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
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