sympathetic nervous system. The cough is usually worse in cold and wet seasons, and with warm and dry weather, the patients feel much better, cough less worried about them and may even cease completely.
At the beginning of the disease cough patients are concerned only in the acute period, in a period of remission, it is almost not expressed. As the progression of chronic bronchitis, cough becomes more regular, almost constant, and worries not only in the morning, but during the day and night. Cough at night in the horizontal position of the patient associated with the receipt of sputum from small bronchi.
Cough is caused by irritation of the vagus nerve receptors in the cough reflex zones (larynx, vocal cords, the bifurcation of the trachea, the area dividing the large bronchi). In the small bronchi cough receptors are absent, so the predominantly distal bronchitis cough may be absent and the main complaint of patients is dyspnea.
In the period of exacerbation of chronic bronchitis, cough receptor sensitivity is significantly increased, leading to a sharp increase in cough becomes hoarse, painful, and sometimes "barking." During the day, bronchial patency is improved and the cough becomes less pronounced and less worried.
Cough in chronic bronchitis can be triggered by a cold, frosty air, returning to the cold weather from the street into a warm room, cigarette smoke, exhaust fumes, the presence of air in various irritants, and other factors. In the later stages of the disease cough reflex may fade away, coughing a little worried sick and drainage of the bronchi is greatly disturbed.
Sputum - a key symptom of chronic bronchitis. Sputum may be mucous, purulent, mucopurulent, sometimes streaked with blood. In the early stages of the disease sputum, usually slimy, light. However, in patients with long-running in a dusty atmosphere, the sputum may acquire gray or black (for example, "black" sputum of miners). As the progression of chronic bronchitis sputum becomes mucopurulent or purulent character, which is especially noticeable in the period of exacerbation. Purulent sputum more viscous and is separated with difficulty. During exacerbation of chronic bronchitis phlegm increases, but in wet weather and after alcohol consumption can be reduced.
There have been cases of chronic bronchitis, flowing without sputum ("dry bronchial catarrh") - not to be confused with the ingestion of sputum! In 10 - 17% of cases of chronic bronchitis possible hemoptysis. It can be caused by damage to blood vessels of the bronchial mucous membrane during the hacking cough (this is especially characteristic of atrophic bronchitis). The appearance of hemoptysis requires careful differential diagnosis of pulmonary tuberculosis, lung cancer, bronchiectasis.
The general condition of patients in the early stages of chronic bronchitis is satisfactory. It essentially breaks down the progression of the disease and the development of bronchial obstruction, emphysema, and the appearance of respiratory failure.
No significant changes in the study of other organs and systems in patients with chronic non-obstructive bronchitis is usually not detected. In marked purulent bronchitis may develop myocardial dystrophy, which manifests itself muted tones of the heart, Moderate systolic murmur at the apex of the heart.
