Bronkhoobstruktivny syndrome at children – a complex of symptoms which is characterized by violation of passability of a bronchial tree of a functional or organic origin. Clinically it is shown by the prolonged and noisy exhalation, suffocation attacks, activation of auxiliary respiratory muscles, dry or unproductive cough. The main diagnostics of a bronkhoobstruktivny syndrome at children includes collecting anamnestichesky data, objective survey, a X-ray analysis, a bronkhoskopiya and spirometry. Treatment – bronkholitichesky pharmacotherapy β2-, elimination of the leading etiologichesky factor.
Bronkhoobstruktivny syndrome at children
The Bronkhoobstruktivny syndrome (is BAREFOOT) – clinical simptomokompleks which is characterized by narrowing or occlusion of bronchial tubes of various calibers owing to a congestion of a bronchial secret, a thickening of a wall, a spasm of gladkomyshechny muscles, reduction of mobility of a lung or squeezing by surrounding structures. It is BAREFOOT – a widespread pathological state in pediatrics, especially among children under 3 years. According to various statistical data, against the background of sharp diseases of the is BAREFOOT respiratory system meets in 5-45% of cases. In the presence of the burdened anamnesis this indicator makes 35-55%. The forecast at is BAREFOOT varies and directly depends on an etiology. In one cases there is a total disappearance of clinical manifestations against the background of adequate etiotropny treatment, in others process synchronization, disability or even a lethal outcome is observed.
The main reason for development of a bronkhoobstruktivny syndrome in children – infectious diseases and allergic reactions. Among a SARS bronchial obstruction is provoked most often by paraflu viruses (type III) and the RS-infection. Other probable causes: congenital heart diseases and bronchopulmonary system, RDS, genetic diseases, immunodeficiency, bronchopulmonary dysplasia, aspiration of foreign matters, GERH, round helminths, giperplaziya of regionarny lymph nodes, new growths of bronchial tubes and adjacent fabrics, collateral influence of medicines.
Besides the main reasons for a bronkhoobstruktivny syndrome at children allocate the promoting factors which significantly increase risk of development of a disease and worsen its current. In pediatrics genetic tendency to atopic reactions, passive smoking, the increased reactivity of a bronchial tree and its anatomo-physiological features at infantile age, a thymus giperplaziya, deficiency of vitamin D, feeding by artificial mixes, deficiency of body weight, pre-natal diseases concern to those. All of them are capable to strengthen influence of each other on an organism of the child and to aggravate a current of a bronkhoobstruktivny syndrome at children.
Pathogenetic the bronkhoobstruktivny syndrome at children can be caused by inflammatory reaction of a bronchial wall, a spasm of gladkomyshechny muscles, occlusion or a compression of a bronchial tube. The above-stated mechanisms are capable to cause narrowing of a bronchial gleam, violation of mukotsiliarny clearance and a condensation of a secret, hypostasis of a mucous membrane, destruction of an epithelium in large bronchial tubes and its giperplaziya in small. As the result – develops deterioration in passability, dysfunction of lungs and respiratory insufficiency.
Depending on pathogenesis of a bronkhoobstruktivny syndrome at children allocate the following forms of pathology:
- It is BAREFOOT allergic genesis. Arises against the background of bronchial asthma, reactions of hypersensitivity, pollinoz and allergic bronchitis, Leffler's syndrome.
- It is BAREFOOT, caused infectious by diseases. Main reasons: sharp and chronic viral bronchitis, SARS, pneumonia, bronkhiolita, bronkhoektatichesky changes.
- It is BAREFOOT, developed against the background of hereditary or congenital diseases. Most often it , insufficiency of α-anti-trypsin, Kartagener and Williams-Campbell's syndromes, GERH, immunodeficiency, , myopathy, emphysema and anomalies of development of bronchial tubes.
- It is BAREFOOT, resulted from neonatal pathologies. Often it is formed against the background of SDR, an aspiration syndrome, a stridor, hernia of a diaphragm, trakheoezofagealny fistula, etc.
- It is BAREFOOT as manifestation of other nozologiya. The Bronkhoobstruktivny syndrome at children can be also provoked by foreign matters in a bronchial tree, a timomegaliya, giperplaziy regional lymph nodes, good-quality or malignant new growths of bronchial tubes or adjacent fabrics.
On current duration the bronkhoobstruktivny syndrome at children is divided on:
- Sharp. The clinical picture is observed no more than 10 days.
- Long. Signs of bronchial obstruction come to light for 10 days and longer.
- Recidivous. Sharp it is BAREFOOT there are 3-6 times in a year.
- Continuously recidivous. It is characterized by short remissions between episodes of long it is BAREFOOT or their total absence.
Symptoms it is BAREFOOT at children
The clinical picture of a bronkhoobstruktivny syndrome at children in many respects depends on the main disease or a factor provoking this pathology. The general condition of the child in most cases medium-weight, is observed the general weakness, a capriciousness, a sleep disorder, appetite loss, symptoms of intoxication etc. It is directly BAREFOOT irrespective of an etiology has characteristic symptoms: noisy loud breath, rattles which are listened at distance, specific whistle at an exhalation.
Also participation of auxiliary muscles in the act of breath, attacks , short wind expiratory (more often) or the mixed character, dry or unproductive cough is observed. At a long current of a bronkhoobstruktivny syndrome at children the barrel-shaped thorax – expansion and protrusion of intercostal intervals, the horizontal course of edges can be formed. Depending on background pathology there can also be fever, deficiency of body weight, mucous or purulent allocations from a nose, frequent vomiting, vomiting, etc.
Diagnostics of a bronkhoobstruktivny syndrome at children is based on collecting anamnestichesky data, an objective research, laboratory and tool methods. At mother's poll the pediatrician or neonatology focuses attention on possible etiologichesky factors: chronic diseases, malformations, existence of an allergy, episodes it is BAREFOOT in the past etc. At a bronkhoobstruktivny syndrome at children fizikalny inspection of the child is very informative. Perkutorno is defined strengthening of a pulmonary sound up to a timpanit. The Auskultativny picture is characterized by the rigid or weakened breath, dry, whistling, in infancy – small-bore damp rattles.
Laboratory diagnostics at a bronkhoobstruktivny syndrome at children includes the general analyses and additional tests. In OAK, as a rule, define the nonspecific changes indicating existence of the center of an inflammation: , shift of a leykotsitarny formula to the left, increase in SOE, in the presence of an allergic component – an eozinofiliya. At impossibility to establish an exact etiology additional analyses are shown: IFA with definition of IgM and IgG to probable infectious agents, serological tests, the test with determination of level of chlorides in sweat at suspicion on etc.
Among tool methods which can be applied at a bronkhoobstruktivny syndrome at children most often use a X-ray analysis of OGK, a bronkhoskopiya, spirometry, is more rare – KT and MPT. The X-ray analysis gives the chance to see expanded roots of lungs, signs of the accompanying defeat of a parenchyma, existence of new growths or expanded lymph nodes. Bronkhoskopiya allows to reveal and remove a foreign matter from bronchial tubes, to estimate passability and a condition of mucous membranes. The spirometry is carried out at a long current of a bronkhoobstruktivny syndrome at children for the purpose of assessment of function of external breath, KT and MPT – at low informational content of a X-ray analysis and bronkhoskopiya.
Treatment, forecast and prevention
Treatment of a bronkhoobstruktivny syndrome at children is directed to an exception of the factors causing obstruction. Irrespective of an etiology in all cases hospitalization of the child and urgent bronkholitichesky therapy with use β2- is shown. Further antikholinergichesky medicines, inhalation corticosteroids, system glucocorticosteroids can be used. As auxiliary medicines also antihistamines, metilksantina, infusional therapy are applied mukolitichesky. After definition of an origin of a bronkhoobstruktivny syndrome at children etiotropny therapy is appointed: antibacterial, antiviral, antitubercular means, chemotherapy. In some cases surgery can be required. In the presence of the anamnestichesky data indicating possible hit of a foreign matter in airways the emergency bronkhoskopiya is carried out.
The forecast at a bronkhoobstruktivny syndrome at children always serious. Than the child – the heavier him a state is younger. Also the outcome is BAREFOOT in many respects depends on a background disease. At sharp obstructive bronchitis and bronkhiolita recovery is, as a rule, observed, hyperreactivity of a bronchial tree seldom remains. It is BAREFOOT at a bronchopulmonary dysplasia is followed by frequent SARS, but it is often stabilized to two-year age. At 15-25% of such children it is transformed to bronchial asthma. Directly OH can have various current: the easy form turns into remission already at younger school age, heavy, especially against the background of inadequate therapy, is characterized by deterioration of life, regular aggravations with a lethal outcome in 1-6% of cases. It is BAREFOOT against the background of the obliterating bronkhiolit often leads to emphysema and the progressing heart failure.
Prevention of a bronkhoobstruktivny syndrome at children means an exception of all potential etiologichesky factors or minimization of their impact on the child's organism. Here antenatalny protection of a fruit, planning of a family, medico-genetic consultation, rational application of medicines, early diagnostics and adequate treatment of sharp and chronic diseases of respiratory system, etc. belongs.