Rough breath sounds

Introduction Rough breath sounds are abnormal breath sounds, due to mild edema or inflammatory infiltration of the bronchial mucosa, resulting in uneven or narrow wall, resulting in poor airflow. Found in the early stages of bronchial and pulmonary inflammation. Under normal circumstances, the respiratory tract has a perfect defense function, which can filter, warm and humidify the inhaled air; ciliary movement and cough reflex on the airway mucosa surface, thereby removing foreign matter and pathogenic microorganisms in the airway. Secretory IgA is also present in the lower respiratory tract, which is resistant to pathogenic microorganisms. Therefore, the lower respiratory tract can generally remain clean. Local or respiratory local defense and immune dysfunction, especially in the elderly, are highly susceptible to chronic bronchitis, and repeated episodes.

Cause

Under normal circumstances, the respiratory tract has a perfect defense function, which can filter, warm and humidify the inhaled air; ciliary movement and cough reflex on the airway mucosa surface, thereby removing foreign matter and pathogenic microorganisms in the airway. Secretory IgA is also present in the lower respiratory tract, which is resistant to pathogenic microorganisms. Therefore, the lower respiratory tract can generally remain clean. Local or respiratory local defense and immune dysfunction, especially in the elderly, are highly susceptible to chronic bronchitis, and repeated episodes.

1. Smoking: the main cause of the disease, cigarettes contain tar, nicotine and hydrogen cyanide and other chemicals, can damage airway epithelial cells, so that cilia movement and macrophage phagocytosis, resulting in airway purification decline. It can stimulate submucosal receptors, make parasympathetic nerve function hyperthyroidism, cause bronchial smooth muscle contraction, lead to increased airway resistance, increased glandular secretion, goblet cell hyperplasia, bronchial mucosal congestion and edema, mucus accumulation, easy to induce infection. In addition, cigarette smoke can also increase the production of toxic oxygen free radicals, induce neutrophils to release proteases, inhibit the anti-protease system, destroy lung elastic fibers, and induce emphysema. Studies have shown that the prevalence of chronic bronchitis in smokers is 2 to 8 times higher than that of non-smokers. The longer the age of smoke, the greater the amount of smoke and the higher the prevalence.

2. Air pollution: Harmful gases such as sulfur dioxide, nitrogen dioxide, chlorine and ozone have stimulating and cytotoxic effects on airway mucosal epithelium. Acute exacerbations of chronic bronchitis have been reported to increase significantly when smoke or sulphur dioxide in the air exceeds 1000 g/m3. Other dusts such as silica, coal dust, sugar cane, cotton dust, etc. can also stimulate the damage of the bronchial mucosa, causing damage to the lung clearance function and creating conditions for bacterial infection.

3. 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 exacerbations. Viral infections are common with influenza, rhinovirus, adenovirus and respiratory syncytial virus. Bacterial infections are more common with Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus. Bacterial infections occur on the basis of damage to the airway mucosa secondary to viral or mycoplasma infection.

4. Allergic factors: patients with wheezing chronic bronchitis have a history of allergies. The positive rate of skin test induced by various allergens is also high. The number of eosinophils and histamine in sputum and IgE in blood increase. The trend is that some patients have positive rheumatoid factor in serum and abnormal distribution of T lymphocyte subsets. Therefore, it is considered that atopy and immune factors are related to the occurrence of this disease, but it is also believed that the specific substance should be asthma. The cause of the disease, such patients should actually be in the category of asthma or chronic bronchitis with asthma.

5. Others: Acute exacerbations of chronic bronchitis are more common in winter, so meteorological factors should be considered as one of the important factors in the pathogenesis. Cold air can stimulate the secretion of mucus in the gland and weaken the ciliary movement, weakening the defense function of the airway. It can also cause bronchial smooth muscle spasm, mucosal vasoconstriction, and local blood circulation disorder through reflection, which is conducive to secondary infection. Most patients with this disease have autonomic dysfunction, some patients with parasympathetic hyperfunction, airway responsiveness is higher than normal people. In addition, elderly patients with adrenal insufficiency, impaired cellular immune function, decreased lysozyme activity, low nutrition, insufficient vitamin A, C, etc. can increase airway mucosal vascular permeability and epithelial repair function. Whether genetic factors are associated with the onset of chronic bronchitis, so far there is no definite evidence.

6. Decreased gonads and adrenal function in the elderly: decreased laryngeal reflexes, degraded respiratory defenses, and decreased function of the mononuclear-phagocytic system, which may also increase the incidence of chronic bronchitis.

7. Nutrition also has a certain effect on bronchitis, vitamin C deficiency, the body's resistance to infection is reduced, vascular permeability is increased; vitamin A deficiency can weaken the repair function of columnar epithelial cells and mucosa of bronchial mucosa, lysozyme activity Reduced, easy to chronic bronchitis.

8. Whether genetic factors are associated with the onset of chronic bronchitis has not been confirmed so far. A severely deficient 1-antitrypsin can cause emphysema, but no symptoms of airway disease suggest that it is not directly related to chronic bronchitis.

an examination

Related inspection

Arterial blood gas analysis

There are no abnormal signs in the early stage of the signs, or you can smell the dry and wet naked male voices at the bottom of the lungs. After the cough and sputum, the snoring sounds can disappear. The acute snoring of the lungs can increase, and the number depends on the condition. Patients with chronic bronchitis and asthma can experience a wide wheezing sound with prolonged exhalation during an acute attack. Patients with advanced emphysema often have signs of emphysema, see obstructive emphysema.

Differential diagnosis

It needs to be distinguished from the following symptoms:

Attenuated breath sounds: The breath sounds are mainly alveolar breath sounds, and the weakening or disappearance of alveolar breath sounds is associated with a decrease in air flow in the alveoli or a decrease in air flow velocity into the lungs and a disturbance in respiratory sound transmission. It can occur locally, unilaterally or in both lungs.

Tubeatic breath sounds: Tube-like breath sounds, also known as abnormal bronchial breath sounds, refer to bronchial breath sounds heard in the normal alveolar breath sound distribution area.

Low breath sounds: low breath sounds are found in acute tracheal-bronchitis. Acute tracheal-bronchitis is a common disease caused by acute inflammation of the tracheal-bronchial mucosa caused by various causes. The prognosis is good, and the mucosal structure can be completely restored to normal after treatment. The incidence rate is higher in winter.

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