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Bronchite: diagnosi, sintomi e terapia


 

La bronchite è una malattia respiratoria molto diffusa, può essere acuta o cronica

Definizione

La bronchite è un processo infiammatorio che interessa la mucosa dell’albero bronchiale causato da infezioni virali o batteriche, insulti atmosferici e/o da fumo di sigaretta. Clinicamente si distinguono una forma di bronchite acuta con tosse (talora produttiva), della durata inferiore alle 3 settimane, e una forma di bronchite cronica con tosse ed espettorazione per almeno 3 mesi l’anno per 2 anni consecutivi​

Eziologia

La bronchite acuta è generalmente dovuta a infezioni virali (adenovirus, rhinovirus, virus respiratorio sinciziale, virus influenzali e parainfluenzali) o batteriche (Mycoplasma pneumoniae, Chlamydophila pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis). Anche l’esposizione ad agenti inquinanti quali polveri, agenti chimici e fumo di sigaretta può essere causa o concausa dell’insorgenza di quadri clinici di bronchite acuta. La bronchite cronica invece è primariamente associata a una persistenza e stimolazione bronchiale irritativa e il fumo di sigaretta ne rappresenti indiscutibilmente la causa principale​.

Epidemiologia

La bronchite infettiva acuta è una malattia relativamente frequente nella popolazione generale. Le persone che vivono in grandi agglomerati urbani, zone altamente industrializzate, nonché in condizioni di sovraffollamento, sembrano essere colpite più frequentemente. I soggetti fumatori, a causa dell’azione irritativa del fumo di sigaretta che determina ipersecrezione bronchiale e inibizione del movimento delle ciglia vibratili dell’epitelio dell’albero respiratorio, sono particolarmente suscettibile all’insorgenza ed episodi ricorrenti di bronchite acuta che spesso evolvono verso forme croniche.

Sintomi

E’ preceduta spesso da segni e sintomi correlabili a infezioni delle prime vie aeree. Il sintomo principale è la tosse inizialmente secca, successivamente produttiva con espettorato mucoso, quindi muco purulento in caso di superinfezione batterica. Il paziente presenta:

  • rinorrea
  • congestione nasale
  • cefalea
  • faringodinia
  • mialgie diffuse

può essere apiretico o presentare febbricola. All’esame obiettivo il faringe è generalmente eritematoso, all’auscultazione del torace si possono apprezzare ronchi nei quadri di tracheobronchite e rantoli a piccole e medie bolle qualora prevalga il coinvolgimento bronchiale. Le potenziali complicanze si verificano più frequentemente nei bambini, negli anziani e nei soggetti immunocompromessi; le più ricorrenti sono le polmoniti e nei bambini di età inferiore ai 2 anni, la bronchiolite. Le riacutizzazioni della bronchite cronica sono caratterizzate da aumento della tosse frequenza e quantità dell’espettorato e della dispnea, senza segni clinici e radiologici di polmonite.

Diagnosi di bronchite

La bronchite deve essere sospettata in ogni paziente che si presenti con un quadro compatibile con un’ infezione respiratoria acuta associata a tosse. La diagnosi microbiologica non è semplice; l’esame batteriologico diretto e colturale dell’espettorato dei pazienti affetti da bronchite acuta permettere raramente l’isolamento dei patogeni. La radiografia del torace mostra una accentuazione della trama bronco vascolare in assenza di lesioni pleuro parenchimali.

 

Prognosi

La prognosi è solitamente favorevole nei soggetti giovani o adulti sani. In pazienti affetti da forme di bronchite cronica soggette a riacutizzazione da superinfezione batterica, la prognosi dipende dalla qualità della funzione cardiaca del paziente. I bambini piccoli, i soggetti anziani e gli immunocompromessi sono maggiormente suscettibili all’insorgenza di complicanze respiratorie peggiorative della prognosi.

Terapia

La terapia è generalmente sintomatica (analgesici, sedativi della tosse, mucolitici). L’impiego di antibiotici non sembra determinare un significativo beneficio nel ridurre i sintomi o modificare la storia naturale della bronchite acuta. Ciò nonostante, dati provenienti da Europa, Australia e Stati Uniti indicano che il 80% dei pazienti con bronchite acuta assume antibiotici. Tale uso improprio degli antibiotici contribuisce all’aumento del rischio di emergenza di ceppi batterici resistenti. La terapia antibiotica in corso di bronchite acuta è indicata solo qualora segni e sintomi indichino un’ eziologia batterica; gli antibiotici raccomandati sono i macrolidi, i β-lattamici, il cotrimossazolo. La terapia antibiotica è indicata anche nei soggetti affetti da bronchite cronica riacutizzata.

Prevenzione 

I pazienti affetti da patologie cardiopolmonari croniche dovrebbero sottoporsi a vaccinazione preventiva antinfluenzale e antipneumococcica. I pazienti con bronchite cronica dovrebbero seguire alcune regole comportamentali al fine di evitare le riacutizzazioni (astenersi dal fumo, evitare l’esposizione ad agenti irritanti).

 

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Bronchite cronica 

 

 

 

 

(Bibliografia, M. Moroni, S. Antinori, V. Vullo, Manuale di Malattie Infettive II Edizione, Edra S.P.A. Milano,2014)


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