Treatment of bronchiectasis in a child

Bronchiectasis in children is a polietiologic disease. As a rule, primary bronchiectasis is formed against the background of previously suffered severe or recurrent bacterial or viral diseases – bronchitis, pneumonia, measles, influenza, whooping cough.

In children, against the background of morphological immaturity of the lung tissue, bronchiectasis can occur in as little as 24 to 48 hours. In some cases, bronchiectasis in children becomes the result of a foreign body entering the bronchus.

With massive obturation, structural deformation can already form after a few hours. Exacerbation of bronchiectasis in children can provoke respiratory viral diseases (adenovirus, influenza virus and parainfluenza, rhinovirus, etc.). The course of BEB is aggravated by chronic bronchitis, which can be caused by a hemophilic bacillus, some types of staphylococci and pneumococci, less often – β-hemolytic streptococcus.

In addition to the main cause of bronchiectasis in children, there are predisposing factors, against which the risk of developing the disease increases significantly. These include hereditary tendency in the form of a genetically determined defect of the walls of the bronchial tree, mother’s use of alcohol, drugs and tobacco products during pregnancy, gastroesophageal reflux disease, reduced immunity, atelectasis of various etiologies, passive smoking, polluted atmosphere. Also important is the localization of the center of inflammation in the basal regions of the lungs in case of potentially dangerous diseases and inadequately administered treatment.

The basis of the pathogenesis of bronchiectasis in children lies in two main factors – inflammation of the bronchi and the violation of their patency. The first causes metaplasia and ulceration of the mucosal epithelium, destruction of elastic and smooth muscle fibers and cartilage rings, hardening of the wall. All this causes a loss of elasticity and resistance of the bronchi to the “cough push”, then – the occurrence of deformity and impaired mucociliary clearance.

In such conditions, intrabronchial pressure increases, which causes the expansion of the bronchus and the development of bronchiectasis in children. Violation of the patency completely blocks the remaining air in the distal bronchi, which, when exhaling, also provokes intrabronchial hypertension. This contributes to the development of inflammation distal to the site of obstruction, which closes the “vicious circle.”

Classification of bronchiectasis in a child

In domestic pediatrics, the following classification of bronchiectasis in children is adopted:

• The shape  of the bronchial deformities : cylindrical, saccular, cystic, spindle-shaped, mixed.
• By  severity of BEB : light, moderate, heavy.
• By the period of the  disease : aggravation, remission.
• By prevalence : segmental, polysegmental, lobar, total.

Symptoms of bronchiectasis in a child
The main occurrence of bronchiectasis in children is chronic bronchitis. Initial symptoms can be observed already at the age of 3-4 years. In this period, the course of the disease often has a continuous recurrent nature. In older children, exacerbations occur with a frequency of 3-5 times a year. The main clinical symptom in the period of remission is a wet cough with sputum discharge. The separation of the latter occurs mainly in the morning, in some cases – in large quantities (“full mouth”).

Some children develop hypovitaminosis, which is manifested by dry skin, brittle hair and nails, cracks in the corners of the mouth and glossitis. Sometimes there is chest deformity. General physical development is rarely affected. During the period of exacerbation of bronchiectasis in children, there may be asteno vegetative syndrome, severe expiratory dyspnea, both during exercise and at rest, oral crepitus, admixture of pus and blood in sputum, fever, very rarely – hemoptysis.

Diagnosis of bronchiectasis in a child

Diagnosis of bronchiectasis in children is based on the collection of anamnestic data, physical examination, laboratory and instrumental studies. When collecting the history of pediatrician special attention is paid to previously transferred viral and bacterial diseases of the bronchopulmonary system, the presence of possible predisposing factors. When visual inspection, depending on the severity, various signs of BEB can be detected.

During auscultation, hard breathing, various-sized moist rales, and amphoric noise are heard. Laboratory tests for acute exacerbation of bronchiectasis in children are not specific and indicate the presence of an inflammatory focus in the body. Increased erythrocyte sedimentation rate, leukocytosis, a shift of blood count to the left. Bacteriological, bacterioscopic analyzes of sputum and serological tests of blood can be used to determine the pathogenic agents that caused the exacerbation.

The instrumental examination of the chest radiography, bronchoscopy and computed tomography plays a leading role in the diagnosis of bronchiectasis in children. On the radiograph, you can determine the decrease in lung volume, its displacement, deformation and cellularity of the pulmonary pattern. More often the left lung is affected. Bronchoscopy makes it possible to identify a violation of mucociliary clearance, inflammatory and structural changes in the lumen of the bronchus. Direct signs of bronchiectasis in children on CT are the expansion of the bronchi, the absence of narrowing of the distal parts of the bronchial tree and the deterioration of its visibility in the marginal areas of the lungs.

Differential diagnosis of bronchiectasis in children as an independent disease is carried out with other nosologies that are accompanied by the expansion of the bronchi. These include pulmonary cystic fibrosis, Mounier-Kun syndrome, Williams-Campbell syndrome, allergic bronchopulmonary aspergillosis, congenital ciliary dyskinesia and congenital malformations of the bronchial tree.

Treatment of bronchiectasis in a child

Treatment of exacerbations of bronchiectasis in children is conservative. Bed or half-bed mode. The diet of the child is saturated with vitamins A, C, protein food and fats. Carbohydrates and salt are limited. The basis of drug treatment – antibacterial drugs selected in accordance with the sensitivity of microflora seeded from sputum.

Also, depending on the clinical situation, mucolytics, bronchodilators and inhaled corticosteroids can be used. If necessary, perform therapeutic bronchoscopy with the purpose of rehabilitation of the bronchial tree. From physiotherapy in children with bronchiectasis, massage, positional drainage, UHF-, DMV-, SMV-therapy, electrophoresis, laser therapy, paraffin and ozokerite are prescribed.

In severe cases of bronchiectasis in children, surgical treatment is carried out in the form of mono-or polysegmental lung resection. The main indications for surgery are the ineffectiveness of the prescribed conservative treatment against the background of stable focal infection and the development of life-threatening conditions, including pulmonary hemorrhage.

The prognosis for bronchiectasis in children against the background of early diagnosis and treatment is favorable. Further progression and spread to the intact parts of the bronchial tree under the condition of adequately selected therapy is not observed. Subsequently, patients retain their performance, fully adapt to society. Primary prevention of bronchiectasis in children is aimed at preventing the development of this pathology. It includes antenatal protection of the fetus, prevention and rational treatment of respiratory infections, the elimination of all potential etiological factors. The essence of the secondary prevention of BEB is to reduce the frequency of exacerbations and the formation of persistent clinical remission. It includes spa treatment, nutrition, exclusion of precipitating factors, physiotherapy and exercise therapy.

Bronchiectasis in children (BEB)  is an acquired chronic pathology of the respiratory system, which is accompanied by irreversible expansion and deformation of the bronchi and a purulent-inflammatory process. Clinically, it manifests itself as a wet cough with sputum, respiratory failure, chest deformity, frequent bronchitis.

Diagnosis of BEB includes radiography, bronchoscopy and chest CT. Treatment of bronchiectasis in children is conservative: antibiotics, mucolytics, bronchodilators, inhaled glucocorticosteroids, physiotherapy. If necessary, surgery can be carried out.

Bronchiectasis in children is a heterogeneous chronic disease of the bronchopulmonary system, which is characterized by irreversible deformity and purulent-inflammatory changes in the bronchial tree and is manifested by recurrent bronchitis. For the first time this nosology was described by a French physician and anatomist Rene Laennec in 1819. The overall prevalence of BEB is between 1.5 and 15 children per 1,000 population.

The disease is more common in ecologically unfavorable regions, as well as in families of smokers. Male sex is more likely to develop BEB – boys get sick 1.5-2 times more often than girls. In recent decades, a decrease in the prevalence of bronchiectasis in children has been observed. This is associated with a decrease in the incidence of infectious morbidity and the effectiveness of antimicrobial treatment.