Bronchiolitis in infants. Bronchiolitis in children: a serious blow to a small body

It's called bronchiolitis inflammatory process, passing in the respiratory canals, resulting in partial or complete blockage of bronchioles and small bronchi. Why do young children develop this disease, how to distinguish bronchiolitis from other diseases of the bronchopulmonary system, and what methods medicine uses to diagnose and treat this disease, read the article.

Why do children of early age and older develop bronchiolitis: the main reasons

It is believed that infants and children under 3 years of age are most often affected by this disease. This is due to the fact that children of this age have not yet fully strengthened their immune system. Parents should be especially careful in late autumn and early winter; doctors say that this is when the peak of this disease occurs. The most vulnerable are children who are prone to allergic reactions. The disease is caused by a virus or bacterial-viral infection.

Factors that provoke the development of bronchiolitis:

• poisoning or any intoxication of the child’s body;
• heart or lung transplant surgery, after which complications arise;
• the presence of mycoplasma in the child’s body;
• connective tissue disorders;
• inflammatory processes of the digestive system;
• carrying out radiation therapy;
• hypothermia of the body;
• entry of cold air into the respiratory tract.

Various children may encounter similar factors, but many children's bodies resist the viruses of this disease well.

A child is at risk for bronchiolitis if:

• the baby's weight is very small;
• the child is bottle-fed;
• baby under 3 months;
• have chronic or congenital diseases hearts and respiratory tract;
• for some reason the child’s immune system is weakened;
• The baby grows up in a smoking family.

Types of bronchiolitis in children: signs of acute and obliterating forms of the disease

Types of bronchiolitis in children:

• Inhalation– bronchiolitis, which is formed as a result of inhalation of dust, gases and all kinds of chemicals.
• Drug- appears as a result medicines, which are taken for any other disease. Particular care should be taken when taking interferon, bleomycin, and cephalosporin.
• Post-infectious – viruses can enter the respiratory tract, causing this disease. It is transmitted by airborne droplets and is most common in children.
• Obliterative– such bronchiolitis is provoked by others viral diseases, such as herpes, HIV, pneumocystitis and others. Its course is considered the most difficult.
• Idiopathic– the causes of this bronchiolitis cannot be determined. Combined with other diseases (lymphoma, iliopathic pulmonary fibrosis and others).

Bronchiolitis can occur in acute and chronic forms:

• With an acute illness, the child may be ill for a month or less. The symptoms are pronounced. In this case, the baby experiences a sharp deterioration in his condition, urgent problem with breathing.
• In the chronic form, the symptoms are mild and noticeable only with careful monitoring of the state of health. The duration of the disease can stretch up to 3 months or more.

Bronchiolitis obliterans is most severe in its acute form. Most often it affects children from 2 to 6 months, sometimes up to 1 year. To provide quick help, you need to know the signs of this disease.

Signs of bronchiolitis obliterans:

• breathing problems are clearly visible - there is shortness of breath, strong intake of air, groans;
• cases of apnea - stopping breathing - cannot be excluded;
• the baby refuses to eat;
• refusal of water;
• the child’s skin becomes pale, with a bluish tint;
• crying, restless sleep, agitated state;
• urination is rare;
• bouts of dry cough;
• the temperature is not too high.

With these signs, it is necessary to get help from pediatricians as soon as possible.

How to determine bronchiolitis in a child: diagnostic methods

In order to begin treatment, it is necessary to make a correct diagnosis. In the case of bronchiolitis, an x-ray will not help, since this disease does not affect the lungs and this method is not effective. To put accurate diagnosis it is necessary to rely on the main symptoms, and a number of studies are carried out to confirm the presumptive diagnosis.

Diagnostic methods for determining bronchiolitis

• Ascultation (listening to the patient to detect wheezing).
• . In this case, the ratio of oxygen and carbon dioxide in the blood is considered. When illness occurs, the correct balance is disrupted. Using the same analysis, information about ESR, hypoxemia and leukocytosis is obtained.
• Percussion (tapping with fingers) in order to identify the nature of the sound.

How to distinguish bronchiolitis from asthma and pneumonia during diagnosis?

In order not to confuse bronchiolitis with pneumonia or asthma, differential diagnosis is carried out. It is as follows:

1. Detection of acute respiratory infections in people who surround a sick child (it is the acute respiratory infections of those around them that cause the baby’s illness).
2. Identification of an allergic history (if, for example, parents suffer from asthma, then the child may have the same disease).
3. The child is prescribed a β-adrenergic drug. The child's reaction to treatment with this drug indicates whether he has asthma.
4. An x-ray is taken. It does not show bronchiolitis, but pneumonia can be excluded, or its manifestation can be detected. X-rays are effective in detecting pneumonia.
5. A blood test is done to further confirm or rule out asthma.

What is worse, bronchiolitis, pneumonia or obstructive bronchitis: what is the difference?

Effective methods of treating bronchiolitis in children

Due to the fact that bronchiolitis is a disease of children, it is very early age, self-medication is extremely dangerous. Regardless of the form of the disease (acute or chronic), treatment should only be prescribed by a doctor.

It is the doctor who will be able to correctly select the methods that will be most productive at a given age and with a certain severity of the disease. If the child is in an acute form of the disease, he is hospitalized. If the form of bronchiolitis is mild, it is prescribed home treatment.

Treatment of bronchiolitis consists of the following steps:

1. For treatment, the doctor uses medications aimed at eliminating the underlying cause of the disease. For this purpose, drugs are prescribed that are destructive to the virus or bacteria, depending on the origin of the disease.
2. After eliminating the causes, the eradication of symptoms begins - the cough itself is eliminated. Inhalations (ultrasonic nebulizers are used), mucolytic drugs, and oxygen masks are very effective. At the same time, the child must be given plenty of fluids (2 times more than usual).
3. After the child has fully recovered, the doctor prescribes preventive actions that parents must perform (hardening, mandatory regimen, proper nutrition, preventing the child from hypothermia).

Some researchers point to a connection between bronchiolitis and the subsequent onset of bronchial asthma, while others reject such a connection.

What is known for certain is that bronchiolitis develops more often in children who exhibit atopic properties both on the skin and on the outside. internal organs. At the same time, bronchiolitis mainly occurs among infants and young children, so it is treated by doctors from intensive care units and intensive care, since it proceeds quite hard.

Reasons for development

Many of the diseases that occur as a side effect of bronchitis and affect certain parts of the respiratory tract in the lower respiratory tract, including bronchiolitis, are usually caused by viral causes. Acute bronchiolitis is often caused by respiratory syncytial virus (RS infection). From 40 to 75% of bronchiolitis in children who are treated inpatiently with a diagnosis of bronchiolitis have this virus as the root cause of inflammation of the small bronchi.

Other causative agents of bronchiolitis include viruses such as parainfluenza virus type 3, rhinovirus, adenovirus types 3, 7 and 21, influenza virus type A, and in rare cases, the causative agent may be mumps virus. One of the atypical causative agents of bronchiolitis in young children can be mycoplasma, although in adults and older children it usually causes other diseases.

Often, the manifestations of bronchiolitis are called the term “wheezing children with respiratory infections,” since children most often develop bronchiolitis in the first year of life, among them it is 12%, while in the second year it is already 5-6%.

At the same time, a pattern is noted that the younger the baby’s age, the more severe the disease, mainly such children require hospitalization and intensive care. Typically, these children with bronchiolitis have low levels of antiviral antibodies, which are passed on to the baby by the mother during pregnancy. In some children, bronchiolitis of a respiratory syncytial nature can cause attacks of apnea (stopping breathing); these are mainly premature children, young children, or those with heart defects. In such groups of children, mortality from bronchiolitis is very high.

Typically, the incidence increases in winter, when the activity of MS viruses is high, and the contagiousness of such an infection is very high, up to 98% of children become infected from a sick child in a children's group. This virus is also dangerous for intrafamily contacts; usually the whole family gets sick at once, but younger children get sick the most. This virus also becomes quite relevant during nosocomial infection.

What happens with bronchiolitis

Typically, viruses infect the area of ​​the mucous membranes of the lower respiratory tract, mainly small bronchioles, which leads to the formation of their obstruction (blockage) and the formation of pulmonary emphysema (bloating).

Intrathoracic air volumes and the final expiratory volume during bronchiolitis increase almost twice as much as normal, while an increase in air resistance in the area of ​​small bronchi is detected both during inhalation and exhalation. Due to this, pulmonary ventilation is impaired. Shortness of breath occurs, both expiratory (on inhalation) and inspiratory (on exhalation) - and this shortness of breath is usually stronger.

Due to shortness of breath and increased breathing, connecting auxiliary respiratory muscles satisfactory pulmonary ventilation is maintained and the blood is supplied with oxygen with the removal of carbon dioxide. But gradually respiratory disturbances increase and tissue hypoxia and hypercapnia (excess carbon dioxide in tissues) may develop. When the respiratory muscles become tired, respiratory failure occurs. As a result of respiratory fatigue, young children may develop periods of apnea - stopping breathing, this is understandable - due to increased muscle work six or more times, their reserves are quickly depleted.

Clinical manifestations of bronchiolitis

Infection of a viral infection in children occurs mainly from older children or adults at home or in a children's group (nursery). With bronchiolitis, symptoms initially occur respiratory infection with cough, runny nose and sneezing, then the first manifestations of damage to the respiratory tract. Subsequently, the infection spreads lower, to the area of ​​small bronchi. Irritability and lethargy develop, increased breathing occurs with the participation of auxiliary muscles, and dry wheezing occurs in the lung area. In this case, there may be symptoms of low fever. Due to shortness of breath, breathing problems can significantly impede breastfeeding or complementary feeding. General state the child's condition progressively worsens, which forces parents to consult a doctor or call an ambulance.

When examining such babies, signs of acute inflammatory infection in the lower respiratory tract are revealed - the respiratory rate is increased, the child turns blue, the wings of the nose swell, in the area chest there is a retraction of compliant places (intercostal spaces, areas near the collarbones), while the lungs are swollen, the edge of the liver can clearly appear from under the costal arch on the right. When listening to the lungs, dry scattered rales, moist rales are observed, and exhalation is sharply prolonged.

Diagnostic methods

To confirm the diagnosis and clarify the extent and severity of the lesion, it is necessary to conduct a series of laboratory and instrumental studies. First of all, it is necessary to perform a general X-ray of the chest, conduct a general blood test, examine the gas composition of the blood and do a virological study of swabs and swabs from the child’s throat and nose to determine the virus. To exclude microbial pneumonia, blood and sputum are cultured for microflora and sensitivity to antibiotics is determined.

An X-ray in children with acute bronchiolitis reveals the presence of acute pulmonary emphysema; there may be peribronchial thickenings in the area of ​​large bronchi; a blood test may show slight lymphocytosis or a normal reaction. The virus is detected by a complement fixation reaction or indirect immunofluorescence in a smear from the nasal mucosa.

Particularly important is the study of blood gases, which reveals a decrease in blood oxygen saturation, which lasts about a month, even if the condition improves. In most of them, when breathing normal air, hypoxia and the development of respiratory failure were detected, and metabolic acidosis formed.

Treatment methods for patients

All children with manifestations of acute bronchiolitis and severe breathing problems, especially those who are not yet six months old, are urgently hospitalized in the intensive care unit of a children's hospital. First of all, it is necessary to calculate the heart rate and find out from the parents whether there are any problems with the lungs and heart, which could complicate the course of the disease. Children with severe manifestations of respiratory failure should be transferred to the intensive care unit; sometimes they require breathing with oxygen or an oxygen mixture.

It is important to isolate children with such manifestations in a boxed unit, as they are very contagious to others. When caring for a child, staff should strictly adhere to the regime.

A pulse oximeter is connected to the child’s finger or earlobe and the blood gas composition is determined, and in case of severe hypoxemia, oxygen therapy is administered through a nasal catheter or mask. Sometimes an oxygen tent or humidified oxygen is used.

According to the recommendation of the AAR, treatment is carried out with ribaverin if there is a high risk of complications associated with concomitant pathology - if the child has heart defects, pulmonary hypertension, with prematurity, with defects of the lungs, pancreas, with immunodeficiencies. Ribaverin is also indicated for children with severe bronchiolitis and those whose blood gas composition is altered and the level of carbon dioxide in the tissues is increased. It is mandatory to use it in children who require mechanical ventilation.

It is important to monitor fluid intake in children with bronchiolitis because antidiuretic hormone production is impaired and fluid retention occurs with increased blood pressure. Subsequently, the production of renin by the kidneys also suffers, which leads to decreased urine output, low urinary excretion of sodium and fluid retention with weight gain. This leads to increased swelling in the bronchi and worsening of the condition.

The use of diuretics in minimal doses under control of weight and condition with some fluid restriction helps in alleviating the condition.

The child is constantly monitored for the effectiveness of oxygen therapy based on the state of blood gases on a pulse oximeter, if possible. spontaneous breathing oxygen mask, nasal catheter or a mixture of air and oxygen are indicated.

The treatment uses bronchodilators that affect muscle spasm. In addition, corticosteroids can be used in the form of inhalations, but they may not always be effective, since the main role is inflammatory swelling of small bronchioles and not spasm. The basis of treatment is the impact on viruses and the fight against swelling and inflammation in the area of ​​small bronchi, respiratory therapy.

The following stages can be distinguished in therapy::

1. use of oxygen therapy,
2. fluid administration and diuresis monitoring,
3. use of antibiotics to prevent secondary infection,
4. glucocorticoid therapy to relieve inflammation,
5. the use of drugs to maintain heart function.

All therapy is selected based on the degree of severity and is strictly controlled by doctors.

Predictions and prevention

Even if bronchiolitis has been fully treated, children may still suffer from functional impairment for a long time. external respiration and their bronchi will be hypersensitive to the effects of various external factors and infections. In half of children with bronchiolitis, with the development of colds and flu, bronchial obstruction syndrome is formed and there may be transitions to asthma.

Especially dangerous option bronchiolitis is obliterating bronchiolitis, with which in half of the cases chronic bronchopulmonary pathology is formed.

The basis for the prevention of bronchiolitis is the separation of young children from sick children, the prevention of viral infections, hardening procedures and a balanced diet. It has been noted that bronchiolitis develops less frequently among infants due to their protection by maternal antibodies. When colds develop in young children, early use of antiviral drugs is necessary.

It will be useful to create a hypoallergenic lifestyle and prevent allergies, since bronchiolitis has a common component with allergies. It is important to monitor the condition of the child’s nasopharynx and constantly clean it of crusts and mucus. After recovery, children with bronchiolitis are registered with a pediatrician and pulmonologist for a long time and require periodic measures for health improvement and prevention.

Respiratory diseases are very common in children, infants and newborns are especially susceptible to them, which is explained by the immune system not yet being fully formed. One of the diseases that affects the lungs is bronchiolitis. How to quickly recognize pathology and provide qualified assistance to a child?

What is bronchiolitis

Bronchiolitis is an acute inflammatory disease of the lower respiratory tract, which affects the bronchioles - the final tiny bifurcations of the bronchi in the pulmonary lobules. The pathology is accompanied by symptoms of respiratory failure, or broncho-obstruction, and clinical signs, similar to the manifestations of ARVI.

Bronchoobstruction is clinical syndrome, which is characterized by impaired pulmonary ventilation and difficulty in clearing mucus.

Bronchiolitis is an inflammatory process that occurs in the bronchioles

Most often, the disease is caused by viruses, and the peak incidence of its development occurs in the autumn-winter period. Diagnosing bronchiolitis today is not difficult, but ignoring the disease can lead to serious complications.

Classification and causes of the disease

Depending on the cause that provoked the development of the disease, the following types of bronchiolitis are distinguished:

• post-infectious. It is most often diagnosed at an early age. Infection occurs by airborne droplets;
• inhalation Found in children who are forced to constantly inhale tobacco smoke;
• drug. May develop after a course of antibiotic therapy;
• obliterating. It has the most severe course. It is extremely rare in children;
• idiopathic. Combined with other pathological conditions, such as lymphoma, idiopathic pulmonary fibrosis and others.

Children prone to allergic reactions are more susceptible to bronchiolitis than others.

Based on the nature of the disease, it is customary to distinguish:

1. Acute bronchiolitis - develops within 2–3 days after infection, with pronounced clinical picture. Acute period The disease lasts 5–7 days.
2. Chronic - resulting from prolonged exposure negative factors bronchiole tissues undergo destructive changes. In most cases it develops in older children.

Causes and causative agents of the disease at an early age - table

Type of bronchiolitis	Pathogen/cause
Post-infectious	respiratory syncytial virus (RSV); adenovirus; influenza virus, parainfluenza; virus mumps; rhinovirus; virus
Inhalation	gas (carbon dioxide, sulfur dioxide, etc.); acid evaporation; tobacco smoke; dust, etc.
Drug	Preparations containing the following active ingredients: penicillin; interferon; cephalosporins; bleomycin; amiodarone.
Obliterative	cytomegalovirus; legionella; HIV infection; herpes virus; Klebsiella etc.
Idiopathic	reason unknown

Risk factors

There are a number of factors that significantly increase the risk of developing bronchiolitis in children:

• child's age up to 3 months;
• prematurity;
• low weight of the newborn;
• improper treatment of respiratory diseases in a baby;
• the presence of other lung diseases or pathologies of cardio-vascular system;
• immunodeficiency states;
• hypothermia.

The fact that this disease mainly affects young children is explained by the following:

1. The bronchial tree in infants is not yet fully formed, so inflammation of even a small number of bronchioles can lead to serious consequences for the child.
2. Unprotected immune system. Interferon and immunoglobulin A are produced in insufficient quantities in the respiratory organs.

Symptoms and signs

The first manifestations of acute bronchiolitis are:

• nasal congestion;
• cough.

Then the disease spreads to the small bronchi, and the following symptoms appear:

• irritability;
• lethargy;
• rapid breathing;
• dry wheezing;
• weight loss associated with the child’s refusal to eat;
• shortness of breath, which is very disturbing when eating.

The patient's condition deteriorates very quickly.

Early bronchiolitis is the easiest to treat, and in late forms of the disease, symptoms can persist for more than 3 months

As for chronic bronchiolitis, shortness of breath is its constant companion. Body temperature constantly rises and falls. There is weakness, sputum is produced when coughing, and the skin has a bluish tint. The fingers become like drumsticks.

Features of the disease in infants and newborns

Most often, children under the age of one year suffer from bronchiolitis. Infants suffer from this disease much more severely, so when the first signs appear, it is necessary to seek medical help.

Babies, including newborns, experience the following symptoms:

• attacks of asphyxia (temporary cessation of breathing);
• watery nasal discharge;
• cough;
• difficulty breathing (a sick child makes considerable efforts to exhale);
• lack of appetite;
• retraction of the large fontanel (against the background of dehydration);
• increase in body temperature up to 39 degrees;
• excessive excitement or, conversely, drowsiness.

Diagnostics

The diagnosis is made by a pulmonologist based on a physical examination and auscultation (listening).

When examining patients with bronchiolitis, the doctor pays attention to the frequency and nature of breathing, the presence of cyanosis skin, retraction of yielding places in the chest (spaces between the ribs and near the collarbones), duration of exhalation.

If there is an increased risk of complications, additional examinations are prescribed, in particular:

• biochemical and general blood tests (with bronchiolitis there is an increase in the number of leukocytes);
• general urine analysis;
• bacteriological examination of mucus from the nose and throat (to exclude the bacterial nature of the disease);
• CT scan;
• spirometry, or spirography (allows you to measure the volume respiratory system);
• blood gas test (carried out to detect insufficient oxygen supply to the body);
• chest x-ray (to exclude acute pulmonary emphysema).

Treatment of bronchiolitis in children

The essence of therapy is to eliminate respiratory failure and overcome infection. At acute course illness, it is necessary to hospitalize the child in the hospital.

Treatment of bronchiolitis requires integrated approach and includes:

1. Bed rest (until body temperature normalizes).
2. Limiting the amount of liquid the child consumes.
3. Drug therapy, in particular:
   • antiviral agents (Ribavirin);
   • expectorant medications (Lazolvan, Bromhexine);
     

     Such drugs cannot be used in the treatment of infants, as this can lead to blockage of the bronchi with mucus.

   • saline solutions (Otrivin Baby);
   • bronchodilators;
   • inhalations with corticosteroids;
   • antibacterial drugs (Sumamed, Macropen, Clarithromycin).
     

     Antibiotic therapy is indicated only if the bacterial nature of bronchiolitis is identified. Prescribed at the discretion of the attending physician.

4. Breathing exercises. It is necessary to apply light pressure on the baby's chest and tummy as you exhale.
5. Vibration massage, which consists of light tapping movements with the edge of the palm in the direction from the bottom of the chest to the top. The baby is placed in such a way that the butt is slightly higher than the head.
6. Oxygen therapy (to eliminate respiratory distress syndrome).

Since bronchiolitis is transmitted by airborne droplets, the patient should be isolated. As a rule, when the baby’s appetite is restored, body temperature returns to normal and there is no need for oxygen therapy, the child is allowed to go home from the hospital.

Drugs for the treatment of the disease - gallery

Prognosis and possible complications

With timely diagnosis of the disease and compliance with all doctor’s recommendations, treatment has a favorable prognosis. Otherwise, the following complications may occur:

• pulmonary hypertension;
• cardiovascular failure;
• prolonged pauses in breathing;
• emphysema;
• renal failure;
• bronchial asthma;
• pneumonia.

Complications from bronchiolitis are most often observed in premature infants, as well as in those who suffer chronic diseases heart or lungs.

Prevention

To avoid bronchiolitis, you must:

• exclude contacts of healthy children with sick ones;
• harden the child, provide him with adequate nutrition and organize a healthy daily routine;
• monitor the condition of the baby’s nasopharynx, clean it of crusts and remove mucus;
• avoid hypothermia;
• promptly treat infectious and viral diseases;
• Avoid crowded places during ARVI outbreaks.

Doctor Komarovsky about cough in children - video

Bronchiolitis is a serious disease that often occurs in young children. Timely diagnosis And competent treatment will help avoid serious complications. Therefore, if the first symptoms occur, consult a doctor immediately. Health to you and your baby!

An inflammatory process occurring in the small bronchi and bronchioles, in medical practice called "bronchiolitis". Most often, the disease develops as a complication against the background of existing influenza and ARVI. The greatest danger is not the inflammation itself, but the signs of respiratory failure, manifested by shortness of breath, severe attacks of coughing and suffocation. Therefore, it is important for parents to know what bronchiolitis is in children and what the manifestations of this disease are. After all, by recognizing it in time, you can save your child’s life.

Dangerous age

Young children are most at risk for developing bronchiolitis, so this diagnosis is more common in medical card children up to three years old. At the very large group Infants as young as one month are at risk. This is due to the imperfection of the immune system, which is unable to resist infections. And if the virus does enter the body, it begins its attack from the most “secluded corners” of the respiratory system:

• Newborns. At the age of up to a month, babies receive passive immunity from their mothers. So the likelihood of inflammation of the bronchioles during this period is quite low. But if the disease could not be avoided, then bronchiolitis is the most difficult for such babies to endure. Treatment of newborn babies is carried out only in a hospital, in the intensive care unit.
• According to statistics, the most common cases of bronchiolitis occur in children aged one month to one year.. Six-month-old babies with inflammation are also hospitalized. For children seven months and older, home treatment is allowed, provided regular examinations at the doctor's.
• By strengthening the immune system and developing the respiratory system, the risk of bronchiolitis in children over one year of age is reduced. And cases of illness after three years practically do not occur.

Bronchiolitis is most dangerous for premature babies, as well as for newborns with various developmental defects. In the absence of qualified assistance, the likelihood fatal outcome very high.

Main causes of the disease

The occurrence of bronchiolitis as a response to an allergen is rare, and the exact relationship between the two diseases has not yet been established. And here timely treatment ARVI and influenza in children significantly increases the likelihood of avoiding severe complication in babies.

So, the main reasons why bronchiolitis develops in young children:

1. Respiratory diseases of viral and bacterial etiology. Including rhinovirus, adenovirus, influenza, mumps, pneumococcal infection, mycoplasmosis and others. Infectious diseases are transmitted primarily through the respiratory route through contact with an infected person. This can happen in kindergarten, in a hospital and in any other public place. Infection from family members who have contracted one of these viruses is possible.
2. Smoking around a child. Tobacco smoke has an irritating effect on the baby’s mucous membranes, reducing resistance to other infections. The possibility of an allergic reaction cannot be ruled out.
3. General decrease in the body's defenses. Regardless of the cause, any decrease in immunity increases the risk of infection.
4. Underweight. Children who gain little weight have always been at risk. Weight is an indicator of a baby's health. And its lack indicates a deficiency of vitamins in the body.
5. Artificial feeding. Together with breast milk the child receives from the mother all the necessary antibodies that allow the still imperfect immune system resist infections. Refusal breastfeeding increases the risk of developing bronchiolitis.

Any diseases of the respiratory and cardiovascular systems can also cause an inflammatory process.

Types of bronchiolitis

In medical practice, there are two forms of the disease: acute and chronic. Acute bronchiolitis is characterized by pronounced symptoms and impaired respiratory function. Period acute form lasts approximately 4 weeks. If the diagnosis is incorrect and, accordingly, treatment is not prescribed, the disease becomes chronic.

With chronic bronchiolitis, the child is usually sick for more than two to six months. During this period, the manifestations of the disease decrease, the signs of respiratory arrest weaken and become less noticeable. At this stage, most often we are talking about the so-called bronchiolitis obliterans.

Signs of acute bronchiolitis

If a newborn child has contracted any viral disease, treatment does not produce tangible results, and the baby’s condition only worsens, this is a serious reason to undergo additional examination. Acute bronchiolitis in children is manifested by the following symptoms:

• loss of appetite, up to complete refusal to eat;
• pale skin, cyanosis that developed due to lack of oxygen;
• emotional agitation, sleep disturbance;
• slight increase in temperature (distinguishes bronchiolitis from pneumonia);
• dry non-productive cough, sputum difficult to separate in small quantities;
• respiratory distress, shortness of breath, shallow, whistling inhalation;
• when listening, pronounced moist rales are noted;
• dry mouth and rare trips to the toilet due to dehydration;
• A clinical blood test shows a slight increase in leukocytes and ESR.

Respiratory failure is the main symptom of bronchiolitis. In severe forms of the disease, breathing becomes more frequent and can exceed 70-80 breaths per minute. At this stage, breathing may stop. Qualified help the child needs it immediately!

The clinical manifestations of bronchiolitis are similar to pneumonia with obstruction syndrome and bronchitis with an asthmatic component. Therefore, do not interfere with the work of doctors, but if possible, consult other specialists. This will help avoid confusion with the diagnosis.

Characteristic symptoms of bronchiolitis obliterans

Bronchiolitis obliterans is chronic form a disease that develops against the background of an acute inflammatory process. At this stage, partial blockage occurs and, as a consequence, narrowing of the lumen of the bronchioles. This condition interferes with normal blood flow in the lungs and bronchi, causing the development of respiratory and heart failure.

Bronchiolitis obliterans in children is manifested by the following symptoms:

• frequent bouts of dry skin nonproductive cough, sputum is separated heavily and in small quantities;
• trouble breathing after any physical activity, as it progresses, shortness of breath begins to bother you even at rest;
• The baby is breathing with a whistling sound, and moist wheezing is clearly audible.

Treatment of acute bronchiolitis

Acute bronchiolitis takes a long time to treat, sometimes to completely stop the inflammatory process and accompanying symptoms respiratory failure may take several months. The treatment regimen is based on normalizing the baby’s breathing, eliminating the cause of the disease and ensuring the discharge of viscous secretions from the bronchi. The following drugs are used for this purpose:

1. Antiviral medicines. The advisability of using interferon and other similar drugs is determined by the doctor. But with a viral etiology of the disease, you cannot do without them.
2. Antibacterial drugs. Antibiotics are prescribed when secondary bacterial infection. If you suspect bacterial nature bronchiolitis, culture for microflora is carried out immediately after admission to medical institution. Most often, drugs are preferred wide range actions.
3. Mucolytic and expectorant agents. These are drugs for symptomatic treatment, diluting sputum and facilitating the process of its removal. Antitussives are not used in pediatrics. And their use in this situation is unjustified, since this can aggravate the inflammatory process.
4. Antihistamines. IN in this case Allergy medications help relieve swelling from tissues and make breathing easier. It is also advisable to prescribe them as part of antibacterial therapy to prevent the development adverse reactions. Preference is given to the latest generation drugs that have a minimum side effects.

In severe cases, Dexamethasone injections may be prescribed. The use of glucocorticosteroids is also effective in the form of solutions for inhalation. Due to the large number of side effects, their administration is possible only in hospital treatment.

At home, before the doctors arrive, it is forbidden to give the child any medications, perform warming physiotherapy procedures, and steam inhalations, since all this can provoke laryngospasm. Parents are required to provide comfortable environmental conditions (temperature 20-22 0 and air humidity 50-70%) and plenty of fluids to prevent dehydration.

Treatment of bronchiolitis obliterans

Chronic bronchiolitis in infants is treated according to a similar scheme:

1. For frequent attacks of shortness of breath, bronchodilators may be prescribed in accordance with the age-specific dosage. Drugs in this category should be taken with caution, so only the attending physician should select the appropriate drug.
2. To ensure liquefaction of viscous secretions, mucolytics are prescribed. When the sputum begins to disappear, mucolytic syrups are replaced with expectorants.
3. If a bacterial infection is confirmed, antibiotics are prescribed. It is recommended to combine a course of antibacterial therapy with taking lactobacilli to normalize the intestinal microflora.

As adjuvant therapy in the treatment of bronchiolitis obliterans, massage courses, breathing exercises, and exercise therapy are recommended and various physiotherapeutic procedures.

Forecasts

Both forms of the disease are treatable. There are risks of developing serious complications and even death, but with timely access to a medical institution severe consequences manages to avoid .

After complete recovery and discharge from the hospital, parents should closely monitor the baby’s health, ensuring comfortable living conditions. They may still be observed for some time residual effects (wheezing, shortness of breath). The condition of the respiratory system completely stabilizes after a few months.

Note! Infants who have previously been diagnosed with acute bronchiolitis should be registered with a pulmonologist. Since the likelihood of repeated damage to the bronchi remains over the next five years, such children are at risk of developing bronchitis and bronchial asthma.

Bronchiolitis in children is one of many diseases that affect the respiratory system and are viral in nature. This is an insidious disease that must be treated to the end in order to avoid serious complications.

What is bronchiolitis

Bronchiolitis - inflammation of the small bronchi

Bronchiolitis is an inflammatory process in the lower respiratory tract, affecting the small bronchi and accompanied by signs of bronchial obstruction (obstruction). Another name for bronchiolitis is capillary bronchitis. It is one of the most serious diseases of the respiratory system of young children.

The difference between bronchiolitis and bronchitis is that bronchitis affects large and medium-sized bronchi, and it is characterized by a slower development. With bronchiolitis, bronchioles are affected - small bronchi, terminal branches bronchial tree. Their function is to distribute air flow and control resistance to this flow. Bronchioles pass into the alveoli of the lungs, through which the blood is saturated with oxygen, so when they become obstructed (blocked), oxygen starvation and shortness of breath develops.

Children most often suffer from bronchiolitis infancy. The maximum incidence rate occurs between 2 and 6 months of age. The reason lies in the fragile immune system of children. If a virus enters their respiratory system, it quickly penetrates quite deeply.

In 90% of cases, bronchiolitis develops as a complication of an acute respiratory viral infection or influenza. Boys get sick more often than girls (they account for 60–70% of cases of the disease).

Causes of the disease

Bronchiolitis is caused viral infection. In children under one year of age, in 70–80% of cases, the cause of the disease is RSV - respiratory syncytial virus. Other viral agents include:

• adenoviruses;
• rhinoviruses;
• influenza and parainfluenza virus type III;
• enterovirus;
• coronavirus.

They account for approximately 15% of cases of acute bronchiolitis among infants.

In children aged 2–3 years, RSV gives way to enterovirus, rhinovirus, and adenoviruses. various types . In preschool and school age Among the causative agents of bronchiolitis, rhinovirus and mycoplasma predominate, and RSV usually causes bronchitis or pneumonia. In addition to typical viruses, the development of bronchiolitis can be triggered by:

• cytomegalovirus;
• chlamydial infection;
• herpes simplex virus;
• measles;
• chickenpox;
• mumps virus (mumps).

In 10–30% of bronchiolitis, more than one virus is detected, in most cases it is a combination of RSV with rhinovirus or human metapneumovirus. However, the question of whether combined infection affects the severity of the disease remains open at present.

Among adolescents, the reasons for the development of bronchiolitis can be immunodeficiency states, organ and stem cell transplantation. How younger child, the more severe and with a higher risk to life the disease progresses - bronchiolitis is especially dangerous for newborns and infants.

Factors that provoke the occurrence of bronchiolitis:

• the child’s tendency to allergic reactions - to household allergens, cold or polluted chemicals air, cow's milk, etc., also diathesis, skin atopy;
• paratrophy - overweight of a child as a result of an unbalanced diet, in which dairy and flour products predominate, and there is a deficiency of vitamins;
• artificial feeding from birth;
• congenital immunodeficiency;
• prematurity;
• concomitant diseases of the lungs or heart;
• perinatal encephalopathy – congenital brain damage;
• enlargement of the thymus (thymus gland);
• poor living conditions: damp, cold, dirt, poor household hygiene;
• parental smoking;
• the presence of older brothers and sisters attending school or preschool institutions - they can become carriers of infection.

Types of bronchiolitis

Depending on the pathogen, the following types of bronchiolitis are distinguished:

• Post-infectious. Caused by viruses. It is post-infectious bronchiolitis that mainly affects young children. It often develops as a complication of a previous acute respiratory infection or acute respiratory viral infection.
• Drug. It develops against the background of the use of certain medications: cephalosporins, Interferon, Bleomycin, Penicillamine, Amiodarone, as well as gold-containing drugs.
• Inhalation. Occurs as a result of inhalation of polluted air, harmful gases (nitrogen oxide, carbon dioxide, vapors of acid compounds), various types dust, tobacco smoke.
• Idiopathic. Bronchiolitis of unknown origin, which can be combined with other diseases (pulmonary fibrosis, aspiration pneumonia, collagenosis, ulcerative colitis, lymphoma, radiation sickness), and be an independent disease.
• Obliterative. Caused by Pneumocystis virus, herpes virus, cytomegalovirus, HIV infection, Legionella, Klebsiella, Aspergillus (fungal infection).

There are also two forms of bronchiolitis: acute and chronic.

Acute (exudative) bronchiolitis occurs against the background of a viral, bacterial, fungal infection and is characterized by rapid development. Clinical symptoms appear on the first day after infection and increase rapidly. The disease can last up to 5 months and ends with either recovery or transition to a chronic form.

Chronic (sclerotic) bronchiolitis characterized by qualitative changes in the bronchioles and lungs. The epithelium of bronchioles is damaged, fibrous and connective tissue, which leads to a gradual narrowing of the lumen of the bronchioles until they are completely blocked.

Symptoms

The main symptoms of acute bronchiolitis in children include:

• decreased appetite – the child eats less or refuses food altogether;
• pallor and bluish tint of the skin;
• nervous overexcitation, restless sleep;
• increased body temperature, but to a lesser extent than with pneumonia;
• runny or stuffy nose;
• signs of dehydration due to intoxication: dry mouth, rare urination, crying without tears, sunken fontanel;
• periodic bouts of coughing, possibly a small amount of sputum;
• difficulty breathing, with wheezing and groaning: flaring of the wings of the nose, retraction of the chest, severe shortness of breath, participation of auxiliary muscles in the respiratory process;
• apnea (stopping breathing), especially in children with birth injuries and premature babies, cases of sleep apnea are possible;
• tachypnea – rapid shallow breathing without rhythm disturbance;
• tachycardia - rapid heartbeat;
• protrusion of the liver and spleen from under the ribs due to flattening of the dome of the diaphragm.

The onset of acute bronchiolitis is similar to ARVI: a runny nose, sneezing, sore throat appears, the temperature rises to 37–38°C, the child becomes restless, capricious, sleeps poorly, and refuses to eat. On days 2–3, cough, wheezing, and shortness of breath appear. Wheezing can be heard even at a distance, without listening with a phonendoscope. The child's general condition is steadily deteriorating, with lethargy, irritability, and increased sweating.

As the disease develops, swelling of the mucous membrane, scaly exfoliation and papillary proliferation of the epithelium occur. In the lumen of the small bronchi and bronchioles, mucus accumulates, which, together with the desquamated epithelium, forms “plugs” inside the bronchi. As a result of this, resistance air flow, as well as the volume of air during inhalation and exhalation almost doubles. This leads to impaired ventilation of the lungs and shortness of breath. Thus, if in obstructive bronchitis the obstruction of the airways is caused by bronchospasm, then in acute bronchiolitis it is a consequence of swelling of the walls of the bronchioles and accumulation of mucus in their lumen.

Symptoms of bronchiolitis in children

Due to increased breathing, normal pulmonary ventilation is maintained for some time, but gradually respiratory failure increases, hypoxia and hypercapnia (lack of oxygen and excess carbon dioxide in the blood and tissues), spasms of the pulmonary vessels occur. As a compensatory reaction, emphysema develops - swelling of areas of the lungs.

At favorable course acute bronchiolitis after 3–4 days pathological changes begin to gradually disappear, but bronchial obstruction persists for 2–3 weeks.

In chronic bronchiolitis, the first place among the symptoms is occupied by slowly increasing shortness of breath, while the cough is dry, without sputum production.

Thus, main feature bronchiolitis is an acute respiratory failure, the consequences of which can be suffocation and death. Therefore, a child with bronchiolitis should be provided with immediate and qualified medical care.

Diagnostics

Listening to the lungs with a phonendoscope is the initial stage of diagnosing bronchiolitis.

To diagnose the disease, a number of laboratory and instrumental studies are carried out:

• listening to the lungs with a phonendoscope;
• general blood and urine analysis;
• virological examination of a nasopharyngeal swab;
• blood gas analysis and pulse oximetry - a non-invasive method for determining the degree of oxygen saturation in the blood;
• X-rays of light;
• if necessary, computed tomography of the lungs.

From laboratory tests The most important test for the presence of RSV in a nasopharyngeal smear is carried out using the ELISA method ( linked immunosorbent assay) or PCR (polymerase chain reaction). Bronchoscopy data (examination of the mucous membrane of the bronchial tree) are not particularly important. When listening to the lungs, multiple moist wheezing rales are detected.

Scintigraphy and computed tomography of the lungs are considered valuable diagnostic methods. Spirometry (measurement of volume and velocity parameters of breathing) is not performed on young children due to the impossibility of performing it.

Of great importance is the determination of the gas composition of the blood, which reveals a decrease in the oxygen content in the blood. This situation usually persists for another month even after the condition improves. On x-rays There are signs of pulmonary emphysema, increased vascular pattern, thickening of the walls of the bronchi, flattening of the dome of the diaphragm. X-ray data for bronchiolitis can be different and sometimes do not correspond to the severity of the disease.

Acute bronchiolitis is differentiated from obstructive bronchitis, aspiration and bacterial pneumonia, whooping cough, cystic fibrosis, heart failure, bronchial asthma.

Treatment methods

If signs of acute bronchiolitis and severe breathing problems appear, the child must be immediately hospitalized in the intensive care unit. This is especially true for children under 6 months of age. Complex therapy includes such components as:

• oxygen therapy (saturation of blood with oxygen);
• the use of medications: antibiotics (to prevent secondary infection), antiviral (Interferon) and hormonal anti-inflammatory drugs, drugs to relieve bronchial edema (Berodual, Eufillin);
• control of body fluids and use of diuretics (diuretics).

All therapy is selected individually depending on the severity of the child’s condition, the presence concomitant diseases heart or lungs.

A pulse oximeter is connected to the child’s finger or earlobe to constantly monitor the blood gas composition. In case of severe oxygen deficiency, oxygen therapy is performed through a nasal catheter or an oxygen mask.

In the presence of heart defects, lungs, pancreas, immunodeficiency and premature babies, treatment with Ribaverin is used. It is also indicated for children with severe disease and high level carbon dioxide in tissues. It is mandatory to use it when carrying out artificial ventilation lungs.

In children with bronchiolitis, it is important to control fluid intake, because with this disease the production of antidiuretic hormone decreases, resulting in fluid retention in the body. Subsequently, the production of renin by the kidneys (a hormone that regulates the level of blood pressure), which leads to increased pressure, decreased urine volume, and decreased excretion of sodium in urine. The consequence of fluid retention is an increase in body weight and increased swelling of the bronchi.

The use of minimal doses of diuretics and some fluid restriction help alleviate the child’s condition. The use of inhaled corticosteroids is ineffective.

Typical mistakes of parents

It is important to remember that during treatment it is prohibited:

• leaving the child at home and passively waiting for improvement;
• self-medicate;
• give the child decoctions of medicinal herbs - this can cause increased shortness of breath;
• put mustard plasters on the child, rub him various ointments and balms, especially with irritating components (Star, etc.).

In addition, preventive and routine vaccinations cannot be carried out within six months after recovery, as the child’s immunity remains weakened.

Possible complications

Serious complications of bronchiolitis, as already mentioned, are respiratory and heart failure. Bronchiolitis is especially severe in premature infants, as well as in children with impaired immunity.

When a secondary bacterial infection occurs, pneumonia can develop. Another possible complication is bronchial asthma, although a clear connection between bronchiolitis and bronchial asthma has not been established to date.

Even after complete treatment of bronchiolitis in children, respiratory dysfunction and increased sensitivity bronchi to the influence of negative external factors and infection. For any cold or flu there is high risk formation of bronchial obstruction syndrome.

Children who have had bronchiolitis are prone to recurrent illnesses. Therefore, after recovery, it is necessary to be observed by a pediatrician, pulmonologist and allergist.

Prevention measures

• timely treatment of respiratory diseases;
• strengthening the immune system, hardening;
• rational balanced diet, for infants - mother's milk;
• exclusion of contact with other sick children;
• maintaining cleanliness in the house;
• allergy prevention;
• smoking cessation by those in the child’s immediate environment.

Bronchiolitis is a serious illness in young children and requires careful and adequate treatment. Timely diagnosis and early therapy will help reduce the risk of complications and avoid the disease becoming chronic.