Recurrent Bronchitis – Causes, Symptoms, Diagnosis and Treatment

Recurrent bronchitis is a recurrent, lingering inflammation of the bronchial mucosa, repeated up to 3 or more times throughout the year, but does not lead to irreversible dysfunctions of the respiratory system. Recurrent bronchitis is accompanied by subfebrile condition, moist, rough cough, sometimes bronchospasm and wheezing. The diagnosis is made according to the data of X-ray of the lungs, bronchography, FVD, sputum culture, allergy test. In case of relapse of bronchitis, pharmacotherapy (mucolytics, bronchodilators, antihistamines) and rehabilitation measures (breathing exercises, vibration massage, physiotherapy) are used. According to indications, antibiotics and antiviral drugs are prescribed.

Recurrent bronchitis - causes, symptoms, diagnosis and treatment

ICD-10

J40  Bronchitis, not specified as acute or chronic

General information

Recurrent bronchitis – repeated (up to 3-4 times a year) recurrent episodes of bronchitis lasting up to 2-3 weeks, occurring with or without symptoms of bronchospasm and reversible changes in the bronchopulmonary system. Recurrent bronchitis is typical for children, usually preschoolers, less often schoolchildren. By adulthood, such patients have already formed chronic bronchitis , which proceeds with periodic exacerbations and persistent damage to the structure of the walls of the bronchi. Recurrent bronchitis usually makes its debut in the second year of a child’s life; this clinical variant accounts for up to a third of all respiratory pathology of an early age. The highest morbidity is recorded among children 4-6 years old, then gradually decreases in the pre- and pubertal period.

Simple recurrent bronchitis has no signs of obstruction. In the case of repeated episodes of bronchitis, accompanied by broncho-obstructive syndrome (BOS), not mediated by non-infectious allergens, pulmonology speaks of its recurrent obstructive form. Relapses of bronchitis more often occur in the cold period, with an obstructive variant – usually in the spring and autumn seasons. Recurrent bronchitis does not tend to progress and develop the phenomena of sclerosis in the bronchi and lungs, but creates favorable conditions for the appearance of chronic bronchitis, bronchial asthma and acute pneumonia .

The reasons

The connection between recurrent bronchitis with acute respiratory viral, mycoplasma, chlamydia, less bacterial etiology ( pertussis , tuberculin-kulezom ). Episodes of bronchitis are very often repeated against the background of an acute viral infection ( rhinovirus , RSV , parainfluenza , measles), acute pneumonia. The tendency to recurrent bronchitis is observed in frequently ill children .

Viral damage to the mucous membrane of the tracheobronchial tree leads to diffuse inflammation, a decrease in the function of the ciliated epithelium, insufficiency of mucociliary clearance, neuroregulatory disorders and the development of nonspecific hyperreactivity of the bronchi. The bronchi begin to respond inadequately to habitual stimuli (pungent odor, cold air, exercise).

Predisposing factors play a significant role in the development of recurrent bronchitis. First of all, these are the features of the child’s body – the immaturity of the tissue structures of the bronchi and the immunocompetent system, frequent chronic pathology of the lymphoid tissue of the upper respiratory tract, allergic mood, as well as the presence of malformations of the respiratory tract and immunodeficiency states (congenital and secondary). 

Alcohol fetopathy, mother’s smoking during pregnancy and after childbirth, aspiration syndrome, mechanical ventilation can lead to the development of nonspecific bronchial hyperreactivity. Cystic fibrosis and undiagnosed foreign bodiesrespiratory tract is also accompanied by the phenomena of recurrent bronchitis. Relapses of bronchitis can occur under the influence of difficult climatic conditions (high humidity, temperature changes), industrial and domestic air pollution.

In 70-80% of children, there is a recurrent obstructive form of bronchitis, occurring in the absence of other obstructive bronchopulmonary diseases. Due to the sufficient narrowness of the airway lumen in young children, bronchial obstruction is initiated by inflammatory changes in the bronchial mucosa against the background of ARVI . The presence of allergies in the patient (skin rashes, positive skin tests), dysplasia of connective tissue allows him to be attributed to the risk group for the development of obstructive bronchitis… 

RSV infection can disrupt the formation of a normal immune response in young children and form an atopic variant of the immune response and sensitization to aeroallergens. With recurrent obstructive bronchitis without signs of allergy and low Ig E levels, most episodes of obstruction stop at 3-4 years of age.

Recurrent bronchitis symptoms

Recurrent bronchitis is characterized by annual periodic exacerbations (3-4 times a year), usually lasting for 2-4 weeks.

Relapses are usually easier than primary acute inflammation of the bronchi and begin with clinical manifestations of ARVI. There is a moderate rise in temperature, catarrhal phenomena: nasal congestion, runny nose , sore throat, and sometimes headache. Gradually, within 3-6 days, a cough appears : first dry and painful, then moist with a rough shade, less often paroxysmal. Viscous mucous or mucopurulent sputum is released . The cough, which is observed throughout the day (more pronounced in the morning), gradually begins to dominate the clinical picture of the disease. It is possible to provoke a cough by physical exertion.

With relapses of obstructive bronchitis, breathing becomes wheezing with audible wheezing, the cough is obsessive. With a sluggish variant of recurrent bronchitis, exacerbations can last for a long time (from 3 weeks to 3 months) with a normal temperature and scanty sputum production. During the period of clinical remission, the child is quite healthy.

Diagnostics

When making a diagnosis, the anamnesis is specified, an X-ray of the lungs , bronchography , FVD , complete blood count, sputum culture, skin allergy tests are performed. Exacerbation of recurrent bronchitis is characterized by hard breathing, dry and wet rales of various sizes of variable nature and localization. Paravertebrally determined bilateral shortening of the percussion tone, lengthening of exhalation. During the period of remission, there is an increased readiness for cough with slight cooling, physical exertion and fatigue.

Radiography of the lungs with recurrent bronchitis demonstrates a long-term stable reactive enhancement of the pulmonary pattern mainly in the hilar regions, preserving it to some extent during remission and a slow return to normal.

Bronchoscopy helps to assess the presence of secretions and changes in the bronchial tree. With relapses of bronchitis, insignificant fibrinous overlays or separate lumps and elongated threads of mucous (mucopurulent) sputum are determined on the walls of the bronchi. Diffuse changes in the contours of the bronchial lumen are visible, more pronounced in the upper parts of the main bronchi. In the study of FVD, indistinct reversible obstructive disorders, latent bronchospasm without relapse, and a weak degree of bronchial hyperreactivity can be detected.

In peripheral blood, slight leukocytosis, a rise in ESR are possible, with allergic genesis – eosinophilia. To assess susceptibility to infection, skin tests with bacterial (staphylococcal and streptococcal) allergens are performed. In case of diagnostic difficulties, referral of the child to a pediatric pulmonologist and allergist is indicated. Recurrent bronchitis should be differentiated from pneumonia , bronchial asthma, cystic fibrosis, obliterating bronchiolitis , tuberculosis, a foreign body in the bronchi.

Recurrent bronchitis treatment

Treatment of exacerbation of recurrent bronchitis is carried out on an outpatient basis with the appointment of rest, an abundant drinking regimen, and a fortified diet. In case of ARVI manifestations, antiviral drugs (remantadine, umifenovir) are used, in the case of mycoplasma or chlamydial genesis of bronchitis, systemic antibiotic therapy (macrolides) is carried out in combination with immunomodulators (tincture of echinacea, tiloron), anti-inflammatory drugs (fenspiride).

With a pronounced productive cough, inhalations with alkaline solutions and mucolytics (ambroxol, carbocisteine), UHF , therapeutic breathing exercises, vibration massage , postural drainage are necessary. In the acute period of bronchitis with symptoms of bronchial obstruction, inhaled bronchodilators (salbutamol, fenoterol) are recommended, in severe cases – glucocorticoids (dexamethasone, prednisolone) aerosol or systemically. Antihistamines are used in children with a history of allergies.

Forecast and prevention

Patients with recurrent bronchitis are shown dispensary observation until the complete cessation of relapses for 2 years, sanatorium treatment. The prognosis of recurrent bronchitis is relatively favorable, the disease is reversible in most cases. The risk of converting recurrent bronchitis into an asthmatic form or bronchial asthma is determined by the presence of bronchospasm and the age of the sick child. The prevention of recurrence of bronchitis covers the prevention of ARVI, early initiation of antiviral treatment, elimination of allergic factors, hardening and physical activity, timely vaccination of children against influenza , measles, pneumococcal infection.