Recurrent bronchitis (according to ICD-10 code - J 20) is a re-evolving protracted inflammation of the bronchial mucosa, which recurs up to 3 or more times during the year, but does not lead to irreversible impairment of the functional properties of the respiratory system. The disease in most cases is accompanied by subfebrile condition, rough wet cough, sometimes - wheezing and bronchospasm. The diagnosis is made according to bronchography, X-ray of the lungs, respiratory function, allergy tests, bacterial culture of sputum. For relapses of bronchitis, drug treatment (bronchodilators, mucolytics, antihistamines) and rehabilitation measures (vibration massage, breathing exercises, physiotherapy) are used. If necessary, antiviral and antibacterial drugs are prescribed.
General characteristics of pathology
Recurrent bronchitis - episodes of bronchitis, repeatedly repeated (up to 3-4 times) throughout the year with a durationup to 2-3 weeks. They occur most often with symptoms of bronchospasm, but the disease may not be accompanied by difficulty in breathing. In addition, there are reversible changes in the bronchopulmonary system. Recurrent bronchitis is more common in children than in adults. This disease most often affects children of preschool age. By maturity, such patients already develop chronic bronchitis, which occurs with persistent damage to the structures of the bronchial walls and periodic exacerbations.
At what age does it occur?
Recurrent bronchitis usually occurs in the second year of life, and this clinical manifestation accounts for up to 1/3 of all respiratory pathologies of early age. The highest incidence is observed among children aged 4-6 years, then gradually decreases in the pre- and pubertal period.
Symptoms of obstruction
This disease generally does not cause symptoms of obstruction. There is recurrent bronchitis with obstructive syndrome, not mediated by allergens. Relapses of the disease occur more often during cold periods, with the second option - at any time of the year.
Recurrent bronchitis does not tend to progress and develop sclerosis in the lungs and bronchi, but this pathological process creates favorable conditions for the development of chronic bronchitis, acute pneumonia and bronchial asthma.
Reasons
The connection of this disease with acute respiratory infections, viral, chlamydial,mycoplasma, less often bacterial nature of origin (whooping cough, tuberculosis). Episodes of bronchitis often recur against the background of acute viral infections (rhinovirus, parainfluenza, RSV, measles) and pneumonia. Predisposition is observed in frequently ill children. It is important to find out the causes of recurrent obstructive bronchitis.
Damage to the mucous membrane of the tracheobronchial tree by viruses leads to a diffuse inflammatory process, a decrease in the functionality of the ciliated epithelium, neuroregulatory disorders, insufficient mucociliary clearance, and the development of nonspecific bronchial reactivity. They begin to react pathologically to quite familiar stimuli (cold air, strong smell, physical activity).
Predisposing factors
Predisposing factors are essential in the formation of recurrent bronchitis. These are, first of all, the characteristics of the child's body - the immaturity of the structures of the bronchi and immunity, frequent chronic pathologies of the lymphoid tissue, allergic mood, the presence of immunodeficiency states of the respiratory tract defects (secondary and congenital). Alcohol fetopathy, aspiration syndrome, maternal smoking during pregnancy and while breastfeeding, and mechanical ventilation lead to the development of bronchial hyperreactivity. Cystic fibrosis and foreign bodies in the airways are also accompanied by signs of recurrent bronchitis. Recurrence of bronchitis can occur under the influence of negative climatic conditions (temperature changes, high humidity), domestic and industrial pollutionair.
70-80% of pediatric patients have an obstructive form that occurs in the absence of other bronchopulmonary diseases. Due to the narrowness of the lumen of the respiratory canals observed in this disease in children, bronchial obstruction is caused by inflammatory changes in the mucous membrane against the background of frequent SARS. The presence of an allergy in a patient (positive skin tests, skin rashes) and connective tissue dysplasia makes it possible to classify such patients as a risk group for obstructive bronchitis. RSV infection can disrupt the formation of a normal immune response and form an atopic immune response and sensitization to air allergens. In recurrent bronchitis with obstruction without allergic signs and low levels of Ig E, the majority of episodes of obstruction resolve at the age of 3-4 years.
Symptoms
With recurrent bronchitis, annual periodic exacerbations occur, usually lasting 2-4 weeks. Symptoms of relapse, as a rule, are much milder than the initial acute inflammation, and begin with clinical signs of SARS. At the same time, there is a slight rise in temperature and some catarrhal phenomena: rhinitis, nasal congestion, sore throat, headache. Gradually, over 3-6 days, a cough occurs: at first painful and dry, later wet and rough, less often paroxysmal. At the same time, viscous mucopurulent sputum is secreted. Throughout the day, the patient has a cough, which gradually dominates inclinical picture of pathology. May cause coughing on exertion.
Breath pattern
When obstructive bronchitis recurs, the patient's breathing becomes wheezing with severe wheezing, and the cough is obsessive. With sluggish recurrent bronchitis, the exacerbation can proceed for quite a long time (up to 3 months) with poor sputum production and normal temperature. During the period of remission, the patient is quite he althy.
Diagnosis
When making a diagnosis of "Recurrent bronchitis" (according to ICD-10 code - J 20), the anamnesis is specified, X-ray, bronchography, respiratory function, complete blood count, skin allergy tests, sputum culture for bacterial flora are performed. The exacerbation of this pathology is characterized by hard breathing, wet and dry wheezing of various sizes, which have a variable character and localization. Paravertebral, you can determine the shortening of the percussion tone on both sides, the lengthening of the exhalation. During remission, there is an increased cough readiness with slight hypothermia, overwork and physical exertion.
X-ray of the lungs with recurrent bronchitis demonstrates a long-term stable increase in the pulmonary pattern in the basal areas, its preservation during remission and a gradual return to normal.
Bronchoscopy allows you to evaluate changes in the bronchial tree and the presence of a secret. With the recurrence of bronchitis on the walls of the bronchi formedslight fibrinous deposits or elongated threads and separate lumps of mucous sputum. Diffuse changes in the contour of the bronchial lumens are also visible, most pronounced in the upper zones of the main bronchi. With FVD, fuzzy obstructive disorders of a reversible nature, latent bronchospasm, and weak bronchial hyperreactivity can be determined.
What will the blood test show?
In the composition of peripheral blood, a slight increase in the number of leukocytes, an increase in ESR, with an allergic nature of the origin of recurrent bronchitis - eosinophilia can be detected. In order to assess sensitivity to infectious agents, skin tests with bacterial (streptococcal and staphylococcal) allergens are carried out. In addition, the patient is referred for a consultation with an allergist and pulmonologist. Recurrent acute bronchitis is recommended to be differentiated from bronchial asthma, pneumonia, cystic fibrosis, tuberculosis, bronchiolitis obliterans, the presence of a foreign body in the bronchi.
Treatment and clinical recommendations for this pathology
Treatment of recurrent bronchitis is carried out on an outpatient basis with the appointment of a plentiful drinking regimen, rest, fortified diet. With symptoms of acute respiratory viral infections, patients are prescribed antiviral drugs (Umifenovir, Remantadin), in the case of chlamydial or mycoplasmal genesis of this form of bronchitis, antibiotic therapy (macrolides) is performed in combination with immunomodulators (Tiloron, echinacea tincture), as well as some anti-inflammatory drugs("Fenspiride").
What else is used in the treatment of recurrent bronchitis in children and adults?
Inhalation
With a strong productive cough, inhalations with alkaline solutions and mucolytic drugs (Ambroxol, Carbocisteine), UHF, vibration massage, therapeutic breathing exercises, postural drainage are recommended. During the period of exacerbation of the disease in the presence of symptoms of broncho-obstruction, the use of inhaled bronchodilators ("Fenoterol", "Salbutamol") is recommended, in severe cases, glucocorticoids ("Prednisolone", "Dexamethasone") are prescribed systemically or aerosolly. Antihistamines are used in children with a history of allergic symptoms. Inhalation with a nebulizer is also recommended. Treatment of recurrent obstructive bronchitis in children should be comprehensive and timely.
Prevention and prognosis
People with such bronchitis, it is desirable to carry out dispensary observation until the absolute cessation of relapses within 2 years, spa treatment is also indicated. With a recurrent form of bronchitis, the prognosis is relatively favorable, since this pathology is reversible in most cases. The risk of its transformation into bronchial asthma or into an asthmatic form is determined by the occurrence of bronchospasm and the age of the patient. Children are more susceptible to these complications. Relapse prevention covers the prevention of viral diseases, earlyantiviral therapy, elimination of allergic causes, physical activity and hardening, as well as timely vaccination against measles, influenza and pneumococcal infection.
Children with a tendency to inflammation of the bronchi are recommended to avoid hypothermia, stay in groups during seasonal exacerbations of respiratory diseases. In addition, doctors consider normalization of lifestyle, improved nutrition, moderate physical activity, and prophylactic use of antiviral drugs as mandatory prevention. If the first signs of the disease occur or are suspected, urgent medical attention is recommended. We reviewed clinical guidelines for recurrent bronchitis in children and adults.
