Under present conditions of increased incidence of pulmonary tuberculosis with chronic bronchitis, while there are common manifestations of both diseases, which complicates tuberculosis detection, specific process for its detection is very timely. On the other hand, tuberculosis, in addition to required direct clinical cure, causes development of chronic non-specific lung disease, which is associated with metatuberculosis residual changes and a tendency to torpid and recurrent course of the underlying disease. Due to the aspect of the existing relation of these two diseases in-depth study is required. The aim of the present work was to determine the criteria of clinical, instrumental and laboratory diagnostic algorithm of pulmonary tuberculosis in combination with chronic bronchitis.

For the treatment of clinical indicators, instrumental and laboratory, 300 patients with destructive pulmonary tuberculosis aged from 15 to 67 years were under the supervision of the algorithm. The patients were divided into two clinical groups: the first group consisted of 93 (31,0 %) patients who had tuberculosis combined with chronic bronchitis, in the second group 207 (69,0 %) patients with pulmonary tuberculosis without chronic bronchitis were observed. Abuse of smoking, the presence of foci of chronic nonspecific inflammation of the upper respiratory tract and frequent acute respiratory viral disease, which contributed to the development of chronic bronchitis, in particular, occurred in 82 (82,2 %) individuals, while only in tuberculosis – in 109 (52,7 %) patients complaints about shortbreathing dominated in 29 (31,2 %) i 21 (10,1 %) patients, respectively.

Studying clinic and anamnestic data allowed establishing that the main cause of chronic bronchitis in patients with lung tuberculosis was smoking, accompanied by a persistent cough, weak immune system and thus initial manifestation of specific inflammation was difficult to identify, which contributed to extending the term of specific verification process.

The study using clinical and laboratory, X-ray and bronchoscopy techniques allowed to establish high percentage (31,0 %) of chronic bronchitis occurring before the emergence of specific inflammation. Among patients with chronic bronchitis in combination with tuberculosis, dominated among males, there were 82 (89,2 %) smokers –as compared to patients only with TB – 109 (52,7 %). Acute onset of the presence of productive cough was observed in 26 (27,9 %) patients, elevated erythrocyte sedimentation rate – in 49 (52,6 %) and leukocytosis – in 29 (32,0 %) were significantly more pronounced in patients with mixed pathology. These patients experienced a longer period of healing the destructive process. Intensive therapy using AMBT, means of pathogenetic treatment and inhalation medications showed a high therapeutic effect in patients with tuberculosis in combination with chronic bronchitis: bacteriological observed in 85 (96,6 %), and healing destructions – in 76 (81,7 %) patients, which is slightly inferior to the results of the treatment of patients with a history of pulmonary tuberculosis only. It is necessary to point out that there are two options endobronchitis: nonspecific diffuse inflammation of the bronchi as a result of chronic bronchitis manifestation, and the so-called reactive „paraspecific” endobronchitis as a consequence of toxic-allergic influence of tuberculosis.

Ключові слова: destructive tuberculosis, chronic bronchitis

Повний текст: PDF (Ukr)

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