Acute obstructive bronchitis – the inflammation of a bronchial tree which is followed by a syndrome of obstruction of bronchial tubes, generally small and average caliber. The expiratory short wind arising against the background of cough, attacks of suffocation, temperature increase whistling or damp rattles is the main sign of acute obstructive bronchitis. Except data of a clinical picture, in diagnostics the spirometry, a pnevmotakhografiya, X-ray of lungs are used. Modern algorithms of therapy of acute obstructive bronchitis include use of bronchial spasmolytics, mucolytics, expectorant means, inhalation glucocorticosteroids, massage.
Acute obstructive bronchitis
Acute obstructive bronchitis – clinical option of an acute bronchitis of which violation of passability of bronchial tubes owing to hypostasis of a mucous membrane, a congestion of a bronchial secret and hyperreactivity of bronchial tubes is characteristic. The disease is most typical for children's age. According to researches in the field of pulmonology and pediatrics, about 20-25% of all sharp bronchitis at children proceed with the bronkhoobstruktion phenomena. Except obstructive bronchitis, at children other sharp obstructive syndromes often develop: laryngotracheitis (croup), bronkhiolit, bronchial asthma. Criteria of acute obstructive bronchitis are preservation of symptoms of an inflammation of bronchial tubes up to 3 weeks in the presence of short wind of expiratory type.
Reasons of acute obstructive bronchitis
Most often acute obstructive bronchitis has infectious and allergic genesis. As a rule, damage of the lower airways is preceded by the postponed SARS: flu, respiratory , rinovirusny, adenoviral, enteroviral infection, paraflu, etc. At the same time actually the bronkhoobstruktion arises at persons with the burdened allergic anamnesis more often.
High prevalence of acute obstructive bronchitis among children of preschool age is caused by anatomo-physiological prerequisites. The immune system of children of this age group differs in immaturity (insufficient secretion of interferon, G and A immunoglobulins, limited activity of a complement, immaturity of T - and V-lymphocytes etc.) that is followed by the raised susceptibility to infections. Along with features of a structure and functioning of a respiratory path (small diameter of bronchial tubes, friability mucous, the increased slime secretion, mukotsiliarny insufficiency, etc.) these factors create conditions for a bronkhoobstruktion.
The mechanism of development of a bronkhoobstruktivny syndrome is connected with a giperplaziya and hypostasis of a mucous membrane of a respiratory path and to a lesser extent - with a bronchospasm. Virus agents cause injury of a mucous membrane of bronchial tubes and start a chain of immunological reactions from which release of mediators results. The last (a histamine, serotonin, leykotriyena, prostaglandins, etc.) cause strengthening of permeability of vessels, hypostasis of bronchial tubes (with a thickening of all layers of a bronchial wall), hyper secretion and the increased viscosity of slime, hyperreactivity of bronchial tubes. Finally it leads to violation of passability of airways. Some researchers consider a bronkhoobstruktion as the protective mechanism interfering penetration of infectious agents into a pulmonary parenchyma – observations show that acute obstructive bronchitis extremely seldom is complicated by bacterial pneumonia.
The environment factors significantly increasing risk of emergence of a bronkhoobstruktion include passive and active smoking, impurity of the atmosphere ingalyatorny irritant (vapors of gasoline, ammonia, chlorine, dioxides are gray), meteofactors (cold air, the increased humidity or dryness of air). Acute obstructive bronchitis usually occurs at often ill children.
Symptoms of acute obstructive bronchitis
The initial clinical picture is defined by symptoms of that respiratory infection which gave an impetus to development of acute obstructive bronchitis. The complicated breath appears already on the first or second (sometimes on the third or fifth) days. Frequency of breath increases to 25 and more in a minute; the exhalation becomes extended, noisy, whistling, heard at distance (remote rattles). Than the child is younger, especially signs of respiratory insufficiency are expressed (, concern, perioralny cyanosis, aspiration to reach the compelled position).
Patients with acute obstructive bronchitis are disturbed by the unproductive, pristupoobrazny cough amplifying at night. Point retraction of intercostal intervals and supraclavicular poles, inflating of wings of a nose to participation of auxiliary muscles in breath. Body temperature can be normal or subfebrilny. Signs of violation of the general health testify to the course of infectious process: weakness, an adynamy, a headache, a loss of appetite, the increased sweating.
Symptoms of acute obstructive bronchitis remain from one to two-three weeks. At repetition of episodes of a disease within a year 2–3 times are also more exposed the diagnosis "recurrent obstructive bronchitis". A sharp and recidivous bronkhoobstruktivny syndrome can be complicated by accession of a bacterial inflammation, formation of chronic obstructive bronchitis, the deforming bronchitis, bronchial asthma.
Diagnosis of acute obstructive bronchitis
Usually for confirmation of the diagnosis survey and the analysis of fizikalny data suffices. In favor of acute obstructive bronchitis its communication with a viral disease, existence and the extended exhalation testifies. The thorax is increased in a front-back size; perkutorno over lungs is defined timpanit. At an auskultation rigid breath with the rattles multiple whistling, buzzing is listened.
The X-ray analysis of lungs finds bilateral strengthening of the pulmonary drawing and expansion of roots, indicates the raised swelling of lungs (flattening and low standing of domes of a diaphragm, horizontal position of edges, strengthening of transparency of pulmonary fields). Shifts in peripheral blood correspond to a viral infection (neytrofilny , increase in SOE). Indicators of gas composition of blood can be within norm or are changed slightly.
Methods of a research of function of external breath (spirometry, pnevmotakhografiya) indicate decrease in ZhYoL and violation of bronchial passability. Acute obstructive bronchitis demands performing differential diagnostics with a sharp bronkhiolit, whooping cough, bronchial asthma, foreign matters of bronchial tubes.
Treatment of acute obstructive bronchitis
Therapy of acute obstructive bronchitis is carried out on an outpatient basis. Children of early age with a medium-weight and severe form of a bronkhoobstruktion need hospitalization. The sparing mode is appointed, the contact with irritants is excluded (perfumery, dust, household chemicals, cigarette smoke and so forth). For the purpose of fluidifying of a phlegm and simplification of its evacuation from airways the sufficient water mode, moistening of air in the room, perkutorny massage of a thorax, a position drainage is recommended.
Rational pathogenetic therapy allows to avoid development of severe forms of acute obstructive bronchitis and its synchronization. Therefore the main role in treatment is assigned to anti-inflammatory, bronkholitichesky and mukolitichesky medicines. From bronchial spasmolytics are usually used , ; appointment beta 2 - (salbutamol, ) in inhalations or via the nebulizer is expedient. Bromhexine and Ambroxol have Mukolitichesky and expectorant effect (in the form of syrup, tablets, inhalations). The mode and dosages are selected the pediatrician or the pulmonologist according to age of the patient. As anti-inflammatory therapy use of a fenspirid, inhalation glucocorticosteroids is recommended. Purpose of protivokashlevy central acting agents at acute obstructive bronchitis is undesirable.
The distracting procedures (can massage, hot foot and manual bathtubs), physiotreatment (UVCh, the laser, electrophoresis) are effective. Severe forms of a bronkhoobstruktion demand performing oxygenotherapy. For fight against causative agents of a respiratory infection medicines of recombinant interferon are used; antibiotic treatment is justified only in case of suspicion of an acute pneumonia.
Forecast and prevention of acute obstructive bronchitis
Approximately at 30-50% of the children who had acute obstructive bronchitis, episodes of a bronkhoobstruktion repeat within a year against the background of a new viral infection. In most cases the obstructive component disappears aged is more senior than 3-4 years. Existence of allergic predisposition significantly increases probability of synchronization of obstructive bronchitis. For decrease in risk of incidence the hardening, restriction of contact with infectious and allergic agents, sanitation of the chronic infectious centers is recommended. At recurrent obstructive bronchitis consultation of the allergist-immunologist and pulmonologist is shown.