Pathogenesis. On chronic bronchitis occurs development of classic pathogenetic triad:

- hypercrinia (mucous hyperproduction);

- dyscrinia (increased sputum viscosity);

- mucostasis (overcrowding of the sputum in bronchi).

Approaching to the bronchi of infection agent leads to the sensebilization and autosensebilization of the organism.

There are the next mechanisms of the bronchial obstruction development:

- brochospasm;

- inflammatory edema and bronchial wall infiltration;

- hyper- and dyscrinia;

- hypotonic dyskinesia of large bronchi;

- collapse of small bronchi during expiration;

- mucus lays hyperplasic reaction.

Clinical features

The main complaints in patients with chronic bronchitis are moist cough, gen­eral weakness, perspiration and dyspnea in cause of bronchium obstruction.

Cough is commonly periodic, moist with difficult sputum expectoration.

Sputum expectoration is the most important symptom of chronic bronchitis. On early stages of the disease the sputum may be mucous, tenacious consistency, glass-like, for the period of progression becomes mucopurulant or purulent. The 24-hours amount of sputum is usually 50-70 ml, due to development of bronchiectasis significantly increase to 100-200 ml.

Dyspnea - commonly has expiratory character and its appearing indicates presence of bronchial obstruction and emphysema.

Objective examination. General patient's condition is usually satisfactory. On progression and complications advance general patient's condition may be from middle grave to grave. Due to gradual chronic hypoxia and intoxication possibly will be observed perspiration and subfebrile or febrile temperature.

The posture of the patients is frequently active. On progression and complications advance is forced in form of orthopnea - sitting position fixing the shoulder girdle in order to reduce dyspnea via assists the accessory muscles and diaphragm to take part in respiration.

The color of the skin and visible mucous depends on the stage and variant of obstruction. In initial stage the color of the skin and visible mucous is without any particularities. Due to the chronic bronchitis progression observe diffuse cyanosis with peripheral edema via to the "cor pulmonale" development. In obstructive emphysema bronchi spasm occurs during expiration therefore alveolar air is a little change and in spite for constant dyspnea the skin and visible mucous cyanosis isn't specific. In purulent chronic bronchitis detect the form of the Hippocratic nails.

The data of chest inspection, palpation and percussion include clinical features of bronchium obstruction: emphysematous form of the chest with accessory respiratory muscles participation in the breathing act, decreased excursion of the chest, badly transmitted vocal fremitus and generalized bandbox sound over the lungs during percussion.

Auscultation of the lungs. Auscultative data in patients with chronic bronchitis is characterized by sibilant and sonorous dry rales of different tone and intensity over the pathologically increased vesicular breathing. In localized affection of medium and large bronchi insignificant amount of low pitched and soft rales are heard. Accumulation of the viscous secret in bronchi via active inflammation, are accompanied by coarse and medium bubbling rales that can be altered by coughing or deep inspiration.