Bronchitis at children – the nonspecific inflammation of the lower departments of airways proceeding with damage of bronchial tubes of various caliber. Bronchitis at children is shown by cough (dry or with a phlegm of various character), temperature increase of a body, pain behind a breast, bronchial obstruction, rattles. Bronchitis is diagnosed for children on the basis of an auskultativny picture, the lungs given to a X-ray analysis, the general blood test, a research of a phlegm, FVD, a bronkhoskopiya, a bronchography. The bronchitis pharmacotherapy at children is carried out by antibacterial medicines, mucolytics, protivokashlevy means; physiotherapeutic treatment includes inhalations, Ural federal district, an electrophoresis, can and vibration massage, LFK.
Bronchitis at children
Bronchitis at children - an inflammation of mucous various etiology of a bronchial tree. 100-200 cases of bronchitis annually are the share of each 1000 children. The acute bronchitis makes 50% of all defeats of a respiratory path at children of early age. Especially often the disease develops at children of the first 3 years of life; most hard proceeds at babies. In view of a variety prichinno of significant factors, bronchitis at children is a subject of studying of pediatrics, children's pulmonology and allergology immunology.
The bronchitis reasons at children
In most cases bronchitis at the child develops after the postponed viral diseases - flu, paraflu, rinovirusny, adenoviral, respiratory an infection. Slightly less often bronchitis at children is caused by bacterial activators (a streptococcus, a pneumococcus, a hemophilic stick, morakselly, sinegnoyny and intestinal sticks, klebsiyelly), fungi from a sort and Candida, an intracellular infection (a hlamidiya, a mycoplasma, a cytomegalovirus). Bronchitis at children quite often accompanies the course of measles, diphtheria, whooping cough.
Bronchitis of an allergic etiology occurs at children, sensibilized the inhalation allergens coming to a bronchial tree with the inhaled air: house dust, means of household chemicals, pollen of plants, etc. In some cases bronchitis at children is connected with irritation mucous bronchial tubes chemical or physical factors: the polluted air, tobacco smoke, gasoline vapors, etc.
Predisposition to bronchitis is available for children with the burdened perinatal background (patrimonial injuries, prematurity, a hypotrophy, etc.), anomalies of the constitution (limfatiko-hypoplastic and ekssudativno-catarrhal diathesis), congenital defects of respiratory organs, frequent respiratory diseases (rhinitis, laryngitis, pharyngitis, tracheitis), violation of nosoyovy breath (adenoides, a curvature of a nasal partition), a chronic purulent infection (sinusitis, chronic tonsillitis).
In the epidemiological plan the seasonal outbreaks of a SARS and flu, stay of children in children's collectives, adverse social conditions have the greatest value cold season (mainly autumn and winter period).
Pathogenesis of bronchitis at children
Specifics of development of bronchitis in children are inseparably linked with anatomo-physiological features of airways at children's age: plentiful blood supply mucous, friability of submucous structures. These features promote bystry distribution of ekssudativno-proliferative reaction from the top airways in depth of respiratory tract.
Virus and bacterial toxins suppress physical activity of a resnitchaty epithelium. As a result of infiltration and hypostasis of the mucous, and also increased secretion of viscous blinking slime of eyelashes even more it is slowed down - the main mechanism of self-cleaning of bronchial tubes thereby is switched off. It leads to sharp decrease in drainage function of bronchial tubes and difficulty of outflow of a phlegm from the lower departments of a respiratory path. On such background conditions for further reproduction and spread of an infection, an obturation are created by a secret of bronchial tubes of smaller caliber.
Thus, as features of bronchitis at children serve the considerable extent and depth of defeat of a bronchial wall, expressiveness of inflammatory reaction.
Classification of bronchitis at children
By origin distinguish primary and secondary bronchitis at children. Primary bronchitis initially begins in bronchial tubes and only the bronchial tree is mentioned. Secondary bronchitis at children is continuation or a complication of other pathology of a respiratory path.
Children can have a sharp course of bronchitis, chronic and recidivous. Taking into account the extent of an inflammation allocate limited bronchitis (an inflammation of bronchial tubes within one segment or a share of a lung), widespread bronchitis (an inflammation of bronchial tubes of two and more shares) and diffusion bronchitis at children (a bilateral inflammation of bronchial tubes).
Depending on the nature of inflammatory reaction bronchitis at children can carry the catarrhal, purulent, fibrinozny, hemorrhagic, ulcer, necrotic and mixed character. At children catarrhal, catarrhal and purulent and purulent bronchitis meets more often. Holds a specific place among damages of airways bronkhiolit at children (including obliterating) - a bilateral inflammation of terminal departments of a bronchial tree.
On an etiology distinguish viral, bacterial, virus and bacterial, fungal, irritatsionny and allergic bronchitis at children. On existence obstructive components allocate not obstructive and obstructive bronchitis at children.
Bronchitis symptoms at children
Development of an acute bronchitis in children is preceded in most cases by symptoms of a viral infection: a sadneniye in a throat, a podkashlivaniye, hoarseness of a voice, cold, the conjunctivitis phenomena. Soon there is cough: persuasive and dry at the beginning of a disease, by 5-7 day it becomes softer, damp and productive with office of a mucous or mucopurulent phlegm. At an acute bronchitis at the child temperature increase of a body to 38 — 38,5 °C is noted, (duration from 2-3 to 8-10 days depending on an etiology), at cough, children of early age have a perspiration, an indisposition, thorax pain short wind. A current of an acute bronchitis at children usually favorable; the disease comes to an end with recovery on average in 10-14 days. In some cases the acute bronchitis at children can be complicated by bronchial pneumonia. At recurrent bronchitis children of an aggravation have 3-4 times a year.
Sharp bronkhiolit develops mainly at children of the first year of life. The current of a bronkhiolit is characterized by the fever, a serious general condition of the child, intoxication expressed by signs of respiratory insufficiency (, expiratory short wind, cyanosis of a nasolabial triangle, akrotsianozy). Complications of a bronkhiolit at children can be and asphyxia.
Obstructive bronchitis at children usually demonstrates on the 2-3rd year of life. The leader is a sign of a disease bronchial obstruction which is expressed by pristupoobrazny cough, the noisy whistling breath extended with an exhalation, remote rattles. Body temperature can be normal or subfebrilny. The general condition of children usually remains satisfactory. , short wind, participation in breath of auxiliary muscles are expressed less, than at a bronkhiolita. Heavy obstructive bronchitis at children can result in respiratory insufficiency and development of sharp pulmonary heart.
Allergic bronchitis at children usually has a recidivous current. During the periods of aggravations perspiration, weakness, cough with office of a mucous phlegm is noted. Body temperature remains normal. Allergic bronchitis at children is quite often combined with allergic conjunctivitis, rhinitis, atopic dermatitis and can pass into asthmatic bronchitis or bronchial asthma.
Chronic bronchitis at children is characterized by the aggravations of inflammatory process 2-3 times a year arising consistently for at least two years in a row. Cough is the most constant symptom of chronic bronchitis at children: during remission it dry, during aggravations – damp. The phlegm clears the throat hardly and in small amounts; has mucopurulent or purulent character. Low and changeable fever is noted. Chronic pyoinflammatory process in bronchial tubes can be followed by development of the deforming bronchitis and bronkhoektaz in children.
Diagnosis of bronchitis at children
Primary diagnosis of bronchitis at children is carried out by the pediatrician, specifying – the children's pulmonologist and the children's allergist-immunologist. At establishment of a form of bronchitis at children clinical data (the nature of cough and a phlegm, frequency and duration of aggravations, features of a current etc.) auskultativny yielded results of laboratory and tool researches are considered.
The Auskultativny picture at bronchitis at children is characterized scattered dry (at obstruction of bronchial tubes – whistling) and damp mixed rattles,
In the general blood test at height of sharpness of inflammatory process increase in SOE is found neytrofilny , . The eozinofiliya is characteristic of allergic bronchitis at children. The research of gas composition of blood is shown at a bronkhiolita for definition of degree of a gipoksemiya. Special value in diagnosis of bronchitis at children has the analysis of a phlegm: a microscopic research, phlegms, a research on the CUBE, the PTsR-analysis. At impossibility of an independent expectoration the child of a secret of bronchial tubes carries out a bronkhoskopiya with a phlegm fence.
The X-ray analysis of lungs at bronchitis at children reveals strengthening of the pulmonary drawing, especially in radical zones. When carrying out FVD to the child moderate obstructive violations can be fixed. In the period of an exacerbation of chronic bronchitis the phenomena widespread catarrhal or catarrhal and purulent endobronchitis are found in children at a bronkhoskopiya. For an exception of a bronkhoektatichesky disease the bronchography is carried out.
Differential diagnosis of bronchitis at children also has to be carried out with pneumonia, foreign matters of bronchial tubes, bronchial asthma, chronic aspiration of food, tubinfitsirovaniy, mukovistsidozy, etc.
Treatment of bronchitis at children
In the sharp period the bed rest, rest, plentiful drink, the good vitaminized nutrition is shown to children with bronchitis.
Specific therapy is appointed taking into account a bronchitis etiology at children: it can include antiviral medicines (an umifenovir Yogidrokhlorid, remantadin, etc.), antibiotics (penicillin, tsefalosporina, macroleads), antifungal means. An obligatory component of treatment of bronchitis at children are the mucolytics and expectorant medicines strengthening fluidifying of a phlegm and stimulating activity of a vibrating epithelium of bronchial tubes (Ambroxol, Bromhexine, , chest collecting). At the dry hoarse, exhausting the child cough protivokashlevy medicines are appointed (, ); at a bronkhoobstruktion – aerosol bronchial spasmolytics. Antihistamines are shown to children with allergic bronchitis; at a bronkhiolita inhalations of bronkhodilyatator and kortikosteroidny medicines are carried out.
From physical therapy methods for treatment of bronchitis at children medicinal, oil and alkaline inhalations, nebulayzerny therapy, Ural federal district, UVCh and an electrophoresis on a thorax, microwave therapy, etc. procedures are used. As the distracting therapy statement of mustard plasters and cans, can massage are useful. At difficulties of an otkhozhdeniye of a phlegm massage of a thorax, vibration massage, a posturalny drainage, sanatsionny bronkhoskopiya, LFK is appointed.
Prevention of bronchitis at children
Prevention of bronchitis at children includes the prevention of viral infections, early use of antiviral medicines, an exception of contact with allergic factors, the child's obereganiye from overcoolings, a hardening. An important role is played by timely preventive vaccination of children against flu and a pnevmokokkovy infection.
Children with recurrent and chronic bronchitis need observation of the pediatrician and children's pulmonologist before the permanent termination of aggravations within 2 years, performing antirecurrent treatment during the autumn and winter period. Vaccinal prevention is contraindicated to children with allergic bronchitis; at other forms it is carried out in a month after recovery.