27.10.2020

Treatment of bronchial obstructive syndrome in a child

The main reason for the development of bronchial obstruction in children is infectious diseases and allergic reactions. Among acute respiratory viral infections, parainfluenza virus (type III) and PC infection most often provoke bronchial obstruction. Other likely causes are congenital heart and bronchopulmonary diseases, RDS, genetic diseases, immunodeficiency states, bronchopulmonary dysplasia, aspiration of foreign bodies, GERH, round worms, hyperplasia of regional lymph nodes, bronchial and adjacent tissues, side effects of medications.

In addition to the main causes of broncho-obstructive syndrome in children, there are contributing factors that significantly increase the risk of developing the disease and worsen its course. In pediatrics, these include genetic susceptibility to atopic reactions, passive smoking, increased reactivity of the bronchial tree and its anatomical and physiological features in infancy, thymus hyperplasia, vitamin D deficiency, artificial feeding, body mass deficiency, intrauterine diseases. All of them are able to enhance the influence of each other on the child’s body and exacerbate the course of the broncho-obstructive syndrome in children.

Pathogenetic bronchial obstruction in children may be due to the inflammatory reaction of the bronchial wall, spasm of the smooth muscle muscles, occlusion or compression of the bronchus.

The above mechanisms can cause a narrowing of the bronchial lumen, a violation of mucociliary clearance and thickening of the secret, swelling of the mucous membrane, destruction of the epithelium in the large bronchi and its hyperplasia in the small ones. As a result, impaired patency, lung dysfunction and respiratory failure develop.

Classification of bronchial obstruction in a child

Depending on the pathogenesis of the broncho-obstructive syndrome in children, the following forms of pathology are distinguished:

  1. BOS of allergic genesis . It occurs on the background of asthma, hypersensitivity reactions, pollinosis and allergic bronchitis, Leffler syndrome.
  2. BOS due to infectious diseases . The main reasons are acute and chronic viral bronchitis, acute respiratory viral infections, pneumonia, bronchiolitis, bronchiectasis.
  3. BOS, developed on the background of hereditary or congenital diseases . Most often, this is cystic fibrosis, α-antitrypsin deficiency, Cartagener and Williams-Campbell syndromes, GERH, immunodeficiency states, hemosiderosis, myopathy, emphysema, and anomalies of bronchial development.
  4. BOS, resulting from neonatal pathologies.  Often, it is formed on the background of SDR, aspiration syndrome, stridor, diaphragmatic hernia, tracheoesophageal fistula, etc.
  5. BOS as a manifestation of other nosologies.  Broncho-obstructive syndrome in children can also be triggered by foreign bodies in the bronchial tree, thymomegaly, hyperplasia of regional lymph nodes, benign or malignant neoplasms of the bronchi or adjacent tissues.

The duration of the course of bronchial obstruction in children is divided into:

  • Acute.  The clinical picture is observed no more than 10 days.
  • Protracted.  Signs of bronchial obstruction are detected for 10 days or longer.
  • Recurrent  Acute BOS occurs 3-6 times a year.
  • Continuously relapsing.  It is characterized by short remissions between episodes of prolonged biofeedback or their complete absence.
Symptoms of bronchial obstruction in a child

The clinical picture of the broncho-obstructive syndrome in children largely depends on the underlying disease or factor provoking this pathology. The general condition of the child in most cases is moderate, there is general weakness, moodiness, sleep disturbance, loss of appetite, signs of intoxication, etc.

Immediately, BOS, regardless of etiology, has characteristic symptoms: noisy loud breathing, wheezing, which are heard at a distance, a specific whistle on expiration.

Also, the participation of auxiliary muscles in the act of breathing, apnea attacks, expiratory dyspnea (more often) or mixed nature, dry or unproductive cough is observed. With a protracted course of the broncho-obstructive syndrome in children, barrel chest can form – expansion and protrusion of the intercostal spaces, a horizontal course of the ribs.

Depending on the background pathology, there may also be fever, body mass deficiency, mucous or purulent nasal discharge, frequent regurgitation, vomiting, etc.

Diagnosis of bronchial obstruction in a child

Diagnosis of bronchial obstruction in children is based on the collection of anamnestic data, objective research, laboratory and instrumental methods.

When a mother is interviewed by a pediatrician or neonatologist, attention is focused on possible etiological factors: chronic diseases, developmental defects, allergies, BOSB episodes in the past, etc. Physical examination of the child is very informative in children with broncho-obstructive syndrome. Perkutorno is determined by the amplification of pulmonary sound until tympanitis. Auscultatory picture is characterized by hard or weakened breathing, dry, whistling, in infancy – small-caliber moist rales.

Laboratory diagnosis of bronchial obstructive syndrome in children includes general tests and additional tests. In the KLA, as a rule, nonspecific changes indicate the presence of an inflammatory focus: leukocytosis, leukocyte shift to the left, increased ESR, and in the presence of an allergic component, eosinophilia. If it is impossible to establish the exact etiology, additional tests are shown: ELISA with the determination of IgM and IgG to probable infectious agents, serological tests, a test with the determination of the level of chlorides in sweat for suspected cystic fibrosis, etc.

Among the instrumental methods that can be used in children with broncho-obstructive syndrome, most often use X-rays of OGK, bronchoscopy, spirometry, less often CT and MRI. Radiography provides an opportunity to see the extended roots of the lungs, signs of a concomitant lesion of the parenchyma, the presence of tumors or enlarged lymph nodes. Bronchoscopy allows you to identify and remove a foreign body from the bronchi, to assess the permeability and condition of the mucous membranes. Spirometry is performed with a long course of bronchial obstruction in children in order to assess the function of external respiration, CT and MRI – with low informative X-ray and bronchoscopy.

Treatment of bronchial obstructive syndrome in a child

Treatment of bronchial obstruction in children is aimed at eliminating the factors causing obstruction. Regardless of the etiology, hospitalization of the child and emergency bronchodilator therapy using β2-adrenomimetics is indicated in all cases. In the future, can be used anticholinergic drugs, inhaled corticosteroids, systemic glucocorticosteroids.

As auxiliary drugs used mucolytic and antihistamines, methylxanthines, infusion therapy. After determining the origin of the broncho-obstructive syndrome in children, etiotropic therapy is prescribed: antibacterial, antiviral, anti-tuberculosis drugs, chemotherapy. In some cases, surgery may be required. In the presence of anamnestic data indicating a possible hit of a foreign body in the respiratory tract, emergency bronchoscopy is performed.

The prognosis for bronchial obstruction in children is always serious. The younger the child, the worse his condition. Also, the outcome of the BOS is largely dependent on the underlying disease. In acute obstructive bronchitis and bronchiolitis, as a rule, recovery is observed, rarely remains hypersensitivity of the bronchial tree. BOS in case of bronchopulmonary dysplasia is accompanied by frequent acute respiratory viral infections, but often stabilizes by two years of age. In 15-25% of these children, it is transformed into bronchial asthma. Directly BA can have a different course: the mild form goes into remission even at the early school age, severe, especially against the background of inadequate therapy, is characterized by deterioration in the quality of life, regular exacerbations with a fatal outcome in 1-6% of cases.

Prevention of bronchial obstruction in children involves the elimination of all potential etiological factors or the minimization of their effects on the child’s body. This includes antenatal protection of the fetus, family planning, medico-genetic counseling, rational use of medications, early diagnosis and adequate treatment of acute and chronic diseases of the respiratory system, etc.

Broncho-obstructive syndrome in children  is a complex of symptoms, which is characterized by impaired patency of the bronchial tree of functional or organic origin. Clinically, it manifests itself as a prolonged and noisy exhalation, asthma attacks, activation of auxiliary respiratory muscles, dry or unproductive cough.

The basic diagnosis of bronchial obstruction in children includes the collection of anamnestic data, physical examination, radiography, bronchoscopy and spirometry. Treatment – bronchodilator pharmacotherapy with β2-adrenomimetics, elimination of the leading etiological factor.

Broncho-obstructive syndrome (BOS)  is a clinical symptom complex that is characterized by narrowing or occlusion of bronchi of various calibers due to accumulation of bronchial secretions, thickening of the wall, spasm of smooth muscle muscles, reduction of mobility of the lung or compression by surrounding structures. BOS – a common pathological condition in pediatrics, especially among children under the age of 3 years.

According to various statistics, amid acute diseases of the respiratory system, BFR is found in 5-45% of cases. In the presence of burdened history, this figure is 35-55%. The prognosis for biofeedback varies and depends on the etiology. In some cases, there is a complete disappearance of clinical manifestations against the background of adequate etiotropic treatment, in others there is a chronic process, disability or even death.

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