Obstructive bronchitis in children: treatment, causes, symptoms. Bronchitis in children: causes, symptoms and treatment Obstructive bronchitis in a child up to a year of causes

Obstructive bronchitis is one of the most dangerous diseases. In terms of severity, it is in second place after. Most often, the disease affects children under the age of 6-7 years. This is due to the fact that babies have very narrow gaps in the bronchi.

The inflammatory process provokes the accumulation of a large amount of mucus in the bronchial canals, which leads to a thickening of the mucous membrane and clogs the bronchi.

general description

Obstructive bronchitis- This is a strong spasm of the bronchi, preventing the release of the resulting mucus. Accompanied by high temperature. It is most dangerous for children under the age of 1-2 years, because they do not have a cough reflex, which contributes to the discharge of sputum. With a strong attack of coughing, the child may even suffocate.

For obstruction the mucous membrane of the bronchi grows, clogs the respiratory channels. Phlegm and mucus accumulate in them, making it difficult to breathe. The accumulation of sputum causes severe inflammation, swelling of the bronchi, which leads to severe oxygen starvation.

Causes of what is dangerous

In addition to hereditary anomalies of the esophagus, diseases of the gastrointestinal tract and nasopharynx, there are many causes of bronchitis. The disease can be caused by:

prone to bronchial obstruction premature babies, immunocompromised. Risk factors - genetic predisposition(, rickets, cystic fibrosis, congenital lung hypoplasia, etc.), passive smoking, polluted atmosphere. Obstructive bronchitis can occur against the background of any cold or hypothermia. Untreated, diseases of the nervous system lead to obstruction.

Consequences of obstructive bronchitis:

Classification

There are three forms of obstructive bronchitis: acute, chronic and allergic.

acute form occurs as a result of a viral infection. The first signs of the disease can be noticed within a few days after the onset of SARS or influenza. There is a strong cough with wheezing, shortness of breath.

Chronic or recurrent obstructive bronchitis is the result of an untreated acute form. It is characterized by morning bouts of coughing, sweating, fatigue, low temperature. The disease can occur several times a year, be provoked by hypothermia.

allergic form obstructive bronchitis in children is paroxysmal in nature, occurs with close contact with the allergen. Often accompanied by a runny nose, lacrimation, but does not cause fever.

Any kind of bronchial obstruction is dangerous, it proceeds in a very severe form, especially at the age of 2 years. It is necessary to treat this disease only in a hospital, so as not to cause serious complications.

Specific and non-specific signs

With obstructive bronchitis, the following primary symptoms develop:

Secondary signs:

The danger lies in the rapid progression of the disease, rapid swelling bronchi, which leads to oxygen starvation.

How to recognize the disease

Infants suffer from obstruction of the small branches of the bronchi (bronchioles). Obstructive bronchitis in children under one year old called bronchiolitis. The very first symptoms of the disease are fever, runny nose, paroxysmal cough, suffocation. There is a strong swelling of the mucosa, which prevents the discharge of sputum. The child constantly cries, cannot sleep. The disease develops very quickly, often leading to serious complications.

For children aged 1 to 4 years obstructive bronchitis is more often diagnosed. It usually appears after suffering viral infections and is caused by bronchospasm. On the early stage disease cough can be rare, weak.

If the disease is not treated in time, then after 3-4 days there are severe attacks of coughing, wheezing, fever, heavy, rapid, wheezing breathing, difficulty in exhaling, and bloating chest. Additional symptoms- runny nose and sore throat. The cough is worse at night.

In children 4-6 years old obstructive bronchitis is treated faster. Thanks to the development of the respiratory muscles, the cough becomes productive, the baby can get rid of sputum on his own. The recovery process is also accelerated by the fact that more serious drugs can be prescribed at this age.

If at least some of these symptoms are detected, it is urgent to call a doctor. In no case should you self-medicate, use "proven" folk remedies without consulting a specialist.

Children under 2 years of age with signs of obstruction are subject to immediate hospitalization.

Diagnostic measures

Obstructive bronchitis is diagnosed by a doctor based on examining and listening to the lungs. Assigned. and talk about a serious inflammatory process.

To confirm the diagnosis and rule out pneumonia, x-ray is prescribed. If the pulmonary pattern is enhanced, but there are no foci of infiltration, darkening, then obstructive bronchitis is diagnosed.

How is the treatment going and what to do if it happens at night - read the article on our website.

We offer to learn about the antibiotics that are used in the treatment of pyelonephritis in children.

And here there is an article about the signs and treatment of another one in children - cystitis.

How and what to treat

Treatment of acute obstructive up to a year is carried out only in a hospital. 2 years and older can be treated at home provided that the condition of the child is satisfactory, does not cause concern. The doctor should draw up a treatment plan.

Mandatory procedures:

• inhalation with saline;
• washing the nasopharynx;
• physiotherapy;
• massage;
• diet;
• plentiful warm drink.

How to massage with obstructive bronchitis in children, watch the video:

If bronchitis is of an infectious origin or the disease is severe, with a prolonged high temperature, then antibiotics. Used to relieve bronchospasm antispasmodics(No-shpa or Papaverine).

In case of obstructive bronchitis, in no case should you take antitussive drugs: only expectorants, thinning sputum (based on ambroxol) are used.

In severe cases, the doctor may prescribe hormone therapy, sometimes with intravenous administration of Eufilin. Antiviral drugs are effective, for example, Erespal, immunomodulators (, Interferon,). For severe allergy symptoms, apply antihistamines.

Mandatory conditions:

• maintaining high humidity in the room;
• regular ventilation;
• adherence to a hypoallergenic milk and vegetable diet;
• daily wet cleaning of the room;
• frequent and plentiful drinking (non-acidic fruit drinks, teas, mineral water without gas).

With obstructive bronchitis in children do not use warming ointments, mustard plasters and essential oils , at high temperature do not make compresses and warming up. Before starting treatment with folk remedies, you need to consult with your doctor and make sure that the child does not have allergies. Call your pediatrician right away and listen to what Dr. Komarovsky says on this topic.

Forecast and preventive measures

With proper and timely treatment, obstructive bronchitis completely disappears and does not recur. But the disease can be recurrent and can lead to serious consequences.

At risk are children prone to allergies, with increased level immunoglobulin in the blood. With frequent relapses, obstructive bronchitis develops into asthma.

Preventive measures:

It is very important to observe the correct indoor temperature conditions (18-21C) and humidity (at least 65%). Avoid contact with allergens, do not take the child to crowded places during epidemics, protect from inhalation tobacco smoke walk more often fresh air(better in the forest or near a pond).

By following these recommendations, you can maintain the health of the baby, prevent the onset of the disease and the complications it causes. If it was not possible to avoid the disease, then it is necessary to consult a doctor who will determine how to cure obstructive bronchitis in your child.

Need strictly follow the instructions of the pediatrician and do not try to cure the disease on your own. this is dangerous. In case of a severe course, you should not refuse hospitalization.

In contact with

Bronchitis in children most often occurs as a complication against the background of SARS, influenza or bad cold, hypothermia. Provoking factors for the development of bronchitis are seasonal sudden changes in temperature, especially periods of rain with high humidity, so this disease usually occurs in autumn or spring.

According to the form, all bronchitis in children are divided into: Acute, Protracted and Recurrent.

For reasons of occurrence, it depends on the causative agent of inflammation and is divided into:

• Viral - influenza, adenoviruses, parainfluenza
• Bacterial - can be acute and obstructive (the causative agent is streptococcus, staphylococcus, moraxella, Haemophilus influenzae, as well as mycoplasma and chlamydia)
• Allergic, obstructive, asthmatic - occurs from irritating chemical or physical factors, such as household chemicals, house dust (read about), animal hair, plant pollen, etc.

Bronchitis in a child under one year old - symptoms and treatment

For babies who are on breastfeeding and not having contact with sick children and adults should not have any respiratory illnesses. However, if the baby is born prematurely, birth defects development respiratory organs and other diseases, as well as in the family there are children before school age attending kindergartens and often ill - the development of bronchitis in a child up to a year is possible for the following reasons:

• narrower than in an adult, bronchi, more dry and vulnerable mucous membranes of the respiratory tract
• existing congenital malformations
• after a viral or bacterial infection
• the presence of individual sensitivity to chemical and physical irritants - an allergy to something.

The most basic symptom of developing bronchitis is a strong dry cough, paroxysmal, accompanied by shortness of breath, shortness of breath. Gradually, the cough becomes wet, but mucus, sputum with bronchitis in a child up to a year makes it difficult to breathe, the normal functioning of the lungs is disrupted, since the airways are in infancy narrow. Bronchitis in children up to a year and even up to 3-4 years is most often of the following types:

• Acute bronchitis simple
• Obstructive bronchitis
• bronchiolitis

On acute and obstructive bronchitis, we will dwell in more detail below. And now consider the most common in children under one year old. bronchiolitis.

Bronchitis in children under one year old - bronchiolitis

This bronchitis affects both small bronchi and bronchioles, develops more often against the background of SARS, influenza viruses, followed by the reproduction of pneumococci (and other streptococci). In case of inhalation of icy air or sharp concentrations various gases, bronchiolitis can develop as an independent disease. The danger of such bronchitis is a pronounced broncho-obstructive syndrome with the development of sometimes even acute respiratory failure:

• Characterized by dry cough attacks, pronounced shortness of breath of mixed or expiratory form with syndromes of swelling of the wings of the nose, with the participation of auxiliary muscles, retraction of the intercostal spaces of the chest, pallor skin, cyanosis.
• The child is observed, there are no tears when crying.
• The child eats and drinks less than usual, respectively, and his urination is more rare.
• An increase in body temperature, but unlike pneumonia, it is less pronounced (see).
• Shortness of breath up to 60-80 breaths per minute, while breathing is grunting, superficial.
• Diffuse, moist, voiced, finely bubbling and crepitant rales are heard on both sides.
• Symptoms of intoxication in bronchiolitis in children are not expressed.
• An x-ray shows a sharp transparency of the lung tissue, a variegated pattern, a horizontal position of the ribs, and the absence of infiltrative changes in the lungs.
• If at first there was a simple bronchitis, then the accession of bronchiolitis after a while manifests itself as a sharp deterioration general condition child, the cough becomes more painful and intense, with scanty sputum.
• Children are usually very restless, capricious, excited.
• The blood test may be slightly changed, a slight leukocytosis and an increase in ESR are possible.
• Usually bronchiolitis in children up to a year has a long course of up to 1-1.5 months.
• The causes of acute bronchiolitis in children are similar to the causes of obstructive bronchitis in children older than a year -2-4 years. The local immune system of the respiratory tract in children under 2 years of age is weak, protection against viruses is insufficient, so they easily penetrate deep into the bronchioles and small bronchi.

Treatment of bronchiolitis in children

There is no cure for bronchiolitis at home. If bronchiolitis occurs in an infant, hospitalization is usually indicated so that the child is under the supervision of doctors. In the hospital, pediatricians, pulmonologists will establish an accurate diagnosis and prescribe appropriate treatment. What should mom do before the ambulance arrives?

You can only alleviate the symptoms of a cold - create optimally comfortable air in the room, turn on a humidifier, air purifier.

If the child does not have a high temperature, it is possible to ease breathing with the help of warming creams and ointments, smear their legs and calves with them. Only you need to be careful with this, if the child has not had any allergic manifestations before, then it helps a lot if the child is allergic, warming ointments should be excluded.

To make the cough softer, you can do steam inhalations - over a boiling pot with a weak saline solution hold the baby in your arms. Or seat him at the table and cover with a towel over a cup of hot healing solution.

Try to get the baby to drink more to avoid dehydration, if the baby refuses breast or formula, just give the baby clean water.

In the hospital, in order to relieve signs of respiratory failure, the baby is given inhalations with bronchodilators and allowed to breathe oxygen. Also, at the discretion of the doctor, an antibiotic is selected - Sumamed, Macropen, Augumentin, Amoxiclav. It is possible to use different medicines with interferon. Be sure to appoint antihistamines to relieve swelling at the site of inflammation and a possible allergic reaction to treatment. If observed, then carry out the necessary rehydration therapy.

Acute bronchitis in children - symptoms

Bronchitis is the most common type of respiratory disease in children. Acute bronchitis is considered an acute inflammation of the bronchial mucosa without symptoms of inflammation of the lung tissue. Simple bronchitis in children in 20% is an independent bacterial disease, 80% is either in the program of viruses (Coxsackie virus, adenovirus, influenza, parainfluenza) or in the form bacterial complication after these viral infections.

Clinical symptoms of bronchitis in children are as follows:

First, the child develops general weakness, malaise, headache, lack of appetite, then a dry cough or cough with sputum appears, the intensity of which is rapidly increasing, when listening, dry diffuse or various wet rales are determined. Sometimes it can be a little different.

In the first 2 days, the temperature rises to 38 C, but with mild form, temperatures can be 37-37.2.

After 6-7 days, a dry cough turns into a wet one, sputum discharge facilitates the child's condition and is a good sign that the body copes with the infection and the virus.

On average, the duration of acute bronchitis in children is 7-21 days, but the nature of the disease, the severity of the inflammatory process depend on the age of the child, his strength immune system, the presence of concomitant chronic and systemic diseases. With inadequate or untimely treatment, acute bronchitis can lead to complications - bronchiolitis, pneumonia.

Sometimes after the flu, the child's condition improves for a while, and then sharp deterioration, rise in temperature, increase in cough - this is due to the weakening of the immune system in the fight against the virus and the addition of a bacterial infection, in which case an antibiotic is indicated.

With mycoplasmal or adenoviral acute bronchitis in children, symptoms of intoxication, such as high fever, headaches, chills, lack of appetite, can be about a week. Usually, acute bronchitis is bilateral, however, with mycoplasmal bronchitis, it is most often unilateral, sometimes combined with conjunctivitis.

Acute bronchitis in children - treatment

Most often, the duration of acute bronchitis in children, the treatment of which is correct and carried out on time, should not be more than 14 days, however, in infants, cough can persist for up to a month, as well as in older children with atypical mycoplasmal bronchitis. If suddenly bronchitis in a child is delayed, a number of diseases should be excluded:

• food aspiration
• pneumonia
• cystic fibrosis
• foreign body in the bronchi
• tuberculosis infection

The pediatrician prescribes a full range of treatment. In addition to following all the recommendations of the doctor, you should provide the child special meals and quality care. It is desirable to create optimal humidity and cleanliness in the room, for this it is convenient to use a humidifier and air purifier, often ventilate the room and carry out daily wet cleaning in the room in which the child is located. As well as:

• Plentiful drink

Provide plenty of warm fluids. To alleviate a cough, warm milk with butter or mineral water borjomi, can be replaced with honey.

• Heat

With fever, temperature only above 38C should be taken.

• Antibiotics

• Cough medicines

With a dry cough, a child, as prescribed by a doctor, can be given antitussive medicines, and when he becomes wet, he can switch to funds that can be combined (). If the cough is wet, then Bromhexine, Gedelix, Altai syrup, Thermopsis herb infusion or its dry extract, Bronchicum, Eucabal, Prospan, are shown.

• Inhalations

Almost always, obstructive bronchitis is associated with a virus or mycoplasmal infection, relapses of obstructive bronchitis in children most often spontaneously stop by the age of 4 years.
If bronchioles and small bronchi are affected, then this is already acute bronchiolitis.

Oobstructive bronchitis in children differs from asthma attacks in that the obstruction develops slowly, and in asthma the child suddenly begins to choke. Although the first attacks of bronchial asthma in children also begin during SARS. If the obstruction occurs several times a year, this is a signal that the child is at risk for developing bronchial asthma in the future.

Obstructive bronchitis in a child may be due to passive smoking, it can be distinguished by a strong cough with a whistle in the morning, while the child's condition is quite satisfactory. Obstruction in allergies occurs upon contact with an allergen, and recently it has become a very common manifestation in children prone to allergies, such bronchitis are recurrent in nature and are threatened by the development of bronchial asthma.

Allergic and obstructive bronchitis in children - treatment

Hospitalization

With obstructive bronchitis in children under one year or 2 years old, treatment should be carried out in a hospital under the supervision of a pediatrician, in other cases at the discretion of the doctor and parents. Treatment is best done in a hospital if:

• In addition to obstruction, the child has symptoms of intoxication - decreased appetite, high fever, nausea, and general weakness.
• Severe signs of respiratory failure. This is shortness of breath, when the respiratory rate increases by 10% of the age norm, it is better to count at night, and not during games or crying. In babies up to 6 months, the respiratory rate should not be more than 60 per minute, 6-12 months - 50 breaths, 1-5 years 40 breaths. Acrocyanosis is a sign of respiratory failure, manifested by the cyanosis of the nasolabial triangle, nails, that is, the body is deficient in oxygen.
• It is not uncommon for obstructive bronchitis in children to disguise pneumonia, so if the doctor suspects pneumonia, hospitalization should not be refused.

Bronchodilators

Bronchiolytics dilate the bronchi, so they are designed to relieve obstruction. Today, they are presented in the pharmaceutical industry market in various forms:

• In the form of syrups (Salmeterol, Clenbuterol, Ascoril), which are convenient to use for young children, their disadvantage is the development and heartbeat.
• In the form of solutions for inhalation (see) - this is the most convenient way for young children, breeding medicinal solution saline solution, inhalation is carried out 2-3 times a day, after improvement it is possible to use only at night. The multiplicity and dosage, as well as the course of treatment, is determined only by the pediatrician.
• Aerosol inhalers can only be used for older children (Berodual, Salbutamol).
• Such tablet forms of bronchodilators as theophylline (Teopek, Eufillin) are not indicated for the treatment of children with obstructive bronchitis, they have more pronounced side effects, are more toxic than local inhaled forms.

Antispasmodics

Can be used to reduce bronchospasm. This or . They can be taken with an inhaler, orally as tablets, or intravenously in a hospital.

Cough remedies

In order to better sputum, various mucoregulatory drugs are used, they help to thin the sputum and accelerate its excretion:

• These are drugs with active substance Ambroxol (Lazolvan, Ambrobene). These funds should not be taken for more than 10 days, it is most convenient to use them in the form of inhalations, as well as carbocysteine ​​preparations (Flyuditek, Bronhobos, Mukosol).
• After the cough has become wet, the attacks have become less intense, the sputum thins, but does not come out well, Ambroxol should be changed to, which should be given no more than 5-10 days, these include Gedelix, Bronchikum, Prospan, Bronchosan, Gerbion (see. ), Tussin, Bronchipret,.
• Codeine-containing drugs are not recommended for children to take if the child has a paroxysmal obsessive cough, as prescribed by a doctor, you can use Sinekod, Stoptusin Fito, Libexin (with caution in childhood), Bronchikum, Broncholitin.
• Erespal - helps to relieve obstruction and reduce sputum production, and it also has anti-inflammatory activity, is used from the first days of the disease, reduces the risk of complications, is contraindicated in children under 2 years of age.

Draining massage

To facilitate the discharge of sputum, parents themselves can give their child a massage of the collar zone, chest, and back. Especially strong massage should be done for the back muscles along the spine. Postural massage is useful for obstructive bronchitis in children - that is, tapping the back of the baby in the morning, you should hang the child upside down from the bed (put a pillow under the tummy) and tap with palms folded in a boat for 10-15 minutes. For older children, when massaging, ask the child to take a deep breath, and tap on the exhale. Useful and additional exercises such as inflating balloons, blowing out candles or).

Antihistamines

Antihistamines are prescribed for children with a predisposition to allergic reactions. Allergy medicines such as Erius in syrup can be taken by children from 1 year old, from six months it is possible to use Claritin and Zirtek, from 2 years old in syrups and drops of Tsetrin, Zodak, Parlazin (see). Such 1st generation antihistamines as Suprastin and Tavegil are used less frequently today, only for drying with abundant liquid sputum.

Allergy or virus

If the obstruction is caused by an allergy or a virus, antibiotics cannot be used, and even dangerous (see). The appointment of antibiotics is possible only with a proven infectious origin of bronchitis in children.

When antibiotics are indicated

Treatment of bronchial obstruction with antibiotics is not indicated, only if the child has a high temperature for more than 4 days, or there was a second jump in temperature up to 39C 4-5 days after the onset of the disease, accompanied by severe intoxication, strong cough if, with adequate treatment, the child suddenly becomes apathetic, lethargic, refuses to eat, he has weakness, nausea, headaches and even vomiting. In such cases, the use of antibiotics is justified. They are prescribed only by a pediatrician based on the clinical picture, the presence of purulent sputum (indicative of bacterial bronchitis), inflammatory changes in the blood test, as well as other signs of bacterial bronchitis or pneumonia (wheezing, x-ray signs).

Antivirals

hormone therapy

Hormonal drugs such as Pulmicort are indicated only for severe or moderate obstructive bronchitis (usually with the help of a nebulizer), they quickly stop obstruction and inflammation, they are prescribed only by a doctor.

What Not to Do

With obstructive bronchitis in children - treatment by rubbing and spreading the child's body with various warming ointments (Doctor Mom ointment, ointments with medicinal plants, essential oils), the use of mustard plasters is unacceptable, since they cause even more allergic reaction and bronchospasm, especially in children under 3 years of age. It is also categorically impossible to carry out inhalations for bronchitis with various medicinal herbs and essential oils. It is only possible to use such folk remedies for warming up - thermal compresses with potatoes, salt, buckwheat.

Physiotherapy

Physiotherapeutic procedures in the acute period are contraindicated when the obstruction is already stopped, it is possible to carry out UHF, electrophoresis or laser.

Hypoallergenic diet and plenty of fluids

Any natural drinks - mineral water with milk, tea, should be drunk by the child as often as possible. The diet should be hypoallergenic, but at the same time as vitaminized as possible, complete in terms of protein and fat content. Eliminate from the child's diet anything that can cause an allergic reaction:

• citrus, red and orange fruits
• purchased spices, sweets, milk curds, yogurts, carbonated drinks, sausages and sausages - everything that contains dyes, flavors, preservatives and flavor enhancers
• honey and other bee products
• fish grown on fish farms, broiler chickens - as they are stuffed with hormones and antibiotics, which causes allergies.

When caring for a child, you should ventilate and humidify the room where the child is located daily. It should not be hot in the apartment, it is better to have cool, fresh, clean air. After recovery, the child should be registered with an allergist.

Obstructive bronchitis in children is primarily an inflammation of the bronchial tree. In the structure of the general morbidity of the population childhood pathology of the bronchopulmonary system takes the first place. Respiratory viral infections are the most common. Bronchitis is the second most common.

They can be both complications of acute respiratory viral infections, and independent diseases that occur primarily. The most dangerous is obstructive bronchitis, which in severe cases can lead to a delay general development child.

Obstructive syndrome is manifested by mucosal edema, which greatly complicates breathing. The increased viscosity of the produced secret is added to the edema, which may contain purulent clots, as well as bronchospasm.

Important. Children who are often diagnosed with bronchitis (both acute and obstructive) may eventually get a chronic bronchopulmonary pathology such as chronic bronchitis, or .

Bronchitis is an inflammatory disease of the bronchial mucosa. In this case, almost the entire bronchial tree is affected, which leads to pronounced clinical manifestations.

For reference. Children are characterized by three types of bronchitis: simple, and bronchiolitis. The first is characterized by catarrhal inflammation of the bronchi, the latter - by inflammation of the smallest branches of the bronchial tree, characteristic of children in the first year of life.

Obstructive bronchitis occurs in children of any age. The main feature of its pathogenesis is obstruction - blocking the lumen of the bronchial tree. At the same time, air easily enters the lungs, but it is difficult to get out of them. It becomes difficult for the child to breathe.

Bronchitis is most often the result of respiratory infection. In this case, they are a complication of the underlying disease. In children, obstructive bronchitis occurs more often than in adults. This is due to the structural features of the bronchial tree. They are as follows:

• Short but wide bronchi, which are easier to get infections;
• Small branching of the bronchial tree, as a result of which the infectious agent spreads more easily to all its departments;
• The failure of the mucociliary apparatus, the main task of which is to bring out the infection;
• Delicate mucosa, which is easily damaged by adverse factors;
• The failure of the immune system, its low differentiation - the child's immune cells still do not know how to deal with different types infections, so children get sick more often than adults.

Simple bronchitis in a child is a common occurrence. Obstructive bronchitis in children occurs much less frequently, but more often leads to complications and has a severe course.

For reference. Obstruction is a dangerous pathology that leads to respiratory failure. As a result, all cells and tissues of the child's body begin to experience oxygen starvation.

Causes of obstructive bronchitis in children

Obstructive bronchitis can be caused by a viral or bacterial infection that first affects the upper respiratory tract.

Among the viruses, the following prevail:

• Respiratory syncytial. It is often the cause of viral bronchitis, and in children of the first year of life it can also cause bronchiolitis.
• adenovirus. It causes inflammation of the lymphoid tissue in various organs from the eyes and nose to the intestines. This is the most common etiological factor childhood cold.
• parainfluenza virus. It is characterized by laryngitis with stenosis of the larynx, but sometimes the virus spreads along the continuation into the underlying parts of the respiratory tube and causes bronchitis.
• Influenza causative agent. Tropene to the mucous membrane of the trachea, but sometimes spreads further and enters the bronchi, causing inflammation there.
• Enterovirus. It has many forms and manifests itself in the form various diseases. Acute obstructive bronchitis in children can be the result of the so-called "Little disease" (otherwise - enterovirus fever, three-day fever, summer flu).

For reference. All of these pathogens are respiratory viruses. Each of them is tropen to its own section of the respiratory tract. Obstructive bronchitis in this case is a complication of SARS.

Bacteria are less selective. Bronchitis can be caused by any bacterial flora. In this case, we are usually talking about purulent-obstructive bronchitis. Less commonly, the cause of this pathology is mycoplasma and chlamydia.

The bronchi are sufficiently protected to resist an infectious agent. The threat of developing the disease occurs if the barrier function of the respiratory tract is impaired.

This happens in the following cases:

• General hypothermia. Cold air enters the bronchi and reduces their protection, facilitating the penetration of infection.
• Hypovitaminosis. Some vitamins are essential for maintaining the immune system. Vitamins C and E are especially important. With their deficiency, frequent colds with complications are observed.
• Passive smoking. Many children are exposed to tobacco smoke, which damages the bronchial epithelium.
• immunodeficiency states. Immunity deficiency can be congenital, such as hypogammaglobulinemia, or acquired, such as acute leukemia.

Pathogenesis of obstructive bronchitis in children

The mechanism of bronchial obstruction consists of three pathogenetic links:

• Edema
• Increase the viscosity of the secret;
• Bronchospasm.

All three components lead to obstruction, exacerbating each other's action. They arise as a result of developing inflammation.

An infectious agent that can cause bronchitis enters the bronchial tree. Due to the fact that the bronchial mucosa is damaged by one of the adverse factors, such as tobacco smoke or cold air, the virus or bacterium easily penetrates the epithelium.

Normally, epithelial cells that are tightly adjacent to each other prevent this penetration, but when exposed to adverse factors, the barrier is broken, which contributes to the development of bronchitis.

Immune cells rush to meet the infectious agent. The latter produce inflammatory mediators that promote blood stasis and plasma release into the interstitial space. This is how swelling occurs.

In addition, the function of the bronchial mucosa is impaired. Normally, it produces a mucous secretion and contributes to its removal.

For reference. During inflammation, the liquid part of the secret remains in the interstitium, and a viscous exudate enters the bronchial lumen. It acts like a cork, closing the lumen of the bronchial tree and preventing the passage of air currents.

The main component of the pathogenesis of obstructive bronchitis in children is bronchospasm. It arises due to the action of mediators like acetylcholine.

Cholinergic receptors are responsible for the contraction of bronchial smooth muscle. When activated, the muscles of the bronchial tree become toned and the lumen of the respiratory tract decreases. It becomes difficult for the child to breathe.

For reference. The action of the three components is summarized, resulting in symptoms of obstructive bronchitis.

What is dangerous obstructive bronchitis in children

Obstructive bronchitis in children is more severe than in adults. This is due to the structural features of the bronchial tree.

Attention. Children are more likely to have complications. The most dangerous of these is pneumonia. A virus or bacterium in a weakened body freely penetrates from the bronchi into the alveoli of the lungs, where inflammation occurs.

Children suffer from pneumonia very hard with high fever and frequent complications in the form of:

• septic conditions,
• pleurisy,
• meningitis,
• myocarditis.

In children, the immune system is still imperfect, because the infectious agent often enters the bloodstream and spreads throughout the body.

In addition, obstructive bronchitis in children is dangerous because adequate ventilation of the lungs is disturbed. It is difficult for a child to breathe, less air enters the lungs, more of it remains inside the alveoli.

Attention! In this case, the body experiences hypoxic hypoxia - a state of oxygen deficiency associated with lung pathology. Hypoxia affects all organs and tissues, but most of all the brain.

Nerve cells begin to experience oxygen starvation. The child becomes either too excited, or, on the contrary, lethargic and apathetic. With prolonged obstructive bronchitis or its frequent relapses, the child may begin to lag behind in psychomotor development. This is especially dangerous in the first years of life, when babies are actively developing and growing.

Symptoms of obstructive bronchitis in children

The clinical picture of the disease is dominated by two syndromes: general infectious and respiratory. The first is typical for any diseases caused by bacteria or viruses.

This symptom complex includes:

• Increase in body temperature. More characteristic of bacterial bronchitis than viral. With viral bronchitis, the temperature can rise to 37-38 ° C, with bacterial bronchitis - up to 39 ° C and above.
• Weakness, fatigue, cognitive decline. These symptoms are typical for school-age children. Toddlers often carry the disease on their feet, they remain active for a long time, sometimes even overexcited. It is difficult to judge the severity of the disease by the activity of the child.

The respiratory syndrome is directly related to the obstruction of the bronchial tree and is manifested by the following symptoms:

• Cough. At the beginning of the disease, it can be dry, then productive with liquid sputum, after which it becomes characteristic of this type of bronchitis - hacking with a small amount of viscous thick sputum. The nature of the latter depends on the infectious agent. At viral disease sputum is mucous, transparent; with bacterial - purulent, yellow-green.
• Wheezing. Dry wheezing with obstruction can be heard even at a distance.
• Dyspnea. Is an characteristic symptom obstruction. Frequency respiratory movements increases, each exhalation is given to the child with difficulty. At exercise, screaming, crying or laughing, shortness of breath increases. Children, unlike adults, cannot say what is more difficult for them to do - inhale or exhale. Therefore, the nature of shortness of breath is difficult to establish.
• Respiratory failure. In children, it comes on very quickly after the onset of obstruction. The child's fingertips and nasolabial triangle become bluish. In severe cases, the entire body of the child may become bluish.

Diagnosis of obstructive bronchitis in children

If obstructive bronchitis is suspected in a child, the following diagnostic methods are used:

• physical methods. Includes percussion and auscultation. Percussion is rarely used, because with bronchitis it is not very informative, but it allows you to distinguish it from pneumonia. On auscultation, various dry rales are heard over the entire surface of the lungs.
• General blood analysis. With bronchitis of viral etiology, leukocytosis with lymphocytosis and accelerated ESR or leukopenia are observed. If the etiology of bronchitis is bacterial, then the content of neutrophilic leukocytes is increased in the blood, ESR is accelerated.
• Sputum analysis. Allows you to identify the etiology of the pathogen. Viruses in sputum are difficult to detect, but bacteria can be detected.
• Oximetry. Using a special device that is worn on the finger like a clothespin, you can measure the oxygen saturation of the blood. Oximetry can detect respiratory failure, in which the concentration of oxygen in the blood is reduced.
• X-ray of the chest organs. Bronchitis is not visible on x-ray. This study allows you to exclude pneumonia, in which local shadows are visible in the lungs.
• Spirometry. Using this method, the function of external respiration is examined. At the same time, indicators characterizing the features of exhalation (FEV and FEV/VC) will be reduced. The study is very informative, but it is rarely used because it requires special equipment.

Attention. Bronchoscopy, which is often used in adults for diseases of the bronchopulmonary system, is rarely used in children. This invasive method requires anesthesia if we are talking about the child. Use bronchoscopy only in extremely severe cases.

Treatment of obstructive bronchitis in children

Therapy consists in the appointment of several groups of drugs that can reduce the obstruction of the bronchial tree.
It is recommended to use combinations of such drugs, allowing to act on all links of pathogenesis.

Treatment of obstructive bronchitis in children includes the appointment of the following groups of drugs:

• Mucolytics (by doctor's prescription). In another way, these funds are called expectorants. They break the chemical bonds in the molecules that make up bronchial mucus, making it more viscous. Viscous sputum is easier to cough up. In this case, the lumen of the bronchial tree is released.
• Glucocorticoids. Powerful anti-inflammatory hormones that significantly reduce swelling. They are used in the form of inhalations.
• Beta-agonists. Norepinephrine and its analogues are able to expand the lumen of the bronchial tree, relaxing the muscles of the bronchi. These substances are also used in the form of inhalations.
• Anticholinergics. They can be used instead of adrenomimetics. Anticholinergics eliminate the effect of acetylcholine, which helps to reduce the smooth muscles of the bronchi. Thus, the muscles relax and the bronchi expand.

In addition, children are prescribed a plentiful drink in the form of warm tea, fruit drink, juice or compote. It is important to give as much vitamin C as possible: lemon, orange, apple, fresh herbs. Favorably affects the bronchi warm milk and cocoa. The latter contains essential oils that help reduce cough.

Attention! Folk methods treatment can only be used in combination with the main treatment and only after consulting a doctor.

If bronchitis has bacterial etiology prescribe antibiotics. You should not be afraid of their use, since the complications of a bacterial infection are more dangerous than side effects these drugs. For children under two years of age, antibiotics are indicated even for viral bronchitis.

Forecast and prevention of obstructive bronchitis in children

The prognosis for obstructive bronchitis depends on how severe the child's condition is. This pathology responds well enough to treatment. The prognosis is favorable if the bronchitis is viral and respiratory failure is minimal.

For reference. With severe respiratory failure or the presence of complications, the prognosis is doubtful.

Prevention of obstructive bronchitis is aimed at reducing the impact of adverse factors on the child's body and strengthening the immune system. First of all, the child must be protected from tobacco smoke, eliminating passive smoking.

For any colds, regardless of its severity, it is unacceptable to continue an active lifestyle. The child should stay at home under the supervision of adults, bed rest is mandatory, active games and walks should be excluded from his daily routine.

Important for strengthening the immune system proper nutrition rich in proteins and vitamins. Children are less likely to get sick if they often walk on the street, go in for sports. Swimming in the pool is especially good for strengthening immunity, but this sport is not suitable for often ill children.

Inflammatory lesion of the bronchial tree, occurring with the phenomenon of obstruction, i.e., a violation of the patency of the bronchi. The course of obstructive bronchitis in children is accompanied by an unproductive cough, noisy wheezing with forced exhalation, tachypnea, distant wheezing. When diagnosing obstructive bronchitis in children, auscultation data, chest x-ray, spirometry, bronchoscopy, blood tests (general analysis, blood gases) are taken into account. Treatment of obstructive bronchitis in children is carried out with the help of inhaled bronchodilators, nebulizer therapy, mucolytics, massage, breathing exercises.

General information

With repeated episodes of obstructive bronchitis in children, bronchial swabs often reveal DNA of persistent infections - chlamydia, mycoplasmas, herpesviruses, cytomegalovirus. Often bronchitis with obstructive syndrome in children is provoked mold fungus, which intensively multiplies on the walls of rooms with high humidity. It is rather difficult to assess the etiological significance of the bacterial flora, since many of its representatives act as conditionally pathogenic components. normal microflora respiratory tract.

An important role in the development of obstructive bronchitis in children is played by an allergic factor - increased individual sensitivity to food products, medicines, house dust, animal hair, plant pollen. That is why obstructive bronchitis in children is often accompanied by allergic conjunctivitis, allergic rhinitis , atopic dermatitis.

Recurrence of episodes of obstructive bronchitis in children is promoted by helminthic invasion, the presence of foci chronic infection(sinusitis, tonsillitis, caries, etc.), active or passive smoking, smoke inhalation, living in environmentally unfavorable regions, etc.

Pathogenesis

The pathogenesis of obstructive bronchitis in children is complex. The invasion of the viral agent is accompanied by inflammatory infiltration of the bronchial mucosa by plasma cells, monocytes, neutrophils and macrophages, and eosinophils. The release of inflammatory mediators (histamine, prostaglandins, etc.) and cytokines leads to swelling of the bronchial wall, contraction of the smooth muscles of the bronchi and the development of bronchospasm.

Due to edema and inflammation, the number of goblet cells that actively produce bronchial secretions (hypercrinia) increases. Hyperproduction and increased viscosity of mucus (dyskrinia) cause dysfunction of the ciliated epithelium and the occurrence of mucociliary insufficiency (mucostasis). As a result of a violation of expectoration, obturation of the respiratory tract with bronchial secretion develops. Against this background, conditions are created for the further reproduction of pathogens that support the pathogenetic mechanisms of obstructive bronchitis in children.

Some researchers see in bronchial obstruction not only a violation of the process of external respiration, but also a kind of adaptive reactions that, under conditions of damage to the ciliated epithelium, protect the lung parenchyma from the penetration of pathogens from the upper respiratory tract into it. Indeed, unlike simple bronchitis, inflammation with an obstructive component is much less likely to be complicated by pneumonia in children.

The terms “asthmatic bronchitis” and “spastic bronchitis” are sometimes used to refer to obstructive bronchitis in children, but they are narrower and do not reflect the fullness of the pathogenetic mechanisms of the disease.

Downstream, obstructive bronchitis in children can be acute, recurrent and chronic or continuously recurrent (with bronchopulmonary dysplasia, obliterating bronchiolitis, etc.). According to the severity of bronchial obstruction, there are: mild (I), moderate (II), severe (III) degree of obstructive bronchitis in children.

Symptoms of obstructive bronchitis in children

Most often, the first episode of obstructive bronchitis develops in a child in the 2-3rd year of life. In the initial period, the clinical picture is determined by the symptoms of SARS - elevated temperature body, sore throat, runny nose, general malaise. In children early age dyspeptic symptoms often develop.

Bronchial obstruction can join already on the first day of the disease or after 2-3 days. At the same time, there is an increase in the frequency of breathing (up to 50-60 per minute) and the duration of expiration, which becomes noisy, whistling, audible at a distance. In addition to tachypnea, expiratory or mixed dyspnea, in children with obstructive bronchitis, accessory muscles are involved in the act of breathing, an increase in the anteroposterior size of the chest, retraction of its compliant places during breathing, swelling of the wings of the nose. Cough in children with obstructive bronchitis is unproductive, with scanty sputum, sometimes painful, paroxysmal, not bringing relief. Even with wet cough sputum comes off with difficulty. Pallor of the skin or perioral cyanosis is noted. Manifestations of obstructive bronchitis in children may be accompanied by cervical lymphadenitis. Broncho-obstruction lasts 3-7 days, disappears gradually as inflammatory changes in the bronchi subside.

In children of the first half of the year, especially those who are somatically weakened and premature, the most severe form of obstructive syndrome may develop - acute bronchiolitis, in the clinic of which signs of severe respiratory failure predominate. Acute obstructive bronchitis and bronchiolitis often require hospitalization of children, since these diseases are fatal in about 1% of cases. A protracted course of obstructive bronchitis is observed in children with a burdened premorbid background: rickets, chronic ENT pathology, asthenia, anemia.

Diagnostics

Clinical, laboratory and instrumental examination of children with obstructive bronchitis is carried out by a pediatrician and a pediatric pulmonologist; according to indications, the child is assigned consultations of a pediatric allergist-immunologist, a pediatric otolaryngologist and other specialists. During auscultation, an elongated exhalation is heard, various wet and scattered dry rales on both sides; with percussion over the lungs, a box shade is determined.

Treatment of obstructive bronchitis in children

Therapy of obstructive bronchitis in young children is carried out in a hospital; older children are subject to hospitalization in case of severe disease. General recommendations include adherence to a semi-bed rest and a hypoallergenic (mainly milk-and-vegetable) diet, drinking plenty of water (teas, decoctions, fruit drinks, alkaline mineral waters). Important regime moments are air humidification, regular wet cleaning and ventilation of the ward where children with obstructive bronchitis are treated.

With severe bronchial obstruction, oxygen therapy, hot foot baths, can massage, and removal of mucus from the upper respiratory tract with an electric suction are actively used. To relieve obstruction, it is advisable to use inhalation of adrenomimetics (salbutamol, terbutaline, fenoterol) through a nebulizer or spacer. With the ineffectiveness of bronchodilators, the treatment of obstructive bronchitis in children is supplemented with corticosteroids.

To thin sputum, the use of drugs with mucolytic and expectorant effects, medicinal and alkaline inhalations is indicated. With obstructive bronchitis, children are prescribed antispasmodic and antiallergic drugs. Antibacterial therapy is carried out only in case of secondary infection.

In order to ensure adequate drainage of the bronchial tree, children with obstructive bronchitis are shown breathing exercises, vibration massage, and postural drainage.

Forecast and prevention

About 30-50% of children are prone to recurrence of obstructive bronchitis within one year. Risk factors for recurrence of bronchial obstruction are frequent acute respiratory viral infections, the presence of allergies and foci of chronic infection. In most children, episodes of obstruction stop at preschool age. Bronchial asthma develops in a quarter of children who have had recurrent obstructive bronchitis.

Measures to prevent obstructive bronchitis in children include the prevention of viral infections, including through vaccination; provision of a hypoallergenic environment, hardening, rehabilitation at climatic resorts. After suffering obstructive bronchitis, children are on dispensary observation at the pediatrician, probably - the children's pulmonologist and the allergist.