Bronsita acuta se caracterizeaza printr-o inflamatie cronica a bronhiilor, care debuteaza de obicei

in contextul unei infectii virale si evolueaza fara complicatii.

Simptomul principal este tusea chinuitoare. Tratamentul bronsitei acute se face cu expectorante si
antitusive. Uneori se impune administrarea de antibiotice. Complicatiile apar datorita evolutiei
spre pneumonie sau bronsita cronica.

Definitie

Bronsita acuta reprezinta inflamarea mucoaselor de la nivelul cailor respiratorii inferioare. De

obicei sunt afectate mai ales bronhiile, cu toate ca inflamatia poate sa se extinda de la nivelul
traheei (traheonbronsita) pana la nivelul celor mai mici unitati (bronhiolele). Bronsita acuta se
declanseaza de obicei datorita unei infectii virale, care poate fi agravata de influente de mediu
(poluare, fum de tigara) sau de suprainfectii bacteriene.
Prevalenta
Infectiile acute ale cailor respiratorii superioare, inclusiv bronsita acuta, sunt cele mai frecvente
patologii. Bronsitele si celelalte boli respiratorii ating un varf al incidentei mai ales primavara si
toamna.
Etiologie
Cea mai frecventa cauza a bronsitei acute este atacul viral ( cam 90%). In cazul adultilor, boala
este declansata adesea de virusi ca : virusul gripal, virusul paragripal, rino- si adenovirusi. In
cazul copiilor, boala este declansata de anumiti virusi respiratori, de adenovirusi, coxsackievirusi
si echovirusi. Bronsita acuta poate sa apara si ca urmare a contractarii virusului rujeolic.
Infectia bacteriana survine destul de rar. De cele mai multe ori bacteriile suprainfecteaza mucoasa
bronhiala care a fost deja supusa atacului viral. Cei mai frecventi agenti patogeni ai bronsitei
bacteriene sunt streptococii, virusul Haemophilus influenzae, virusul Mycoplasma pneumoniae si
Moraxella catarrhalis in cazul adultilor, iar la copiii si sugari clamidiile. Bronsita acuta poate sa
apara si secundar unui episod de tuse convulsiva.
Infectiile acute ale bronhiilor cu ciuperci apar foarte rar, la persoanele cu sistem imunitar slabit.

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Diagnostic
Examenul clinic
Diagnosticarea bronsitei acute se face de regula pe baza anamnezei (istoricul bolii) si a
rezultatelor de la auscultatia pulmonara si a bronhiilor. Suplimentar, se poate face consultatia
urechilor, a cavitatii orale, nazale si faringiene, dar si a ganglionilor de la nivelul gatului.
Examene de laborator
In caz de febra si expectoratii purulente se va recolta sange pentru a se decide daca se impune sau
nu tratamentul cu antibiotice. Cresterea usoara a vitezei de sedimentare a hematiilor (VSH-ul) si
scaderea numarului de leucocite (leucopenie) indica o infectie virala. Cresterea semnificativa a
vitezei de sedimentare a hematiilor, asociata cu leucocitoza (cresterea numarului de leucocite) ,
semnalizeaza o infectie bacteriana.
Daca evolutia bronsitei este ingrijoratoare, se recomanda examenul bacteriologic al secretiei
expectorate si un exudat faringian pentru identificarea germenilor patogeni, care vor fi urmate de
o antibiograma.

Radiografia pulmonara
Daca manifestarile patologice nu cedeaza sau se inrautatesc, este posibil ca bronsita acuta sa fi
evoluat spre pneumonie. In acest caz se impune radiografia pulmonara. Examenul radiologic al
plamanilor se recomanda si in cazul in care pacientul prezinta hemoptizie, pentru a exclude din
diagnostic tumorile pulmonare sau bronhiale.

Evolutie si complicatii
Bronsita acuta evolueaza de regula fara complicatii, cu sanse bune de vindecare la pacientii cu un
sistem imunitar puternic, care in general nu au probleme de sanatate. Chiar si infectia secundara
de etiologie bacteriana raspunde de cele mai multe ori pozitiv la tratamentul medicamentos.
Complicatii
Complicatiile bronsitei acute apar mai ales la oamenii batrani, cu imunitate scazuta, in cazul
carora bronsita poate sa evolueze spre pneumonie sau sa se cronicizeze. Copiii mici sunt supusi
riscului de a dezvolta bronhiolita, afectiune caracterizata de inflamarea celor mai mici unitati
functionale ale aparatului respirator (alveolele), care se vindeca de obicei cu cicatrici la nivelul
pulmonului. Aceste sclerozari pot determina mai tarziu boli pulmonare cronice, cum ar fi bronsita
cronica sau bronhopneumonia obstructiva cronica (BPOC).
O bronsita acuta care evolueaza normal nu ar trebui sa dureze mai mult de 8-10 zile. In caz
contrar, se recomanda consultarea medicului, care va recomanda anumite investigatii paraclinice
pentru a face diagnosticul diferentiat cu afectiuni mai grave.
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Manifestari clinice
Bronsita acuta se asociaza, de obicei, cu simptomele tipice unui episod de raceala:
- febra;
- tuse (mai ales matinala);
- uneori senzatie de arsura in spatele sternului (pirozis);
- dureri articulare;
- senzatie de arsura la nivel ocular;
- guturai;
- raguseala;
Initial tusea este seaca, dar dupa cateva zile devine productiva, bolnavul expectorand sputa
albicioasa. Daca infectia virala este agravata de o suprainfectie bacteriana, culoarea sputei devine
galben-verzuie, iar starea generala a pacientului se deterioreaza. Se impune chemarea de urgenta
a medicului, care va descoperi la auscultatia pulmonara asa-numitele raluri crepitante, care
semnalizeaza prezenta secretiei mucopurulente la nivelul bronhiilor. Odata cu eliberarea acestei
secretii, apare un sunet suierat la nivelul plamanilor.
In cazurile de bronsita acuta cu evolutie mai indelungata, poate sa apara, izolat, impregnarea
hemoragica a secretiei expectorate. Prezenta sangelui se datoreaza unor mici leziuni de la nivelul
mucoaselor, care apar ca urmare a acceselor frecvente si severe de tuse. Hemoptizia este de cele
mai multe ori inofensiva, dar trebuie informat medicul, care va decide daca se impune efectuarea
de investigatii paraclinice, cum ar fi radiografia pulmonara.
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Masuri de prevenire
Masuri generale
In prezent nu se cunosc masuri care sa ofere protectie completa impotriva bronsitei acute.
Sistemul imunitar poate fi insa intarit printr-un stil de viata sanatos, o dieta echilibrata, renuntarea
la fumat si activitate fizica regulata. In cazul copiilor predispusi la infectii, care se imbolnavesc
regulat de bronsita acuta, se recomanda cure balneoclimaterice.
Vaccinare antigripala
Vaccinul antigripal se recomanda in special persoanelor peste 60 de ani, copiilor, adolescentilor
si adultilor a caror stare de sanatate este deja afectata datorita unei alte patologii, de natura
pulmonara, vasculara, hepatica, renala, datorita diabetului sau maladiei SIDA.Vaccinul se
recomanda si in cazul persoanelor care au un risc profesional de expunere la infectii (de exemplu
personalul medical). Dat fiind faptul ca in unele tari s-au raportat cazuri de contractare a virusului
gripei aviare de catre oameni, vaccinarea antigripala se recomanda si persoanelor expuse unui
risc ridicat de imbolnavire datorita contactului direct cu pasari de curte sau salbatice.
Vaccinul antigripal trebuie repetat an de an, deoarece virusii gripali se diversifica.
Care sunt grupele de risc pentru care se recomanda vaccinul?
- Persoanele peste 60 de ani;
- Pacientii cu imunitate scazuta datorita unor afectiuni cum ar fi SIDA sau bolile autoimune;
- Pacientii cu afectiuni cardiace si pulmonare cronice;
- Pacientii cu diabet zaharat;
- Pacientii la care a fost indepartata splina;
- Pacientii imobilizati la pat;
- Pacientii cu afectiuni frecvente ale caii respiratorii;
- Pacientii supusi chimioterapiei;
- Persoanele cu risc profesional;
Vaccinarea antipneumococica
La fel de importanta ca si vaccinarea antigripala este vaccinarea antipneumococica. Pneumococii
sunt bacterii care pot provoca pneumonie. Vaccinul antipneumococic se recomanda persoanelor
peste 60 de ani, sugarilor pana in 2 ani, precum si copiilor, adolescentilor si adultilor care sufera
deja de o patologie grava.

Tratament

Daca bronsita acuta se manifesta intr-o forma blanda, nu este necesar tratament medicamentos. In
cazul in care simptomatologia se agraveaza, apare febra mare si expectoratie purulenta, se
recomanda consultarea medicului.

Pentru ameliorarea simptomelor se pot pune in aplicare, complementar cu tratamentul

medicamentos, urmatoarele masuri:
- odihna, in nici un caz suprasolicitare. Activitatea fizica usoara favorizeaza expectoratia;
- hidratare suficienta (apa sau ceai);
- inhalatii cu musetel sau sare. Eficienta uleiurilor eterice nu este mai ridicata si, datorita faptului
ca pot provoca tuse iritativa sau alergii, nu sunt recomandabile;
- comprese umede si calde aplicate pe piept 20 de minute, dupa care se usuca foarte bine pielea si
bolnavul se odihneste la pat;
- o baie fiebinte, dupa care odihna la pat sub o patura calduroasa ( bolnavul va transpira intens) si
bauturi fierbinti cu suc de lamaie;
- in cazul persoanelor batrane, mai ales a celor imobilizate la pat, se recomanda tapotaj regulat pe
spate (pentru mobilizarea secretiilor si prevenirea pneumoniilor de staza);
Tratamentul medicamentos
Mucolitice (Substante fluidizante ale secretiilor bronsice)
Pentru a declansa reflexul de tuse si a favoriza eliminarea secretiilor mucopurulente, se prescriu
mucolitice ca Acetilcisteina, Ambroxol (forma de prezentare: solutie sau comprimate).
Antipiretice si Antialgice
Daca pacientul are febra ridicata se prescriu antipiretice ca paracetamol sau acid acetilsalicilic
(aspirina). Este important sa se aiba totusi in vedere ca febra este o reactie normala a sistemului
imunitar la atacul unui agent patogen ( reprezinta modul organismului de a lupta cu infectia) si ca
nu se impune mereu combaterea ei.
Antitusive
Daca tusea bolnavului este uscata si chinuitoare, medicul poate prescrie medicamente care contin
codeina. Antitusivele se administreaza doar pe termen scurt si in cazuri exceptionale, deoarece
reprima reflexul de tuse si, consecutiv, expectorarea secretiilor de la nivelul bronhiilor. Folosirea
abuziva a antitusivelor determina staza secretiilor in bronhii, care este foarte periculoasa si poate
declansa o pneumonie.
Antibiotice
Daca se evidentiaza o infectie bacteriana, se impune administrarea de antibiotice, cum ar fi
aminopeniciline si cefalosporine sau, in caz de infectie cu micoplasme, tratament cu macrolide.

Antibioticele se recomanda si atunci cand starea generala se inrautateste considerabil, insotinduse de febra ridicata si expectoratii purulente abundente. In rest, antibioticele nu se utilizeaza in
tratamentul bronsitei acute decat in mod exceptional, la persoanele in varsta cu imunitate scazuta
sau la pacientii cu afectiuni secundare grave.
Tratamentul cu antibiotice in formele usoare de bronsita
In cazul pacientilor cu imunitate scazuta, a celor batrani sau a celor cu imunosupresie datorata
unei afectiuni secundare - cum ar fi infectia HIV- se va folosi tratamentul cu antibiotice si pentru
tratarea bronsitei acute de etiologie virala, cu scopul de a preintampina o aparitie secundara
bacteriana, care poate actiona fatal pe un fond imunitar deja slabit. Antibioticele se prescriu si
pacientilor cu valve cardiace artificiale, deoarece bacteriile pot disemina pe cale sangvina pana la
nivel cardiac, colonizand valva artificiala.
Tratamentul cu cortizon pentru tusea iritativa
Accesele puternice de tuse iritativa persistenta se trateaza, mai ales la persoanele a caror bronhii
sunt deja degradate, cu cortizon (spray-uri).