Obstructive bronchitis in children - causes, types, symptoms, treatment. How to recognize and treat obstructive bronchitis in children? Reflux and frequent obstructive bronchitis in children

Bronchitis is a common pathology of the bronchopulmonary system in childhood. It manifests itself in patients aged 1-6 years in the form of inflammatory changes in the bronchi due to the defeat of a viral or bacterial infection, physicochemical factors.

Allergies, lack of vitamin D, insufficient or overweight can also be causes. For a pathology such as obstructive bronchitis, in children, treatment is aimed at restoring bronchial patency and eliminating respiratory failure.

Due to the narrow lumen in the organ, the unformed epithelial layer produces very thick sputum. Congestion and secondary infection occur in the bronchi.

Compared to, bronchitis develops slowly.

Obstruction is classified according to severity into mild, moderate and severe.

It is possible to distinguish such a disease from bronchial asthma by the absence of allergic manifestations.

There are the following forms of the disease:

Acute. Acute obstructive bronchitis often occurs as a complication of acute respiratory infections.
Protracted.
Recurrent. Occurs after infectious diseases without respiratory failure. This type of bronchitis can occur with frequent aspiration (food entering the respiratory tract).

Often the symptoms of obstructive bronchitis in children manifest themselves in the form of complications against the background of hypothermia, flu, colds or SARS. Provocateurs of the appearance of the disease are high humidity, temperature changes. Therefore, pathology occurs in the spring or autumn.

Causes of the disease

The main cause of obstruction is viral pathology (adenovirus, parainfluenza virus, respiratory syncytial virus, cytomegalovirus), chlamydia and mycoplasma.

In early childhood, the disease can appear as a result of aspiration in violation of swallowing, gastroesophageal reflux and other pathologies of the nasopharynx, esophagus. In children aged 2 years and older, bronchial obstruction may occur due to the migration of helminths.

Predisposing factors for the appearance of pathology include the formation of viscous sputum, an increase in glandular bronchial tissue, the structure of the diaphragm, and low immunity.

Symptoms of the development of the disease

The first signs appear 2-3 days after hypothermia or the onset of the disease, and in case of serious disorders (diathesis, digestive tract disorders, liver or kidney dysfunction), symptoms can be observed on the first day.

At an older age, patients complain of bronchospasm, pain in the interscapular region, yellow sputum discharge, high fever.

The main signs of obstructive bronchitis:

Suffocation attacks.
Mucus accumulation.
Blue nasolabial triangle and nails (with insufficient oxygen supply).
Abscess and swelling.
Wheezing and noisy breathing.
Unproductive cough paroxysmal, sometimes causing vomiting.
Involvement of auxiliary muscles during breathing (bloating of the chest and retraction of the intercostal spaces).

2-4 days after the development of an infectious respiratory disease, catarrhal phenomena occur (sore throat, redness, runny nose). Due to an unproductive and irritating cough, infants often spit up and vomit. It is difficult for the child to take a deep breath and exhale.

Whistling rales can be heard even at a distance, and breathing becomes rapid and noisy, compliant areas of the chest are drawn in. Sometimes there is shortness of breath with an increase in respiratory rate of at least 10% of the norm. For children aged 1-3 years, the number of breaths for bronchitis should not exceed 40 times per minute.

Also for obstructive bronchitis in children, symptoms may be associated with elevated body temperature. The child becomes restless. The duration of this condition is about two days, and with rickets it can last longer.

Carrying out diagnostics

Before you start treating obstructive bronchitis in children, you should be diagnosed by a pulmonologist and pediatrician. Often the pathology is interconnected with sinusitis.

To eliminate the risk of sinusitis, you need to contact an otolaryngologist.

The diagnosis is determined after performing the following studies:

analysis of anamnesis;
listening to the respiratory organs for small bubbling rales and breath sounds;
conducting a detailed radiography to reflect the pulmonary pattern;
sputum culture (to determine the pathogen);
blood test (there is a deviation from the norm, leukocytosis and increased ESR);
spirometry (analysis of the respiratory volume of the lungs during inhalation and exhalation) after the age of five.

Additionally, doctors may prescribe allergy tests and a consultation with a phthisiatrician.

Complications of the disease

Sometimes the signs of acute obstructive bronchitis are similar to bronchial asthma, which is associated with asthma attacks. Therefore, with frequent manifestations of pathology, it is desirable to conduct a study of the child at the risk of having bronchial asthma. If respiratory failure develops, the patient may die due to untimely assistance.

With a tendency to allergic diseases, a recurrent form can develop, when, against the background of acute respiratory infections, obstructive bronchitis develops several times a year.

Obstruction treatment

Obstruction can be treated at home or in a hospital setting.

Indications for hospitalization include rapid development, lack of a therapeutic effect when taking drugs for 4-6 hours, age up to 1.5 years, the risk of complications or symptoms of intoxication (weakness, fever, nausea and loss of appetite), increasing signs of respiratory failure ( acrocyanosis, shortness of breath).

The basis of inpatient therapy includes:

Providing emergency care for respiratory failure. In severe cases, ventilation of the lungs, drug inhalations or oxygen masks are prescribed.
hormone therapy. In case of serious complications, hormones are administered intravenously. This eliminates inflammation and obstruction of the bronchi.
rehydration treatment. It is carried out in infants with moderate and severe dehydration (glucose-salt solutions are administered intravenously).

In the absence of complicating factors, it is better to be treated at home under the supervision of a pediatrician. The doctor will determine the need for the use of certain drugs, set the optimal dosage, based on the severity of the pathology.

With an exacerbation of obstructive bronchitis, it is necessary to take emergency measures related to the normalization of patency in the bronchi.

These measures include:

Elimination of nervousness (the use of sedatives, support for the mother, the presence of a favorite toy).
Medication inhalations. To stop obstruction in the child's body, you can use electric nebulizers with glucocorticoids, drugs based on salbutamol.
Therapeutic gymnastics and physical education with an instructor.
Acupressure (an operative way to relieve obstruction).
Climatotherapy. Useful sea and mountain climate, stay in the fresh air.
The use of humidified oxygen to eliminate shortness of breath.

At high temperatures, vitamins, saline solutions and hormones are additionally injected into the vein. If the pathology is often exacerbated, then doctors recommend spa treatment with a pulmonary profile. Additionally, physiotherapy (laser, electrophoresis, UHF) and vibromassage can be prescribed. In the absence of temperature, walks are recommended 2 times a day for 1.5 hours away from tracks and roads, playgrounds.

Complementary Therapies

It is necessary to ventilate the rooms daily, especially before rest, control the humidity of the air (if necessary, use a humidifier), and exclude the contact of the child with detergents.

In the course of treatment can be used:

Warm plentiful drink (mineral alkaline water).
Bronchodilators. Medications dilate the bronchi, are designed to eliminate obstruction: syrups and inhaled solutions of glucocorticoids for bronchitis in children, diluted with saline. Inflammation relieves Fenspiride.
Antispasmodics. Substances are aimed at reducing spasms in the bronchi, can be used by means of an inhaler, in the form of tablets or intravenously in stationary conditions.
Mucolytic and expectorant cough preparations. For the discharge of mucus, substances with ambroxol, carbocysteine are prescribed, then expectorant drugs, chest fees are used. The dosage of drugs is determined according to the age and weight of the child.
Draining massage. You can massage the child's back, chest and collar area, do postural massage (beat the back in the morning and hang it upside down).
Antihistamines. Eliminate allergic manifestations. They are prescribed for concomitant allergies, atopic dermatitis.
Antiviral agents in the form of syrups, drops or suppositories.
Antibiotics. They are prescribed for infectious bronchitis, when a child develops bronchial obstruction, purulent discharge, vomiting, headache. Macrolides, cephalosporins, penicillins are used.
Treatment with hormones (only under medical supervision).

Prohibited treatments

Also, you can not smear or rub the child with warming ointments, use mustard plasters, carry out inhalations with herbs, make compresses with buckwheat, potatoes, salt. This can lead to frequent spasms of the bronchi.

It is recommended to drink infusions of lime blossom, raspberries, diaphoretics (at least 1.5 liters per day), a collection of licorice roots, coltsfoot and plantain leaves. With a strong cough, thyme grass, a decoction of sage in milk will be effective.

Folk methods

Rubbing on butter and vegetable oil in a heated form will be effective. You can make a creamy honey compress by mixing the substances in equal proportions and heating them over low heat. A warm composition is applied to the back and chest of the child, insulated with a cloth and covered with polyethylene until the morning.

If the baby's body temperature rises, then bed rest is prescribed. It is recommended to walk a lot in the fresh air for 1-1.5 hours, dress the child according to the season. It is also recommended to drink plenty of warm water to eliminate dehydration, thin the mucus.

Features of nutrition and care

For the period of fever, a diet is prescribed for obstructive bronchitis with fortified easily digestible foods (warm purees, soups), drinking plenty of water to reduce intoxication and thin sputum. It is also useful to drink freshly squeezed juices, dried fruit decoctions, fruit drinks, compotes made from fresh berries. For a child, weak tea and mineral water will be useful.

Highly allergenic products (spices, honey, chocolate, citrus fruits) are excluded from the diet, which may cause bronchospasm.

While caring for a small patient, it is necessary to ventilate the premises daily, carry out wet cleaning without detergents and disinfectants. Careful control of air humidity is required, since its excessive dryness leads to a delay in the pathology, the development of complications.

Preventive procedures

The child needs to ensure healthy sleep, eliminate provoking factors and allergens, and carry out wet cleaning. You also need to protect the child from infectious diseases, carry out hardening and not visit crowded places.

For allergy sufferers, contacts with provoking factors (dry air, tobacco smoke, sharp toxic odors) should be limited as much as possible.

In case of recurrence of the disease, a pulmonologist should be consulted to rule out asthma and develop rehabilitation measures.

A frequently ill child is a concept that does not exist in official medicine, but all doctors and parents know it. It is mainly used in relation to respiratory diseases. Why does a child often develop bronchitis, and what to do in this case?

In a healthy state, the bronchi are covered from the inside with a thin layer of mucous membrane.

It performs a protective function: envelops the respiratory tract and retains small particles of dust that enter with the breath.

With the help of a cough reflex and contraction of the muscle layer, the bronchi remove from the body all foreign particles that have settled on the mucosa.

When an infection enters the body, inflammation, swelling appear in the bronchi, and degenerative changes may occur.

The lumen of the path narrows due to excessive production of mucus, which is difficult to expectorate. The same happens with an allergic course, when the provoking factor constantly irritates the respiratory mucosa.

The causes of inflammation can be different. The form of bronchitis, its course and the rate of recovery of the patient depend on the duration of their exposure.

Causes of bronchitis

Inflammation in the bronchial tree can be caused by:

infection. Viruses enter through the respiratory tract much more often than you think. Due to the protective properties of the body, only a small part of them is activated and causes disease. The causes of frequent bronchitis may be a violation of the immune defense, when it is not able to defeat the infection at the initial stage.
Toxins. Irritation of the mucous membrane, for example, with toxic poisoning, leads to an inflammatory process. If the action of toxins has stopped, then the airways begin to heal, and the symptoms subside. However, the recovery process is accompanied by increased sputum production, due to which a person may still complain of a cough. In adults, persistent bronchitis can occur, for example, due to the peculiarities of working with chemicals.
Allergens. Every time you come into contact with an allergen, your body reacts in a certain way. For example, with hay fever, coughing can bother you every time you go outside in the spring. In this case, it is important to distinguish an infectious course from an allergic one.

Correctly identifying the cause of bronchitis is very important, since the treatment regimen may vary.

Recurrent bronchitis

Doctors call frequent bronchitis in children recurrent bronchitis. Its characteristics:

Occurs against the background of a respiratory viral infection.
Rhinitis and redness of the throat in a patient pass much faster than a cough.
It is more common in children under 4 years of age.
Symptoms last 2 weeks or longer.
Acute episodes appear 4 times a year or more.

The cause of recurrent bronchitis is the increased sensitivity of the mucosa, which begins to actively respond to the slightest hit of the virus. This feature is observed in children prone to allergies, as well as non-observance of healthy climatic conditions in the room. For example, children may often get sick when:

Hereditary predisposition to allergies, especially respiratory ones (hay fever, animal hair).
Passive smoking.
Congenital pathologies of bronchial tissue (dysplasia).
Chronic overdrying of the mucosa due to dry and hot air.

If the child has frequent bronchitis, it is recommended to take care of his lifestyle, and not treat with pills. Komarovsky says that the optimal air temperature is 20 degrees, and humidity - 60%. Maintaining these parameters will help to significantly reduce the frequency of relapses.

Treatment

With frequent recurrent cough treatment is in:

Eliminate the cause of the acute condition.
Relief of the patient's symptoms.
Identification of the causes of frequent relapses and their prevention.

Standard therapy for acute bronchitis includes the following groups of drugs:

Antivirals.
Antibiotics. Doctors may prescribe them to prevent the development of pneumonia.
Immunostimulants. Raise the body's own defenses and prevent relapses.
Mucolytics. Liquefies mucus and makes it easier to expel.
Expectorants. Promotes expectoration and cleansing of the respiratory tract.
Antihistamines. Effectively relieve swelling in any etiology of the disease.

With recurring bronchitis, which "are treated for six months", it is necessary to adhere to the following rules:

Lots of outdoor walks.
Maintain humid and cool indoor air.
In the summer, during the heat, use an inhaler with saline daily to prevent the mucosa from drying out.
Lead an active lifestyle and eat right.
Avoid smoky and dusty areas.

Such activities will help strengthen the cardiovascular and immune systems so that the child does not get sick. They are also the basis for the prevention of many respiratory diseases..

During an illness, patients are often interested in the following questions:

Doctors are allowed to walk on the street if the child feels well, and he no longer has a temperature.

Smoking only aggravates the course of the disease. Chronic bronchitis in adults is often triggered by smoking.

The warming effect of pepper and other folk remedies should extend to the focus of inflammation, so they glue it on the back and chest, avoiding the heart area.

Treatment of recurrent bronchitis should be aimed at raising general and local immunity.

With obstructive bronchitis, it is very important to keep the airway mucosa moist. Moist and cool air will help relieve spasm and reduce the frequency of attacks. In severe cases, bronchodilators are recommended, which are available in the form of aerosols.

Residual cough

Residual is a cough that continues after recovery. It appears as a result of damage to the mucous membrane during an illness. Recovery may take up to three weeks, during which time the cough may persist. As a rule, it is not accompanied by sputum discharge..

The recovery period depends on the strength of the immune system. The bronchi are irritated and easily infected. Again, humidified air and a diet rich in vitamins will help speed up the healing of the mucosa.

Doctor Komarovsky will talk about bronchitis

The doctor will tell you about the causes of obstructive bronchitis and how to treat it.

Inflammation of the bronchi is a common occurrence in childhood. Simple forms of the disease, subject to the treatment regimen prescribed by the doctor, are successfully treated at home. But this does not apply to such a type of illness as obstructive bronchitis in children, since most babies with a similar diagnosis need hospitalization.

The task of parents is to pay attention to signs of obstruction in time and call a doctor. With obstructive bronchitis, the risk of developing serious complications is quite high, and only timely therapy helps to avoid life-threatening consequences of the disease.

The term "obstructive bronchitis" in medicine refers to inflammation of all elements of the bronchial tree, occurring with a violation of the normal patency of the bronchi (obstruction). As a result, the discharge of the produced mucus is difficult, in turn, this is due to the following changes:

bronchial muscles spasm, and, as a result, the lumen of the bronchial tree narrows;
the viscosity of sputum increases, it becomes dense, difficult to separate. At the same time, more mucus begins to be produced;
swelling of the mucous membranes increases, which further narrows the airways.

The frequent development of obstructive bronchitis in preschool age is associated with the anatomical and physiological characteristics of the respiratory system, with the imperfection of the immune system and with the special functioning of the bronchi.

Obstructive bronchitis in children most often occurs in the first three years of their life. According to statistics, at this age, more than 20% of babies suffer from bronchitis with obstruction. The risk group includes frequent respiratory infections (more than 6 times a year) children and preschoolers with a history of allergic diseases. In most cases, obstructive bronchitis occurs during the cold months of the year.

Recurrent forms of obstructive bronchitis increase the likelihood of developing bronchial asthma, bronchiolitis obliterans, emphysema, and chronic bronchitis.

The main causes of the disease

In most cases, the cause of obstructive bronchitis under the age of three years is infection of the respiratory system with viruses. Most often it is:

influenza and parainfluenza viruses;
enterovirus;
adenoviruses;
respiratory syncytial virus.

Among the bacterial pathogens, Streptococcuspneumoniae, Haemophilusinfluenza are distinguished. Moraxellacatarrhalis. Obstruction can develop against the background of viral and bacterial infection; if recurrent forms of pathology are detected, it is necessary to exclude the presence of mycoplasmas, chlamydia, cytomegalovirus, herpes infection in the body. Most often, the first signs of bronchial obstruction in young children appear against the background of SARS.

There are several provoking factors of the disease that explain the frequent occurrence of obstruction in childhood, these are:

features of the structure and functions of the respiratory system:
- narrowness of the lumen of all respiratory tracts;
- insufficient functioning of the organs of local immunity;
- insufficient elasticity of the framework of the bronchial tree;
- weakness of the muscles of the respiratory system;
- increased viscosity of the produced mucus;
- in young children - the predominance of sleep over the active period, prolonged stay in the supine position, which worsens the drainage properties of the bronchi;
pathology of the mother during the period of bearing a child - the threat of miscarriage, preeclampsia and toxicosis, infections;
harmful to a pregnant woman - alcohol abuse, smoking;
hereditary predisposition to allergic diseases;
bronchial hyperreactivity;
congenital anomalies in the development of the broncho-pulmonary system.
prematurity of the child;
low birth weight of the baby;
vitamin D deficiency in the body and rickets;
SARS that occur in the first months of life;
early transfer of the child to artificial nutrition.

The development of obstructive bronchitis is also influenced by the unfavorable conditions in which the child lives. These are increased humidity of residential premises, fungus on the walls, smoking of parents in the presence of children, poor environmental conditions in the area of residence.

The likelihood of the disease is increased, and if the child, along with food, receives less essential vitamins and minerals.

Pathogenesis

Bronchial obstruction develops according to a specific mechanism.

The pathogenic microorganism is introduced into the mucous membranes of the bronchi, which leads to the appearance of a local inflammatory reaction.
Under the influence of viruses or bacteria, the immune system begins to produce interleukin-1, an inflammatory mediator, in large quantities. In turn, under its influence, the permeability of the vascular walls increases, the mucous membranes swell, and the microcirculation in the bronchi is disturbed.
The secretion of mucus increases, and its rheological properties change, that is, it becomes viscous and less fluid.
The drainage function of the bronchial tree worsens, this leads to the accumulation of sputum, as a result of which ideal conditions are created for the further development and reproduction of the pathogenic microorganism.
The reactivity of the bronchi increases, bronchospasm occurs.

All changes that accompany the development of bronchial obstruction reduce the effectiveness of breathing and lead to insufficient oxygen supply to most tissues and internal organs.

At the initial stage, the disease can manifest itself only with perspiration and sore throat, fever, rhinorrhea. The child may worry, often refuses to eat, and dyspeptic symptoms are not excluded at an early age.

Signs of bronchial obstruction usually appear after 1-2 days. Pathology can be determined independently by the following symptoms:

the child's respiratory rate increases to 60 breaths per minute;
the duration of the exhalation increases, due to which the breath becomes wheezing, the noise is clearly audible at a distance;
cough with obstruction is paroxysmal, sputum practically does not go away;
during breathing, the chest rises, and the intercostal spaces retract;
the skin turns pale, and cyanosis of the skin may appear in the mouth area.

Lack of oxygen causes the child to apathy, drowsiness. In the first months of life, obstruction can lead to the development of a severe form of respiratory failure - acute bronchiolitis.

Broncho-obstruction can persist for 4-7 days, as the inflammatory process decreases, the severity of the main signs of the disease also decreases.

Diagnostics

The diagnosis is established on the basis of examination, auscultation of the respiratory tract, laboratory and instrumental methods of examination. When listening with a phonendoscope, various rales (dry and wet), an elongated exhalation are revealed.

Diagnostics includes:

complete blood count - shows an inflammatory reaction;
biochemical, immunological and serological examination of blood;
allergy tests. They are of greater importance in the recurrent form of bronchitis;
sputum culture to identify the causative agent of the disease;
radiography. It is used to exclude pneumonia, foreign bodies in the bronchial tree, emphysema;
bronchoscopy;
FVD - a study of the functions of external respiration.

A set of diagnostic measures is selected depending on the severity of the manifestations of obstruction and the age of the child. Obstructive bronchitis must be differentiated from an attack of bronchial asthma; with a sharp development of bronchospasm, it is not excluded that a foreign object enters the baby's airways.

Hospitalization of a child with obstructive bronchitis in a hospital is necessary:

if the child is less than one year old;
with severe intoxication, as indicated by high body temperature, vomiting, refusal to eat, drowsiness;
when revealing signs of respiratory failure - acrocyanosis (cyanosis of the nasolabial triangle and nails), shortness of breath. The respiratory rate in children should be counted during sleep, since the child will breathe more often when crying and worrying. In uncomplicated forms of bronchitis, the respiratory rate per minute in children is up to 40 per minute, exceeding this value indicates obstruction.

In other cases, the treatment of hospitalization of a sick child is taken by a doctor. The child is left for treatment at home if the parents are aware of the need to perform the prescribed therapy.

Treatment should be comprehensive - medications are necessarily used, they are selected depending on the symptoms of the disease. The therapy is supplemented by inhalations, massage to improve the drainage function of the bronchi, folk methods of treatment. Properly organized nutrition is also important in recovery.

In the acute phase of the disease, it is necessary to observe a half-bed rest. The child's room should be ventilated, wet cleaning should be done in it 2-3 times a day, with increased dryness of the air, humidifiers should be used.

Medical therapy

If obstructive bronchitis begins with symptoms of acute respiratory viral infections, then it is advisable to prescribe antiviral drugs in the first days of the disease - Viferon, Grippferon, Kagocel, Arbidol.

Antibiotics for obstructive bronchitis are not used in all cases. Indications for the appointment of antibiotic therapy:

the temperature rises for 3 days or more;
the disease proceeds with severe intoxication;
when coughing, purulent yellow-green sputum is separated (indicates bacterial inflammation);
increased risk of developing pneumonia.

In all cases of bronchial obstruction, cough medicines are prescribed. First, it is necessary to use those means that can thin the sputum and improve its exit from the bronchi. These drugs include Lazolvan, Ambroxol, Fluditec, Bronchobos. The duration of their reception can reach up to 10 days.

After the paroxysmal cough becomes wet, expectorants are prescribed - Tussin, Gerbion, Prospan, Bronchicum. Their child needs to drink on average one week.

With bronchial obstruction, antitussives are prescribed in rare cases - the resulting sputum must be coughed up, otherwise the infected secret will enter the lungs and cause inflammation.

With a tendency to allergic reactions, the main drug therapy is supplemented by taking antihistamines. When the temperature rises, antipyretics are used.

Obstruction in a child quickly resolves with the introduction of bronchodilator drugs through a nebulizer. Used drugs such as Berodual, Pulmicort. Inhalations are mainly carried out up to three times a day, the dose of the drug is selected based on the age of the child.

Folk remedies

Obstructive bronchitis in a child should be treated only with medications. Phytotherapy will not give the desired result, and in some cases, especially for children with a predisposition to allergies, it can worsen the course of the disease.

From folk remedies, you can only use decoctions of herbs that soften the throat and relieve coughing. This is chamomile, coltsfoot, Bogorodskaya grass, oregano.

It must be remembered that with obstructive bronchitis it is impossible:

apply warm compresses. Their use creates ideal conditions for the reproduction of bacteria, which worsens the course of the disease;
rub the child with vodka at a temperature. This can cause vasospasm, that is, the obstruction will increase;
rub the baby's breasts with fat. The oil film disrupts thermoregulation, as a result of which the viscosity of the mucus increases even more.

At the time of the attack, it is allowed to do hot foot baths. Facilitates breathing and steam inhalation, only you need to breathe over warm, not hot steam.

Massage

Massage improves the discharge of accumulated sputum from the respiratory tract. If the child is only a few months or years old, then it is enough to carry out vibration massage. To do this, you need to put him with his tummy on a pillow, so that his head drops below his back. Massage is carried out by tapping on the back with fingertips or the edge of the palm. The procedure is not carried out after feeding, as it can cause vomiting.

An older child can perform postural drainage. To do this, in the morning after waking up, he should hang his head down from the bed, rest his palms on the floor and hold out in this position for up to 20 minutes.

Breathing exercises

Breathing exercises that help improve the patency of the bronchial tree can be performed by babies 2-3 years old. The simplest ones are imitation of inflating a balloon with your lips, blowing out a candle, deep breaths through your nose.

Food

With the development of obstructive bronchitis, the child's nutrition should be reviewed. The diet should be hypoallergenic, preference should be given to dairy and vegetable foods, cereals on the water, vegetable soups.

Be sure the child should drink as much as possible - the liquid reduces the viscosity of the mucus, promotes its removal and prevents the growth of bacteria. From drinking it is better to choose rosehip broth, compotes, freshly squeezed juices, mineral water without gases.

Consequences and complications

Obstructive bronchitis in children can become chronic with exacerbations up to several times a year. Possible complications also include pneumonia, bronchial asthma. Chronic hypoxia negatively affects the overall development of the child.

Prevention

The likelihood of developing obstructive bronchitis in children is reduced if the following conditions are met:

acute respiratory diseases must be treated in time and completely;
foci of chronic infection of the oral cavity and nasopharynx should be sanitized;
children should live in favorable social conditions;
food should always be varied and fortified;
it is necessary to improve the functioning of the child's immune system, this helps hardening, walking in the fresh air, age-appropriate workouts.

With recurrent forms of pathology, children should be periodically taken out for sanatorium treatment. With a predisposition to allergies, it is necessary to identify the allergen and minimize its effect on the body.

Conclusion

Obstructive bronchitis that develops in children can cause bronchospasm with suffocation. To prevent this from happening, when fixing the first symptoms of the disease, you need to consult a pediatrician. Self-selected treatment can harm the child, and parents should always be aware of this.

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 by a mold fungus that 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 opportunistic components of the normal microflora of the respiratory tract.

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

Recurrent episodes of obstructive bronchitis in children are promoted by helminthic invasion, the presence of foci of 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 - fever, sore throat, runny nose, general malaise. In young children, 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, there is an involvement in the act of breathing of auxiliary muscles, 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 a wet cough, sputum is difficult to cough up. 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 under dispensary observation by a pediatrician, possibly a pediatric pulmonologist and an allergist.

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 susceptibility to helminthic invasions, bacterial and viral infections. With a disappointing diagnosis of chronic obstructive bronchitis in children, there is a chance to avoid serious consequences. Effective treatment consists in eliminating the inflammatory reaction in the bronchi, restoring their normal patency, 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, prone to irritation and damage. Often, in diseases, the viscosity of the mucus increases, the cilia cannot evacuate thick sputum. All this should be considered before treating obstructive bronchitis in a child with medicines and home remedies. It must be remembered that the severity of the disease in babies is influenced by the intrauterine infections they have suffered, SARS in infancy, underweight, and the presence of allergies.

The most important causes of obstructive bronchitis in children are:

viruses - respiratory syncytial, adenoviruses, parainfluenza, cytomegalovirus;
ascariasis and other helminthiases, migration of helminths in the body;
anomalies in the structure of the nasal cavity, pharynx and esophagus, reflux esophagitis;
microorganisms - chlamydia, mycoplasmas;
weak local immunity;
aspiration.

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

Viral infection has the greatest influence on the occurrence of obstructive bronchitis in children of all ages. Also, a negative role belongs to environmental factors, climatic anomalies. The development of obstructive bronchitis in infants can occur against the background of early refusal of breast milk, the transition to mixed or artificial feeding. There are spasms of the bronchi in infants, even with frequent ingestion of drops and pieces of food into the respiratory tract. Helminth migrations can cause bronchial obstruction in children older than 1 year.

Among the reasons for the deterioration of the bronchial mucosa, doctors call the poor environmental situation in the places of residence of children, smoking of parents. Inhalation of smoke disrupts the natural process of clearing the bronchi of mucus and foreign particles. Resins, hydrocarbons and other components of smoke increase the viscosity of sputum, 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 dependence.

Obstructive bronchitis - symptoms in children

The bronchial tree of a healthy person is covered with mucus from the inside, 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 joins due to the fact that the inflamed mucosa thickens in the inflamed bronchi. As a result, the lumen of the bronchial tubes narrows, obstruction occurs.

Manifestations of bronchial obstruction syndrome in children:

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

Wheezing and wheezing in the lungs of a child with obstructive bronchitis can be heard even at a distance. The frequency of breaths is up to 80 breaths per minute (for comparison, the average rate at 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 small patients, the characteristics of metabolism, the presence of hypo- and beriberi. A serious condition in weakened babies can last up to 10 days.

With a recurrent course of the disease, a repeated exacerbation of symptoms is possible. Against the background of ARVI, irritation of the mucous layer occurs, cilia are damaged, bronchial patency 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 are cautious about 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. Outwardly, the symptoms resemble bronchial asthma, bronchiolitis, cystic fibrosis. With ARVI, children sometimes develop stenosing laryngotracheitis, when a sick baby speaks with difficulty, coughs hoarsely, and breathes heavily. It is especially difficult for him to take a breath, even at rest there is shortness of breath, the skin triangle around the lips turns pale.

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

Attacks of suffocation in a perfectly healthy child can provoke reflux of the contents of the stomach into the esophagus, aspiration of a foreign body. The first is associated with reflux, and the second - with solid pieces of food, small parts of toys, and other foreign bodies that have entered the respiratory tract. With aspiration, changing the position of the baby's body helps him reduce asthma attacks. The main thing in such cases is to remove the foreign object from the respiratory tract as soon as possible.

The causes of bronchiolitis and obstructive bronchitis are similar in many ways. Bronchiolitis in children is more severe, the epithelium of the bronchi grows and produces a large amount of sputum. Obliterating bronchiolitis often takes a chronic course, accompanied by bacterial complications, pneumonia, 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, strong emotions. In asthma, bronchial obstruction persists day and night. It is also true that over time, chronic bronchitis can turn into bronchial asthma.

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

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

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

When treating acute obstructive bronchitis in children, it must be taken into account that therapy is not always carried out only on an outpatient basis. In the absence of effectiveness, babies with bronchospasm are hospitalized. Often in young children, acute obstructive bronchitis is accompanied by vomiting, weakness, poor appetite or lack of it. Also indications for hospitalization are age up to 2 years and an increased risk of complications. It is better for parents not to refuse inpatient treatment if the child's respiratory failure progresses despite treatment at home.

Features of drug therapy

The relief of seizures in sick children is carried out using several types of bronchodilator drugs. Use drugs "Salbutamol", "Ventolin", "Salbuvent" based on the same active ingredient (salbutamol). Preparations "Berodual" and "Berotek" also belong to bronchodilators. They differ from salbutamol in their combined composition and duration of exposure.

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

To decide on the choice of medicines, decide what to do with them during the period of outpatient treatment, consultations with a doctor and pharmacist will help. With bronchial obstruction that has arisen against the background of SARS, anticholinergic drugs are effective. Most of the positive feedback from specialists and parents collected the drug "Atrovent" from this group. The agent is used for inhalation through a nebulizer up to 4 times a day. The age-appropriate dose for a child should be discussed with the pediatrician. The bronchodilatory effect of the drug appears after 20 minutes.

Features of the drug "Atrovent":

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

Antihistamines for obstructive bronchitis are prescribed only for children with atopic dermatitis and other associated allergic manifestations. Use in infants drops "Zirtek" and its analogues, "Claritin" is used to treat children after 2 years. Severe forms of bronchial obstruction are removed with an inhalation drug "Pulmicort" related to glucocorticoids. 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 medicines for childhood bronchitis also find use. From the rich arsenal of expectorants and mucolytics, preparations with ambroxol deserve attention - "Lazolvan", "Flavamed", "Ambrobene". Doses for single and course intake 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 ingredient has a faster anti-inflammatory, expectorant and mucolytic effect when inhaled.

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

With obstructive bronchitis, various combinations of drugs are used, for example, 2-3 expectorants. First, drugs are given that thin the mucus, in particular, with acetylcysteine or carbocysteine. Then inhalations with solutions that stimulate expectoration - 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.

Apply to facilitate the discharge of sputum breathing exercises, a special massage. For the same purpose, they perform a procedure that promotes the outflow of sputum: they lay the child on his stomach so that his legs are slightly higher than his head. Then the adult folds his palms in 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.

Do you know that…

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