Bronchitis is one of the most common forms of respiratory damage in children. These are inflammatory diseases of the bronchi of various etiologies (allergic, infectious, physico-chemical, etc.
In most cases, acute bronchitis is observed , which is the most frequent manifestation or complication of an acute respiratory viral or viral-bacterial infection and proceeds without signs of bronchial obstruction.
Etiology. Most often children with the first 2 years of life are ill with bronchitis. Acute bronchitis can occur with a viral, bacterial or fungal infection. Among viruses, parainfluenza viruses, adenoviruses, PC viruses, and influenza viruses A and B play the largest role. In children in the first half of life, bronchitis is most often caused by chlamydia. In preschoolers and schoolchildren – a common etiological factor may be mycoplasma infection.
In the occurrence of acute bronchitis, cooling, air pollution by tobacco smoke, industrial dust and other factors of human activity are important. Children with allergic tendencies and children who have or suffer from rickets are most susceptible to bronchitis. In older children, predisposing factors may be chronic nasopharyngitis, carious teeth.
Pathological data for the viral etiology of bronchitis indicate the presence in the bronchi of changes in the type of catarrhal bronchitis, manifested by hyperemia, swelling and swelling of the mucous membrane, increased secretion of mucus. With bacterial bronchitis, purulent exudate appears.
Clinic OB . In the initial period of the disease, the clinic depends on the type of pathogen: under the action of PC viruses or parainfluenza virus, bronchitis often develops with moderate toxicosis and severe catarrhal phenomena. The duration of a fever rarely exceeds 2-3 days.
With mycoplasma and adenoviral etiology, OB fibrillation can last up to 10 days. Subsequently, the temperature decreases to subfebrile or normal numbers.
OB itself does not cause a sharp violation of the general condition of the child’s body. Cough at the beginning is dry, intrusive, in the second week the disease becomes softer, moist, productive and gradually disappears. The disease rarely lasts more than 3 weeks.
ABOUT is usually not accompanied by respiratory failure, there are no pronounced signs of bronchial obstruction. However, in some children of the first year of life during sleep, moderate dyspnea (up to 60 breaths) and dry wheezing on exhalation can be determined.
Percussion changes with OB are usually absent. Auscultation is determined by diffuse dry rales, large and medium-bubbly wet rales, the amount of which changes with coughing. With a deeper lesion of the bronchial tree, one can also hear small-bubbly moist rales. Bronchitis rales are often heard symmetrically on both sides. The asymmetry of auscultatory data should alert the doctor regarding possible pneumonia.
Mycoplasmal bronchitis in preschoolers and schoolchildren is characterized by the asymmetry of moist rales (small-bubbly). It is accompanied by scanty catarrhal phenomena from the upper respiratory tract, conjunctival hyperemia without discharge.
Hematological changes in OB are not constant. With viral and mycoplasma etiology, OB can slightly increase ESR with a normal or reduced number of leukocytes, sometimes with neutrophilia and a slight left shift.
Radiological OB is manifested by soft-shadow bilateral strengthening of the pulmonary pattern, especially in the basal and lower medial zones, which lasts longer than the OB clinic. With mycoplasma etiology of OB, pulmonary pattern is enhanced on the side of greater severity of physical data.
Diagnosis and differential diagnosis of simple acute bronchitis is not complicated, although its viral etiology can be deciphered only with special virological studies. From a therapeutic point of view, it is important to establish mycoplasma etiology of OB. This helps outfits with clinical, epidemiological data, mainly a one-sided lesion, conjunctivitis without discharge, serological data and the age of the child.
Differentiating with pneumonia is not difficult. In favor of OB is the diffusion of lesions, the identity of physical data on both sides, the absence of local symptoms and signs of intoxication. Patients with a pronounced basymmetry of physical data are required to undergo radiography of the lungs, even with moderate symptoms of intoxication. With prolonged (more than 2 weeks) OB, you need to think about a foreign body of the bronchi, chronic aspiration of food, cystic fibrosis.
Acute obstructive bronchitis is an OB occurring with a syndrome of bronchial obstruction.
Etiology. Most often, the disease occurs against the background of acute respiratory viral infections caused by RS viruses, as well as parainfluenza, influenza, enteroviruses and adenoviruses.
Clinic. Most often, children with second and third years of life are ill with SAR. For OBD, a dry cough is characteristic at normal or subfebrile temperature. Symptoms of intoxication are mild. Signs of DN develop gradually. Dyspnea with a predominance of the expiratory component is moderate. The exhalation is noisy, whistling, heard from a distance. The chest is swollen. Percussion appears boxed shade of pulmonary sound. Auscultation listened to a mass of dry wheezing, and in young children, moist, small-bubbly prevail. Over the course of 2-3 days, the daylight rate decreases, and wheezing gradually disappears.
Radiologically determined bloating of the lung tissue.
Hematologic blood picture corresponds to that with uncomplicated ARVI. With OB, moderate eosinophilia can be determined, somewhat more often than with bronchiolitis, which is associated with a more frequent predisposition of children to allergic diseases.
SAR usually has a favorable course. Respiratory distress decreases within 2–3 days, but elongated exhalation and wheezing can be heard up to 1–2 weeks. In some patients (5-30%), later there are repeated episodes of SAR with the formation of recurrent obstructive bronchitis and bronchial asthma.
Acute bronchiolitis – a disease in children of the first year of life occurs with a syndrome of bronchial obstruction, which is characterized by severe DN and an abundance of small-bubbly moist rales.
The etiology of acute bronchiolitis is most often parainfluenza, adenovirus, and PC virus. Moreover, parainfluenza and MS infection are characteristic of children in the first months of life, while adenovirus infection is the predominant etiological factor in older children.
Obstructive syndrome with bronchiolitis is accompanied by shortness of breath up to 70-90 breaths or more per minute, difficulty in exhaling with the participation of auxiliary muscles, retraction of the compliant places of the chest, bloating of the wings of the nose, sometimes with perioral cyanosis, and appears 2-3 days after the onset of SARS. Dry cough often has high overtones. The increase in DN is accompanied by a sharp anxiety of the child. May be vomiting. This symptomatology develops against a background of normal or subfebrile temperature. With an adenoviral etiology of bronchiolitis, the fever can be febrile, have a wavy character for 6-8 days. With parainfluenza and RS infections, in most cases, fever with bronchiolitis does not exceed 3 days.
On examination, a child with acute bronchiolitis gives the impression of a seriously ill patient, and the severity of the condition is due to DN, and signs of intoxication in most patients do not come to the fore. The chest is swollen, a boxy shade of percussion sound, a decrease in heart dullness, lowering of the borders of the liver and spleen, with auscultation – against the background of hard breathing with an elongated, less often whistling exhalation, the mass of small-bubbly and crepitating wheezing is determined both at the height of the inspiration and at the exhalation. This picture of a moist lung is often supplemented by coarser wet rales, creating the impression of bubbling, which changes dramatically when coughing, while the number of wet rales is small. With pronounced shortness of breath, elongation of the exhalation may not be determined.
Hematological changes are uncharacteristic. Possible moderate leukocytosis and an increase in ESR, eosinophilia.
Radiologically determined, as a rule, bloating of the lungs, increased bronchovascular pattern. Atelectases, linear focal shadows are rare.
The prognosis of a single episode is usually favorable, the mortality rate is 102%. However, a third, and sometimes half of children with bronchiolitis subsequently experience repeated episodes of obstruction.
Diagnosis of bronchiolitis is not difficult in typical cases. Differential diagnosis is carried out with pneumonia. Diffuse changes in the lungs, severe obstruction with a high degree of probability (95%) exclude pneumonia. In favor of the latter, the asymmetry of physical data, persistent (more than 3 days) febrile temperature, severe toxicosis can speak.
Obliterating bronchiolitis. This form of bronchiolitis is characterized by a transition to a chronic disease. It is characterized by a common lesion of the bronchial epithelium with the subsequent organization of exudate and granulomatous reaction of the lung tissue, and then obliteration of the lumen of the bronchi.
The etiology of obliterating bronchiolitis in childhood is most often adenovirus, some cases are described with whooping cough and measles.
Clinic. As a rule, children of the first 2-3 years of life suffer. The acute period of the disease is characterized by severe respiratory distress against a background of persistent febrile temperature, often with signs of adenovirus infection such as rhinopharyngitis and conjunctivitis. DN persists for 1-2 weeks with febrile fever. Auscultatory listening to asymmetric small-bubbly and crepitating rales.
X-ray picture may be different. Total blackouts of one pulmonary field with a picture of an air bronchogram indicating the prevalence of atelectasis are described. Often changes in the lungs resemble pneumonic infiltration, combined with air areas – the so-called “cotton” lung.
Hematological changes – moderate leukocytosis with a neutrophilic shift, accelerated ESR.
With a typical obliterating bronchiolitis, severe obstructive disorders persist after normalizing the temperature for 3-4 weeks. Auscultatory prescriptions are defined in the form of a variety of different-ripe rips, wheezing exhalation on the side of the lesion. Obstruction may periodically worsen, sometimes resembling an asthmatic attack. At the same time, the x-ray data disappear, the pulmonary fields are cleared of shadows. However, signs of DN are usually preserved, indicating persistent changes in the bronchioles and arterioles of the affected area of the lung, the evolution of which after 6-8 weeks leads to the phenomenon of “super-transparent lung” (MACLEODE syndrome)
Diagnosis of a typical obliterating bronchiolitis in the acute period is simple – persistent febrile temperature, a bright clinic of bronchiolitis, asymmetry of wheezing, the appearance of “cotton” shadows on the radiograph, expressed DN. Such a patient with suspicion of an obliterating bronchiolitis must be urgently hospitalized.
Recurrent bronchitis is a recurrence of episodes of acute bronchitis without obstruction 2-3 times within 1-2 years against the background of acute respiratory viral infections. The duration of clinical manifestations is typical (2-3 or more weeks). This group includes most of the so-called often ill children. Within 3-4 years, the relapse rate decreases, by 6-7 years, they stop. At the same time, up to 80% of children have a history of allergy.
Recurrent obstructive bronchitis is obstructive bronchitis, episodes of which are repeated against the background of acute respiratory viral infections. Unlike bronchial asthma, obstruction is not paroxysmal in nature and is not associated with exposure to non-infectious allergens. In some children, recurrent obstructive bronchitis may be the debut of bronchial asthma.
The diagnosis of recurrent obstructive bronchitis is made before the age of 3 years, after 4 years the diagnosis is replaced by asthmatic bronchitis, as a form of bronchial asthma.