ACUTE OBSTRUCTIVE BRONCHITIS

In the basis of syndrome is violation of the bronchial passage, conditioned by the diffuse inflammatory edema of mucus, hypersecretion and accumulation of mucous and purulent phegma in bronchial tubes, transitory reflex spasm of smooth musculature.

                 Until the 70's, the last century, the term "obstructive bronchitis and its analogs (asthmatic bronchitis, spastic bronchitis, etc.) were widely used by pediatricians. However, in the early 70's a series of epidemiological studies were performed, which showed that distinguish obstructive bronchitis and asthma in the general pediatric practice is almost impossible. Thus, equal sign between these states was put. This approach in older children has largely justified itself, as would save many patients from antibiotic therapy. But in younger children the problem is more complicated. It was established that cromoglycate in these patients is not effective enough or not effective at all. Inhaled bronchodilators such as salbutamol, are ineffective enough or not effective at all at wheezing in children of the first three years of life. Information regarding the effectiveness of inhaled steroids for acute or chronic bronchiolitis was contradictory.

               In addition, numerous studies in our country and abroad have shown that the outcomes of obstructive bronchitis in general are favourable. 54% of children with repeated episodes of obstructive bronchitis stopped hurting after four years, and another 37% of - at a later age, thus recovering is more than 90% of patients. In addition, the presence of obstructive syndrome in the first three years of life can not be considered as a factor predisposing to the appearance of asthma in the future. That is, it became clear that the mechanism of development of wheezing in infants, other than for the older children, and the main role is played not hyper reactivity in bronchial mucosa and muscle spasm and tone of the bronchial wall and edema of bronchial mucosa. This reflects the fact that "wheezing" in young children is a consequence of various causes, including abnormalities of the respiratory system and inflammatory processes of other etiologies.

Clinics: subfebril temperature, trouble, crabbiness of child, cyanosis of lips, nasolips triangle, acrocyanosis. Dyspnea, noisy, with the prolonged inspiration and  distance wheezes. Downing in of interrib intervals, supraclavia areas, jugular pit.  Unproductive coughing. A thorax is emphysematous, at percussion above lungs -box sound, аt auscultation- breathing is hard, with the prolonged inspiration and dry and different moist wheezes, character of which is changed after a cough. Таchycardia. A liver is often enlarged. In the general blood analysis there is not substantial changes or insignificant neutrophyls leucocytosis.

                

                                           Barrel thorax

Diagnostic criteria of acute obstructive bronchitis in children

  - Long whistling breath, which is audible at a distance                         

- Inflated thorax when viewed from (horizontal placement

    ribs) participated in the act of breathing support muscles,

   retraction of the intercostal spaces, signs of respiratory

    failure

- Dry cough, paroxysmal, prolonged and at the end of the first

   week passes in the moist

- Percussion determined bandbox pulmonary sound

- Auscultation: hard breathing, exhaling is prolonged,

   large amount of dry whistling rales. There may be coarse

   bubbling low sound rales

- On the chest radiograph is observed decreased lung

   pattern in the lateral regions of the lungs, and increased in the medial

  (hidden emphysema).

On the X-ray of thorax organs - the strengthening of pulmonary pattern, areas of promoted pneumatization without of infiltration changes in lungs.

     

Radiographs of the chest in front projection with AOB: total marked bilateral increase the transparency of lung fields, depletion of vascular pattern on the periphery with its increasing in the central parts, the expansion of the roots of the lungs and flattening of the diaphragm.

              Differential diagnosis of obstructive bronchitis and pneumonia

Symptoms	Obstructive bronchitis	Pneumonia
Temperature	Subfebril	Hyperthermia
Intoxication	Absent or slight	Expressed
Dyspnea	+	+
Dry whistling rales	+	–
Local moist rales	–	+
Percussion sound	Bandbox	Dull
X-ray	The strengthening of pulmonary pattern	Local (segmental, lobe, focal) infiltrates

    Differential diagnosis of bronchial asthma and obstructive bronchitis  

Symptoms	Bronchial asthma	Obstructive bronchitis
Allergologic anamnesis	Positive	Sometimes positive
Start of illness Catarrhal sings of ARVI	Attack of dyspnea with or without ARVI	Gradual increasing of symptoms
Temperature	Normal, sometimes increased	Everytimes increased
Course of disease	Repeating attack of dyspnea	Frequency of obstructive episodes decreases, recovery is possible
Ig E	Increased	Normal
Eosynophylia in blood	Present	Absent

Help on prehospital stage.

1.             To provide access of fresh air.

2.             To release from squeezing clothes.

3.             Succing with electrosuccer mucus and phlegma from upper

                     respiratory tracts.

4.             Oxygentherapy with  clean moistened oxygen through a mask.

5.             Broncholytin for  children upto 3 years– harf of  tea-spoon, 3-10 years

                    a 1 tea-spoon, more senior than 10 years  a 1 dessert-spoon 3 times per

                   day or Solutani 5-10 drops 3 times per  day.                                                                                                                                                     

6.             Euphyllini in  dose of a 3-5 mg per kg of  mass orally or 24 % Euphyllini

                             solution intramuscular.                                   

7.             Salt-alkaline inhalation.

8.             In default of effect - hospitalization.

Help on  hospital stage.

            1. Succing with electrosuccer mucus and phlegma from upper respiratory

               tracts.

            2. Oxygentherapy through the nasal catheter with 40 % moistened oxygen

               constantly.

               

Nasal catheters for oxygenotherapy

            3. Inhalations of broncholitic mixture: Euphyllini - 0,3, ephedrine  – 0,2,

               novocaine – 0,25, water – 50,0 мл. On inhalation 3–5 ml, before inhalation

               to add 1,0 ml of  5 % sodium ascorbinati solution .

            4. Mucolytic drugs: salt-alkaline inhalations; Acetylcysteini or Lasolvani in

               inhalations, syrup, tablets; Mucaltini in tablets, extract of altey.      

            5. Vibromassage of  thorax in drainage position with next active aspiration

                of phlegma.

           6.  2,4 % solution of Euphyllini 3-5 mg/kg of  mass of intravenously

                 in drops on isotonic solution of chloride sodium  10-15 ml/kg of mass.

          7. 5 % solution of sodium ascorbinati 0,2 mg/kg of the masses intravenously

               streamly on 5 ml of  10 % glucose solution .

          8. Cocarboxylazae 5-8 mg/kg of mass of intravenously streamly on 5 ml of 

              10 % glucose solution.

          9. In default of effect from previous therapy Prednisoloni 1–2 mg/kg of the

              masses (or Hydrocortisoni 5 mg/kg of  mass) intravenously streamly on

             5 ml of  10 % glucose solution.

          10. Alkaline drink: 1 % solution of sodium bicarbonates 10-15 ml/kg of