Acute bronchitis in children
Acute bronchitis is an inflammatory lesion of bronchi of any caliber of various etiology (infectious, allergic, toxic) that has developed in a short period of time. There are acute bronchitis, acute obstructive bronchitis, acute bronchiolitis.
Causes of acute bronchitis
Most often, the etiologic factor of acute bronchitis is various viruses, less often bacteria. Irritant bronchitis occurs when exposed to toxic and chemical substances, physical factors. Allergic acute bronchitis is possible. Bronchitis often accompanies diphtheria, typhoid fever, whooping cough. The etiology of bronchitis and their clinical features often depend on the age of the children.
Etiology of acute bronchitis
| Etiology | Criteria for diagnosis |
| Influenza A, B, C Adenovirus infection Parainfluenza, respiratory syncytial infection Rhinovirus infection Chlamydia and mycoplasma infections | Epidemic rise in morbidity. Specific influenza intoxication (high body temperature, chills, dizziness, headaches and muscle pains) Expressed catarrhal phenomena. Hyperplasia of the lymphoid formations of the nasopharynx. Lymphadenopathy. Catarrhal-follicular, more often membranous conjunctivitis Croup syndrome. Bronchoobstructive syndrome Uncontrollable rhinorrhea with mild catarrh of the respiratory tract Prolonged subfebrile condition, persistent cough, defeat of the bronchial system up to malosymptomatic (atypical) pneumonia |
Pathogenesis of acute bronchitis
The pathogenesis of bronchial obstruction in obstructive bronchitis and bronchiolitis is complex and is caused, on the one hand, by the influence of the respiratory viruses themselves, on the other, the anatomical and physiological features of children, their tendency to allergic reactions. Influence of respiratory viruses on the bronchopulmonary system of the child is diverse: they damage the respiratory epithelium, increase the permeability of the mucous membrane, promote the development of edema and inflammatory infiltration by cellular elements, violate mucociliary clearance. Bronchial spasm can be caused by the release of biologically active substances. In a significant part of children episodes of bronchial obstruction recur, part of the subsequent development of bronchial asthma.
Acute bronchitis (simple) in children - an acute inflammatory disease of the bronchi, which proceeds without signs of bronchial obstruction.
Symptoms of acute bronchitis
In acute bronchitis, as a rule, body temperature rises. The duration of the fever varies and depends on the type of pathogen. So, with respiratory syncytial and parainfluous infections, the duration of fever is 2-3 days, and with mycoplasmal and adenovirus infection - 10 days or more. The main symptom of bronchitis is a cough, dry and obtrusive at the onset of the disease, in the future - moist and productive. Auscultation reveals widespread diffuse coarse dry and moist medium- and large-bubbling rales.
Laboratory and instrumental research
In the peripheral blood of the changes may not be. When a viral infection is detected, leukopenia, lymphocytosis. There may be a small increase in ESR, and with the attachment of a bacterial infection - neutrophilia, a small shift of the leukocyte formula to the left. Chest radiographs are performed to exclude pneumonia; when bronchitis is usually found a moderate diffuse enhancement of the pulmonary pattern.
Acute bronchiolitis
Acute bronchiolitis is an acute inflammation of the small bronchi and bronchioles, proceeding with respiratory insufficiency and an abundance of small bubbling rales. The disease develops mainly in children in the first year of life. Most often bronchiolitis is caused by respiratory syncytial virus, parainfluenza viruses, somewhat less often - adenoviruses, even less often - mycoplasma and chlamydia.
Clinical picture of acute bronchiolitis
Usually, fever lasts 2-3 days (with adenovirus infection - up to 8-10 days). The condition of children is quite severe, signs of respiratory failure are expressed: cyanosis of the nasolabial triangle, shortness of breath, expiratory or mixed, tachypnea. Often observed bloating, involvement of ancillary muscles in breathing, the entrainment of compliant places of the chest. When percussion reveals a boxed percussion sound, with auscultation - scattered wet small bubbling rales on inhaling and exhaling. Significantly less likely to listen to medium- and large-bubbly wet wheezing, the number of which changes after coughing.
Complications of acute bronchiolitis in children can develop with the progression of respiratory disorders. An increase in P a C0 2 , the development of hypercapnia, indicating a worsening of the condition, can lead to apnea and asphyxia; Very rarely there are pneumothorax and mediastinal emphysema.
Laboratory and instrumental research
When radiographing chest organs, signs of bloating are determined, including an increase in the transparency of the lung tissue. Possible atelectasis, strengthening basal pulmonary pattern, expansion of the roots of the lungs. When examining the gas composition of the blood, hypoxemia is detected, a decrease in P a 0 2 and P a C 2 (the latter due to hyperventilation). Spirographic examination at an early age is usually not possible. Peripheral blood parameters may not be altered or reveal an ineffective increase in ESR, leukopenia and lymphocytosis.
Acute obstructive bronchitis in children
Acute obstructive bronchitis is acute bronchitis, which occurs with bronchial obstruction syndrome. Usually develops in children in the 2-3rd year of life.
Clinical picture of acute obstructive bronchitis
Signs of bronchial obstruction often develop on the first day of acute respiratory infections (earlier than bronchiolitis), less often - on the 2-3rd day of the disease. The child is observed noisy wheezing with an extended exhalation, audible at a distance (distal rales). Children can be restless, often change their position. However, their general condition, despite the severity of obstructive phenomena, remains satisfactory. Body temperature is subfebrile or normal. Expressed tachypnea, mixed or expiratory dyspnea; The respiratory tract can be assisted by the musculature; the chest is swollen, its compliant places are drawn in. The percussion sound is boxed. Auscultation reveals a large number of scattered moist medium- and large-bubbles, as well as dry wheezing.
Laboratory and instrumental research
On the roentgenogram of the chest organs, signs of swelling of the lungs are expressed: increased transparency of the lung tissue, horizontally placed ribs, and low position of the diaphragm dome. When studying the gas composition of blood, moderate hypoxemia is found. In the analysis of peripheral blood a slight increase in ESR, leukopenia, lymphocytosis, with an allergic background - eosinophilia.
Diagnostics
Most often acute bronchitis in children must be differentiated from acute pneumonia. Bronchitis is characterized by a diffuse nature of physical data with a satisfactory general state of children, whereas in pneumonia, physical changes are asymmetric, signs of infectious toxicosis are expressed, and the general condition is significantly impaired. The fever is longer, in the peripheral blood inflammatory changes are expressed: neutrophilic leukocytosis, an increase in ESR. Radiographically, local infiltrative changes in pulmonary tissue are determined.
With repeated episodes of bronchial obstruction, differential diagnostics with bronchial asthma should be performed.
Treatment
Treatment for acute bronchitis in children is symptomatic in most cases.
- Bed rest before normal body temperature.
- Milk-vegetable, vitamin-enriched diet.
- Abundant drink (tea, mors, broth of wild rose, alkaline mineral water, hot milk with Borjomi in the ratio 1: 1).
- Restoration of nasal breathing. Various vasoconstrictive drugs are used [oxymetazoline, tetrisolin (tizin), xylometazoline], including combined (with antihistamines, glucocorticoids). The use of drops, especially vasoconstrictors, should not be prolonged, as it can lead to atrophy or, conversely, mucosal hypertrophy.
- Antipyretics in the age dosage with an increase in body temperature above 38.5-39.0 ° C. The drug of choice is paracetamol. A single dose of paracetamol is 10-15 mg / kg orally, 10-20 mg / kg in candles. From the list of used antipyretic drugs, amidopyrine, antipyrine, phenacetin are excluded. Do not recommend the use of acid acetylsalicylic (aspirin) and sodium metamizole (analgin) because of possible side effects.
- Antitussive agents [butamir (sinecode), glaucin, prenoxdiazin (libexin)] are used only in the case of dry compulsive cough. Hyper secretion of mucus and bronchospasm - contraindications to the appointment of antitussive drugs.
- Expectorants (preparations of thermopsis, althea, licorice, essential oils, terpinhydrate, sodium and potassium iodides, sodium hydrogen carbonate, salt solutions) and mucolytic drugs (cysteine, acetylcysteine, chymotrypsin, bromhexine, ambroxol) are indicated in all clinical variants of bronchitis. Means that facilitate sputum evacuation are usually administered orally or by inhalation with a nebulizer or an aerosol inhaler. Currently, there is a large number of effective combination drugs that have a multidirectional effect: muco-and secretolitic, expectorant, anti-inflammatory, reducing edema of the mucous membrane (bronchicum, etc.).
- Bronchodilators are used for clinical signs of bronchial obstruction in the form of inhalations (through a nebulizer, with the help of spacers), inside, less often rectally. The bronchodilator has ß-adrenomimetics, anticholinergic agents [ipratropium bromide (atrovent), ipratropium bromide + fenoterol (berodual)] and methylxanthines (theophylline preparations, including prolonged ones). They use salbutamol, fenoterol, clenbuterol, salmeterol (sulfur), formoterol (oxy turbuhaler, foradil). Assign also fenspirid (erespal), which has a bronchodilating, anti-inflammatory effect, reducing the reactivity of the bronchi, reducing the secretion of mucus, normalizing mucociliary clearance.
- Rehydration of respiratory tracts is carried out by moistened aerosols, steam inhalations with alkaline solutions, including mineral ones, to which, in the absence of allergic reactions, essential oils can be added.
- Drainage and removal of sputum with the help of medical gymnastics, vibrating massage, postural drainage.
- They also struggle with dehydration, acidosis, heart failure, prescribe vitamins.
Antibacterial and antiviral therapy is prescribed only on strict indications:
- febrile fever for 3 days or more;
- increased signs of infectious toxicosis and respiratory failure;
- marked asymmetry of physical data;
- inflammatory changes in the analysis of peripheral blood (neutrophilic leukocytosis, increased ESR).
When choosing a starting drug, it is necessary to take into account the age of the patient and the spectrum of prospective pathogens. The predominance of penicillin-sensitive pneumococcus strains among them makes it possible to use penicillin preparations and macrolides for the treatment of community-acquired infections. Standards for antibiotic therapy have been developed and are recommended.
Standards of antibiotic therapy for children aged 1-6 months.
| Alleged pathogens | Drugs of choice | Alternative drugs |
| Atypical pathogens (with body temperature <38 ° C): chlamydia (often) pneumocysts (rarely) mycoplasmas (rarely) | Macrolides (roxithromycin) | Cotrimoxazole |
| Typical pathogens (body temperature > 38 "C, dyspnea, toxicosis): intestinal flora (E. coli , etc.) rarely - staphylococci,Moraxella catarrhalis | Amoxicillin + clavulanic acid (amoksiklav, augmentin) | Cephalosporins of the II-III generation (cefuroxime, zinnate, zinacef) |
Standards of antibacterial therapy for children aged 6 months to 6 years
| Alleged pathogens | Drugs of choice | Alternative drugs |
| Typical pathogens (often): pneumococcus, including in combination with H. influenzae type b | Amoxicillin Macrolides | Amoxicillin + clavulan-new acid (amoksiklav, augmentin) Cephalosporins |
| Atypical pathogens (rare): mycoplasma | Macrolides | Doxycycline |
Standards of antibacterial therapy for children aged 7-15 years
| Alleged pathogens | Drugs of choice | Alternative drugs |
| Atypical pathogens (often): mycoplasma | Macrolides | Doxycycline |
| Typical pathogens (rare): pneumococcus | Amoxicillin Macrolides | Amoxicillin + clavulanic acid (amoksiklav, augmentin) Cephalosporins |