Obstructive bronchitis in children is an inflammatory lesion of the bronchial tree, occurring with the phenomenon of obstruction, i.e., impaired patency of the bronchi. The course of obstructive bronchitis in children is accompanied by an unproductive cough, noisy wheezing with forced expiration, tachypnea, and distant wheezing. When diagnosing obstructive bronchitis in children, data from auscultation, 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.
Bronchitis in children is the most common respiratory tract disease. In young children, inflammation of the bronchi often occurs with broncho-obstructive syndrome caused by mucosal edema, increased bronchial secretion and bronchospasm. In the first three years of life, about 20% of children suffer from obstructive bronchitis ; in half of them, episodes of bronchial obstruction are repeated at least 2-3 times in the future.
Children who repeatedly suffer from acute and obstructive bronchitis constitute a risk group for the development of chronic bronchopulmonary pathology ( chronic bronchitis , obliterating bronchiolitis , bronchial asthma, bronchiectasis , pulmonary emphysema). In this regard, the issues of interpretation of the etiology and pathogenesis, clinical course, differential diagnosis and modern therapeutic treatment are priorities for pediatrics and pediatric pulmonology.
Respiratory syncytial virus , parainfluenza virus type 3, enteroviruses , influenza viruses , adeno- and rhinoviruses play a primary role in the etiology of obstructive bronchitis in children . Confirmation of the leading importance of viral pathogens is the fact that in most cases, the manifestation of obstructive bronchitis in a child is preceded by ARVI .
With repeated episodes of obstructive bronchitis in children, the lavage from the bronchi often reveals the DNA of persistent infections – chlamydia , mycoplasma, herpes viruses , cytomegalovirus . Often bronchitis with obstructive syndrome in children is provoked by mold, which multiplies intensively 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 are conditionally pathogenic 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 – an increased individual sensitivity to food, drugs, house dust, animal hair, and plant pollen. That is why obstructive bronchitis in children is often accompanied by allergic conjunctivitis, allergic rhinitis , and atopic dermatitis.
Relapses of obstructive bronchitis episodes in children are facilitated by helminthic invasion , the presence of foci of chronic infection (sinusitis, tonsillitis, caries, etc.), active or passive smoking , smoke inhalation, living in ecologically unfavorable regions, etc.
The pathogenesis of obstructive bronchitis in children is complex. The invasion of a viral agent is accompanied by inflammatory infiltration of the bronchial mucosa by plasma cells, monocytes, neutrophils and macrophages, eosinophils. The release of inflammatory mediators (histamine, prostaglandins, etc.) and cytokines leads to edema of the bronchial wall, contraction of bronchial smooth muscles and the development of bronchospasm.
Due to edema and inflammation, the number of goblet cells, actively producing bronchial secretions (hypercrinia), increases. Overproduction and increased viscosity of mucus (discrinia) cause dysfunction of the ciliated epithelium and the occurrence of mucociliary insufficiency (mucostasis). Due to impaired coughing, obstruction of the airways with bronchial secretions develops. Against this background, conditions are created for the further multiplication of pathogens that support the pathogenetic mechanisms of obstructive bronchitis in children.
Some researchers see in bronchial obstruction not only a violation of the external respiration process, but also a kind of adaptive reactions that, in conditions of damage to the ciliated epithelium, protect the lung parenchyma from the penetration of pathogens from the upper respiratory tract into it. Indeed, in contrast to simple bronchitis, inflammation with an obstructive component is much less likely to be complicated by pneumonia in children .
To designate obstructive bronchitis in children, the terms ” asthmatic bronchitis ” and “spastic bronchitis” are sometimes used , but they are narrower and do not reflect the fullness of the pathogenetic mechanisms of the disease.
In the course of obstructive bronchitis in children can be acute, recurrent and chronic or continuously recurrent (with bronchopulmonary dysplasia , 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 acute respiratory viral infections – increased body temperature, sore throat, runny nose , general malaise. Dyspeptic symptoms often develop in young children.
Bronchial obstruction can join as early as 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 exhalation, which becomes noisy, sibilant, audible at a distance. In addition to tachypnea, expiratory or mixed dyspnea in children with obstructive bronchitis, there is an involvement of auxiliary muscles in the act of breathing, an increase in the anteroposterior size of the chest, retraction of its compliant places during breathing, and inflation 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, the sputum comes out with difficulty. Pallor of the skin or perioral cyanosis is noted. Obstructive bronchitis in children may be accompanied by cervicallymphadenitis . Bronchial obstruction lasts 3-7 days, disappears gradually as the inflammatory changes in the bronchi subside.
Children of the first half of the year, especially those who are somatically weakened and premature , may develop the most severe form of obstructive syndrome – acute bronchiolitis, in the clinic of which signs of severe respiratory failure prevail . Acute obstructive bronchitis and bronchiolitis often require hospitalization of children, since these diseases are fatal in approximately 1% of cases. A protracted course of obstructive bronchitis is observed in children with a burdened premorbid background: rickets , chronic ENT pathology, asthenization , anemia .
Clinical, laboratory and instrumental examination of children with obstructive bronchitis is carried out by a pediatrician and pediatric pulmonologist; according to the indications, the child is assigned consultations with a pediatric allergist-immunologist , pediatric otolaryngologist and other specialists. During auscultation, a prolonged expiration is heard, various wet and scattered dry rales on both sides; when percussion over the lungs, a box shade is determined.
On radiographs of the chest organs , signs of hyperventilation are expressed: increased transparency of the lung tissue, horizontal arrangement of the ribs, low standing of the dome of the diaphragm. In a general blood test, leukopenia, lymphocytosis, a slight increase in ESR, eosinophilia can be detected. In the study of the gas composition of the blood, moderate hypoxemia is found.
If necessary, an additional immunological, serological, biochemical blood test is carried out; determination of DNA of the main respiratory pathogens in the blood by PCR method, setting of allergological tests. The identification of pathogens can be facilitated by microscopic examination of sputum, bacterial culture of sputum for microflora, examination of lavages from the nasopharynx.
With obstructive bronchitis in children, it is necessary to study the tidal volumes (FVD), including with medicinal samples. In order to visually assess the state of the bronchial mucosa, conduct bronchoalveolar lavage, cytological and bacteriological examination of wash water for children with obstructive bronchitis, bronchoscopy is performed.
Repeated episodes of obstructive bronchitis require differential diagnosis with bronchial asthma in children .
Treatment of obstructive bronchitis in children
Therapy for obstructive bronchitis in young children is carried out in a hospital; older children are hospitalized for severe disease. General recommendations include adherence to a semi-bed regime and a hypoallergenic (mainly milk-vegetable) diet, abundant drinking (teas, decoctions, fruit drinks, alkaline mineral waters). Humidification of the air, regular wet cleaning and airing of the ward, where children with obstructive bronchitis are treated, are important regime points.
With severe bronchial obstruction, oxygen therapy , hot foot baths , cupping massage , removal of mucus from the upper respiratory tract with electric suction are actively used . To relieve obstruction, it is advisable to use inhalation of adrenergic agonists (salbutamol, terbutaline, fenoterol) through a nebulizer or spacer. With the ineffectiveness of bronchodilators, treatment of obstructive bronchitis in children is supplemented with corticosteroids.
To dilute 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. Antibiotic therapy is carried out only in the case of a secondary infection.
In order to ensure adequate drainage of the bronchial tree, children with obstructive bronchitis are shown breathing exercises, vibration massage , postural drainage.
Forecast and prevention
About 30-50% of children are prone to recurrence of obstructive bronchitis within one year. Risk factors for recurrent bronchial obstruction are frequent acute respiratory viral infections, the presence of allergies and foci of chronic infection. In most children, episodes of obstruction stop during preschool age. Bronchial asthma develops in a quarter of children who have had recurrent obstructive bronchitis.
Prevention of obstructive bronchitis in children includes prevention of viral infections, including through vaccination ; providing a hypoallergenic environment, hardening, health improvement in climatic resorts. After suffering obstructive bronchitis, children are under dispensary observation by a pediatrician, possibly a pediatric pulmonologist and allergist.