Bronchitis in children is a nonspecific inflammation of the lower respiratory tract, which occurs with the defeat of the bronchi of various sizes. Bronchitis in children is manifested by coughing (dry or with sputum of a different nature), fever, chest pain, bronchial obstruction, wheezing.
Bronchitis in children is diagnosed on the basis of an auscultatory picture, data on lung radiography, general blood count, sputum examination, FVD, bronchoscopy, bronchography. Pharmacotherapy of bronchitis in children is carried out with antibacterial drugs, mucolytics, antitussives; physiotherapy treatment includes inhalation, ultraviolet irradiation, electrophoresis, cupping and vibration massage, exercise therapy.
Bronchitis in children is an inflammation of the mucous membrane of the bronchial tree of various etiologies. For every 1000 children, there are 100-200 cases of bronchitis annually . Acute bronchitis accounts for 50% of all respiratory tract lesions in young children. Especially often the disease develops in children of the first 3 years of life; most severe in infants. Due to the variety of causally significant factors, bronchitis in children is the subject of study in pediatrics , pediatric pulmonology and allergology-immunology.
Causes of bronchitis in children
In most cases, bronchitis in a child develops after the transferred viral diseases – influenza , parainfluenza , rhinovirus, adenovirus, respiratory syncytial infection . Somewhat less often, bronchitis in children is caused by bacterial pathogens ( streptococcus , pneumococcus, haemophilus influenzae, moraxella, Pseudomonas aeruginosa and Escherichia coli, Klebsiella), fungi from the genus Aspergillus and Candida , intracellular infection ( chlamydia , mycoplasma , cytomegalovirus ). Bronchitis in children often accompanies the course of measles , diphtheria , whooping cough .
Bronchitis of allergic etiology occurs in children sensitized by inhalation allergens entering the bronchial tree with inhaled air: house dust, household chemicals, pollen, etc. In some cases, bronchitis in children is associated with irritation of the bronchial mucosa by chemical or physical factors: polluted air, tobacco smoke, gasoline vapors, etc.
Susceptibility to bronchitis is available in children with a history of perinatal background ( birth trauma , prematurity , malnutrition , etc.), Anomalies of the constitution (limfatiko-hypoplastic and exudative-catarrhal diathesis ), congenital malformations of the respiratory system , frequent respiratory diseases ( rhinitis , laryngitis , pharyngitis , tracheitis ), impaired nasal breathing ( adenoids , curvature of the nasal septum ), chronic purulent infection ( sinusitis , chronic tonsillitis ).
In epidemiological terms, the most important are the cold season (mainly the autumn-winter period), seasonal outbreaks of acute respiratory viral infections and influenza, the stay of children in children’s groups, and unfavorable social conditions.
Pathogenesis of bronchitis in children
The specificity of the development of bronchitis in children is inextricably linked with the anatomical and physiological features of the respiratory tract in childhood: abundant blood supply to the mucous membrane, looseness of the submucosal structures. These features contribute to the rapid spread of the exudative-proliferative reaction from the upper respiratory tract to the depth of the respiratory tract.
Viral and bacterial toxins inhibit the motor activity of the ciliated epithelium. As a result of infiltration and edema of the mucous membrane, as well as increased secretion of viscous mucus, the “flickering” of the cilia slows down even more – thereby turning off the main mechanism of bronchial self-cleaning.
This leads to a sharp decrease in the drainage function of the bronchi and difficulty in the outflow of sputum from the lower respiratory tract. Against this background, conditions are created for further reproduction and spread of infection, obturation with a secretion of the bronchi of a smaller caliber.
Thus, the peculiarities of bronchitis in children are the significant length and depth of damage to the bronchial wall, the severity of the inflammatory reaction.
Classification of bronchitis in children
By origin, distinguish between primary and secondary bronchitis in children. Primary bronchitis initially begins in the bronchi and only the bronchial tree is affected. Secondary bronchitis in children is a continuation or complication of another pathology of the respiratory tract.
The course of bronchitis in children can be acute, chronic and recurrent. Given the extent of the inflammation, limited bronchitis (inflammation of the bronchi within one segment or lobe of the lung), widespread bronchitis (inflammation of the bronchi of two or more lobes) and diffuse bronchitis in children (bilateral inflammation of the bronchi) are distinguished.
Depending on the nature of the inflammatory reaction, bronchitis in children can be catarrhal, purulent, fibrinous, hemorrhagic, ulcerative, necrotic and mixed. In children, catarrhal, catarrhal-purulent and purulent bronchitis is more common . A special place among the lesions of the respiratory tract is occupied by bronchiolitis in children (including obliterating ) – bilateral inflammation of the terminal sections of the bronchial tree.
By etiology, there are viral, bacterial, viral-bacterial, fungal, irritable and allergic bronchitis in children. By the presence of obstructive components, non-obstructive and obstructive bronchitis in children is distinguished .
Symptoms of bronchitis in children
In most cases, the development of acute bronchitis in children is preceded by signs of a viral infection: sore throat, coughing, hoarseness, runny nose, and conjunctivitis . Soon there is a cough: obsessive and dry at the onset of the disease, by 5-7 days it becomes softer, wetter and more productive with the separation of mucous or mucopurulent sputum. In acute bronchitis, a child has an increase in body temperature up to 38-38.5 ° C (lasting from 2-3 to 8-10 days, depending on the etiology), sweating, malaise, chest pain when coughing, in young children Shortness of breath.
The course of acute bronchitis in children is usually favorable; the disease ends with recovery on average after 10-14 days. In some cases, acute bronchitis in children can be complicatedbronchopneumonia . With recurrent bronchitis in children, exacerbations occur 3-4 times a year.
Acute bronchiolitis develops mainly in children of the first year of life. The course of bronchiolitis is characterized by fever, severe general condition of the child, intoxication, severe signs of respiratory failure (tachypnea, expiratory dyspnea, cyanosis of the nasolabial triangle, acrocyanosis). Complications of bronchiolitis in children can be apnea and asphyxia .
Obstructive bronchitis in children usually manifests itself in the 2-3rd year of life. The leading symptom of the disease is bronchial obstruction, which is expressed by paroxysmal cough, noisy wheezing, prolonged exhalation, and distant wheezing. Body temperature can be normal or subfebrile. The general condition of children usually remains satisfactory. Tachypnea, shortness of breath, participation in the respiration of the auxiliary muscles are less pronounced than with bronchiolitis. Severe obstructive bronchitis in children can lead to respiratory failure and the development of acute cor pulmonale .
Allergic bronchitis in children usually has a recurrent course. During periods of exacerbation, sweating, weakness, cough with mucous sputum are noted. Body temperature remains normal. Allergic bronchitis in children is quite often combined with allergic conjunctivitis , rhinitis, atopic dermatitis and can turn into asthmatic bronchitis or bronchial asthma .
Chronic bronchitis in children is characterized by exacerbations of the inflammatory process 2-3 times a year, occurring sequentially for at least two years in a row. Cough is the most persistent symptom of chronic bronchitis in children: it is dry during remission, and moist during exacerbations. Sputum is coughing up with difficulty and in small quantities; has a mucopurulent or purulent character.
Fever is mild and inconsistent. Chronic purulent-inflammatory process in the bronchi may be accompanied by the development of deforming bronchitis and bronchiectasis in children.
Diagnosis of bronchitis in children
Primary diagnostics of bronchitis in children is carried out by a pediatrician , clarifying – by a pediatric pulmonologist and a pediatric allergist-immunologist . When establishing the form of bronchitis in children, clinical data are taken into account (the nature of cough and sputum, the frequency and duration of exacerbations, features of the course, etc.), auscultatory data, the results of laboratory and instrumental studies.
The auscultatory picture in bronchitis in children is characterized by scattered dry (with obstruction of the bronchi – whistling) and moist rales of various sizes.
In the general analysis of blood at the height of the severity of the inflammatory process, neutrophilic leukocytosis, lymphocytosis, and an increase in ESR are found. Eosinophilia is characteristic of allergic bronchitis in children . The study of the gas composition of the blood is indicated for bronchiolitis to determine the degree of hypoxemia. Of particular importance in the diagnosis of bronchitis in children is sputum analysis:
microscopic examination, bacterial culture of sputum, examination for CFB, PCR analysis. If it is impossible for the child to independently cough up the secretions of the bronchi, bronchoscopy is performed with a sputum sampling .
Radiography of the lungs with bronchitis in children reveals an increase in the pulmonary pattern, especially in the basal zones. When carrying out FVD, a child may have moderate obstructive disorders. During the period of exacerbation of chronic bronchitis in children, bronchoscopy reveals the phenomena of widespread catarrhal or catarrhal-purulent endobronchitis. To exclude bronchiectasis , bronchography is performed .
Differential diagnosis of bronchitis in children should also be carried out with pneumonia , foreign bodies of the bronchi , bronchial asthma, chronic aspiration of food, tuberculosis, cystic fibrosis , etc.
Treatment of bronchitis in children
In the acute period, children with bronchitis are shown bed rest, rest, drinking plenty of fluids, and full fortified food.
Specific therapy is prescribed taking into account the etiology of bronchitis in children: it may include antiviral drugs (umifenovir hydrochloride, rimantadine, etc.), antibiotics (penicillins, cephalosporins, macrolides), antifungal agents. An obligatory component of the treatment of bronchitis in children is mucolytics and expectorant drugs that increase the liquefaction of sputum and stimulate the activity of the ciliated epithelium of the bronchi (ambroxol, bromhexine, mucaltin, breast fees).
With a dry, painful, exhausting cough of a child, antitussive drugs (oxeladin, prenoxdiazine) are prescribed; for bronchial obstruction – aerosol bronchodilators. Antihistamines are indicated for children with allergic bronchitis; with bronchiolitis, inhalation of bronchodilators and corticosteroid drugs is carried out .
From the methods of physiotherapy for the treatment of bronchitis in children, medicinal , oil and alkaline inhalations , nebulizer therapy , ultraviolet irradiation, UHF and electrophoresis on the chest, microwave therapy and other procedures are used. As a distraction therapy, the setting of mustard plasters and cans, cupping massage are useful . In case of difficulties in sputum discharge, chest massage , vibration massage , postural drainage, sanitation bronchoscopy, exercise therapy are prescribed .
Prevention of bronchitis in children
Prevention of bronchitis in children includes the prevention of viral infections, early use of antiviral drugs, exclusion of contact with allergic factors, protection of the child from hypothermia , hardening. An important role is played by timely preventive vaccination of children against influenza and pneumococcal infection .
Children with recurrent and chronic bronchitis need to be monitored by a pediatrician and a pediatric pulmonologist until a persistent cessation of exacerbations within 2 years, anti-relapse treatment in the autumn-winter period. Vaccine prophylaxis is contraindicated in children with allergic bronchitis; in other forms, it is carried out one month after recovery.