21.10.2020

Treatment of bronchitis in children

In most cases, bronchitis in a child develops after suffering viral diseases – influenza, parainfluenza, rhinovirus, adenoviral, respiratory syncytial infection.

More rarely, bronchitis in children is caused by bacterial pathogens (streptococcus, pneumococcus, hemophilus bacillus, moraxella, pseudomonas and intestinal rods, Klebsiella), fungi of the genus Aspergillus and Candida, intracellular infection (chlamydia, mycoplasma, cytomegalovirus). Bronchitis in children often accompanies the course of measles, diphtheria, whooping cough.

Bronchitis of allergic etiology occurs in children sensitized with inhaled allergens entering the bronchial tree with inhaled air: household dust, household chemicals, plant pollen, etc. In some cases, bronchitis in children is associated with irritation of the bronchial mucosa by chemical or physical factors: polluted air, tobacco smoke, gasoline vapors, etc.

Predisposition to bronchitis is present in children with an aggravated perinatal background (birth trauma, prematurity, hypotrophy, etc.), anomalies of the constitution (lymphatic-hypoplastic and exudative catarrhal diathesis), congenital respiratory diseases, as well as congenital respiratory diseases (rhinitis), and congenital respiratory illnesses, as well as congenital respiratory illnesses, as well as congenital respiratory diseases, and congenital abnormalities of the constitution; tracheitis), a violation of nasal breathing (adenoids, curvature of the nasal septum), chronic purulent infection (sinusitis, chronic tonsillitis).

In epidemiological terms, the cold season (mainly the autumn-winter period), seasonal outbreaks of acute respiratory viral infection and influenza, children’s stay in children’s groups, and unfavorable social conditions are of most importance.

Specificity of bronchitis in children

The specificity of the development of bronchitis in children is inextricably linked with the anatomical and physiological features of the respiratory tract in childhood: abundant blood supply to the mucous membrane, laxity of the submucosal structures. These features contribute to the rapid spread of exudative-proliferative reaction from the upper respiratory tract into the depth of the respiratory tract.

Viral and bacterial toxins suppress the motor activity of the ciliary epithelium. As a result of infiltration and edema of the mucous membranes, as well as increased secretion of viscous mucus, the “flickering” of cilia slows down even more – thereby turning off the main mechanism of bronchial self-purification.

This leads to a sharp decrease in the drainage function of the bronchi and impede the outflow of sputum from the lower respiratory tract. Against this background, conditions are created for further reproduction and spread of infection, obturation by the secret of the bronchi of a smaller caliber.

Thus, the peculiarities of bronchitis in children are a considerable length and depth of the lesion of the bronchial wall, the severity of the inflammatory reaction.

Classification of bronchitis in children

By origin distinguish primary and secondary bronchitis in children. Primary bronchitis initially begins in the bronchi and only the bronchial tree is affected. Secondary bronchitis in children is a continuation or complication of another pathology of the respiratory tract.

The course of bronchitis in children can be acute, chronic and recurrent. Considering the extent of inflammation, limited bronchitis (inflammation of the bronchi within one segment or lung lobe), widespread bronchitis (inflammation of the bronchi of two or more lobes) and diffuse bronchitis in children (bilateral inflammation of the bronchi) are distinguished.

Depending on the nature of the inflammatory response, bronchitis in children may be catarrhal, purulent, fibrinous, hemorrhagic, ulcerative, necrotic, and mixed. In children, catarrhal, catarrhal-purulent and purulent bronchitis are more common. A special place among respiratory tract lesions is bronchiolitis in children (including obliterating) – bilateral inflammation of the terminal parts of the bronchial tree.

According to etiology, there are viral, bacterial, viral-bacterial, fungal, irritative and allergic bronchitis in children. The presence of obstructive components secrete non-obstructive and obstructive bronchitis in children.

Symptoms of bronchitis in children

The development of  acute bronchitis  in children in most cases is preceded by signs of a viral infection: sore throat, coughing, hoarseness, runny nose, conjunctivitis. Soon a cough occurs: obsessive and dry at the onset of the disease, by 5-7 days it becomes softer, more moist and productive with the separation of mucous or mucopurulent sputum.

In acute bronchitis, a child has an increase in body temperature to 38–38.5 ° C (duration from 2-3 to 8-10 days depending on etiology), sweating, indisposition, chest pain when coughing, in young children – shortness of breath. The course of acute bronchitis in children is usually favorable; the disease ends in recovery after an average of 10-14 days. In some cases, acute bronchitis in children may be complicated by bronchopneumonia. With recurrent bronchitis in children, exacerbations occur 3-4 times a year.

Acute bronchiolitis develops mainly in children of the first year of life. The course of bronchiolitis is characterized by fever, severe general condition of the child, intoxication, severe signs of respiratory failure (tachypnea, expiratory dyspnea, nasolabial cyanosis, acrocyanosis). Complications of bronchiolitis in children may be apnea and asphyxia.

  • Obstructive bronchitis  in children usually manifests in the 2-3rd year of life. The leading symptom of the disease is bronchial obstruction, which is expressed by paroxysmal cough, noisy wheezing, prolonged expiration, distant wheezing. Body temperature may be normal or subfebrile. The general condition of the children usually remains satisfactory. Tachypnea, shortness of breath, participation in the breathing of the auxiliary muscles are less pronounced than with bronchiolitis. Severe  obstructive bronchitis in children  can lead to respiratory failure and the development of  an acute pulmonary heart .
  • Allergic bronchitis  in children usually has a relapsing course. During periods of exacerbation, there is sweating, weakness, cough with the separation of mucous sputum. Body temperature remains normal. Allergic bronchitis in children is often combined with  allergic conjunctivitis , rhinitis,  atopic dermatitis  and can turn into  asthmatic bronchitis  or  bronchial asthma .
  • Chronic bronchitis  in children is characterized by exacerbations of the inflammatory process 2-3 times a year, occurring sequentially for at least two consecutive years. Cough is the most constant symptom of  chronic bronchitis  in children: it is dry during remission, and wet during exacerbations. The phlegm is coughing with difficulty and in small quantities; has a mucopurulent or purulent character. There is a low and unstable fever. Chronic suppurative inflammation in the bronchi may be accompanied by the development of deforming bronchitis and bronchiectasis in children.

Diagnosis of bronchitis in children

Primary diagnosis of bronchitis in children is carried out by a pediatrician, specifying – a pediatric pulmonologist and a children’s allergist-immunologist. When determining the form of bronchitis in children, clinical data (the nature of cough and sputum, the frequency and duration of exacerbations, course features, etc.), auscultation data, and laboratory and instrumental studies are taken into account.

The auscultatory picture in children with bronchitis is characterized by scattered dry (with bronchial obstruction with whistling) and moist various-sized rales.

In general, a blood test at the height of the inflammatory process is detected neutrophilic leukocytosis, lymphocytosis, increased ESR. For allergic bronchitis in children characterized by eosinophilia. The study of the gas composition of the blood is shown in bronchiolitis to determine the degree of hypoxemia. Of particular importance in the diagnosis of bronchitis in children is the analysis of sputum: microscopic examination, sputum bakposev, research on KUB, PCR analysis. If it is impossible for a child to cough up a secret of the bronchi, a bronchoscopy with sputum is taken.

Radiography of the lungs in children with bronchitis reveals an increase in pulmonary pattern, especially in the root zones. When conducting a respiratory function, a child can have moderate obstructive disorders. In the period of exacerbation of chronic bronchitis in children with bronchoscopy revealed the phenomenon of common catarrhal or catarrhal-purulent endobronchitis. To exclude bronchiectasis, bronchography is performed.

Differential diagnosis of bronchitis in children should also be carried out with pneumonia, bronchial foreign bodies, bronchial asthma, chronic aspiration of food, tubin-infection, cystic fibrosis, etc.

Treatment of bronchitis in children

In the acute period, children with bronchitis are shown bed rest, rest, plentiful drinking, and full vitaminized nutrition.

Specific therapy is prescribed taking into account the etiology of bronchitis in children: it may include antiviral drugs (umifenovira hydrochloride, rimantadine, etc.), antibiotics (penicillins, cephalosporins, macrolides), antifungal agents.

A mandatory component of the treatment of bronchitis in children are mucolytics and expectorant drugs that enhance the dilution of sputum and stimulate the activity of the bronchial epithelium of the bronchi (Ambroxol, Bromhexine, mukaltin, chest preparations). With a dry, hacking, coughing harassing child, antitussive drugs (okseladin, prenoksdiazin) are prescribed; with bronchial obstruction – aerosol bronchodilators. Antihistamines are indicated for children with allergic bronchitis; with bronchiolitis inhaled bronchodilators and corticosteroid drugs.

From the methods of physiotherapy for the treatment of bronchitis in children, medicinal, oil and alkaline inhalations, nebulizer therapy, UVA, UHF and chest electrophoresis, microwave therapy and other procedures are used. The setting of mustard plasters and cans, as well as cupping massage are useful as a distracting therapy. For difficulties in sputum discharge, a chest massage, vibration massage, postural drainage, rehabilitation bronchoscopy, exercise therapy are prescribed.

Prevention of bronchitis in children

Prevention of bronchitis in children includes the prevention of viral infections, early use of antiviral drugs, the elimination of contact with allergic factors, the protection of the child from hypothermia, hardening. An important role is played by timely preventive vaccination of children against influenza and pneumococcal infection.

Children with recurrent and chronic bronchitis need to be monitored by a pediatrician and pediatric pulmonologist until the persistent cessation of exacerbations within 2 years, conducting anti-relapse treatment in the autumn-winter period. Vaccine prophylaxis is contraindicated in children with allergic bronchitis; with other forms is carried out a month after recovery.

Bronchitis in children  – non-specific inflammation of the lower respiratory tract, occurring with lesions of the bronchi of various sizes. Bronchitis in children is manifested by coughing (dry or with sputum of different nature), fever, chest pain, bronchial obstruction, wheezing.

Bronchitis in children is diagnosed on the basis of the auscultatory picture, x-ray data of the lungs, complete blood count, sputum examination, respiratory function, bronchoscopy, bronchography. Pharmacotherapy of bronchitis in children is carried out with antibacterial drugs, mucolytics, antitussive drugs; physiotherapy includes inhalation, ultraviolet irradiation, electrophoresis, canned and vibratory massage, exercise therapy

Bronchitis in children – inflammation of the mucous membrane of the bronchial tree of various etiologies. For every 1,000 children, 100–200 cases of bronchitis occur every year. Acute bronchitis accounts for 50% of all lesions of the respiratory tract in young children. Especially often the disease develops in children of the first 3 years of life; most severe in infants.

Due to the diversity of causally significant factors, bronchitis in children is the subject of a study of pediatrics, pediatric pulmonology and allergology-immunology.

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