Airway obstruction in children what. What to do with an airway obstruction in a child

The syndrome of obstruction of the respiratory tract, observed at any level, from the pharynx to the bronchioles, is called airway obstruction. In most cases, the condition is due to the complete closure or reduction of the lumen of the larynx, which becomes possible for the following reasons:

• Entry into the respiratory tract of a foreign body;
• Allergic, infectious and inflammatory diseases - bacterial tracheitis, Ludwig's angina, fungal infection, pharyngeal and peritonsillar abscess, laryngotracheobronchitis and diphtheria;
• Adenoids and post-intubation edema;
• Burns and injuries of the respiratory tract;
• Systemic disorders, tumors and cysts of the larynx;
• Hypertrophic tonsillitis;
• Neurological damage and post-tracheostomy stenosis;
• Volumetric processes in the areas located near the airways and larynx.

Also, the causes of airway obstruction can be congenital diseases, which include:

• Anomalies of the craniofacial region;
• Hypocalcemia and tracheoesophageal fistula;
• Laryngomalacia and laringocele;
• neurological disorders;
• Subglottic stenosis and vascular ring;
• birth trauma;
• Tracheomalacia and cystohygroma.

Allocate obstruction of the upper and lower respiratory tract, as well as two of their forms - fulminant (acute) and chronic. Also in medicine, it is customary to separate the stages of airway obstruction, namely:

• Compensation;
• subcompensation;
• Decompensation;
• Terminal stage of asphyxia.

Airway obstruction and hypoventilation (impaired breathing) most often occurs in patients at night. Hypoventilation increases as obstruction increases.

In patients or victims who are in a coma, obstruction can be triggered by blocking the airways with a sunken tongue.

Symptoms of airway obstruction

Obstruction of the upper respiratory tract usually occurs in newborns and preschool children due to the anatomical and physiological characteristics of the respiratory system. This condition manifests itself with the following symptoms:

• arterial hypotension;
• Strengthened work of the respiratory apparatus;
• Increased blood pressure and inspiratory dyspnea;
• Lack of cyanosis at rest, perioral or diffuse cyanosis appears during exercise;
• Coma and convulsions;
• Tachycardia and bradycardia;
• increased sweating;
• Lethargy and severe pallor;
• Inspiration paradox.

Lower airway obstruction is also most common in young children, and this condition is manifested by the following symptoms:

• The inability of the patient to breathe air;
• The appearance of a loud sound, rough noise or whistling during inspiration;
• Cough;
• Slow heart rate;
• Blueing of the skin;
• swelling of the lungs;
• Stopping breathing.

With obstruction of the respiratory tract by a foreign body, the development of aphonia, cyanosis, and acute respiratory failure is observed. At the same time, the patient cannot speak, cough, breathe, he often clutches his throat, convulsions may begin, and asphyxia may develop. If the patient is not provided with emergency assistance in time, he loses consciousness, and then sudden death occurs.

Treatment of airway obstruction

When the first symptoms of obstruction are detected, the patient must be urgently taken to the intensive care unit. Often, even at the prehospital stage, first aid is required. If airway obstruction is observed in a child, he should not be left alone, it is important to calm the baby and take it in his arms, as fear, screaming and anxiety can increase the effects of stenosis. First aid directly depends on the cause of the condition, as well as on the severity of the obstruction.

If a foreign body, mucus, vomit or liquid is present in the airways, it is necessary, provided that the patient is conscious, to ask him to try to cough well. In cases where the patient cannot cough or such manipulation does not help, it is possible to apply the Heimlich maneuver at the prehospital stage to eliminate complete obstruction of the airways by a foreign body. The method of admission, if the patient is conscious, consists in the following actions:

• It is necessary to stand behind the patient, wrap his arms around him and press his palms on his stomach, at a level above the navel;
• Sharply compress the chest with quick jerks 4-5 times;
• Then, slowly continue to compress the chest until the foreign body comes out, and the patient begins to breathe normally.

If the patient is unconscious, the Heimlich maneuver is performed as follows:

• The patient is laid on his back on the floor;
• The person providing first aid sits on the hips of the victim, puts one palm in the supra-umbilical region of the patient;
• He puts the second palm on the first, then presses 5 times with quick jerky movements on the stomach;
• Then it is necessary to open the victim's mouth and try to remove the foreign body with a bent index finger.

If the victim shows symptoms of increasing airway obstruction and hypoventilation, gradually leading to cardiac arrest, it is necessary to provide emergency resuscitation measures, which cannot be carried out without special medical equipment.

The general principles for the treatment of airway obstruction in children in a medical facility, depending on the stage of the syndrome, are:

• Measures aimed at restoring obstruction - reducing or eliminating spasm and swelling of the mucous membrane of the respiratory tract;
• Elimination of obstruction - the release of the lumen of the larynx from the pathological secret;
• Correction of metabolic disorders;
• Antibacterial therapy;
• tracheal intubation;
• Artificial ventilation of the lungs.

Airway obstruction is a condition in which a patient develops obstruction of the respiratory tract at the level from the pharynx to the bronchioles. The victim must be given first aid and taken to the intensive care unit as soon as possible.

Video from YouTube on the topic of the article:

Causes of obstructive bronchitis in children and risk factors for its development

During the first months of postnatal development, there is an intensive development of the bronchopulmonary system, which is due to the start of the process of external respiration after birth.

The increase in the size of the bronchial tree (including the diameter of the bronchial section) at this time lags behind the increase in the mass and volume of the lung; in young children and infants, the ratio of the size of the bronchi to the volume of the lung and the number of alveoli is greater than in an adult. It is also known that the diameter of small bronchi in children is much smaller (up to 5 times compared to adults), which contributes to severe violations of bronchial patency in the development of acute inflammatory reactions.

In addition, the walls of the bronchi in young children are thin, contain a small amount of muscle and connective tissue, the elastic frame is not developed, so the bronchi easily collapse on exhalation. The mucous membrane lining the inside of the bronchial tree in young children is loose, thin, tender, contains a small amount of secretory immunoglobulin A.

The respiratory muscles in the first months of life are not sufficiently developed, which, along with incomplete myelination of the vagus nerve, explains the weakness of the cough impulse, the high probability of blockage of the small bronchi with viscous mucus during the inflammatory process. Other self-cleaning mechanisms are also imperfect: less active ciliated epithelium, weak peristalsis of bronchioles.

In addition to age-related features of the anatomical structure of the respiratory system, children also have a difference in the chemical composition of bronchial mucus: the secret produced by the bronchial glands consists almost exclusively of viscous and thick sialic acid, the more liquid sulfomucine is almost not represented.

The most common cause of obstructive bronchitis in children of the first 3 years is a viral infection (from 45-50% to 90% of all cases). Despite the fact that in children older than 3 years the frequency of viral bronchitis decreases, this cause remains the leading one.

Bacterial obstructive bronchitis is most often caused by the following microorganisms:

• haemophilus influenza;
• Streptococcus pneumoniae;
• Moraxella catarrhalis.

Recently, the proportion of bacterial obstructive bronchitis in children, provoked by mycoplasma and chlamydia, has significantly increased, which can not only provoke an acute disease, but also become the cause of its chronicity. In some cases, the disease is caused by a bacterial-viral association.

The ease with which obstructive bronchitis develops in children, especially younger children, explains a number of predisposing factors:

• anatomical and physiological features (narrowness of the airways, insufficient activity of local immunity, poor development of the respiratory muscles, incompetent elastic framework of the bronchi, high viscosity of bronchial mucus, longer sleep time in relation to the active period, in children of the first months of life - a long stay in the position on back, etc.);
• pathological conditions during the mother's pregnancy (toxicosis, gestosis, threat of abortion, intrauterine infection);
• smoking and alcohol abuse during pregnancy;
• aggravated hereditary allergic anamnesis;
• congenital malformations of the bronchial tree;
• genetically determined bronchial hyperreactivity (increased sensitivity to stimuli);
• prematurity;
• light weight;
• hypovitaminosis D, rickets;
• acute respiratory diseases suffered by a child in the first six months of life;
• artificial feeding(early introduction of mixtures or complete replacement of breastfeeding from the first days of life);
• impact of adverse environmental factors ( parents smoking, unfavorable environmental conditions, unsatisfactory sanitary living conditions, for example, high levels of humidity or the presence of mold on walls, furniture).

The formation of the phenomena of bronchial obstruction is provided by the following pathogenetic mechanisms:

• the introduction of a pathogenic microorganism into the mucous membrane of the bronchial tree, followed by the development of local inflammation;
• increased production under the influence of provoking pathogenic influences by the cells of the immune system of the inflammatory mediator - interleukin-1 (IL-1), which causes an increase in vascular permeability, swelling of the mucous membrane, impaired local microcirculation, etc .;
• an increase in the amount of synthesized bronchial secretion, a change in its rheological properties (an increase in viscosity along with a decrease in fluidity), a deterioration in immune characteristics;
• damage to the drainage function of the bronchi (due to a change in the properties of mucus), accompanied by a more active introduction of an infectious agent, colonization of the bronchial epithelium;
• development of transient bronchial hyperreactivity, bronchospasm.

The combination of pathogenetic mechanisms leads to a violation of the separation of the altered, viscous bronchial secretion through the respiratory tract, local mucosal edema and bronchospasm. These phenomena contribute to stagnation and secondary infection of bronchial mucus, a decrease in the efficiency of breathing and the development, along with local inflammation, of hypoxia of all organs and tissues.

Bronchial obstruction occurs not only with bronchitis

Infants are characterized by poor development of the upper respiratory tract, bronchi and lungs. The glandular tissue of the inner walls of the bronchial tree is delicate, prone to irritation and damage. Often, in diseases, the viscosity of the mucus increases, the cilia cannot evacuate thick sputum. All this should be considered before treating obstructive bronchitis in a child with medicines and home remedies.

The most important causes of obstructive bronchitis in children are:

• viruses - respiratory syncytial, adenoviruses, parainfluenza, cytomegalovirus;
• ascariasis and other helminthiases, migration of helminths in the body;
• anomalies in the structure of the nasal cavity, pharynx and esophagus, reflux esophagitis;
• microorganisms - chlamydia, mycoplasmas;
• weak local immunity;
• aspiration.

The inflammatory process in obstructive bronchitis causes swelling of the mucosa, resulting in the accumulation of thick sputum. Against this background, the lumen of the bronchi narrows, spasm develops.

Viral infection has the greatest influence on the occurrence of obstructive bronchitis in children of all ages. Also, a negative role belongs to environmental factors, climatic anomalies. The development of obstructive bronchitis in infants can occur against the background of early refusal of breast milk, the transition to mixed or artificial feeding.

Among the reasons for the deterioration of the bronchial mucosa, doctors call the poor environmental situation in the places of residence of children, smoking of parents. Inhalation of smoke disrupts the natural process of clearing the bronchi of mucus and foreign particles. Resins, hydrocarbons and other components of smoke increase the viscosity of sputum, destroy the epithelial cells of the respiratory tract. Problems with the functioning of the bronchial mucosa are also observed in children whose parents suffer from alcohol dependence.

The main symptoms and treatment of obstructive bronchitis in children differ from those of other respiratory diseases. Outwardly, the symptoms resemble bronchial asthma, bronchiolitis, cystic fibrosis. With ARVI, children sometimes develop stenosing laryngotracheitis, when a sick baby speaks with difficulty, coughs hoarsely, and breathes heavily. It is especially difficult for him to take a breath, even at rest there is shortness of breath, the skin triangle around the lips turns pale.

When ascaris larvae migrate into the lungs, a child develops a condition resembling the symptoms of bronchial obstruction.

Attacks of suffocation in a perfectly healthy child can provoke reflux of the contents of the stomach into the esophagus, aspiration of a foreign body. The first is associated with reflux, and the second - with solid pieces of food, small parts of toys, and other foreign bodies that have entered the respiratory tract. With aspiration, changing the position of the baby's body helps him reduce asthma attacks. The main thing in such cases is to remove the foreign object from the respiratory tract as soon as possible.

The causes of bronchiolitis and obstructive bronchitis are similar in many ways. Bronchiolitis in children is more severe, the epithelium of the bronchi grows and produces a large amount of sputum. Obliterating bronchiolitis often takes a chronic course, accompanied by bacterial complications, pneumonia, emphysema. The bronchopulmonary form of cystic fibrosis is manifested by the formation of viscous sputum, whooping cough, and suffocation.

Bronchial asthma occurs if inflammatory processes in the bronchi develop under the influence of allergic components.

The main difference between bronchial asthma and chronic bronchitis with obstruction is that attacks occur under the influence of non-infectious factors. These include various allergens, stress, strong emotions. In asthma, bronchial obstruction persists day and night. It is also true that over time, chronic bronchitis can turn into bronchial asthma.

Obstructive bronchitis - symptoms

It all started with a slight cough for 2-3 weeks. Yes, and you can’t call it coughing, so um-hm 1 time in 2 days. At first I did not pay attention to it, but in vain, if I had helped my body during that period, perhaps I would not have gotten sick at all. I want to note that Lizonka is breastfeeding, and it was this factor that gave the body additional strength to fight the virus that we caught.

One night, after Lizonka had eaten, she coughed and almost immediately began to wheeze, breathing heavily, I became very scared for my baby. At 5:30 in the morning, it's hard to figure out what's going on, but I remembered that hot steam in the bathroom helps with croup, and I took a steam inhalation in the bathroom. Intuitively, I did the right thing, and so after 15 minutes everything was gone. Our doctor, when he came, did not hear anything and prescribed us an antitussive. The daughter was breathing heavily, but there was no obstruction.

The bronchial tree of a healthy person is covered with mucus from the inside, which is removed along with foreign particles under the influence of miniature outgrowths of epithelial cells (cilia). Typical obstructive bronchitis begins with attacks of dry cough, the acute form is characterized by the formation of thick, difficult to separate sputum.

Manifestations of bronchial obstruction syndrome in children:

• first, catarrhal processes develop - the throat becomes red, painful, rhinitis occurs;
• the intercostal spaces, the area under the sternum are drawn in during breathing;
• breathing becomes difficult, shortness of breath, noisy, rapid, wheezing breathing occurs;
• suffers from a dry cough that does not turn into a productive (wet);
• subfebrile temperature is maintained (up to 38 ° C);
• attacks of suffocation periodically develop.

Wheezing and wheezing in the lungs of a child with obstructive bronchitis can be heard even at a distance. The frequency of breaths is up to 80 breaths per minute (for comparison, the average rate at 6-12 months is 60-50, from 1 year to 5 years - 40 breaths / minute). Differences in the course of this type of bronchitis are explained by the age of small patients, the characteristics of metabolism, the presence of hypo- and beriberi. A serious condition in weakened babies can last up to 10 days.

With a recurrent course of the disease, a repeated exacerbation of symptoms is possible. Against the background of ARVI, irritation of the mucous layer occurs, cilia are damaged, bronchial patency is impaired. If we are talking about an adult, then doctors talk about chronic bronchitis with obstruction. When young children and preschoolers get sick again, experts are cautious about the recurrent nature of the disease.

Signs of obstructive bronchitis in children are quite specific:

• an increase in body temperature (with an acute process);
• wheezing, "heavy" breathing, heard at a distance;
• expiratory dyspnea, on exhalation (due to the fact that exhalation in conditions of bronchial obstruction requires increased intrathoracic pressure, provided by the tension of the respiratory muscles, which makes it longer, noisy and difficult) or mixed;
• involvement in the act of breathing auxiliary muscles;
• persistent, paroxysmal, dry, non-productive cough, intensifying at night, resolving in the wet for 5–7 days.

Objective picture:

• cyanosis of the nasolabial triangle, acrocyanosis with moderate obstruction or diffuse cyanosis with severe;
• increased respiratory movements;
• percussion - box shade of sound;
• dry, wheezing rales are determined by auscultation (in children of the first years of life, possibly in combination with various wet rales);
• in some cases, rhinitis, hyperemia of the pharynx, an increase in the palatine tonsils, or hypertrophy of the mucous membrane of the posterior pharyngeal wall are noted.

If episodes of obstructive bronchitis in children are repeated 3 or more times during the year, they speak of a recurrent course of the disease.

In this case, relapses occur in the form of acute obstructive bronchitis with a longer course (manifestations of the disease persist for 3-4 weeks or longer). Occur, as a rule, against the background of acute respiratory viral diseases, subject to seasonality. A distinctive feature is the protracted nature of the cough, which persists for several weeks or more in the absence of other manifestations of the disease. The general condition of the child at the same time suffers slightly.

An obsessive paroxysmal dry cough in a child may be a symptom of obstructive bonchitis.

Outside of periods of exacerbation, the child retains increased coughing readiness due to bronchial hyperreactivity, which is provoked by intense physical or psycho-emotional stress, cold, wet weather, etc.

Forms of the disease

Depending on the duration of the pathological process, obstructive bronchitis in children can occur in several forms:

• acute (phenomena of bronchial obstruction persist for no more than 10 days);
• protracted;
• chronic (recurrent and continuously recurrent).

In accordance with the severity of the phenomena of bronchial obstruction, the disease can have several degrees of severity:

• mild - there is no shortness of breath at rest and with light physical exertion, the gas composition of the blood is not changed, slight changes in the function of external respiration are recorded, wheezing is determined only by auscultation, the general well-being of the child does not worsen;
• medium severity- shortness of breath during exhalation or a mixed character is noted with a slight load, whistling distant wheezing (audible at a distance) is recorded, the gas composition of the blood is slightly changed, cyanosis of the nasolabial triangle is objectively determined, the inclusion of additional muscles in the act of breathing (intercostal spaces, supraclavicular, subclavian fossae);
• severe - the child's condition is unsatisfactory, there is noisy labored breathing with the participation of auxiliary muscles, diffuse cyanosis, indicators of the function of external respiration are sharply reduced, the gas composition of the blood is significantly changed (partial pressure of oxygen is less than 60 mm Hg, carbon dioxide - more than 45) .

Unfortunately, the chronic form of the disease in children is often detected only at an advanced stage. The airways at this point are so narrow that it is almost impossible to completely cure bronchial obstruction. It remains only to contain inflammation, to alleviate the discomfort that occurs in small patients. Antimicrobials, glucocorticosteroids, expectorants and mucolytics are used for this purpose.

Massage and feasible gymnastics increase the vital capacity of the lungs, help slow down the development of the disease, and improve the general well-being of a sick child.

1. Do inhalations with saline, alkaline mineral water, bronchodilators through a steam inhaler or use a nebulizer.
2. Choose expectorant drugs with the help of a doctor and pharmacist.
3. Give more often herbal tea and other warm drinks.
4. Provide your child with a hypoallergenic diet.

When treating acute obstructive bronchitis in children, it must be taken into account that therapy is not always carried out only on an outpatient basis. In the absence of effectiveness, babies with bronchospasm are hospitalized. Often in young children, acute obstructive bronchitis is accompanied by vomiting, weakness, poor appetite or lack of it.

Diagnostics

Diagnosis of obstructive bronchitis in children is based on a comprehensive assessment of the clinical picture, history data, as well as the results of instrumental and laboratory studies:

• general blood analysis(signs of inflammation);
• assessment of the function of external respiration through spirography and pneumotachymetry (not performed in children under 5-6 years old due to their inability to produce a full forced exhalation);
• study of peripheral airway resistance - flow interruption technique;
• body plethysmography (allows you to assess the structure of the total lung capacity, taking into account the residual volume, is indicated in young children);
• X-ray examination;
• conducting allergy tests[the level of general and specific IgE, skin prick tests (not very informative in children under 3 years old, the risk of false positive and false negative results is high)].

Spirography is included in the list of diagnostics of obstructive bronchitis in children

Features of drug therapy

The relief of seizures in sick children is carried out using several types of bronchodilator drugs. Use the drugs "Salbutamol", "Ventolin", "Salbuvent" based on the same active substance (salbutamol). Preparations "Berodual" and "Berotek" also belong to bronchodilators. They differ from salbutamol in their combined composition and duration of exposure.

Bronchodilator drugs can be found in pharmacies in the form of syrups and tablets for oral administration, powders for the preparation of an inhalation solution, aerosols in cans.

To decide on the choice of medicines, decide what to do with them during the period of outpatient treatment, consultations with a doctor and pharmacist will help. With bronchial obstruction that has arisen against the background of SARS, anticholinergic drugs are effective. Most of the positive feedback from specialists and parents collected the drug "Atrovent" from this group.

Features of the drug "Atrovent":

• exhibits pronounced bronchodilator properties;
• acts effectively on large bronchi;
• causes a minimum of adverse reactions;
• remains effective in long-term treatment.

Antihistamines for obstructive bronchitis are prescribed only for children with atopic dermatitis and other associated allergic manifestations. Use in infants drops "Zirtek" and its analogues, "Claritin" is used to treat children after 2 years. Severe forms of bronchial obstruction are removed with the inhalation drug Pulmicort, which belongs to glucocorticoids.

Treatment of obstructive bronchitis

Obstruction - spasm. Bronchi is a section in the lungs. Bronchitis with obstruction - spasmodic bronchitis, is a spasm of the bronchi, in which mucus cannot go out and accumulates in the bronchi. The goal of treatment is to relieve bronchospasm, thin the sputum and bring it out. ARVI infection can affect any part of the body.

When the infection enters the body, it enters the fight against the body's defenses responsible for suppressing the virus. At this stage, it is necessary to support the body's immunity with such means as Interferon, Kipferon, Viferon and similar immunostimulating drugs that enhance and strengthen the body's work. Be sure to rinse the nasopharynx every hour.

I didn’t do anything like that, and the doctor didn’t advise. The only thing we thought of was to breathe over a bath with pine extract. Well, they breathed, provoking a new attack of obstruction. It turns out that coniferous extract helps only 50%, and the other 50 is very harmful. Not a single doctor who listened to us said what to be afraid of, what to pay attention to, and even when I called an ambulance, the doctor gave us an obstruction, but did not say a word about how to remove it, prescribing us only an antihistamine. And only the doctor on duty, who came the next day, urgently sent us to the hospital so as not to get pneumonia.

Thank God, they did not work, but now we know how to treat bronchitis with obstruction. I want to give general recommendations based on such a sad experience.

If the virus still won, then it begins its effect and can affect any part of the body (complication). When coughing, you need to keep in mind that it can be of a different nature, and the existing drugs are so diverse that you should definitely ask the doctor what type of cough your child has in this case.

And be sure to read and analyze the annotation with side effects before buying, and not after, in order to avoid regrading and unsuccessful experiments on your child. The course of treatment is prescribed, of course, by the doctor, but you must be no less knowledgeable in this matter than the doctor himself, otherwise you can miss precious time and not have time to help the child.

1. There is no need to be afraid of a course of antibiotics for bronchitis, the microflora can be restored with the right approach. But the effect is fast and reliable. Doctors have certain standards for every sore, by which they try to act. Your situation may not always fit this standard, so doctors are doctors, and it’s all the same for you to think and decide for your child.
2. Since mucus accumulates in the bronchi, the child wheezes. The mucus needs to be thinned so that the child can cough it up. For this, inhalations are used. You don't need to take cough suppressants. Inhalations on the device "Nibulizer" help well. This is the spray method. Pour 1 ml of "Lazolvan" and 2 ml of saline and inhale for 5-7 minutes. The effect is amazing. Pulmicort also helps a lot, for inhalation: 0.5 ml per 2 ml of saline. Borjomi or its analogue helps perfectly, 3 ml 3 times a day. With all my heart I recommend buying a Nibulizer for a house with children, it costs 2460 rubles. Very easy to use and suitable for the whole family, but especially for small children.
3. Don't forget the nasopharynx. "Aquamaris" perfectly flushes out the infection, Borjomi, saline solution - all these natural remedies help well in the prevention and treatment of acute respiratory infections and acute respiratory viral infections. Means containing silver are in a place of honor in the fight against the common cold. Of the vasoconstrictor drugs, I would like to note the Swiss drops "Vibrosol". It also has anti-allergic and anti-edema effects.
4. Antibiotics treat one thing, cripple another, so during and after taking it is necessary to rehabilitate the stomach. Biopreparations with live bacteria help well. "Linex", "Laktofiltrum", "Bifidobacterin" and others must be taken until the intestinal flora is fully restored.

And the most important advice. Unfortunately, we have poor case management in polyclinics. Not always your doctor has the knowledge and skills that are needed for your child here and now. Therefore, do not be shy, and even more so, do not be afraid to ask the opinion of at least three doctors. Go to the manager, call an ambulance (they have a lot of experience), eventually call a paid specialist in this disease.

The child should neither sniff, nor wheeze, nor cough. If this is observed, there is always a reason, and your task as a mother is to identify this reason and try to remove it with the help of medicine, your own intuition and great love for your child. Love with your heart, think with your head, trust doctors and your child will be healthy!

Katerina

Treatment of obstructive bronchitis in children in most cases is carried out at home, patients with severe and moderate course of the disease, severe respiratory failure are subject to hospitalization.

It is imperative to comply with the therapeutic and protective regimen for the duration of the treatment of the disease:

• bed rest;
• fortified milk and vegetable diet;
• plentiful alkaline drink.

Drugs used in the treatment of obstructive bronchitis in children (preference is given to inhaled forms):

• anticongestive drugs (possibly combined) to reduce swelling of the nasal mucosa and facilitate nasal breathing;
• bronchodilators, bronchodilators (β-agonists, M-anticholinergics, methylxanthines);
• mucolytics (drugs that thin sputum);
• means stimulating expectoration (secretory);
• antipyretics on demand (preparations based on ibuprofen and paracetamol, other antipyretics are contraindicated for use in children);
• with moderate and severe course - glucocorticosteroid hormones by inhalation;
• antibiotic therapy is carried out in case of persistent bronchial obstruction, in children under one year old, with hyperthermia for more than 3 days, intensive intoxication syndrome, pronounced inflammatory changes in the general blood test (semi-synthetic penicillins, cephalosporins of 2, 3 generations, in the case of a chlamydial or mycoplasmal nature of the disease - macrolides).

Caution should be taken with antitussive drugs in the treatment of obstructive bronchitis in children. A direct contraindication for taking them is a combination of wet cough and bronchospasm.

Mucolytic drugs for obstructive bronchitis should also be taken with caution, strictly in the recommended dosage. If the dose is exceeded or when these drugs are combined with antitussives, the so-called effect of swamping, stagnation and infection of mucus in the bronchi may develop, which can lead to an aggravation of the disease, up to the development of pneumonia.

Means and methods for improving sputum discharge

A variety of cough medicines for childhood bronchitis also find use. From the rich arsenal of expectorants and mucolytics, preparations with ambroxol deserve attention - Lazolvan, Flavamed, Ambrobene. Doses for single and course intake are determined depending on the age or body weight of the child.

It is forbidden to take antitussive syrups and drops (cough reflex blockers) with obstructive bronchitis.

With obstructive bronchitis, various combinations of drugs are used, for example, 2-3 expectorants. First, drugs are given that thin the mucus, in particular, with acetylcysteine ​​or carbocysteine. Then inhalations with solutions that stimulate expectoration - sodium bicarbonate and its mixtures with other substances. The improvement in the child's condition becomes more noticeable after a week, and the full duration of the therapeutic course can be up to 3 months.

Apply to facilitate the discharge of sputum breathing exercises, a special massage. For the same purpose, they perform a procedure that promotes the outflow of sputum: they lay the child on his stomach so that his legs are slightly higher than his head. Then the adult folds his palms in a "boat" and taps them on the baby's back. The main thing in this drainage procedure is that the movements of the hands are not strong, but rhythmic.

Do you know that…

1. The genetic background of lung diseases has been proven as a result of scientific research.
2. Among the risk factors for broncho-pulmonary diseases, in addition to genetics, are anomalies in the development of the respiratory system, heart failure.
3. In the mechanism of development of respiratory diseases, the sensitivity of the mucous membrane to certain substances plays an important role.
4. Children who are prone to allergic reactions or already suffering from allergies are more susceptible to recurrent forms of chronic respiratory diseases.
5. Experts from the US have discovered the effect on the lungs of microbes that cause dental caries.
6. To detect lung diseases, methods of radiography and computed tomography, biopsy are used.
7. Modern alternative methods of treating respiratory diseases include oxygen therapy - treatment with oxygen and ozone.
8. Of the patients who have undergone lung transplantation, 5% are minors.
9. Reduced body weight often accompanies the progression of lung diseases, so care must be taken to increase the caloric content of the diet of frequently ill children.
10. Frequent obstructive bronchitis - up to 3 times a year - increase the risk of bronchospasm without exposure to infection, which indicates the initial signs of bronchial asthma.

Preventive measures

The diet and lifestyle of the mother during pregnancy affects the health of the baby. It is recommended to follow a healthy diet, do not smoke, avoid passive smoking. It is very important for a pregnant or lactating woman and her baby to stay away from harmful chemicals that provoke allergies and toxicosis.

Negative factors that increase the chances of getting obstructive bronchitis:

• the harmful effects of air pollutants - dust, gases, fumes;
• various viral and bacterial infections;
• genetic predisposition;
• hypothermia.

Contributes to the prevention of obstructive bronchitis in children under one year of breastfeeding. It is necessary to regularly clean, ventilate and humidify the air in the room where the child is. The health season in summer is recommended to devote to hardening procedures, relaxation by the sea. All these activities will help protect children and adult family members from bronchitis with obstruction.

Particular attention should be paid to the prevention of acute respiratory viral infections and allergies, as the most important causes of chronic bronchitis in children.

It is more difficult to protect from various infections, helminthic invasions of children attending children's institutions. It is recommended from an early age to constantly form hygiene skills in a child, monitor compliance with the daily routine, and diet. During the period of seasonal infections, it is advisable to avoid visiting crowded places where new viruses quickly attack the children's body.

These diseases are severe and very often accompanied by broncho-obstructive syndrome, which further aggravates the condition of a small patient.

The term "obstructio" in Latin means "obstacle, barrier, barrier", which quite accurately reflects the essence of the process - the occurrence of obstacles to the normal flow of air into the baby's lungs. Airway obstruction is the narrowing or complete obstruction of the airway lumen, which can occur as a result of either accumulation of mucus in the lumen of the bronchi, or thickening of the walls of the bronchus, or muscle spasm in its wall, without disturbances in the lung tissue itself.

What is bronchial obstruction

Most often, with bronchial obstruction, a cough appears. Usually it is dry, sputum is practically not coughed up or there is little of it and it is very viscous. Cough on the background of allergies can become paroxysmal; during an attack, the baby's lips and fingertips may turn blue - this is a sign of respiratory failure.

In addition, many children have shortness of breath, rapid and difficult breathing during exercise, and if the obstruction is severe, even at rest. Due to shortness of breath, babies can take a forced position: they sleep on their stomach, sometimes hanging their heads or placing them below body level, since in this position sputum discharge is facilitated.

The breathing of a sick child can be heard in the distance. Inhalation occurs almost invariably, and exhalation is usually with effort, it lengthens, the chest looks swollen, with retraction of the intercostal spaces.

With severe degrees of obstruction, attacks of suffocation are possible.

Respiratory system of a child

Broncho-obstructive syndrome is not a disease and not a diagnosis - it is a condition that occurs when exposed to various factors. In other words, this syndrome may be just one of many manifestations of various diseases.

The development of bronchial obstruction against the background of acute respiratory viral infections in children often occurs, this is facilitated by the characteristics of the child's respiratory system. It is sensitive to the impact of adverse factors, has age-related features: the diameter of the bronchi that conduct air is much smaller in children than in adults. Due to the smaller diameter of all the bronchi of the child, the resistance to air flow during breathing is much higher, and much more effort is required to carry out breathing. Therefore, inflammation and swelling of the bronchial wall, which always occur with bronchitis, are so dangerous for the baby. If there is a decrease in the lumen of at least 1-2 mm, the efforts to carry out breathing will require two to three times more. In addition, the peculiarity of the structure of the mucous membranes of the bronchi contributes to the deterioration: they have many special cells that produce a large amount of viscous mucus. The organs of the respiratory system in children are very abundantly supplied with blood, and the walls of the vessels are easily permeable to fluid, which contributes to swelling of the bronchial wall.

Additional factors contributing to the development of bronchial obstruction in babies is their lack of mobility in the first months of life. Frequent positions on the back during sleep and wakefulness do not contribute to the drainage of the secret, the mucus stagnates and causes inflammation.

Obstructive bronchitis: causes of the disease

In addition to the structural features of the bronchi already described, a viral infection plays a leading role in the development of bronchial obstruction in children.

Risk factors for bronchial obstruction in a child are also:

• neurological problems;
• hereditary predisposition to allergic diseases;
• increased sensitivity of the bronchi to external influences;
• rickets;
• malnutrition and overweight;
• early transition to mixtures and mixed feeding;
• respiratory diseases in the first months of life, especially in the first six months.

One of the important reasons for the development of obstruction is smoking in the family, including with a child.

In babies under 1 year old, the causes of this condition can be regurgitation and aspiration of food masses, that is, the ingress of food particles from the oral cavity into the respiratory tract.

Obstructive bronchitis: how the disease develops

The main clinical sign of the bronchial obstruction syndrome is difficulty in breathing, which occurs due to the fact that if the bronchial tree malfunctions and there is an obstruction, i.e. obstructions, it is difficult for air to pass to the lungs. Then more strength is expended on breathing, the work of the respiratory muscles increases and intrathoracic pressure increases. In turn, an increase in intrathoracic pressure contributes to squeezing the bronchi, and dry wheezing and whistling sounds occur during breathing.

The main "culprit" of broncho-obstructive syndrome in babies is inflammation, which is provoked by all factors - infectious, allergic, toxic, physical and even neurological. As soon as an inflammatory process occurs in the bronchus wall, damaged cells immediately begin to produce special biologically active substances - inflammatory mediators. They raise the temperature, cause pain, redness, rash.

One of these substances is histamine, known to us from antihistamines, or antiallergic drugs. However, its effects in the body are much more extensive than parents usually imagine: in particular, it plays one of the leading roles in bronchial obstruction. Because of it, increased vascular permeability develops and edema occurs, there is an increase in the production of viscous sputum and mucus, a bronchospasm develops and a sharp narrowing of the lumen for the passage of air. The result is the manifestation of broncho-obstructive syndrome. In addition, further damage to the epithelium joins, the cells begin to exfoliate and become excessively sensitive to seemingly ordinary factors - for example, to cool or humid air. Therefore, in the future, due to this increased sensitivity, attacks of obstruction may be repeated. And this again leads to the release of histamine and inflammation: a vicious circle is formed, and all therapeutic measures should be aimed at breaking this circle.

Obstructive bronchitis: diagnosis

It is very difficult to carry out a full diagnosis for the crumbs - the doctor has to rely on the examination data and complaints from the parents, as well as on the results of listening to the lungs. It is important to note the presence of allergy sufferers in the family, the diseases previously transferred by the baby, data on the presence of chronic infections and the unfavorable course of childbirth and the first months of life.

If the baby has relapses of bronchial obstruction, then additional studies will also be required. It will definitely be necessary to examine the blood, especially the leukocyte formula and the erythrocyte sedimentation rate, which will show the presence of inflammation or allergies. In addition, it is necessary to exclude infection with chlamydia, mycoplasmas, cytomegalovirus, herpes and pneumocystosis. This is usually done by a blood test and the presence of specific antibodies - class M and G immunoglobulins. It is necessary to exclude helminthiases in a child, i. worms, toxocariasis and ascariasis. To do this, conduct the same blood test for antibodies.
If these problems are excluded, it is necessary to consult an allergist and examine specific IgE - general and specific to certain allergens. You may also need skin tests - if the baby is older than 1.5-2 years.

If pneumonia, complications, or a foreign body in the airway are suspected, a chest x-ray is also recommended. In addition, in each case, the doctor may recommend many other studies - bronchography, bronchoscopy, and even computed tomography.

Obstructive bronchitis: treatment

In severe cases, or if the child is less than 1 year old, hospitalization is recommended. Inpatient treatment is also carried out for babies with repeated episodes of bronchial obstruction.

Naturally, the optimal treatment is aimed at eliminating the cause of this condition - infections, allergies, dust, etc. In addition, it is necessary to take into account as fully as possible all the mechanisms for the development of bronchial obstruction.

The main therapy should be measures that improve sputum discharge. These include copious amounts of drinking, and it is better - with an alkalizing effect, such as still mineral water, milk or ordinary water.

Expectorants and mucolytics are actively used, i.e. thinning viscous sputum, drugs. Medicines are selected strictly taking into account the age of the baby, the severity of his condition, the amount and properties of sputum. If it is not plentiful and very viscous, it will be difficult to withdraw, so the main goal is to thin the sputum, reduce its "stickiness" and switch the cough from unproductive, dry, to wet, expectorant.

Inhalation therapy has a good thinning effect, especially through special nebulizers, which make it possible to accurately dose drugs. In addition, drugs are administered through the mouth - in the form of syrups, solutions or drops. AMBROXOL preparations have proven themselves well - AMBROGEXAL, FLAVAMED, LASOLVAN, AMBROBEN, HALIXOL. They well dilute sputum, increase its movement and have a moderate anti-inflammatory effect. These drugs can be used from 3 months.

In the treatment of mild and moderate seizures in children from 1.5–2 years old, you can use drugs containing ACETYLCYSTEINE - FLUIMUCIL, ACC, ACESTIN. They are especially effective in the first days of an attack, but they can only be taken by mouth - they are not used in inhalations.
It is necessary to act not only on sputum, but also on the muscle component, relaxing the bronchi. All drugs used for this are carefully selected, preference is given to a group of inhalation forms. Usually, for children from 2 years old, SALBUTAMOL is used through a nebulizer. BERODUAL and ATROVENT are used from birth in the form of inhalations several times a day as prescribed by a doctor.

To alleviate the condition of the child, anti-inflammatory therapy is needed, which reduces swelling of the bronchi and mucus production. One of these drugs is FENSPIRIDE (ERESPAL), used from 6 months: it reduces swelling, mucus secretion, reduces inflammation. Dosing this remedy is not difficult, it is offered for babies in the form of a syrup.

In the case of severe bronchial obstruction, hormonal preparations are used - corticosteroids in the form of inhalation, and in extremely severe cases - intramuscularly and intravenously. This is a highly effective and safe method of treatment, it is carried out in a short course. Usually hormones are prescribed for no more than 5-7 days.

With broncho-obstructive syndrome, antihistamines are also used - but only in the case of a reliably known allergic cause of this condition or with an initially unfavorable allergic background in a baby. These substances reduce the release of histamine, which was discussed above. For babies under 3 years old, only first-generation drugs are used - FENISTIL, FENCAROL, PERITOL, SUPRASTIN. It is worth noting, however, that their use should be strictly limited, since they have a “drying” effect on mucous membranes, which may not be very favorable for the viscosity of bronchial secretions.

The so-called postural drainages and drainage massages are carried out, that is, treatment with a certain position of the body and special measures that improve the outflow of sputum from the bronchi and stimulate the ventilation function. Special breathing exercises are very useful, which help to ventilate the lungs more efficiently and help to relax and calm the excited baby.

Antibiotics are prescribed only for the bacterial nature of inflammation, fever above 38 ° C for 3 or more days, with symptoms of intoxication or pneumonia.

Obstructive bronchitis: prevention

Of course, attacks of bronchial obstruction must be prevented. Knowing the main reasons for their development, it is worth developing preventive measures for your crumbs.

The first and most useful habit to develop from the birth of a child is a healthy lifestyle. It is necessary to exclude smoking, put in order your nutrition and the nutrition of the baby, removing potential allergens from it and balancing it in terms of the main food components, vitamins and minerals. It is necessary to create a hypoallergenic life by removing animals from the house. You should also maintain a room temperature of 20–22 ° C and a humidity of 55–60%.

For babies with bronchial obstruction, an individual and sparing vaccination scheme is prescribed, measures are taken to treat foci of chronic infection in the nose and throat. It is imperative to harden the child, walk often and a lot, adequately dress the baby: wrapped children get sick more often and longer, because overheating reduces immunity. The doctor may recommend massage and gymnastics, breathing and drainage exercises to the child. Vitamin therapy courses and restorative treatment will help.

Of course, bronchial obstruction is a serious condition, and very often it frightens parents. However, it is quite possible to cope with it and prevent repeated attacks - you just need to be aware of this condition, be able to recognize its first signs in time and properly help the baby together with his doctor.

• Acute obstructive bronchitis(phenomena of bronchial obstruction persist for no more than 10 days)
• Protracted obstructive bronchitis(phenomena of bronchial obstruction persist for more than 10 days) often occurs in children with a burdened premorbid background, chronic ENT pathology, vitamin D deficiency, asthenia.
• Recurrent (continuously recurrent) obstructive bronchitis(the phenomena of bronchial obstruction are observed 3 or more times a year), can lead to the formation of bronchial asthma.

The mechanism of development of obstructive bronchitis

• respiratory syncytial viruses;
• parainfluenza virus of the third type;
• influenza virus;
• rhinovirus;
• adenovirus;

• haemophilus influenza;
• Streptococcus pneumoniae;
• Moraxella catarrhali
• DNA persistent infectious agents - chlamydia, mycoplasmas.

Risk factors leading to the development of obstructive bronchitis

• Physiological features of the structure of the respiratory tract (narrowness of the respiratory tract, insufficient activity of local immunity, poor development of the respiratory muscles, high viscosity of bronchial mucus, etc.)
• Pathological conditions of a woman during pregnancy (toxicosis, preeclampsia, threatened miscarriage, intrauterine infection)
• Smoking and alcohol abuse during pregnancy
• Burdened hereditary allergic anamnesis;
• Congenital malformations of the bronchial tree;
• Prematurity (especially children born with extremely low weight and low body at 22-30 weeks gestation); light weight s; hypovitaminosis D.
• Anomalies of the constitution (exudative-catarrhal diathesis, lymphatic diathesis).
• Acute respiratory diseases suffered by a child in the first six months of life; artificial feeding (early introduction of mixtures or complete replacement of breastfeeding from the first days of life).

Symptoms of obstructive bronchitis

• Cough. It can be exhausting, obsessive, unproductive. Often the child coughs with attacks. The cough may get worse with physical activity.
• Noisy or wheezing breathing. Even at a distance, wheezing and whistling in the chest can be heard.
• Dyspnea. The baby begins to breathe more often, anxiety appears. The symptom can be checked at home. To do this, you should count the respiratory movements that are performed by the chest in one minute, putting your hand to your chest. Increased shortness of breath is an unfavorable symptom. It may indicate the development of respiratory failure, and requires the prompt intervention of emergency and ambulance specialists.
• Temperature rise. It can rise up to 37-39 degrees. Against the background of an increase in temperature, shortness of breath and anxiety in young children may increase.
• Violation of the general condition. Young children refuse breastfeeding, act up, their physical activity decreases, drowsiness and general weakness appear.
• On thedisruption of nasal breathing and redness of the oropharynx. Occurs in viral and bacterial infections.

Diagnosis of obstructive bronchitis.

• cough
• the appearance of a box percussion sound.
• hard breathing; prolonged exhalation
• whistling dry rales (their tone and number may vary).
• measuring the level of oxygen in the blood, will reveal the phenomenon of respiratory failure.

Laboratory examination methods:

• Clinical blood test (allows you to clarify the signs of inflammation)
• In case of recurrent obstructive bronchitis, allergological tests (level of general and specific IgE), skin prick tests (uninformative in children under 3 years old, high risk of false positive and false negative results).
• PCR and serological testing for infections.

Instrumental examinations:

• pneumonia
• foreign body (history, weakening of breathing on one side, unilateral wheezing), aspiration (frequent regurgitation, vomiting, children with aggravated premorbid background with swallowing disorders)
• squeezing process in the mediastinum (persistent metallic cough).

Treatment of acute obstructive bronchitis in children

• peace;
• air humidification in the apartment;
• plentiful alkaline and warm drink;
• dairy-vegetarian diet.

• Mucolytics, mucoregulators, expectorants
• Inhalation therapy for bronchodilators
• Inhaled corticosteroid therapy

• Postural drainage (positional massage) is a complex of manipulations: patting, stroking and tapping at a certain drainage position of the body.
• Vibration chest massage. Vibration effect on tissues, provided with the help of special vibration massagers, reduces the inflammatory process
• Breathing exercises
• Antipyretic drugs
• Anticongestants (possibly combined), to reduce swelling of the nasal mucosa and improve nasal breathing.
• Antibiotics

ethnoscience

• Pneumonia, bronchopneumonia
• Chronicization of the inflammatory process
• Bronchial asthma

• Timely treatment and prevention of acute respiratory diseases.
• Vaccination against influenza, Haemophilus influenzae, pneumococcal infection. Premature babies are also vaccinated against respiratory sentience infection.
• Sanitation of foci of chronic inflammation in the oropharynx and nasopharynx.
• Stop smoking during pregnancy, in the presence of the child.
• Carrying out community activities. Spa treatment.