Chronic pneumonia is the outcome of an unresolved acute form of the disease. It is characterized by persistent changes in the lungs: carnification , replacement of elastic lung tissues with coarse connective fibers in the affected area, irreversible deformations of the branches of the bronchial tree. The disease proceeds with a change in the phases of exacerbation and remission.
In 4% of cases in an adult and in 1% of cases in a child, acute pneumonia becomes chronic. In the structure of chronic nonspecific lung diseases, this disease accounts for about 12%. Today, there is a steady trend towards a decrease in the incidence of chronic pneumonia due to the emergence of new effective antibiotics and treatments.
It should be noted that the concept of chronic pneumonia is widely used in domestic pulmonological practice, but most Western doctors do not recognize it. For this reason, the disease is not included in the international classifier of diseases of the tenth revision (ICD-10).
Ideas about which cases of pneumonia should be considered chronic have changed over time. Previously, it was believed that the chronization of the process occurs if there is no positive dynamics on the roentgenogram in the period from three months to a year or longer, subject to prolonged antibiotic therapy. Today, ideas about the timing of the transition of pathology into a chronic course are somewhat different. The defining sign is the frequent recurrent development of inflammation in a certain area of the lung (always the same), the absence of positive changes in X-ray images during intensive therapy for a long time.
In the phase of remission, clinical manifestations of pneumonia are absent or not expressed. Dry cough in the morning may be present. When a relapse begins, the patient experiences general malaise, weakness, and sweats a lot. The temperature rises, sometimes significantly. The patient is tormented by a persistent cough with sputum production. Sometimes it has a purulent character, the appearance of a blood impurity is possible. With a severe cough, chest pain may occur.
If, during an exacerbation, treatment is not carried out in full, then the remission phase may not occur, and the inflammatory process becomes sluggish. With this course, the patient has a constant cough, sometimes there is a temperature. With physical exertion, shortness of breath occurs. In such cases, it is necessary to carry out long-term treatment until the remission phase comes.
Causes of occurrence
Most often, the reasons for the chronicity of the pathological process are:
- lack of treatment;
- improper therapy (eg, self-medication);
- late detection of acute pneumonia;
- premature discharge from the hospital;
- non-compliance with the recommendations of the attending physician after the relief of acute inflammation.
In addition, the transition to the chronic form is most likely in elderly patients, people suffering from severe concomitant pathologies, alcoholism. There is a high risk of developing a chronic form in smokers, especially those suffering from chronic bronchitis.
A relapse can be provoked by acute respiratory viral infections, influenza and other infectious respiratory diseases. In a child, in addition to the listed diseases, a relapse can be a consequence of measles, whooping cough, chickenpox.
Diagnosis of the disease
The diagnosis is made on the basis of data obtained in the following studies:
X-rays of light
- general research and blood biochemistry;
- microscopic examination of sputum;
- sputum culture ;
- X-ray of the lungs (in two or three projections) and bronchi;
- respiratory function test (spirometry).
Laboratory studies are most informative when carried out during an exacerbation. Then the blood tests reveal signs characteristic of the inflammatory process (increased ESR, an increase in the number of leukocytes with a shift of the leukocyte formula to the left). Biochemical analysis reveals an increase in the number of immunoglobulins, fibrinogen, haptoglobin . Microscopic examination of sputum determines a high content of leukocytes. Bacteriological inoculation makes it possible to identify the causative agents of the pathological process.
Chronic pneumonia must be treated during both relapse and remission. With an exacerbation, pneumonia is treated in the same ways as in the acute form of the disease. Antibacterial agents are prescribed. They are selected by the doctor individually, depending on which pathogen provoked the inflammation. As a rule, a combination of two antibiotics is selected.
Also, drugs are prescribed to reduce the severity of symptoms of pneumonia and alleviate the patient’s condition. Means are used to liquefy and improve sputum discharge, immunostimulating drugs, vitamins. To reduce the symptoms of intoxication with fever, detoxification therapy is prescribed with infusion of saline solutions and intravenous administration of calcium chloride.
An important role is played by bronchoscopic and endotracheal sanitation. With oral and parenteral administration of antibacterial drugs, their active substances penetrate into the foci of inflammation in insufficient quantities. When the bronchial tree is flushed with sodium bicarbonate solution and the direct administration of antibiotics into the respiratory tract, the active substances accumulate in the foci of the pathological process in the required concentration.
After the relief of acute symptoms of inflammation, regular treatment with physiotherapy methods (UHF, CMB therapy, electrophoresis, inductothermy) is indicated. Modern methods of treatment, such as intravenous laser cleansing and ultraviolet blood irradiation, help well. After discharge, the patient needs to continue treatment at home: doing breathing exercises, undergoing physiotherapy courses. It is permissible to use alternative methods of treatment during the period of remission to reduce the frequency and severity of exacerbations. Decoctions of medicinal herbs help to strengthen the immune system.
If relapses are very frequent and difficult, your doctor may suggest surgical excision of the affected area of the lung.
For prevention purposes, it is recommended:
- observe the norms of a healthy lifestyle, exercise regularly;
- timely identify and adequately treat the acute form of pneumonia;
- to treat acute and chronic forms of bronchitis, chronic infectious foci in the nasopharynx;
- carefully care for the oral cavity;
- undergo mandatory regular dispensary examinations after suffering an acute form of pneumonia;
- reduce or completely eliminate occupational hazards, reduce the influence of external factors that provoke damage and pathology of the respiratory system;
- quit smoking.
The listed measures must also be observed in patients with diagnosed chronic pneumonia in order to prevent relapses and reduce their frequency. An important preventive measure is the annual treatment in sanatoriums in resorts with sea or mountain air. In addition, patients with chronic pneumonia are advised to engage in breathing exercises, take massage courses, ultraviolet radiation, and harden the body.
The course of chronic pneumonia can be complicated by the following pathological processes:
- asthmatic bronchitis;
- development of bronchiectasis ;
- diffuse pneumosclerosis;
- respiratory failure;
- heart failure.
These are the most important and severe complications that have a serious impact on the further course of the pathology.
Forecasts depend on the general health of the patient, the presence of concomitant diseases, complications. If the patient often has recurrences of inflammation, pathological changes in the lung tissues progress, this leads to the development of cardiopulmonary failure and increases the risk of death. In some cases, it is not possible to completely compensate for the inflammation; the patient may be assigned a second or third disability group.
Chronic pneumonia is a serious and dangerous disease. The patient must strictly follow the recommendations of the attending physician in order to stabilize the process, reduce the frequency and severity of exacerbations, and ideally achieve a stable remission. With proper treatment, smoking cessation, regular (at least twice a year in the absence of an exacerbation) visit to the pulmonologist – the prognosis is relatively favorable.