Acute bronchitis in children: treatment, clinical guidelines
The content of the article:
- Causes and risk factors
- The mechanism of development of the disease
- Classification
- Symptoms of acute bronchitis in children
- Complications
- Diagnostics
- Treatment of acute bronchitis in children
- Prevention
- Video
Acute bronchitis in children is an infectious and inflammatory process that affects the trachea, bronchi and bronchioles, while lasting no more than one month. The disease should be distinguished from bronchiolitis - inflammation of the bronchioles with characteristic seasonal epidemic outbreaks.
Acute bronchitis is a common childhood disorder. According to medical statistics, about 100-200 out of a thousand children fall ill with it every year. About half of all cases of respiratory system diseases in children in the first years of life are represented by acute bronchitis. Especially often the disease develops in children aged 1-3 years.
Acute bronchitis in a child begins with manifestations typical of ARVI
Doctors of various specializations are involved in the diagnosis, treatment and development of measures for the prevention of acute bronchitis: pediatricians, pediatric allergists, pulmonologists, immunologists.
Causes and risk factors
The most common cause of bronchitis in children is a viral infection (influenza, parainfluenza, adenoviruses, respiratory syncytial infection). Much less often, bacterial flora (Klebsiella, E. coli and Pseudomonas aeruginosa, moraxella, Haemophilus influenzae, pneumococcus, streptococcus), fungi of the genus Candida or Aspergillus, intracellular infection (cytomegalovirus, mycoplasma, chlamydia) act as the causative agent of the disease. Quite often in children, bronchitis develops against the background of whooping cough, diphtheria, measles.
Bronchitis can also be allergic. Its development is provoked by the entry into the bronchial tree with the current of inhaled air of various inhalation allergens (plant pollen, aerosols of household chemicals and perfumery products, house dust).
In some cases, the cause of bronchitis lies in the irritation of the bronchial mucosa with gasoline vapors, tobacco smoke, gas-polluted air of megacities.
The contributing factors are:
- burdened perinatal background (prematurity, birth trauma, hypotrophy, asphyxia);
- anomalies of the constitution (exudative-catarrhal or lymphatic-hypoplastic diathesis);
- congenital anomalies of the respiratory system;
- frequent respiratory diseases (laryngitis, rhinitis, tracheitis, pharyngitis);
- disturbances in nasal breathing (curvature of the nasal septum, adenoid vegetation);
- chronic purulent infection (chronic tonsillitis, sinusitis).
In epidemiological terms, seasonal outbreaks of acute respiratory viral infections, the cold season, finding a child in poor social conditions, staying in organized children's groups (nurseries, kindergartens, schools) are of major importance.
The mechanism of development of the disease
The pathogenesis of acute bronchitis is inextricably linked with a number of anatomical and physiological features of the respiratory system in childhood, the main of which are:
- looseness of submucosal tissue;
- abundant blood supply to the mucous membrane of the respiratory tract.
These features create favorable conditions for the spread of inflammation from the upper part of the respiratory tract to its lower parts.
In the process of vital activity, microbial agents produce toxins that disrupt the movement of the ciliated epithelium, promote swelling of the mucous membrane and increased secretion of viscous thick mucus. Slow flickering of cilia turns off the mechanism of cleansing the bronchi from pathogenic agents and promotes the spread of the inflammatory process, blockage (obstruction) of the bronchial secretions of small bronchi.
The main features of acute bronchitis in childhood are:
- the severity of the inflammatory reaction;
- the depth of the defeat of the walls of the bronchi;
- a significant length of the inflammatory process.
Classification
By origin, primary and secondary bronchitis are distinguished. The primary form of the disease affects only the tracheobronchial tree and initially begins in it. Secondary bronchitis is considered as a complication of another pathology of the respiratory system.
Depending on the spread of the inflammatory process, acute bronchitis is divided into the following forms:
- limited (inflammation does not go beyond one lobe of the lung);
- widespread (two or more lobes of the lung are drawn into the pathological process);
- diffuse (inflammation of the bronchi of both lungs).
By the type of inflammatory reaction, acute bronchitis is:
- catarrhal (simple bronchitis);
- purulent;
- purulent fibrous;
- ulcerative;
- hemorrhagic;
- necrotic;
- mixed character.
In children, catarrhal, catarrhal-purulent and purulent forms of the disease are usually observed.
According to the etiological factor, acute bronchitis is divided into bacterial, viral, fungal, allergic, mixed. Depending on the presence or absence of an obstructive component, they are divided, respectively, into obstructive and non-obstructive.
Symptoms of acute bronchitis in children
The appearance of symptoms of bronchitis in a child is usually preceded by signs of ARVI:
- runny nose;
- hoarseness of the voice;
- dry cough;
- sore throat;
- conjunctivitis.
After a while, the cough intensifies, becomes obsessive. After 5-7 days, the nature of the cough changes. It becomes moist, with a mucous or purulent-mucous sputum discharge.
Other signs of acute bronchitis are:
- fever (temperature rise to 38-38.5 ° C);
- excessive sweating;
- chest pain;
- general weakness;
- shortness of breath (especially common in children in the first years of life).
In children under one year old, bronchiolitis often develops, that is, a disease in which inflammation mainly affects the terminal sections of the bronchial tree, bronchioles. The course of this disease is severe. It is characterized by:
- fever up to 39-39.5 ° C;
- toxicosis with exicosis;
- acute respiratory failure (expiratory dyspnea, tachypnea, cyanosis of the mucous membranes and skin).
Obstructive bronchitis usually develops in children over 2 years of age. Its main symptom is bronchial obstruction, which is manifested by:
- whistling noisy breathing, often audible even at a distance;
- paroxysmal cough;
- prolonged exhalation;
- participation in the act of breathing of auxiliary muscles;
- subfebrile temperature (but it can be normal).
Allergic bronchitis develops after a child comes into contact with a substance to which he has sensitization, that is, with an allergen. For this form of the disease, the characteristic signs are:
- cough with mucous sputum;
- general weakness;
- sweating;
- other manifestations of an allergic reaction (atopic dermatitis, allergic rhinitis and / or conjunctivitis).
Complications
Acute bronchitis in childhood usually proceeds favorably and ends with complete recovery 10-15 days after the onset of the disease. In some cases, bronchitis becomes recurrent. With an untimely start of therapy, the disease can be complicated by the development of bronchopneumonia.
The most dangerous complications of bronchiolitis are asphyxia and respiratory arrest (apnea).
Severe obstructive bronchitis can cause acute respiratory failure and the formation of acute cor pulmonale.
Frequently recurring allergic bronchitis in a child can eventually transform into bronchial asthma.
Diagnostics
When making a diagnosis of acute bronchitis, it is necessary to consider:
- clinical symptoms (features of the course, the nature of the cough);
- auscultation data;
- results of instrumental and laboratory studies.
If necessary, the pediatrician will refer the child for a consultation with a pulmonologist and / or an allergist-immunologist.
In acute bronchitis, the auscultatory picture is characterized by dry and variegated wet wheezing (whistling in the obstructive form).
In a general blood test, lymphocytosis, neutrophilic leukocytosis, an increase in ESR can be detected. Eosinophilia is characteristic of allergic bronchitis.
In severe bronchitis with symptoms of respiratory failure, a study of the gas composition of the blood is shown.
Of no small importance in the diagnosis of acute bronchitis in children is the analysis of sputum (microscopy, PCR, bacterial culture).
A characteristic radiological sign of acute bronchitis is an increase in the pulmonary pattern, which is most noticeable in the area of the roots of the lungs.
Differential diagnosis is carried out with diseases such as pneumonia, bronchial asthma, tuberculosis, cystic fibrosis (in babies) and the presence of foreign bodies of the bronchi.
Only a specialist should deal with the treatment of acute bronchitis in pediatric patients, self-medication is excluded
Treatment of acute bronchitis in children
The Union of Pediatricians of Russia approved the clinical guidelines "Acute bronchitis in childhood" (ICD code 10 of this disease - J20). They discuss in detail the principles of treatment of acute bronchitis in pediatric practice:
- Due to the lack of evidence of efficacy in acute bronchitis, it is not recommended to prescribe to children electric procedures and antihistamines (with the exception of allergic bronchitis).
- Considering that the harm from the use of cans, burning plasters and mustard plasters significantly exceeds their possible benefits, these procedures are undesirable.
- In uncomplicated viral bronchitis, antibiotic therapy is not recommended. Only if there are clear indications that should be reflected in the medical history, the child can be prescribed antibiotics.
- Children with uncomplicated viral bronchitis are treated at home. They are advised to drink plenty of warm drinks, drainage of the chest and during the period of convalescence - breathing exercises.
- With a painful unproductive cough and the absence of signs of bronchial obstruction, antitussives with a central mechanism of action can be prescribed in a short course.
- If indicated, other drugs may be prescribed, for example, antiviral action in the presence of ARVI symptoms.
- With difficult to separate viscous sputum, the child is shown the appointment of expectorant and mucolytic agents.
- If the body temperature remains above 38 ° C, then an additional examination of the child (chest x-ray, complete blood count) is recommended and a decision on the advisability of including broad-spectrum antibiotics in the therapy regimen is recommended.
- In the presence of signs of bronchial obstruction, inhalation of β 2 -adrenoreceptor antagonists through a nebulizer is recommended. Oral bronchospasmolytics are not prescribed for children, as there is a high risk of side effects.
- For bronchitis caused by chlamydia or mycoplasma, macrolides are prescribed.
- In acute bronchitis of bacterial etiology, a course of antibiotic therapy is carried out for 5-7 days.
The well-known pediatrician Komarovsky E. O. gives similar recommendations.
Prevention
The main measures for the prevention of acute bronchitis in children are:
- increasing the general defenses of the body (rational nutrition, adherence to the daily regimen, regular stay in the fresh air, carrying out hardening procedures, playing sports);
- exclusion of contact with inhaled allergens and toxic substances;
- timely vaccination of children against pneumococcal infection and influenza;
- protecting the child from hypothermia and contact with patients with acute respiratory viral infections.
Video
We offer for viewing a video on the topic of the article.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
