Tracheitis

Tracheitis, tracheitis, inflammation of the mucous membrane of the trachea. Inflammatory diseases of the trachea are rarely isolated; more often the trachea is affected in descending, less frequently ascending catarrh of the upper respiratory tract. Most frequently, tracheitis occurs during acute infectious diseases affecting the upper respiratory tract—influenza, measles, whooping cough, less frequently in typhoid fevers. The occurrence of primary acute tracheitis, besides infection, is often caused by cold in the form of general severe chilling, inhalation of dry and dusty air, toxic vapors and gases. Predisposing factors may include diseases of the heart and lungs leading to stagnation and hyperemia of the mucous membrane of the upper respiratory pathways, weakening of the nutritional state and decreased immunity after infectious diseases. In children, corresponding factors are exudative diathesis, rickets, dystrophies, and poor hygienic conditions. Tracheitis is more common in childhood and old age, and usually occurs in spring and autumn. Symptoms. The disease begins with acute catarrh of the nose and nasopharynx. The inflammatory process spreads from the nasal mucous membrane, pharynx to the larynx and trachea with the corresponding clinical picture of involvement of these organs. In other cases, along with the trachea, the large bronchi are also involved in the disease, and the clinical picture takes on the character of tracheo-bronchitis. The most characteristic clinical sign of tracheitis is cough, which troubles patients most at night and especially in the morning before getting up. The cough in tracheitis is less distressing and constant than in bronchitis, appears in paroxysms during deep breathing, laughing, crying, when changing the temperature of the surrounding environment. In severe tracheitis, for example during influenza, patients sometimes complain of dull, burning pain in the throat and behind the sternum, especially after a coughing fit. Due to pain during deep breathing, patients try to limit respiratory movements. In such cases, in children breathing becomes shallow and rapid. The place of bifurcation of the trachea is particularly sensitive: mucus accumulated here can cause especially strong, convulsive coughing. The voice, often accompanying tracheitis laryngitis, may be hoarse. The general condition usually suffers slightly, sometimes headaches, a feeling of brokenness, pains throughout the body are observed; temperature is usually slightly elevated, especially in the evenings; in children the temperature often reaches 39°. Shortness of breath in tracheitis and inflammation of large bronchi is usually absent. At the beginning of the disease, sputum is separated with difficulty, in small quantities, has a viscous mucous character, and then gradually acquires a mucopurulent character, begins to separate more easily and becomes more abundant. The microscopic picture of this sputum is not very characteristic. Sometimes, especially during influenza, due to pinpoint hemorrhages into the tracheal mucous membrane, a small admixture of blood may be observed in the sputum. Course. Under favorable conditions and appropriate treatment, the disease ends in 1-2 weeks. With insufficient caution of the patient, as well as with the continuing action of causes causing or maintaining the disease, recovery is delayed, and the process can turn into chronic tracheitis. A complication of tracheitis and tracheo-bronchitis can be the spread of the inflammatory process to the mucous membrane of other parts of the respiratory tract. In this sense, the subsequent development of bronchopneumonia in the elderly and capillary bronchitis in children is especially dangerous. Diagnosis is established on the basis of the patient's complaints, the presence of cough in the absence of data from the lungs and bronchi, and objective examination. With the help of laryngoscopy, the mucous membrane of the trachea can be directly examined. It is usually hyperemic, covered with mucus, which sometimes forms separate clumps. In severe degrees, pinpoint hemorrhages may be found on the surface of the mucous membrane. Percussion and auscultation in case of damage to only one trachea do not give reference points for diagnosis. The prognosis for acute, uncomplicated tracheitis is usually favorable. Treatment. Preventively, it is necessary to eliminate all those factors that served as the cause of the disease or contributed to it. Treatment—as in acute laryngitis. Mustard plaster on the sternum. For distressing cough—narcotics, for difficult sputum expectoration—expectorants: senega, ipecacuanha, apomorphine. Chronic catarrh of the trachea develops from acute tracheitis when the causes that caused the acute disease of the trachea continue to act. Chronic catarrh of the trachea and bronchi is more often a consequence of such diseases as emphysema of the lungs, diseases of the heart, kidneys, leading to phenomena of stagnation on the basis of circulatory disorders. Chronic tracheitis and tracheo-bronchitis is a disease mainly of adults, but can also be observed in children after measles, whooping cough. According to the nature of the developing patho-anatomical changes, chronic tracheitis is divided into hypertrophic and atrophic. Hypertrophic tracheitis is characterized by venous hyperemia and swelling of the mucous membrane of the respiratory throat, increased secretion of mucus and pathological secretion (pus cells). Due to hyperplasia of the mucous membrane, its surface often becomes uneven. In other cases, atrophy of the mucous membrane occurs, the latter thins out, has a smooth shiny appearance, grayish color, sometimes covered with small crusts causing distressing cough. The atrophic form of chronic tracheitis is usually accompanied by atrophy of the mucous membrane of the higher respiratory pathways. Symptoms and course. The main symptom, as in acute tracheitis, is cough, stronger in the morning and at night. The amount of sputum varies. In some cases, with dry cough, the amount of viscous sputum is small. In other cases, sputum is more abundant, has a seropurulent character and is separated easily. Percussion and auscultation in chronic tracheitis also reveal no pathological changes. The course of the disease in most cases is long with temporary improvements, followed by deteriorations. Diagnosis of the disease is not difficult, examination of the trachea with the help of a laryngeal mirror helps. Treatment should be aimed at eliminating the main causes of the disease. In general, it coincides with the treatment of chronic bronchitis. In cases with abundant discharge, insufflation of astringent powders into the trachea during inhalation works well. Crusts are removed in the same way as from the larynx (see Laryngitis and Bronchitis). Lit.: Hoffer G., Entzündliche Erirankungen der Luftrohre und der Bronchiien (Handb. d. Hals-Nasen-Ohren-heilkunde, hrsg. v. A. Denver u. O. Kahler, B. III, München, 1928, S.); Mo J., Über Tracheitis, Acta oto-laryngol., B. I, 1918-.