Bronchitis with obstructive syndrome. Respiratory diseases

- inflammation bronchial tree, accompanied by bronchial obstruction syndrome, mainly of small and medium caliber. The main symptom of acute obstructive bronchitis is expiratory shortness of breath, which occurs against the background of coughing, asthma attacks, fever, whistling or moist rales. In addition to the clinical picture data, spirometry, pneumotachography, and lung x-ray are used in diagnosis. Modern treatment algorithms for acute obstructive bronchitis include the use of bronchodilators, mucolytics, expectorants, inhaled glucocorticosteroids, and massage.

General information

Symptoms of acute obstructive bronchitis

Initial clinical picture determined by the symptoms of that respiratory infection, which gave impetus to the development of acute obstructive bronchitis. Difficulty breathing appears already on the first or second (sometimes on the third or fifth) days. The respiratory rate increases to 25 or more per minute; exhalation becomes elongated, noisy, whistling, audible at a distance (distant wheezing). How younger child, the more pronounced are the signs of respiratory failure (tachypnea, anxiety, perioral cyanosis, desire to take a forced position).

Patients with acute obstructive bronchitis are bothered by an unproductive, paroxysmal cough that gets worse at night. The participation of auxiliary muscles in breathing is indicated by retraction of the intercostal spaces and supraclavicular fossae, and flaring of the wings of the nose. Body temperature may be normal or low-grade. About the current infectious process indicate signs of a violation of general health: weakness, asthenia, headache, decreased appetite, increased sweating.

Symptoms of acute obstructive bronchitis last from one to two to three weeks. If episodes of the disease are repeated 2-3 times or more within a year, a diagnosis of “recurrent obstructive bronchitis” is made. Acute and recurrent broncho obstructive syndrome may be complicated by the addition of bacterial inflammation, the formation of chronic obstructive bronchitis, deforming bronchitis, bronchial asthma.

Diagnosis of acute obstructive bronchitis

Usually, examination and analysis of physical data are sufficient to confirm the diagnosis. Acute obstructive bronchitis is supported by its association with viral disease, the presence of tachypnea and prolonged expiration. The chest is enlarged in anteroposterior size; tympanitis is determined by percussion over the lungs. On auscultation, harsh breathing with multiple whistling, buzzing rales is heard.

Treatment of acute obstructive bronchitis

Treatment of acute obstructive bronchitis is carried out on an outpatient basis. Children need hospitalization early age with moderate and severe forms of bronchial obstruction. A gentle regime is prescribed, contact with irritants (perfumes, dust, household chemicals, cigarette smoke, etc.) is excluded. In order to dilute mucus and facilitate its evacuation from the respiratory tract, sufficient water regime, humidification of the air in the room, percussion massage of the chest, positional drainage.

Rational pathogenetic therapy avoids the development of severe forms of acute obstructive bronchitis and its chronicity. Therefore, the main role in treatment is given to anti-inflammatory, bronchodilator and mucolytic drugs. Among bronchodilators, aminophylline and theophylline are usually used; It is advisable to prescribe beta-2 adrenergic agonists (salbutamol, terbutaline) by inhalation or through a nebulizer. Bromhexine and ambroxol (in the form of syrup, tablets, inhalations) have a mucolytic and expectorant effect. The regimen and dosage are selected by a pediatrician or pulmonologist in accordance with the patient’s age. The use of fenspiride and inhaled glucocorticosteroids is recommended as anti-inflammatory therapy. Prescription of antitussives central action in acute obstructive bronchitis it is undesirable.

Distractive procedures (cupping massage, hot foot and hand baths), physiotherapy (UHF, laser, electrophoresis) are effective. Severe forms bronchial obstruction requires oxygen therapy. To combat respiratory pathogens, recombinant interferon preparations are used; Antibiotic therapy is justified only if acute pneumonia is suspected.

Prognosis and prevention of acute obstructive bronchitis

Approximately 30-50% of children who have had an acute obstructive bronchitis, episodes of bronchial obstruction are repeated throughout the year against the background of a new viral infection. In most cases, the obstructive component disappears after the age of 3-4 years. The presence of an allergic predisposition significantly increases the likelihood of chronic obstructive bronchitis. To reduce the risk of morbidity, hardening, limiting contact with infectious and allergic agents, and sanitizing chronic infectious foci are recommended. For recurrent obstructive bronchitis, consultation with an allergist-immunologist and pulmonologist is indicated.

Obstructive bronchitis is a disease of the bronchi associated with long-term inflammation mucous membrane, its damage and narrowing of the lumen of the bronchi, which causes difficulties in removing the accumulated respiratory tract mucus. The disease is accompanied by periodic spasms of the bronchial tree, which are manifested by difficulty breathing.

Over time, inflammation in the bronchial wall progresses, bronchospasm and shortness of breath intensify, obstructive syndrome develops and chronic disorder pulmonary ventilation.

What is it?

Obstructive bronchitis is the occurrence of reflex spasms that prevent mucus from coming out. Obstruction may be intermittent, especially when chronic form. The peculiarity of such bronchitis is that it can occur latently.

Reasons for development

The disease in most cases becomes complicated by the continuation of respiratory viral infections, exposure to external factors: smoking, unfavorable environmental conditions, hazardous production, poor living conditions.

Environmental factors:

1. The presence of chemical irritants in the air at work or at home - inorganic and organic dust, acid vapors, ozone, chlorine, ammonia, silicon, cadmium, sulfur dioxide, etc. (see influence household chemicals for health).
2. Long-term exposure of the bronchial mucosa to physical irritants located in external environment– allergens, such as pollen from certain plants, house dust, animal hair, etc.

Socio-economic factors:

1. Alcohol abuse;
2. Unfavorable living conditions;
3. Smoking, passive smoking(see video of what cigarettes are made from);
4. Old age.

Medical factors:

1. Tumors of the trachea and bronchi;
2. Airway hyperresponsiveness;
3. Genetic predisposition;
4. Tendency to allergic reactions;
5. Injuries and burns;
6. Poisoning;
7. Infectious and inflammatory diseases of the respiratory system and impaired nasal breathing, foci of infection in the upper respiratory tract - bronchitis, pneumonia;
8. Repetitive viral infections and diseases of the nasopharynx.

Chronic obstructive bronchitis

This is a progressive obstruction of the bronchi in response to various stimuli. Violation bronchial obstruction conditionally divided into: reversible and irreversible.

Signs with which patients usually consult a doctor:

1. Severe cough, with the release of scanty mucous sputum in the morning
2. Shortness of breath, initially appears only when physical activity
3. Wheezing, difficulty breathing
4. Sputum can become purulent during the period of addition of other infections and viruses and is regarded as a relapse of obstructive bronchitis.

Over time, with irreversible chronic process the disease progresses, and the intervals between relapses become shorter.

Symptoms

The clinical picture of obstructive bronchitis is formed by the following symptoms:

• Cough - on early stages dry, without phlegm, “wheezing”, mainly in the morning, and also at night, when a person is in horizontal position. The symptom intensifies in the cold season. Over time, when coughing, sputum and clots appear; in older people, there may be traces of blood in the secretion;
• Difficulty breathing, or shortness of breath (7-10 years after the onset of cough) - first appears during physical activity, then during rest;
• In case of exacerbation - elevated temperature, sweating, fatigue, headaches, muscle pain;
• Acrocyanosis - blueness of the lips, tip of the nose, fingers;
• Watch glass syndrome, Hippocrates' nail - deformation nail plates when they look like watch glasses;
• Symptom " drumsticks"- characteristic change in the phalanges of the fingers;
• Emphysematous chest - shoulder blades fit tightly to chest, the epigastric angle is deployed, its value exceeds 90 o, “short neck”, enlarged intercostal spaces.

It is important to remember that obstructive bronchitis does not make itself felt immediately. Typically, signs appear when the disease is already fully dominant in the body. As a rule, most patients seek help late, after the age of 40.

Diagnostics

Typically, the diagnosis is made based on the patient's complaints, concomitant clinical history, auscultation of the lungs and heart rhythm.

The task differential diagnosis- exclude the development of such severe pathologies as pulmonary tuberculosis, pneumonia, tumor lung tissue, developing heart failure due to decreased fraction cardiac output. If a patient experiences a decrease in cardiac ejection fraction, severe persistent cough, there is a suspicion of alveolar edema ( pulmonary edema), then the actions of doctors should be lightning fast.

Obstructive bronchitis is characterized by the following:

• listening percussion sound over the lungs;
• loss of mobility of the pulmonary edge;
• hard breathing;
• on inspiration, wheezing sounds are auscultated;
• the appearance of moist wheezing during exacerbation of the disease.

If the patient is a smoker, then the doctor needs to find out the total length of service bad habit, calculate the smoking index. When classifying obstructive bronchitis at the development stage, the indicator of forced expiratory volume in 1 minute (in the abbreviation FEV) is used in relation to the vital capacity of the lungs (in the abbreviation VC). The following stages are distinguished:

1. Stage I. FEV = 50% of normal. At this stage, the patient experiences almost no discomfort, and clinical monitoring is not needed in this situation.
2. Stage II. OFI = 34-40% of the norm. The patient is recommended to visit a pulmonologist due to a marked deterioration in the quality of life.
3. Stage III. FEV<33% от нормы. Этот этап заболевания предполагает стационарное либо амбулаторное лечение.

To exclude pneumonia, pulmonary tuberculosis, and dilation of the heart, a chest x-ray procedure is performed. As additional research methods, laboratory test data (blood, urine, scraping of mucus or sputum) are required. Accurate diagnosis will allow you to quickly identify the underlying disease, relieve the symptoms of obstructive bronchitis, and eliminate its relapses in the future.

Complications

When obstruction develops, the lungs are no longer able to get enough air. Inhalations become heavy, the diaphragm does not open completely. In addition, we inhale more than we exhale.

Some part remains in the lungs and provokes pulmonary emphysema. In severe and chronic forms, pulmonary failure may occur, and this is a cause of mortality. Untreated bronchitis almost always ends in pneumonia, which is much more difficult to treat.

How to treat obstructive bronchitis?

First of all, when treating obstructive bronchitis in adults, it is important to minimize, and if possible completely eliminate, contact with irritating factors, which may be a prerequisite for the progression of the process in the bronchi and its exacerbations.

You need to give up smoking and other bad habits, stop contact with allergens, which in some cases may require quite radical steps: changing your job or place of residence.

The next step should be treatment at home with effective modern means.

Drug treatment

For obstructive bronchitis, which is caused by a viral infection, antiviral drugs are prescribed:

1. Rimantadine (Algirem, Orvirem) has an intense antiviral effect by blocking healthy body cells from viral penetration. The drug is prescribed 100 mg (1 tablet) 1-3 times a day for 3-4 days. Allergic reactions are rare.
2. Inosine pranobex (Isoprinosine, Groprinosine) have an antiviral (stimulate the death of viral cells) and immunomodulatory (strengthen the immune system) effect. The drugs are prescribed 1-2 tablets 3-4 times a day. The course of treatment is 7–10 days, but can be extended by 1 month according to indications. The drug is well tolerated and usually does not cause allergic reactions.

For obstructive bronchitis caused by a bacterial infection, antibacterial drugs are prescribed, with which the disease can be cured within 5–10 days:

1. Macrolides (Clarithromycin, Rovamycin) have a bactericidal effect. Prescribed 500 mg 1 time per day. The course of treatment is 5–7 days. The drug does not cause allergic manifestations;
2. Protected penicillins (Augmentin, Flemoxin-solutab) have a bacteriostatic (reduce the growth and division of bacterial cells) and bactericidal (promote the death of bacteria) effect. The drug is prescribed in tablets of 625 mg 3 times a day or 1000 mg 2 times a day for 7–14 days. This group of drugs is given with caution to patients with frequent allergic reactions;
3. In extremely severe cases of disease development, the drugs of choice are respiratory fluoroquinolones - levofloxacin (Loksof, Leflok) 500 mg once a day or 500-1000 mg in a 100.0 ml bottle intravenously once a day. This medicine may cause acute allergic reactions.

If cough occurs, use mucolytic drugs:

1. Ambroxol (Lazolvan, Abrol) has an expectorant effect and stimulates the movement of ciliated epithelium in the bronchi, which promotes better removal of sputum. Prescribed 30 mg (1 tablet) 3 times a day or 75 ml (1 tablet) 1 time a day. The course of treatment is 10 days. The drug does not provoke allergic effects;
2. Acetylcysteine ​​(ACC) reduces the viscosity of sputum and thereby stimulates its better discharge. Prescribed 400–800 mg 1–2 times a day for 10 days. Allergic reactions in the form of skin rash;
3. Local anti-inflammatory drugs - Erespal, Inspiron eliminate hyperproduction of mucus and reduce swelling of the mucous and submucosal layers of the bronchial tree. Prescribed 1 tablet 2 times a day. The course of treatment is 10 days. Special instructions: causes increased heart rate and interruptions in heart function. Allergic reactions are rare.

At elevated body temperatures, non-steroidal anti-inflammatory drugs are used - Nimesulide, Ibuprofen - they have an antipyretic, decongestant and analgesic effect. Prescribed 200 mg 1-2 times a day.

If shortness of breath occurs, treatment of obstructive bronchitis is supplemented with bronchodilators in aerosols (Salmeterol, Berodual, Ventolin, Salbutamol), which have a bronchodilator effect and promote better clearance of mucus from the bronchi. Prescribed 2 breaths 3-6 times a day.

Inhalations

With exacerbation of obstructive chronic bronchitis, the following is noted:

• increased shortness of breath with changes in the frequency of respiratory movements, depth of inspiration;
• change in the nature of cough, sputum discharge;
• tightness in the chest.

When these symptoms appear, indicating an exacerbation, bronchodilators of all three groups are prescribed by inhalation. You can read about the properties of these drugs in the article Bronchodilators.

The main cause of obstruction in adults is bronchospasm. To eliminate it, they resort to short- and long-acting drugs. The drugs of choice for chronic obstructive bronchitis are Atrovent, Troventol, and oxythorpium bromide. The effect of their use appears after 30 minutes, lasts up to 6 hours, 3-4 doses are taken per day.

If therapy is ineffective, the following is additionally prescribed:

• adrenergic stimulants – Ventolin, Bricanil, Berotek inhalations, Clenbuterol Sopharma tablets, Clenbuterol syrup;
• theophylline tablets – Teopek, Theotard.

In acute conditions, inhalation of combination drugs is prescribed, combining the action of a hormonal agent with a bronchodilator. Read more about inhalations for bronchitis in our article Inhalations for bronchitis with a nebulizer.

Physiotherapy

Physiotherapy will improve the patient's condition. One of its means is massage (percussion, vibration, back muscles). Such manipulations help relax the bronchi and eliminate secretions from the respiratory tract. Modulated currents and electrophoresis are used. Her health has stabilized after sanatorium-resort treatment in the southern resorts of Krasnodar and Primorsky Krai.

Nutrition and diet

The diet during an exacerbation of the disease is aimed at eliminating swelling of the bronchial tree, stimulating the immune system, and replenishing protein reserves. Food should be high in calories, at least 3000 cal/day, with a predominance of proteins.

Useful products:

• fruits with vitamin C: orange, lemon, raspberry, grapefruit;
• dairy products: cheese, milk, cottage cheese;
• products containing magnesium: nuts, bananas, sesame seeds, pumpkin seeds, rye bread, buckwheat, olives, tomatoes;
• products with Omega-3 acids: fish oil, cod liver;
• vitamins A and E: green peas, beans, spinach, peach, avocado, carrots.

During treatment of a relapse, it is necessary to reduce the consumption of sugar and salt, limit the intake of allergenic foods (tea, chocolate, coffee, cocoa). Spicy, spicy, and smoked foods contribute to the development of bronchospasm, so they should also be excluded from the diet or eaten in small quantities.

Prevention

Prevention of obstructive bronchitis also involves:

• giving up the bad habit of smoking;
• reducing dust levels at home through wet cleaning. You can replace feather-filled pillows with hypoallergenic fillers. You can also remove carpets and soft toys, which are the first accumulators of dust particles;
• following a hypoallergenic diet, during which all foods that can intensify coughing attacks are excluded;
• taking vitamins B and C to support immunity. For this purpose, you can use herbal teas, which also help remove mucus from the bronchi;
• During the period of plant dusting, you can organize a stay in a comfortable microclimate, where any allergens are excluded.

Patients with obstructive asthmatic bronchitis first of all need to undergo hardening procedures and perform therapeutic breathing complexes.

Chronic obstructive bronchitis is the undisputed leader in the list of the most common respiratory diseases. Often exacerbating, it can lead to the development of pulmonary insufficiency and loss of ability to work, therefore, at the first suspicion of the disease, it is important to immediately consult a pulmonologist.

What is obstructive bronchitis?

The word “obstruction” is translated from Latin as “obstacle,” which quite accurately reflects the essence of the pathological process: due to narrowing or blocking of the airways, air has difficulty leaking into the lungs. The term means inflammation of the small respiratory tubes - the bronchi. So it turns out that “obstructive bronchitis” is a violation of the patency of the bronchi, which leads to the accumulation of mucus in them and difficulty breathing. A disease is called chronic if it lasts at least 3 months a year for 2 or more years.

Currently, the concept of “chronic obstructive bronchitis” is increasingly being replaced by another, more generalized one – chronic obstructive pulmonary disease (abbreviated as COPD). This diagnosis more accurately describes the nature of the lesion, because in reality, inflammation affects not only the bronchi. Very quickly it spreads to all elements of the lung tissue - blood vessels, pleura and respiratory muscles.

Causes of the disease

In 9 out of 10 people with this pathology, the cause is smoking.

The European Respiratory Society found that in 90% of cases, the appearance of obstructive bronchitis is associated with smoking. The fact is that cigarette smoke causes a burn to the mucous membrane of the respiratory tract. The attack on the irritated membranes is completed by the tars and formaldehydes contained in tobacco, which provoke their destruction. The disease can occur with both active and passive smoking.

An important role in the development of bronchitis is played by inhalation of other harmful substances that float in the atmosphere: industrial emissions, exhaust gases. That is why the victims of chronic disease often include residents of large cities and chemical industry workers.

More rare causes of the disease include severe congenital deficiency of α1-antitrypsin, an enzyme produced by liver cells. One of the functions of this compound is to protect lung tissue from aggressive factors.

In addition, the following can contribute to the development of the disease:

• frequent,
• alcohol abuse,
• old age,
• low immunity,
• hereditary predisposition to bronchitis,
• neurological disorders.

Chronic bronchitis worsens when weakened mucous membranes are infected with viruses, pneumococci or mycoplasmas.

Stages of development

The development of the disease begins with irritation of the bronchial mucosa. In response to it, special substances are produced in the walls of the respiratory tubes - inflammatory mediators. They cause swelling of the membranes and increase mucus secretion.

At the same time, the formation of protective factors (interferon, immunoglobulin) that prevent the proliferation of microbes on the mucous membranes is reduced. The surface of the respiratory tract is colonized by all kinds of pathogenic bacteria.

With prolonged inflammation, scar tissue grows around the bronchi, which further compresses them and prevents normal breathing. During this period, a person experiences dry wheezing and whistling sounds when exhaling.

The outcome of the inflammatory process is the “sticking together” of the smallest branches of the bronchi - bronchioles, as a result of which the supply of oxygen to the air sacs of the lungs (alveoli) is disrupted. This is how respiratory failure develops. This is the last stage of obstructive bronchitis, at which it is no longer possible to restore the destroyed bronchi.

Symptoms

The causative factor irritates the bronchial mucosa, which reacts to this with inflammation, secretion of large amounts of mucus and spasm.

The main symptom of chronic bronchitis is cough. At first, it bothers patients only during periods of exacerbations that occur in the cold season. During attacks, a small amount of sputum is released. During the illness, the temperature may rise slightly (up to 37.5–37.8 degrees).

Over time, patients begin to complain of a daily annoying morning cough. For some, attacks recur during the daytime. Their provocateurs are irritating odors, cold drinks, and frosty air.

Sometimes bronchospasms are accompanied by hemoptysis. Blood appears due to rupture of capillaries during strong straining.

The second symptom of chronic bronchitis is shortness of breath. In the early stages, it is felt only during physical activity. As the disease progresses, shortness of breath becomes permanent.

In the later stages, the disease resembles in many ways. Patients have difficulty inhaling. They exhale with wheezing and whistling. The duration of their exhalation increases.

Because of respiratory failure all tissues and organs begin to suffer from oxygen deficiency. This condition manifests itself:

• pale or blue discoloration of the skin,
• pain in muscles and joints,
• increased fatigue,
• sweating,
• decrease in body temperature.

The appearance of the nails changes - they become rounded and convex like watch glass. The fingers take on the shape of drumsticks. Against the background of shortness of breath, patients' neck veins swell. All these external signs help the doctor distinguish obstructive bronchitis from other similar conditions (lung cancer).
Doctor Komarovsky about what not to do with obstructive bronchitis

Diseases of the bronchopulmonary system are more often diagnosed in children in the age group from 8 months to 6 years. An important role in the development of this pathology is played by the hereditary factor, the child’s exposure to helminthic infestations, bacterial and viral infections. With a disappointing diagnosis of chronic obstructive bronchitis, children still have a chance to avoid serious consequences. Effective treatment consists of eliminating the inflammatory reaction in the bronchi, restoring their normal patency, and using bronchodilators and expectorants.

Infants are characterized by poor development of the upper respiratory tract, bronchi and lungs. The glandular tissue of the inner walls of the bronchial tree is delicate, susceptible to irritation and damage. Often, with diseases, the viscosity of mucus increases, and the cilia cannot evacuate thick mucus. All this should be taken into account before treating obstructive bronchitis in a child with medications and home remedies. It must be remembered that the severity of the disease in babies is influenced by intrauterine infections, acute respiratory viral infections in infancy, low body weight, and the presence of allergies.

The most important causes of bronchitis with obstruction in children:

• viruses - respiratory syncytial, adenovirus, parainfluenza, cytomegalovirus;
• ascariasis and other helminthiasis, migration of helminths in the body;
• structural anomalies of the nasal cavity, pharynx and esophagus, reflux esophagitis;
• microorganisms - chlamydia, mycoplasma;
• weak local immunity;
• aspiration.

The inflammatory process in obstructive bronchitis causes swelling of the mucous membrane, resulting in the accumulation of thick sputum. Against this background, the lumen of the bronchi narrows and spasm develops.

Viral infection has the greatest influence on the occurrence of obstructive bronchitis in children of all ages. Also, environmental factors and climatic anomalies play a negative role. The development of obstructive bronchitis in infants can occur against the background of early refusal of breast milk, transition to mixed or artificial feeding. Bronchial spasms occur in infants even when drops and pieces of food often enter the respiratory tract. Migrations of helminths can cause bronchial obstruction in children over 1 year of age.

Among the reasons for the deterioration of the bronchial mucosa, doctors name the poor environmental situation in the places where children live and parental smoking. Inhaling smoke disrupts the natural process of cleansing the bronchi from mucus and foreign particles. Resins, hydrocarbons and other components of smoke increase the viscosity of sputum and destroy the epithelial cells of the respiratory tract. Problems with the functioning of the bronchial mucosa are also observed in children whose parents suffer from alcohol addiction.

Obstructive bronchitis - symptoms in children

The bronchial tree of a healthy person is covered from the inside with mucus, which is removed along with foreign particles under the influence of miniature outgrowths of epithelial cells (cilia). Typical obstructive bronchitis begins with attacks of dry cough; the acute form is characterized by the formation of thick, difficult to separate sputum. Then shortness of breath occurs due to the fact that the inflamed mucous membrane thickens in the inflamed bronchi. As a result, the lumen of the bronchial tubes narrows and obstruction occurs.

Manifestations of bronchial obstruction syndrome in children:

• first, catarrhal processes develop - the throat becomes red, painful, and rhinitis occurs;
• when breathing, the intercostal spaces, the area under the sternum, are drawn in;
• it is difficult to breathe, shortness of breath, noisy, rapid, wheezing occurs;
• suffers from a dry cough that does not turn into a productive (wet) cough;
• low-grade fever persists (up to 38°C);
• attacks of suffocation periodically develop.

Wheezing and whistling in the lungs of a child with obstructive bronchitis can be heard even from a distance. The frequency of breaths is up to 80 per minute (for comparison, the average rate in 6–12 months is 60–50, from 1 year to 5 years – 40 breaths/minute). Differences in the course of this type of bronchitis are explained by the age of young patients, metabolic characteristics, and the presence of hypo- and avitaminosis. The serious condition in weakened babies can last up to 10 days.

With a recurrent course of the disease, repeated exacerbation of symptoms is possible. Against the background of ARVI, the mucous layer is irritated, the cilia are damaged, and the patency of the bronchi is impaired. If we are talking about an adult, then doctors talk about chronic bronchitis with obstruction. When young children and preschoolers get sick again, experts cautiously declare the recurrent nature of the disease.

Bronchial obstruction occurs not only with bronchitis

The main symptoms and treatment of obstructive bronchitis in children differ from those of other respiratory diseases. Externally, the symptoms resemble bronchial asthma, bronchiolitis, cystic fibrosis. With ARVI, children sometimes develop stenosing laryngotracheitis, when the sick baby has difficulty speaking, coughs violently, and breathes heavily. It is especially difficult for him to take a breath; even at rest, shortness of breath occurs, and the skin triangle around the lips turns pale.

When roundworm larvae migrate into the lungs, a child develops a condition resembling symptoms of bronchial obstruction.

Attacks of suffocation in a completely healthy child can be caused by reflux of stomach contents into the esophagus or aspiration of a foreign body. The first is associated with reflux, and the second is associated with hard pieces of food, small parts of toys, and other foreign bodies that have entered the respiratory tract. During aspiration, changing the position of the baby’s body helps him reduce attacks of suffocation. The main thing in such cases is to remove the foreign object from the respiratory tract as quickly as possible.

The causes of bronchiolitis and obstructive bronchitis are largely similar. Bronchiolitis in children is more severe, the bronchial epithelium grows and produces a large volume of sputum. Bronchiolitis obliterans often takes a chronic course, accompanied by bacterial complications, pneumonia, and emphysema. The bronchopulmonary form of cystic fibrosis is manifested by the formation of viscous sputum, whooping cough, and suffocation.

Bronchial asthma occurs if inflammatory processes in the bronchi develop under the influence of allergic components.

The main difference between bronchial asthma and chronic bronchitis with obstruction is that attacks occur under the influence of non-infectious factors. These include various allergens, stress, and strong emotions. In asthma, bronchial obstruction persists day and night. It is also true that over time, chronic bronchitis can develop into bronchial asthma.

Unfortunately, the chronic form of the disease in children is often detected only in an advanced stage. The airways are so narrow at this point that it is almost impossible to completely cure bronchial obstruction. All that remains is to restrain inflammation and alleviate the discomfort that occurs in young patients. Antimicrobial drugs, glucocorticosteroids, expectorants and mucolytics are used for this purpose.

Massage and feasible exercises increase the vital capacity of the lungs, help slow down the development of the disease, and improve the overall well-being of the sick child.

1. Do inhalations with saline solution, alkaline mineral water, bronchodilators through a steam inhaler or use a nebulizer.
2. Select expectorant medications with the help of a doctor and pharmacist.
3. Give herbal tea and other warm drinks more often.
4. Provide your child with a hypoallergenic diet.

When treating acute obstructive bronchitis in children, it is necessary to take into account that therapy is not always carried out only on an outpatient basis. If there is no effectiveness, children with bronchospasm are hospitalized. Often in young children, acute obstructive bronchitis is accompanied by vomiting, weakness, poor appetite or lack thereof. Also, indications for hospitalization are age under 2 years and an increased risk of complications. It is better for parents not to refuse hospital treatment if the child’s respiratory failure progresses despite treatment at home.

Features of drug therapy

Relief of attacks in sick children is carried out using several types of bronchodilators. Use drugs "Salbutamol", "Ventolin", "Salbuvent" based on the same active ingredient (salbutamol). The drugs "Berodual" and "Berotec" are also bronchodilators. They differ from salbutamol in their combined composition and duration of action.

Bronchodilators can be found in pharmacies in the form of syrups and tablets for oral administration, powders for the preparation of inhalation solution, and aerosols in cans.

Consultations with a doctor and pharmacist will help you decide on the choice of medications and decide what to do with them during outpatient treatment. For bronchial obstruction caused by ARVI, anticholinergic drugs are effective. The drug Atrovent from this group received the most positive reviews from specialists and parents. The product is used for inhalation through a nebulizer up to 4 times a day. The age-appropriate dosage for the child should be discussed with the pediatrician. The bronchodilator effect of the drug appears after 20 minutes.

Features of the drug "Atrovent":

• exhibits pronounced bronchodilator properties;
• acts effectively on large bronchi;
• causes a minimum of adverse reactions;
• remains effective during long-term treatment.

Antihistamines for obstructive bronchitis are prescribed only to children with atopic dermatitis and other concomitant allergic manifestations. Drops of Zyrtec and its analogues are used in infants; Claritin is used to treat children after 2 years of age. Severe forms of bronchial obstruction are relieved with the inhaled drug Pulmicort, a glucocorticoid. If the fever persists for more than three days and the inflammation does not subside, then systemic antibiotics are used - cephalosporins, macrolides and penicillins (amoxicillin).

Means and methods for improving sputum discharge

A variety of cough medications for childhood bronchitis are also used. From the rich arsenal of expectorants and mucolytics, preparations with ambroxol deserve attention - "Lazolvan", "Flavamed", "Ambrobene". Doses for single and course doses are determined depending on the age or body weight of the child. The most suitable dosage form is also selected - inhalation, syrup, tablets. The active component has a faster anti-inflammatory, expectorant and mucolytic effect when inhaled.

It is forbidden to take antitussive syrups and drops (cough reflex blockers) for obstructive bronchitis.

For obstructive bronchitis, various combinations of drugs are used, for example, 2-3 expectorants. First, they give medications that thin the mucus, in particular with acetylcysteine ​​or carbocysteine. Then inhalations with solutions that stimulate coughing - sodium bicarbonate and its mixtures with other substances. The improvement in the child’s condition becomes more noticeable after a week, and the full duration of the therapeutic course can be up to 3 months.

Breathing exercises and special massage are used to facilitate the discharge of sputum. For the same purpose, a procedure is performed to promote the outflow of sputum: the child is laid on his stomach so that his legs are slightly higher than his head. Then the adult folds his palms into a “boat” and taps them on the baby’s back. The main thing in this drainage procedure is that the movements of the hands are not strong, but rhythmic.

Did you know that...

1. The genetic basis of lung diseases has been proven through scientific research.
2. Among the risk factors for bronchopulmonary diseases, in addition to genetics, are abnormalities in the development of the respiratory system and heart failure.
3. In the mechanism of development of respiratory diseases, the sensitivity of the mucous membrane to certain substances plays an important role.
4. Children who are prone to allergic reactions or already suffer from allergies are more susceptible to recurrent forms of chronic respiratory diseases.
5. Experts from the USA have discovered the effect on the lungs of microbes that cause dental caries.
6. To identify lung diseases, radiography, computed tomography, and biopsy methods are used.
7. Modern alternative methods of treating respiratory diseases include oxygen therapy - treatment with oxygen and ozone.
8. Of the patients who have undergone lung transplantation, 5% are minors.
9. Reduced body weight often accompanies the progression of lung diseases, so care must be taken to increase the calorie content of the diet of frequently ill children.
10. Frequent obstructive bronchitis - up to 3 times a year - increases the risk of bronchospasm without exposure to infection, which indicates the initial signs of bronchial asthma.

Preventive measures

The diet and lifestyle of the mother during pregnancy affects the health of the baby. It is recommended to follow a healthy diet, not smoke, and avoid second-hand smoke. It is very important for a pregnant or nursing woman and her baby to stay away from harmful chemicals that cause allergies and toxicosis.

Negative factors that increase the chances of developing obstructive bronchitis:

• harmful effects of air pollutants - dust, gases, fumes;
• various viral and bacterial infections;
• genetic predisposition;
• hypothermia.

Continuing breastfeeding helps prevent obstructive bronchitis in children under one year of age. It is necessary to regularly clean, ventilate and humidify the air in the room where the child is. It is recommended to devote the health season in the summer to hardening procedures and relaxation by the sea. All these measures will help protect children and adult family members from bronchitis with obstruction.

Particular attention should be paid to the prevention of acute respiratory viral infections and allergies, as the most important causes of the development of chronic bronchitis in children.

It is more difficult to protect children attending children's institutions from various infections and helminthic infestations. It is recommended to constantly develop hygiene skills in a child from an early age, monitor compliance with the daily routine and diet. During seasonal infections, it is advisable to avoid visiting crowded places where new viruses quickly attack the child’s body. As a result, illnesses - ARVI, sore throat - are becoming more frequent. The mucous membrane of the upper respiratory tract and bronchi does not have time to recover, which provokes the development of bronchitis and its complications.

Signs of obstructive bronchitis in children, treatment, risk factors updated: March 21, 2016 by: admin

Obstructive bronchitis is an inflammatory disease that affects the bronchi and is complicated by obstruction. This pathological process is accompanied by severe swelling of the respiratory tract, as well as a deterioration in the ventilation capacity of the lungs. Obstruction develops more rarely; doctors diagnose non-obstructive bronchitis several times more often.

This disease is the “prerogative” of young children starting from the age of 3. It is more rare in people of working age.

Reasons

Obstructive bronchitis in children and adults most often begins to progress due to the penetration of infection into the body - viruses or bacteria. But in order for pathology to begin to develop, favorable conditions are also needed. The following factors contribute to the development of obstructive bronchitis in adults and children:

• decrease in the body's immune forces;
• inadequate and irrational nutrition;
• frequent diseases of the upper respiratory tract;
• stressful situations that are repeated repeatedly.

The second reason for the development and progression of the disease is an allergic reaction. If a child is prone to allergies, then the likelihood of developing chronic obstructive bronchitis increases.

Chronic obstructive bronchitis is a disease that most often begins to progress in people who smoke for a long time, work in production with various chemicals. substances and so on.

It is also worth highlighting internal factors that contribute to the development of obstructive bronchitis in adults and children:

• second blood group;
• hereditary deficiency of immunoglobulin A;
• deficiency of the enzyme alpha1-antitrypsin.

Stages

The severity of chronic obstructive bronchitis in an adult or child is assessed by FEV1, which stands for the volume of forced expiration produced in one second. There are three degrees of severity of the disease:

• Stage 1. FEV1 is more than 50% of normal values. At this stage, chronic obstructive bronchitis does not impair the patient’s quality of life. There is also no need to constantly be registered with a pulmonologist;
• Stage 2. FEV1 is reduced to 35–49%. In this case, the pathology affects the patient’s quality of life, so he needs to be systematically monitored by a pulmonologist;
• Stage 3. FEV1 less than 34%. The symptoms of the pathology are very pronounced. Patients should undergo treatment as an inpatient or outpatient in a pulmonary department.

Symptoms

Symptoms of obstructive bronchitis in children and adults are somewhat different. They largely depend on the severity of the pathology, the functioning of the immune system, as well as on the characteristics of the patient’s body.

Symptoms of the disease in adults

It is worth noting that acute obstructive bronchitis mainly affects children under five years of age, while in adults, symptoms appear only when the acute course becomes chronic. But sometimes primary acute obstructive bronchitis can begin to progress. As a rule, this occurs against the background of acute respiratory infections.

Symptoms:

• increase in temperature;
• dry cough. It usually develops in attacks, worsening in the morning or at night;
• the respiratory rate per minute increases up to 18 times. For a child this figure will be slightly higher;
• During exhalation, wheezing sounds are observed, which can be heard even at a distance.

If the above symptoms persist for three weeks, then doctors say that acute obstructive bronchitis has developed. If this condition recurs more than three times in a year, we will be talking about a recurrent form of the disease. But if the symptoms do not disappear within 2 years, then clinicians talk about the development of chronic obstructive bronchitis. In this case, the main clinical picture is supplemented by the following symptoms:

• headaches. Occur due to hypoxia;
• cough in the morning. Usually during it, sputum of a mucous or purulent nature is released;
• in severe cases of chronic obstructive bronchitis, hemoptysis may be observed;
• dyspnea;
• sweating;
• changes in the appearance of fingers and nails;
• increased fatigue.

Symptoms of the disease in children

Obstructive bronchitis in children usually occurs in an acute form. Risk group: children under 5 years of age. And it is possible that obstructive bronchitis may develop in an infant. There is one peculiarity - in a child, the symptoms of acute obstructive bronchitis are difficult to distinguish from bronchiolitis, so it is very important that the doctor conducts a competent differential diagnosis.

The development of acute obstructive bronchitis in children usually occurs due to the penetration of a viral infection into the body: adenovirus, etc. The pathology in a child is much more severe and complex. At first, you can note symptoms that are more indicative of development: the child is capricious, the temperature rises, and a slight cough appears.

The following symptoms indicate that acute obstructive bronchitis has begun:

• body temperature rises again;
• the cough is not productive and manifests itself in attacks;
• wheezing is observed when exhaling;
• increased breathing rate above the age norm (it is especially important to pay attention to this symptom when obstructive bronchitis develops in an infant);
• several elements of the body take part in the act of breathing at once - intercostal spaces, wings of the nose, jugular fossa, etc.;
• drowsiness or, conversely, constant anxiety;
• weak cry;
• the child refuses to eat.

Diagnostics

Diagnosis of acute and chronic obstructive bronchitis includes physical, endoscopic, laboratory, functional and radiological techniques. The program includes:

• percussion of the lungs;
• auscultation of the lungs;
• X-ray;
• spirometry;
• pneumotachometry;
• peak flowmetry;
• bronchography;
• sputum analysis by PCR;
• immunological tests.

The doctor will be able to tell how to treat obstructive bronchitis only after he has assessed the test results and identified the cause of the development of the pathology, as well as the severity of its course.

Treatment

Treatment for obstructive bronchitis requires a very long period of time and should only be carried out in a hospital setting. Therapy for an adult and a child is somewhat different. When drawing up a treatment plan for obstructive bronchitis, everything is taken into account - the characteristics of the pathology, the degree of FEV1, the general condition of the patient’s body, and age.

Treatment in adults

In order for the treatment of obstructive bronchitis in adults to be as effective as possible, it is necessary:

• eliminate the harmful factor that contributed to the progression of the disease - this could be an unfavorable place of work or smoking;
• stick to a diet;
• During the period of exacerbation, antibacterial drugs are added to the treatment plan for obstructive bronchitis. This is especially true in the case of purulent sputum. The drugs of choice are Sumamed, Amoxil;
• take bronchodilators;
• medications are prescribed that help thin sputum and remove it;
• vibration massage is indicated.

Treatment in children

Treatment of obstructive bronchitis in a child is carried out strictly in a hospital setting. Especially when it comes to babies. The treatment plan for a child’s illness includes the following measures:

• carrying out inhalations using a nebulizer. As a rule, a saline solution with the addition of Ventolin, Berodual and other drops is used;
• It is important to drink enough liquid per day;
• Only a doctor prescribes antibiotics to treat a child. Self-medication is unacceptable, as it can only worsen the course of the pathology;
• during the period of bronchial blockage, it is strictly forbidden to give expectorants;
• in more severe clinical situations, they resort to placing a dropper in the child with saline solution and the addition of active substances.

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