The inflammatory process that occurs in the bronchi with a primary lesion of their mucous membrane is called bronchitis. The pathological process in which inflammation affects the walls and mucous membrane of the bronchi is acute bronchitis. Symptoms in a child develop quickly, on the second or third day from the onset of SARS, which is often the cause of bronchitis. With a complicated and protracted course of the disease, the lesion affects the fibromuscular tissue of the walls of the organ. Acute bronchitis ranks first in frequency of occurrence and second in severity. About one hundred and fifty thousand children fall ill with it every year.
General information
Bronchi, or the bronchial tree, is part of the individual's respiratory system. Thanks to the cilia that line their surface, the air is cleared of dust and microorganisms.
When inhalingair enters through the larynx and trachea, and then passes into the branched system of the bronchi, which deliver oxygen to the lungs. Sections of the bronchi called bronchioles adjoin directly to the lungs. When exhaling, the products of gas exchange formed in the lungs are excreted through the bronchi and trachea. Therefore, violations of their patency adversely affect the process of breathing and lead to insufficient supply of oxygen to the body. The mechanism of the development of the disease is as follows. The pathogen, hitting the wall of the bronchi, provokes an immune response in the form of:
- edema;
- increased mucus production;
- increased blood supply to the affected area.
Thus, the body takes action to neutralize the bacterial, viral or other disease agent.
Acute bronchitis in a child: causes
Viral etiology of pathology differs depending on the age category of children. The provocateurs of the disease are:
- Up to two years - rhino-, entero-, cytomegaloviruses, as well as herpes virus and respiratory syncytial.
- Up to three years - parainfluenza and influenza viruses.
- Children of the third year of life - corona-, adeno-, rhinoviruses and parainfluenza, respiratory syncytial virus.
- Children aged five to eight have influenza viruses and adenoviruses.
An independent cause of acute bronchitis in a child aged 3 years and older are viruses, unlike infants and toddlers under three years of age. In this age category to thema bacterial infection also joins, which is represented by the following microorganisms: streptococci, pneumococci, Pseudomonas aeruginosa and Escherichia coli, mycoplasma.
In addition, the causes of the disease are: congenital anomalies, parasitic pathogens, fungi, adverse factors - strong gas pollution, industrial and tobacco smoke, low air temperature, various allergens and other factors.
Acute bronchitis can also be a symptom of another disease, such as influenza, diphtheria, measles.
Thus, in newborns and infants, acute bronchitis of a mixed and bacterial nature predominates. In a 5-year-old child, the development of the disease occurs due to the negative influence of allergic, physical and chemical factors. In older children and adolescents, viruses act as provocateurs.
In epidemiological terms, seasonal outbreaks of influenza and SARS, the cold season, being in children's groups are important. Polluted air, passive smoking, hypothermia or vice versa overheating are also considered provocateurs of the disease.
Risk factors
The following factors increase the risk of acute bronchitis:
- young children have chronic indigestion, with ongoing underweight and malnutrition;
- prematurity;
- birth trauma;
- congenital malformations of the respiratory organs;
- anomalies of the nasopharynx - deviated septum, adenoids;
- frequent respiratory diseases - tracheitis, rhinitis, pharyngitis, laryngitis;
- diathesis;
- chronic infections – tonsillitis;
- seasonal epidemics of SARS and influenza;
- finding a child in children's organizations;
- autumn-winter period;
- not good enough social and living conditions.
Diagnosis
A preliminary diagnosis is made by a pediatrician, specifying - an allergist-immunologist or a pulmonologist. The following methods are used for diagnostics:
- Complete blood count - the following indicators are analyzed: ESR, lymphocytes, leukocytes, neutrophils.
- Microscopic examination, PCR - the secret (sputum) is examined. With the help of this analysis, infection with the Koch stick is excluded.
- X-ray of the lungs - in the pictures there is an increase in the vascular pattern in the lower lobes of the lungs. With bronchiolitis and obstructive bronchitis, swelling of the lung tissue, flattening of the diaphragm, and expansion of the intercostal spaces are observed.
- Examination of the functions of external respiration - carried out in older children.
Classification
According to the presence of complications and the variety of symptoms, acute bronchitis in a child is divided into types such as:
- Simple - an infection of a viral nature is considered to be its provocateur. The disease proceeds without signs of impaired air permeability and does not give complications. Affects a child of any age.
- Obstructive - there are symptoms of obstruction, which can lead to a failure of gas exchange in the lungs and contribute to the occurrence of hypoxia. Obstruction develops due to mucosal edema, increased mucus synthesis, thickening of the bronchial walls and their spasm. This form of bronchitis is most oftendiagnosed in children two to three years old.
- Broncholithitis - in this case, the smallest bronchi are affected. Babies have severe respiratory failure, airflow failure. Often they get sick crumbs up to a year.
- Obliterating - bronchioles, small bronchi, alveoli are affected.
- Recurrent - several times during the year, cases of acute bronchitis occur against the background of respiratory viral infections. This variety is often found in children of four or five years old.
Depending on the nature of the pathogen, acute bronchitis can be caused by:
- Bacteria - mainly pneumococci, in rare cases - Haemophilus influenzae.
- Viruses - adenovirus, parainfluenza virus and PC virus (common pathogens), influenza viruses, measles, rhinoviruses. In children in the first three months of life - entero-, cytomegaloviruses and herpes viruses.
- Bacteria and viruses.
- Viruses and fungi.
- Mycoplasma and chlamydia.
Non-infectious acute bronchitis is subdivided into:
- Irrigation - occurs when the negative impact of physical or chemical factors that have an irritating and traumatic effect on the respiratory system. Cough in a child with acute bronchitis in this case is observed with the release of copious watery sputum. In addition, there is swelling of the mucosa.
- Allergic - the cause of its appearance are allergens that penetrate into the respiratory tract along with the air. It cannot be ruled out thatbronchospasm. As a result of the narrowing of the lumen of the bronchi, mucus accumulates in them, which is especially good for the reproduction of pathogens. Therefore, its course is often complicated by the addition of an infection.
Signs of illness
The main symptom of acute bronchitis in children is a cough. Depending on the severity of the course of the disease, as well as the causes that caused it, other signs differ somewhat:
- Allergic - is chronic, proceeds without fever. During exacerbations, sweating, malaise, cough appear. Often associated with atopic dermatitis and conjunctivitis. Before prescribing therapy, an allergen is identified. There is a high risk of developing bronchial asthma.
- Simple acute bronchitis - the child has a fever, nausea, cough, general weakness. These symptoms last for about three days. If bronchitis is caused by mycoplasma or adenovirus, then fever is observed within a week. Changes in breathing and wheezing are not observed.
- Recurrent or chronic - the main symptom is cough, during the period of weakening of the disease it becomes dry, and during exacerbation, i.e. exacerbation - wet. The secret with purulent inclusions departs in small quantities and with great difficulty.
Clinical picture
Let's consider in more detail the clinical manifestations of different types of acute bronchitis in children: simple, bronchitis, obstructive. In the first case:
- External signs - weakness, excessive sweating, hoarseness of voice, auxiliary muscles are not involved inbreath.
- Breathing is hard with wheezing and prolonged exhalation. Respiratory failure and shortness of breath occurs only in the smallest patients.
- Pain syndrome - behind the sternum, in the throat, headache. In addition, itching and burning in the throat.
- Cough - Initially frequent and dry, becomes wet by about the fifth day and then gradually disappears.
- Temperature - up to thirty-eight degrees.
- Associated symptoms - pharyngitis, rhinitis, conjunctivitis, laryngitis.
Duration of illness is five to fourteen days.
In acute bronchiolitis, the following clinic is observed:
- External signs - when breathing, the chest is retracted, the wings of the nose swell, the nasolabial region and the body are bluish in color, additional muscles are involved in breathing.
- Breathing is heavy and with severe shortness of breath, respiratory failure is present, wheezing is crackling and moist when listening.
- Pain syndrome - in the abdomen and chest.
- Cough - intermittent, sometimes with secretions.
- Temperature - in most cases normal or subfebrile.
- Associated symptoms - rapid breathing without rhythm failure, tachycardia, intoxication, pharyngitis, fever, rhinitis.
Duration of illness up to five months.
Symptoms of acute obstructive bronchitis in children:
- External signs - the chest is swollen, auxiliary muscles are involved in breathing, pale skin, cyanosisaround the lips.
- Breathing - with a whistle that can be heard from a distance. Exhalation is difficult, there is no obvious shortness of breath. Scattered rales in the lungs.
- Pain syndrome - in rare cases, a headache. Burning and tickling in the throat.
- Cough - persistent, paroxysmal, dry. May become damp after a few days.
- Symptoms of acute bronchitis in children without fever are observed only after a few days. In the initial phase of the disease, it is high.
- Associated symptoms - moderate fever, pharyngitis, rhinitis, laryngitis.
A distinctive feature is an extended expiration and wheezing wheezing on auscultation. When percussion of the lungs, low tympanitis is possible. On the x-ray, the position of the ribs changes, they acquire a horizontal position, and the diaphragm, its dome flattens, and itself falls, the lung field becomes more transparent. The duration of the illness is from ten to twenty days.
Bronchiolitis
It is this form of acute bronchitis that develops in the youngest children. Symptoms in children under 2 years of age are:
- hyperthermia;
- cough with a lot of sputum and sometimes blood;
- shortness of breath;
- bronchial spasm with dry wheezing;
- cyanosis of the dermis in the area of the nasolabial triangle;
- respiratory failure clinic develops rapidly in the absence of adequate therapy.
In addition, the baby's general he alth worsens, weakness and anxiety appear, increased sweating, sneezing, rhinitis.
Causedefeat by viruses of small bronchi and bronchioles at this age is an unformed immunity and underdevelopment of the respiratory organs.
Treatment activities are carried out in stationary conditions and include:
- Strict bed rest.
- For babies, increase the number of feedings by two. For the rest of the children, the daily volume is reduced by half, while they are given a balanced, high-calorie and hypoallergenic food.
- The amount of liquid is increased by one and a half times.
- Antiviral drugs.
- Inhaled bronchodilators.
- Antibiotics in rare cases.
Medications of the following pharmacological groups are used as additional means for the treatment of symptoms of acute bronchitis in children under 2 years of age: mucolytics, expectorants, antipyretics, antihistamines. As well as breathing exercises, vibration massage, physiotherapy exercises.
Uncomplicated bronchiolitis lasts no more than three weeks. However, for a long period after recovery, the baby has a prolonged cough. The reason for this phenomenon is the increased sensitivity of the bronchi.
Mechanisms of failure of bronchial patency
The obstruction phenomena in acute bronchitis in a child depend on age:
- 2 years - High mucus production is considered the leading cause. The muscles of the bronchi and epithelial cells are unable to cope with its excretion, as a result, it accumulates and blocks the lumen of the bronchi.
- Ages three to sevenyears - the narrowing of the lumen is associated with swelling of the walls of the organ.
- Schoolchildren often develop a sharp contraction of the bronchi, i.e. bronchospasm.
Acute obstructive bronchitis in children, the clinical treatment protocols of which are known to any therapist, is manifested by noisy breathing with wheezing. You can hear it even from a distance. The origin of this phenomenon is caused by the following reason: due to the existing obstacle in the large bronchi and trachea, turbulent air movement occurs. In addition, there is a hypothesis that broncho-obstructive syndrome plays a protective role, that is, it prevents the infection from penetrating into the respiratory sections of the lungs.
Drug and non-drug therapy
It is carried out under the supervision of a pediatrician. Consider how to treat acute bronchitis in a child using drugs from different pharmacological groups:
- Antipyretic - they are recommended only at temperatures above thirty-eight degrees and in the absence of contraindications to their use. Paracetamol is recognized as the most demanded. Vinegar-water rubdowns also help with fever.
- Antitussives - they are used to relieve an obsessive dry cough.
- Mucolitics and expectorants - have proven themselves with a viscous secret and unproductive cough, and in addition, they contribute to the accelerated removal of sputum during a productive cough. Children are most often recommended - "Ambroxol", "Acetylcysteine acid", "Bromhexine", as well as preparations with sodium and potassium iodide, based on licorice root ormarshmallow, and breast fees from medicinal plant materials.
- Antivirus - they are effective in the first three days of illness.
- Antihistamines - used for swelling of the mucosa and in the case of an allergic nature of acute bronchitis.
- Antibiotics - drugs of this group are indicated only with a confirmed bacterial nature of the infection. However, crumbs (up to six months) with a burdened history, such as prematurity or birth trauma, are sometimes prescribed macrolides and cephalosporins to prevent infection.
- Anspasmodics and bronchodilators - are indicated for obstructive disease and hormones in case of no result.
- Glucocorticoids, antibiotics and cardiotonic drugs are mandatory recommended for acute bronchiolitis.
Additionally, to increase the effectiveness of pharmacotherapy, physiotherapy is used:
- physiotherapy exercises;
- inhalations;
- electrophoresis with iodine, calcium, magnesium;
- light therapy;
- vibration chest massage;
- giving the body special positions in which the discharge of the secret improves, i.e. postural drainage;
- mustard plasters;
- UHF.
Unconventional methods
As an adjuvant therapy, in the treatment of acute bronchitis in children, the symptoms of which are described in the article, the use of folk remedies is allowed. However, before using them, a consultation with the attending doctor is required, and it should also be noted that:
- Any thermal manipulations - steam inhalations, rubbing, warm compresses, body wraps are contraindicated at high temperatures. In addition, when exposed to heat, exclude the area of the heart.
- All drinks given to the child must be warm.
- Steam inhalation is only effective for upper respiratory infections, not bronchitis.
- Honey products and medicinal plants are allergens, so before using them, you need to make sure that the child does not have hypersensitivity to them.
The following are a few folk recipes that are most often used to relieve the symptoms of acute bronchitis in a child:
- To relieve dry cough - fresh lingonberry juice with sugar or honey, infusions of viburnum, linden, coltsfoot, blackcurrant. For their preparation, take no more than fifteen grams of medicinal plant materials per glass of water.
- Compresses on the chest area from vegetable oil or iodine and mashed potatoes, previously boiled in their skins.
- Wrapping the chest, with the exception of the heart area, with any vegetable oil that is preheated. They are impregnated with thin cloth or gauze folded in several layers, covered with paper coated with wax.
Treatment courses and doses will be recommended by a physician depending on the age of the child.
Acute bronchitis in children: clinical guidelines for treatment
According to them, the use is not recommended to cure the disease:
- antiallergicdrugs;
- electroprocedure;
- mustard plasters;
- cans;
- Patches with burning effect;
- antibiotics for uncomplicated viral form.
According to the protocol, treatment is carried out on an outpatient basis. Child recommended:
- Warm, plentiful drink in the amount of up to one hundred milliliters per kilogram of body weight per day.
- Breathing exercises.
- Stimulation of the cough reflex when it decreases.
- Chest drain.
For dry painful and painful cough (in the absence of signs of obstruction) - antitussive central action medicines in a short course.
Additionally, it is allowed to take other drugs according to indications:
- Antiviral - for signs of flu.
- Expectorant and mucolytic - with difficult to separate viscous sputum.
- Antibiotics - if the temperature is maintained for more than three days. In addition, it is necessary to further examine the child.
This is the treatment outlined in the clinical guidelines.
Acute obstructive bronchitis in children - in this case, drug therapy depends on the severity of respiratory failure. Bronchodilators are used, for example, "Salbutamol" or combined - "Berodual". Their introduction is carried out through a nebulizer. After use, the clinical effect is evaluated. If not, then inhaled corticosteroids are indicated.
For disease caused by chlamydia or mycoplasma - macrolides, and for obstruction -inhaled B2 agonists or combined bronchodilators.
Due to the fact that cough is considered the main symptom of acute bronchitis in children, its treatment should be complete, aimed at:
- destruction of the inflammatory process;
- release of bronchial smooth muscle contraction;
- activation of expectoration;
- dilution of thick secretion.
The reason for choosing this tactic is explained by the following reasons. The process of expectoration in young patients is much more complicated than in adults, and the excreted secret is rather viscous in consistency, and the respiratory muscles that push out the mucous masses are not fully formed. In addition, they make it difficult to separate sputum:
- bronchospasm;
- weak cough;
- mucosal edema;
- anatomical narrow lumen of the bronchi.
Coughing fits may be accompanied by discomfort in the chest area.
General recommendations for child care
Regular airing, at least four times a day, and maintaining the optimal temperature, not more than 19 degrees and humidity in the room where the sick child is located, greatly alleviates his condition and contributes to the fastest recovery.
Oxygen therapy is necessary when there is a pronounced sharp decrease in the supply of oxygen to the body of the individual. In this case, it is served through the Bobrov apparatus or the children spend some time in a special device called an oxygen tent. It is used foroxygen therapy in bed rest. Gas mixtures or IVL (artificial ventilation of the lungs) is indicated with a high degree of respiratory failure requires.
If one of the symptoms of acute bronchitis in a child is an accumulation of mucus, then it is sucked off with an electric suction or a rubber syringe. In the case of a high viscosity of the secret, it is preliminarily liquefied. For this purpose, inhalations are performed with mucolytics or with alkaline solutions.
Bed rest is observed for fever and about three days after the temperature returns to normal. During this period, it is necessary to give the baby a lot of liquid, its consumption should exceed the age norm by fifty to one hundred percent. Doctors recommend the following drinks - alkaline mineral water, fruit drink, lemon tea, herbal decoctions. In case of dehydration, during the period of temperature rise, the use of "Rehydron" is allowed.
During the treatment of symptoms of acute bronchitis in children, food should be light and quickly absorbed. The amount of food should be reduced by almost half. Babies, if they have respiratory failure, are fed little and often. Complementary foods are temporarily canceled.
Prognosis and complications
The disease itself is not dangerous, the prognosis for this disease is favorable. In most cases, full recovery can be achieved in about two weeks. Bronchitis is somewhat more severe with damage to the small bronchi and obstruction. In these cases, serious treatment is required.
Complications that arise whenwrong therapy. For example, the appointment of antibiotics in the viral nature of the disease. Depending on the state of immunity, the age of the child and the type of pathogen, the severity of the consequences also differs. The following are possible complications of different forms of acute bronchitis in children:
- Simple - bronchial asthma or pneumonia.
- Recurrent - chronic pathologies of the respiratory system in adulthood.
- Bronchiolitis - severe heart and respiratory failure, failure of blood gas exchange, i.e. low oxygen content in it.
- Obstructive - emphysema, in which there is swelling of the lungs and expansion of the alveoli.
Prevention measures
Often, acute bronchitis in children (ICD 10: J20) is a consequence of SARS. Therefore, it is necessary to engage in the prevention of these ailments:
- Strengthen the immune system: harden, follow the regime, eat well, walk daily. Limit visits to public places during the rise of viral infections.
- Do not overcool or overheat, both of which negatively affect immunity.
- Do not come into contact with sick children or adults.
- Passive smoking adversely affects the he alth of children and contributes to a weakening of the immune system. In addition, it not only increases the risk of asthma and bronchitis, but also affects intelligence.
- Maintaining the optimal air temperature in the room where the child is.
- From the first days, treat acute bronchitis in a child, and how to do this will be prompted by the attending doctor. Protect the child from contact with irritants and allergens. These actions will help prevent the inflammatory process of a non-infectious nature.
Certainly, warm sea air is good for the respiratory system, especially if babies often get bronchitis. Therefore, it is advisable to take the child to the sea. Walking in coniferous forests is also of great benefit. Tree needles release phytoncides, substances endowed with antimicrobial properties.
