Diseases in which breathing is impaired are the most common in pediatric practice. The leading symptom of such diseases is cough. A pronounced narrowing in the bronchi can lead to it.
What it is?
With obstructive bronchitis, severe narrowing of the bronchi occurs - obstruction. This condition is caused by numerous causes and provoking factors. As a result of obstruction, breathing is impaired. A few days after the onset of the disease, all symptoms begin to progress, which leads to a deterioration in the baby’s condition.
The bronchial tree is covered with microscopic cilia. They are found on the surface of the cells that form the bronchi. After exposure to provoking factors, the movements of the cilia are disrupted, which also contributes to impaired sputum discharge and increases obstruction.
Causes
Any bronchitis develops only after exposure to various provoking factors on the child’s body. There are quite a large number of them. They are especially dangerous for newborns and infants.
The immunity of children of the first year has not yet fully formed. Any agent foreign to the child’s body can cause severe inflammation in the bronchi. This immediately leads to bronchial obstruction.
Reasons that can cause the disease include:
Viral infections. The most common culprits of the disease: influenza and parainfluenza viruses, MS virus, adenoviruses. They easily penetrate the baby's upper respiratory tract and quickly spread through the bloodstream, reaching the bronchi and lungs. Viral infections are the leading cause of bronchial obstruction in babies in the first months of life.
Bacteria. Streptococci, staphylococci and moraxella are the most common causes that can cause bacterial forms of the disease. These microorganisms contribute to the development of severe inflammation, which leads to a pronounced narrowing of the lumen of the bronchi. The disease caused by bacterial flora has a more severe course and requires intensive care.
Allergies. When an allergen enters the body, the immune system is activated. This contributes to a large release of various biologically active substances into the blood, which strongly spasm the bronchi. Against the background of allergies, breathing is significantly impaired and shortness of breath increases.
Inhalation of polluted air. Living next to major industrial enterprises or factories, the baby has more high risk bronchial obstruction. This occurs as a result of the constant entry of tiny toxic substances into the small bronchi. Industrial emissions quickly lead to the development of breathing problems.
Prematurity. In the third trimester of pregnancy, the final formation of the respiratory organs of the unborn baby occurs. This process occurs almost until the days of birth. If for some reason the child is born earlier, then the risk of underdevelopment of the respiratory organs increases several times. Such an anatomical defect often leads to impaired respiratory function.
Quick cessation of breastfeeding. Children who have been breastfed for a very short time have a higher risk of developing bronchitis. To fight various infections you need a good level of immunity. During breastfeeding, babies receive large amounts of immunoglobulin G. These protective antibodies help them not to get sick during seasonal colds and protect them from the development of diseases of the bronchopulmonary system.
How does it arise?
The influencing provoking factor leads to the development of severe inflammation. Most viruses and bacteria enter the body through the upper respiratory tract. Settling on the epithelial cells lining the respiratory organs, they begin to have a strong toxic effect.
The incubation period varies and depends on the characteristics of the specific microorganism that causes the disease. On average, it is 7-10 days. At this time, the child does not make any complaints. There are no specific signs of the disease during the incubation period. Only weakened children may feel a little tired and drowsy.
After the end of the incubation period, the first specific symptoms characteristic of of this disease. An active inflammatory process occurring in the bronchial tree contributes to disruption of the discharge of mucus and sputum.
Babies who have anatomical defects in the structure of the bronchi have a very narrow lumen of the bronchi. Bronchial obstruction in such children develops much more often and is much more severe.
Kinds
The course of diseases accompanied by bronchial obstruction may be different. This depends on the initial state of the baby’s immunity, the features of the anatomical structure of the respiratory system, as well as the cause that caused the disease.
According to the frequency of occurrence, all obstructive bronchitis can be divided:
Spicy. These variants of the disease are appearing for the first time. They last, on average, 1-2 weeks. After the therapy, the baby is completely cured.
Chronic. May be recurrent. They occur with periods of exacerbations and remissions. If the treatment is not of sufficient quality or the baby has concomitant diseases acute forms become chronic.
By severity:
Lungs. Occurs with minimally expressed symptoms. They are treated well. After the therapy, the babies fully recover. There are no long-term consequences of the disease.
Average. The cough is more severe, annoying. Body temperature with moderately severe obstructive bronchitis rises to 38 degrees. Shortness of breath may increase. The child's general condition suffers greatly. In some cases, hospitalization and more intensive therapy are required.
Heavy. They occur with a pronounced disturbance in the general condition and well-being of the baby. Body temperature rises to 38.5-39.5 degrees, severe shortness of breath, accompanied by signs respiratory failure. Treatment is carried out only in a children's hospital, and if cardiopulmonary failure develops, in the intensive care unit.
Symptoms
Narrowing of the bronchial lumen and impaired sputum discharge lead to the child developing specific signs of the disease:
Cough. Appears 2-3 days after the end of the incubation period. A hacking cough bothers the baby more during the daytime. May be paroxysmal.
Dyspnea. Occurs in moderate to severe disease. With shortness of breath the amount increases breathing movements in one minute. Babies breathe more often. This symptom can be seen from the outside, paying attention to movements chest while breathing.
Pain in the chest when coughing up. With bronchial obstruction, the sputum becomes very dense and thick. All attempts at coughing lead to increased pain in the chest area.
Increased body temperature. It increases to 37-39.5 degrees. Bacterial forms of the disease are accompanied by a higher temperature.
Blue discoloration of the nasolabial triangle. The skin in this area of the face is very thin and sensitive. A pronounced decrease in the level of oxygen in the blood leads to the development of acrocyanosis (blue discoloration) of this area. Against the background of a pale face, the nasolabial triangle contrasts strongly.
Poor nasal breathing and redness of the pharynx. These secondary signs occur with viral and bacterial infections and often appear in a child with obstructive bronchitis.
Severe drowsiness and poor health. Sick children refuse to eat and begin to act up. Little children are more willing to be held. Prolonged coughing attacks lead to the baby starting to cry.
Thirst. It appears during severe intoxication of the body. The more severe the disease, the more pronounced it becomes this symptom at the baby's.
Active movements of the ribs during breathing. Breathing movements have a large amplitude and become visible from the side.
Loud breathing. During breathing movements, bubbling sounds are heard. They arise as a result of the passage of air through tightly closed bronchi.
Diagnostics
At the first appearance of signs of bronchial obstruction, the child should be shown to a pediatrician. The doctor will conduct a clinical examination and recommend additional examinations. Such tests are needed to determine the severity and cause of the disease.
To diagnose obstructive bronchitis, use:
General blood analysis. An increase in the number of leukocytes and an accelerated ESR indicate the presence of inflammatory process. Changes and shifts in the leukocyte formula make it possible to clarify the viral or bacterial nature diseases.
Biochemistry of blood. Allows you to identify the presence of complications that develop with respiratory pathology. Also used for differential diagnosis.
X-ray of the chest organs. This method is used in children older than one year. This study allows us to determine the degree of narrowing of the bronchi, as well as to identify concomitant diseases lungs.
Spirometry. Helps evaluate functional disorders. Indications of forced inhalation and exhalation allow doctors to draw a conclusion about the presence and severity of bronchial obstruction.
Specific laboratory tests to identify allergens. Necessary to establish the cause of bronchial obstruction in children with an allergic form of the disease.
Differential diagnosis
Narrowing of the lumen of the bronchi occurs not only with obstructive bronchitis. Bronchial obstruction syndrome can occur in various diseases. In order to correctly establish a diagnosis, differential diagnosis is required.
Most often obstructive bronchitis may be confused with:
Stenosing laryngotracheitis. Most often caused by viruses. It usually occurs 3-4 days after the onset of a viral infection. Characterized by the appearance of a barking cough and severe shortness of breath.
Obliterating alveolitis. With this disease, the inner epithelial layer of the bronchi grows, which leads to the appearance and accumulation of foamy sputum. Usually the cough is paroxysmal. Often the disease leads to various complications.
Acute bronchitis. The symptoms are similar. Only spirometry can accurately establish the correct diagnosis.
Cystic fibrosis. This disease is congenital. Typically, children develop poorly and lag behind their peers in physical development. During an exacerbation appears coughing with difficult to clear and very viscous sputum. The course of the disease is quite severe. The disease requires systemic treatment.
Consequences and complications
Frequent obstructive bronchitis can lead to the development of persistent breathing problems in children. With reduced immunity, the baby experiences new exacerbations over a relatively short period of time.
Poorly performed treatment or untimely diagnosis of the disease contribute to the development of complications in the future. Persistent bronchial obstruction can lead to the development of bronchial asthma, especially if the cause of the narrowing of the lumen of the bronchi is an allergy.
Prolonged and persistent cough contributes to the formation of bronchiectasis. With this pathology, the distal sections of the bronchi expand with the formation additional cavities. Bronchiectasis contributes to the appearance of shortness of breath with increasing respiratory failure. Surgery is performed to eliminate this condition.
During an exacerbation of obstructive bronchitis caused by bacterial infection, the inflammatory process may spread to the lungs.
In this case, pneumonia or abscesses appear. They, in turn, lead to a deterioration in the baby’s well-being. Intensive antibiotic therapy is required to eliminate purulent formations.
Treatment
To eliminate the unfavorable symptoms of the disease, various methods of therapy are used. After examining the child and establishing a diagnosis, the pediatrician will recommend a specific treatment regimen, which is provided for in the clinical guidelines. These medical developments contain the necessary algorithm for doctors’ actions when identifying a specific pathology.
Obstructive bronchitis should be treated from the first days after the onset of symptoms. Early prescription of medications helps to cope with all the adverse manifestations of the disease and prevent chronicity. Medicines that eliminate bronchial obstruction and promote better mucus discharge are prescribed by the attending physician.
For the treatment of obstructive bronchitis use:
- Agents with mucolytic effects. They help thin thick mucus and facilitate its easier passage through the bronchopulmonary tree. Preparations based on ambroxol are widely used in pediatric practice. "Ambrobene", "Lazolvan", "Flavamed" help eliminate even a severe cough. Prescribed according to age, 2-3 times a day for 7-10 days.
- Antipyretic. Prescribed when the temperature rises above 38 degrees. In children, various paracetamol-based products are used. Not prescribed for long-term use. May cause allergic reactions and side effects.
- Bronchodilators. P Designed to eliminate blockage in the bronchi and improve breathing. They are usually prescribed in the form of aerosols or inhalations. The effect is achieved in 10-15 minutes. Bronchodilators short acting based on salbutamol, they act within 5 minutes.
- Combined drugs containing bronchodilators and anticholinergic drugs. To improve bronchial conduction in children, “Berodual” is used. Prescribed by inhalation. The dosage and frequency of inhalations is carried out taking into account the age of the child. Usually the drug is prescribed 3-4 times a day.
- Antihistamines. Helps cope with adverse symptoms of allergic forms diseases. In children, drugs based on loratadine, Claritin, and Suprastin are used. Prescribed 1-2 times a day, usually in the first half of the day. Discharged for 7-10 days. For more severe cases - for 2-3 weeks.
- Vitamin complexes enriched with selenium. These substances are needed to combat intoxication. Biologically active ingredients, which are present in the vitamin complex, help the baby fight infection and improve the functioning of the immune system. Selenium is needed for the active functioning of the immune system.
- Glucocorticosteroids. Used for severe and long-term illness. Pulmicort inhalations are usually prescribed. The drug is prescribed for long-term use. Apply 1-2 times a day until a lasting good result is achieved. May cause side effects with long-term use.
- Leukotriene receptor blockers. Helps quickly eliminate bronchospasm. They have a lasting effect. The drug "Singulair" begins to have an effect within 2 hours after administration. Apply once a day.
Treatment at home
You can help your child cope with the disease not only with the help of medicines and pills. The use of medicines prepared at home also helps to eliminate a persistent cough and improve the child’s well-being.
To methods that are safe and effective for self-use, include:
Warm, plenty of drink. Alkaline mineral waters heated to a temperature of 40-45 degrees are perfect. They are prescribed 20 minutes before or an hour after meals, 3-4 times a day. The course of treatment is 7-10 days. You can use “Essentuki” or “Borjomi”.
Liquorice root. This wonderful remedy improves mucus discharge and promotes better expectoration. It should be used with caution, keeping in mind possible allergic reactions. Works great even with a strong cough.
Breast fees. The composition of such pharmaceutical preparations includes several medicinal plants that have expectorant and anti-inflammatory effects. Licorice, coltsfoot, and sage help relieve coughs and improve bronchial conduction.
Radish juice. To prepare this home medicine An ordinary black radish will do. To prepare 250 ml of drink, you only need 1 teaspoon of juice. Before use, add honey to taste.
Breathing exercises
It is used after the acute process has subsided. Typically, such gymnastics is carried out 5-6 days after the onset of the disease. The correct sequence of breathing movements helps normalize the functioning of the respiratory system and cope with adverse symptoms.
In order to improve the outflow of mucus, when performing breathing exercises, a sharp and short breath is taken. Exhale – quite slow and smooth. While exhaling, you should count to 5. Each set of exercises consists of 3-4 repetitions. It is recommended to practice every day. Even during remission, breathing exercises will be very useful.
See the video below for more details on how to do breathing exercises.
Nutrition
The diet of a baby suffering from bronchial obstruction must be complete and contain all the necessary nutrients and vitamins.
Breastfeeding should not be canceled during the acute period of illness. Together with mother's milk, the baby receives all the necessary protective antibodies that help him fight the infection that causes bronchitis.
Older children should eat small meals, at least 5-6 times a day. A child's diet should include a variety of protein foods. It is better that your baby receives some source of protein with each meal. Veal, rabbit, chicken or fish are perfect.
Try to choose leaner varieties. Fatty foods take longer to be absorbed by a weakened child's body. You can supplement proteins with cereals and vegetables. Fresh ones also work well as protein dishes. dairy products. They make a great afternoon snack or second dinner.
All dishes are best steamed, baked or stewed. They should have a more liquid consistency. For babies younger age Fruit and vegetable purees are perfect. It is not necessary to give your child foods from jars. Homemade cauliflower or potato purees are a good choice.
The baby must drink enough liquid. As drinks you can use compotes, various fruit drinks and juices made from fruits and berries. Frozen fruits are also suitable for cooking useful decoctions. Try to give your child more boiled water. This will help eliminate the adverse symptoms of intoxication.
Prevention
To prevent your baby from getting obstructive bronchitis, use the following recommendations:
Visit the dentist regularly with your child. Often the presence of carious and untreated teeth leads to the development of various infectious pathologies. Make sure your child brushes his teeth regularly.
Avoid catching colds. Any frequent respiratory diseases, which mainly occur during the cold season, lead to disruption of the respiratory system and reduce immunity. The risk of bronchial obstruction in frequently ill children increases several times.
Strengthen your immune system. Active walks in the fresh air, good nutrition and a proper daily routine contribute to the normal functioning of the immune system.
Treat inflammatory diseases of the upper respiratory tract. Children suffering from chronic otitis media or sinusitis are more likely to develop obstructive bronchitis in the future. To prevent this, regularly visit an otolaryngologist with your child.
Use special room humidifiers. Too dry air contributes to breathing problems. Room humidifiers help create a comfortable and physiologically favorable microclimate in any room.
After the complex of treatment, the children feel much better. Their breathing normalizes and shortness of breath goes away. With properly selected therapy, the transition from acute to chronic does not occur. Compliance with preventive recommendations helps prevent the occurrence of new exacerbations in the future.
Dr. Komarovsky will tell you more about obstructive bronchitis in the video below.
Obstructive bronchitis in children is primarily an inflammation of the bronchial tree. In the structure of the general morbidity of the child population, pathology of the bronchopulmonary system occupies first place. The most common are respiratory viral infections. Bronchitis is in second place in terms of occurrence.
They can be both complications of ARVI and independent diseases that occur primarily. The most dangerous is obstructive bronchitis, which in severe cases can lead to delay general development child.
Obstructive syndrome is manifested by swelling of the mucous membrane, which significantly complicates breathing. Added to the edema is the increased viscosity of the secretion produced, which may contain purulent clots, as well as bronchospasms.
Important. Children who are often diagnosed with bronchitis (both acute and obstructive) may eventually develop chronic bronchopulmonary pathology such as chronic bronchitis, or.
Bronchitis is an inflammatory disease of the bronchial mucosa. In this case, almost the entire bronchial tree is affected, which leads to severe clinical manifestations.
For reference. Three types of bronchitis are typical for children: simple and bronchiolitis. The first is characterized by catarrhal inflammation of the bronchi, the latter by inflammation of the smallest branches of the bronchial tree, characteristic of children of the first year of life.
Obstructive bronchitis occurs in children of any age. The main feature of its pathogenesis is obstruction - blocking the lumen of the bronchial tree. In this case, air easily enters the lungs, but it is difficult to leave them. It becomes difficult for the child to breathe.
Bronchitis is most often a consequence respiratory infection. In this case, they are a complication of the underlying disease. In children, obstructive bronchitis occurs more often than in adults. This is due to the structural features of the bronchial tree. They are as follows:
- Short but wide bronchi, which are easier for infections to get into;
- Small branching of the bronchial tree, as a result of which the infectious agent spreads more easily to all its parts;
- Failure of the mucociliary apparatus, the main task of which is to remove infection;
- Delicate mucous membrane, which is easily damaged under the influence of adverse factors;
- Failure of the immune system, its low differentiation - immune cells Children do not yet know how to fight different types of infections, which is why children get sick more often than adults.
Simple bronchitis in a child is a common occurrence. Obstructive bronchitis in children occurs much less frequently, but more often leads to complications and has a severe course.
For reference. Obstruction is dangerous pathology which leads to respiratory failure. As a result, all cells and tissues of the child’s body begin to experience oxygen starvation.
Causes of obstructive bronchitis in children
The cause of obstructive bronchitis can be a viral or bacterial infection that first affects the upper respiratory tract.
The predominant viruses are:
- Respiratory syncytial. It is often the cause of viral bronchitis, and in children of the first year of life it can also cause bronchiolitis.
- Adenovirus. Causes inflammation of lymphoid tissue in different organs from the eyes and nose to the intestines. This is the most common etiological factor childhood cold.
- Parainfluenza virus. It is characterized by laryngitis with laryngeal stenosis, but sometimes the virus spreads further into the underlying parts of the respiratory tube and causes bronchitis.
- The causative agent of influenza. Tropen to the mucous membrane of the trachea, but sometimes spreads further and enters the bronchi, causing inflammation there.
- Enterovirus. It has many forms and appears as various diseases. Acute obstructive bronchitis in children can be a consequence of the so-called “Minor illness” (otherwise known as enteroviral fever, three-day fever, summer flu).
For reference. All of these pathogens are classified as respiratory viruses. Each of them is targeted to its own section of the respiratory tract. Obstructive bronchitis in this case is a complication of ARVI.
Bacteria are less selective. Bronchitis can be caused by any bacterial flora. In this case, we are usually talking about purulent-obstructive bronchitis. Less commonly, the cause of this pathology is mycoplasma and chlamydia.
The bronchi have sufficient protection to resist the infectious agent. The threat of disease development arises if the barrier function of the respiratory tract is impaired.
This happens in the following cases:
- General hypothermia. Cold air enters the bronchi and reduces their protection, facilitating the penetration of infection.
- Hypovitaminosis. Some vitamins are essential for maintaining the immune system. Vitamin C and E are especially important. With their deficiency, frequent colds with complications are observed.
- Passive smoking. Many children are exposed to tobacco smoke, which damages the bronchial epithelium.
- Immunodeficiency states. Immune deficiency can be congenital, for example, hypogammaglobulinemia, or acquired, for example, in acute leukemia.
Pathogenesis of obstructive bronchitis in children
The mechanism of bronchial obstruction consists of three pathogenetic links:
- Edema;
- Increased secretion viscosity;
- Bronchospasm.
All three components lead to obstruction, exacerbating each other's effects. They arise as a result of developing inflammation.
An infectious agent that can cause bronchitis enters the bronchial tree. Due to the fact that the bronchial mucosa is damaged by one of the unfavorable factors, for example, tobacco smoke or cold air, a virus or bacteria easily penetrates the epithelium.
Normally, epithelial cells tightly adjacent to each other prevent this penetration, but when exposed to unfavorable factors, the barrier is broken, which contributes to the development of bronchitis.
Immune cells rush to meet the infectious agent. The latter produce inflammatory mediators that promote blood stasis and the release of plasma into the interstitial space. This is how swelling occurs.
In addition, the function of the bronchial mucosa is impaired. Normally, it produces a mucous secretion and promotes its elimination.
For reference. During inflammation, the liquid part of the secretion remains in the interstitium, and viscous exudate enters the lumen of the bronchi. It acts like a cork, closing the lumen of the bronchial tree and preventing the passage of air flow.
The main component of the pathogenesis of obstructive bronchitis in children is bronchospasm. It occurs due to the action of mediators like acetylcholine.
Cholinergic receptors are responsible for the contraction of bronchial smooth muscle. When they are activated, the muscles of the bronchial tree become toned and the lumen of the respiratory tract decreases. It becomes difficult for the child to breathe.
For reference. The effect of the three components is summed up, resulting in symptoms of obstructive bronchitis.
Why is obstructive bronchitis dangerous in children?
Obstructive bronchitis in children is more severe than in adults. This is due to the structural features of the bronchial tree.
Attention. Children are more likely to experience complications. The most dangerous of these is pneumonia. A virus or bacteria in a weakened body easily penetrates from the bronchi into the alveoli of the lungs, where inflammation occurs.
Children suffer from pneumonia very seriously with high fever and frequent complications such as:
- septic conditions,
- pleurisy,
- meningitis,
- myocarditis.
In children, the immune system is still imperfect, so the infectious agent often penetrates the blood and spreads throughout the body.
In addition, obstructive bronchitis in children is dangerous because adequate ventilation of the lungs is disrupted. It is difficult for the child to breathe, less air enters the lungs, and a larger volume remains inside the alveoli.
Attention! In this case, the body experiences hypoxic hypoxia - a state of oxygen deficiency associated with lung pathology. All organs and tissues suffer from hypoxia, but most of all the brain.
Nerve cells begin to experience oxygen starvation. The child becomes either too excited or, on the contrary, lethargic and apathetic. With prolonged obstructive bronchitis or its frequent relapses, the child may begin to lag behind in psychomotor development. This is especially dangerous in the first years of life, when babies are actively developing and growing.
Symptoms of obstructive bronchitis in children
The clinical picture of the disease is dominated by two syndromes: general infectious and respiratory. The first is typical for any 
pathology caused by bacteria or viruses.
This symptom complex includes:
- Increased body temperature. More typical for bacterial bronchitis than for viral bronchitis. With viral bronchitis, the temperature can rise to 37-38°C, with bacterial bronchitis – up to 39°C and higher.
- Weakness, fatigue, decreased cognitive function. These symptoms are typical for school-age children. Children often suffer from illness on their feet; they remain active for a long time, sometimes even overexcited. It is difficult to judge the severity of his illness based on a child’s activity.
Respiratory syndrome is directly related to obstruction of the bronchial tree and manifests itself the following symptoms:
- Cough. At the beginning of the disease, it can be dry, then productive with liquid sputum, after which it becomes characteristic of this type of bronchitis - irritated with a small amount of viscous, thick sputum. The nature of the latter depends on the infectious agent. In case of a viral disease, the sputum is mucous and transparent; with bacterial – purulent, yellow-green.
- Wheezing. Dry wheezing with obstruction can be heard even at a distance.
- Dyspnea. It is a characteristic symptom of obstruction. The frequency of respiratory movements increases, each exhalation is difficult for the child. When exercising, screaming, crying or laughing, shortness of breath increases. Children, unlike adults, cannot say what is more difficult for them to do - inhale or exhale. Therefore, the nature of shortness of breath is difficult to establish.
- Respiratory failure. In children it occurs very quickly after the onset of obstruction. The child's fingertips and nasolabial triangle become blue. In severe cases, the child's entire body may take on a bluish tint.
Diagnosis of obstructive bronchitis in children
If obstructive bronchitis is suspected in a child, the following diagnostic methods are used: 
- Physical methods. Includes percussion and auscultation. Percussion is rarely used, since it is not very informative for bronchitis, but it allows you to distinguish it from pneumonia. On auscultation, dry rales of various sizes are heard over the entire surface of the lungs.
- General blood analysis. With bronchitis of viral etiology, leukocytosis with lymphocytosis and accelerated ESR or leukopenia are observed. If the etiology of bronchitis is bacterial, then the content of neutrophilic leukocytes in the blood is increased and the ESR is accelerated.
- Sputum analysis. Allows you to identify the etiology of the pathogen. Viruses are difficult to detect in sputum, but bacteria can be detected.
- Oximetry. Using a special device that fits on your finger like a clothespin, you can measure the oxygen saturation of the blood. Oximetry can detect respiratory failure, in which the concentration of oxygen in the blood is reduced.
- X-ray of the chest organs. Bronchitis is not visible on an x-ray. This study allows us to exclude pneumonia, in which local shadows are visible in the lungs.
- Spirometry. Using this method, the function of external respiration is examined. At the same time, indicators characterizing the characteristics of exhalation (FEV and FEV/VC) will be reduced. The study is very informative, but it is rarely used because it requires special equipment.
Attention. Bronchoscopy, which is often used in adults for diseases of the bronchopulmonary system, is rarely used in children. This invasive method requires anesthesia if we are talking about a child. Bronchoscopy is used only in extremely severe cases.
Treatment of obstructive bronchitis in children
Therapy consists of prescribing several groups of drugs that can reduce obstruction of the bronchial tree. 
It is recommended to use combinations of such drugs that allow them to act on all stages of pathogenesis.
Treatment of obstructive bronchitis in children includes the administration of the following groups of drugs:
- Mucolytics (as prescribed by a doctor). In another way, these drugs are called expectorants. They break down the chemical bonds in the molecules that make up bronchial mucus, making it more viscous. Sticky mucus is easier to cough up. In this case, the lumen of the bronchial tree is cleared.
- Glucocorticoids. Powerful anti-inflammatory hormones that significantly reduce swelling. They are used in the form of inhalations.
- Beta-agonists. Norepinephrine and its analogues are able to expand the lumen of the bronchial tree, relaxing the muscles of the bronchi. These substances are also used in the form of inhalations.
- Anticholinergics. They can be used instead of adrenergic agonists. Anticholinergic blockers eliminate the effect of acetylcholine, which promotes contraction of bronchial smooth muscle. This way the muscles relax and the bronchi expand.
In addition, children are prescribed plenty of fluids in the form of warm tea, fruit drink, juice or compote. It is important to give as much vitamin C as possible: lemon, orange, apple, fresh herbs. Warm milk and cocoa have a beneficial effect on the bronchi. The latter contains essential oils that help reduce cough.
Attention! Traditional methods of treatment can only be used in combination with the main treatment and only after consulting a doctor.
If bronchitis has a bacterial etiology, antibiotics are prescribed. There is no need to be afraid of their use, since the complications of a bacterial infection are more dangerous than the side effects of these drugs. For children under two years of age, antibiotics are indicated even for viral bronchitis.
Forecast and prevention of obstructive bronchitis in children
The prognosis for obstructive bronchitis depends on how severe the child’s condition is. This pathology responds quite well to treatment. The prognosis is favorable if bronchitis is viral and respiratory failure is minimal.
For reference. In case of severe respiratory failure or the presence of complications, the prognosis is questionable.
Prevention of obstructive bronchitis is aimed at reducing the impact of adverse factors on the child’s body and strengthening the immune system. First of all, the child must be protected from tobacco smoke by eliminating passive smoking.
With any cold, regardless of its severity, continuing to lead an active lifestyle is unacceptable. The child must stay at home under adult supervision, bed rest is required, active games and walks should be excluded from his daily routine.
To strengthen the immune system, proper nutrition, rich in proteins and vitamins, is important. Children are less likely to get sick if they often walk outside and play sports. Swimming in the pool is especially good for strengthening the immune system, but this sport is not suitable for children who are often ill.
Children often suffer from bronchitis, which occurs as a result of complications after acute respiratory infections, colds or colds. Most often this happens in the autumn-winter season, characterized by sudden changes in weather and increased dampness due to rain. Obstructive bronchitis in children, the symptoms and treatment of which parents need to know, is an inflammatory process in the bronchi, leading to a narrowing of their lumens and interfering with the passage of air through them. It is considered the most common respiratory disease in children from one to 6 years of age.
Airway obstruction is a distinctive painful syndrome that occurs as a result of a disorder of bronchial permeability. The limited supply of air to the lungs leads to the development of the main symptom – shortness of breath. When symptoms last for more than 3 weeks, the disease passes from acute to chronic. The disease can be treated well at an early stage.
The difference between obstructive bronchitis and bronchial asthma is that the cause is not an allergy. The causative agents of the disease are most often various types viruses; less commonly, the disease is caused by chlamydia and mycoplasma. The insufficient development of the digestive system in children under three years of age, which often leads to the entry of food debris into the bronchi during the process of swallowing or regurgitation, leads to the appearance of infection in them, the consequence of which is the occurrence of obstruction in the form of shortness of breath.
Etiology of bronchitis formation
The main and most common cause of obstruction is considered to be infection of the baby with influenza or ARVI. Huge variety viral diseases and untimely therapy leads to a lot of consequences, including bronchitis. The frequency of complications after viral illnesses in children is explained by the specifics of their anatomy and physiology, as well as external factors:
- congestion in the bronchi and the layering of secondary infection due to immature epithelium and underdeveloped cilia that cannot cope with the removal of sputum;
- increased excitability of smooth muscles, producing strong spasms at the slightest irritation;
- underdevelopment of local immunity of the respiratory organs;
- the presence of an allergic reaction in the baby;
- the narrowness of the bronchi themselves;
- intrauterine pathologies and complicated childbirth;
- artificial nature of feeding during the first year of life;
- violation of weight standards up or down;
- vitamin deficiency;
- multiple viral infections in infancy;
- unfavorable climatic conditions in the area of residence;
- smoking or alcoholism of parents during pregnancy.
Even in the absence of smoke in the room where the baby is, the exhalation of carbon dioxide by adults mixed with the smell of tobacco makes the child a passive smoker. Children of parents who drank alcohol during pregnancy are more likely to suffer from obstructive bronchitis.
Symptoms of the disease
Clinical signs of bronchitis are quite characteristic. Initially, the child experiences general weakness, deterioration in health, refuses to eat, and later a cough develops (dry or with sputum), which gradually intensifies. Listening can detect wheezing. If a barking cough occurs, a completely different treatment is prescribed.
During the first days, the temperature may rise to 38 degrees, but a milder form with a temperature not exceeding 37-37.2 degrees is also possible. After a week, the dry cough becomes wet, the release of mucus improves the baby’s well-being, and this is considered an excellent signal that the disease is receding. The average duration of the disease is from one week to three.
The severity of the disease is determined by the age of the child, the instability of his immune system, and the presence of chronic or systemic ailments. Incorrect or inappropriate treatment of obstructive bronchitis in children can result in complications such as bronchiolitis or pneumonia. Sometimes healing from the flu brings an improvement in the child’s well-being, but later the health condition worsens again, the temperature rises again, and the cough intensifies. Such signs signal a weakening of the immune system in combat with the virus and infection with bacteria.
Allergic obstructive bronchitis
This type of disease is characterized by a non-temperature course. Its onset is caused by a reaction to a powerful allergen for the baby. Usually parents even guess what could have caused such a severe attack. Symptoms of obstruction begin in a child on the 3rd or 4th day of influenza or acute respiratory viral infection with the appearance of expiratory shortness of breath - an increase in the frequency of respiration and the addition of difficulty in inhaling.
The baby begins to breathe noisily, with a whistle, especially noticeable when exhaling. There is noticeable swelling of the chest. A dry, paroxysmal cough that begins unexpectedly, does not bring relief to the child, and intensifies at night. During listening, dry wheezing and whistling sounds are noted in the lungs. X-ray reveals increased transparency and, in the absence of infiltrate, increased pulmonary pattern. A blood test shows the same parameters as for a viral disease:
- increased number of lymphocytes in the blood;
- reduced number of leukocytes per unit volume of blood;
- accelerated ESR;
- absolute or relative increase in the number of eosinophils in bronchitis of allergic origin.
Recurrences of obstruction in children often end spontaneously by the age of 4 years. The difference between this disease and asthma is that the obstruction occurs slowly, and with asthma the baby begins to experience a lack of respiration suddenly. Repeated development of obstruction throughout the year is a signal that the baby is at risk of developing bronchial asthma in the future. Obstruction of allergic etiology occurs as a result of contact with an irritant. It often occurs in children who are prone to allergic reactions; this occurs repeatedly and threatens the development of asthma.
Manifestations of obstruction in infants
Obstructive bronchitis in children, the causes of which all parents should know, occurs sporadically in the youngest children, but its course is much more severe. It can be complicated by asphyxia, which is why parents should monitor their baby’s breathing, especially while he is sleeping. Its occurrence is due to allergic reactions.
Diagnosing such a disease is quite difficult due to the fact that the baby is not able to voice her problems. Difficult respiration and mucus production when coughing can complicate the child’s well-being. Competent and timely assistance from a specialist will help cure the child without causing complications. Statistics say that only a quarter of all episodes of the disease develop into obstruction.
Symptoms of bronchitis in infants
In babies receiving breast milk and not communicating with infected people, there is no danger of getting bronchitis. However, the disease may occur in premature babies with congenital defects of the respiratory system. The risk is created by the presence of preschool children attending child care institutions. The reasons are:
- narrowness and underdevelopment of the bronchi;
- dryness and vulnerability of the respiratory tract;
- the presence of congenital or acquired defects after viral infections;
- personal sensitivity to chemical irritants.
The main symptom of bronchitis is the appearance of a dry, severe paroxysmal cough, which is accompanied by difficulty breathing and shortness of breath. Over time, the child may cough, but the mucus produced interferes with respiration, disrupting the natural functions of the lungs. Bronchiolitis often occurs in infants.
Its development is associated with a viral illness and further reproduction of the infection. As an independent disease, bronchiolitis appears when breathing cold air, with a strong concentration of gases. This type of disease is dangerous due to obvious broncho-obstructive syndrome with symptoms of acute respiratory deficiency.
The disease is characterized by a dry cough of a paroxysmal nature and manifestations of shortness of breath with indicators of flared nostrils, muscle tension and a retracted chest, as well as pale skin and cyanosis. Characterized by feelings of dehydration, lack of tears when crying, decreased amount of fluid when urinating, shallow breathing. When listening, wheezing can be clearly distinguished. There are usually no signs of intoxication. There are no infiltrative changes in the lungs.
The addition of bronchiolitis worsens the baby’s well-being. The cough intensifies, becomes painful, tearing, and there is almost no sputum. Children are usually anxious, nervous, capricious, and irritated. A blood test reveals slight leukocytosis and an increase in ESR. Bronchiolitis continues quite long time– sometimes up to one and a half months.
Diagnosis of obstruction
It is not difficult for an experienced doctor to recognize the disease. During the examination, the doctor listens to the child’s breathing, gets acquainted with complaints about well-being and signs of illness reported by the mother, and prescribes tests:
- biochemical blood test;
- laboratory study of the excreted;
- allergy tests to detect irritants;
- x-ray – after a year (before this it is better not to prescribe);
- spirometric test - to determine lung volume.
The obtained facts make it possible to determine the stage of the disease and make prescriptions for treatment. During the diagnostic process, alternative variations of therapy and the likelihood of using non-traditional traditional methods of treatment are discussed.
In the case of a chronic illness, attentive and caring mothers, based on the initial signs of deviations in the condition and behavior of the baby, can foresee the emergence of complications, which allows them to take immediate measures and weaken the manifestations of the disease, making the baby feel better. The initial occurrence of symptoms of obstruction requires a visit to a doctor and examination. Appointment possible additional tests: allergy tests, test for helminths, consultation with a phthisiatrician.
Treatment methods for these diseases differ from the treatment of obstruction, which is why it is important to accurately diagnose the disease and prescribe adequate remedies.
Cure the disease
The first symptoms that appear in the form of a characteristic cough in babies require urgent medical attention. Treatment is provided by pediatricians, pulmonologists, allergists, and otolaryngologists. Any delay, especially in the acute form, is fraught with complications - heart failure, respiratory system disorder, even stopping respiration, suffocation and death.
If the symptoms are not too severe, the parents themselves can begin treatment, but under the supervision of a doctor. The necessary assistance consists of drinking plenty of fluids, ensuring the recommended air humidity in the room and a temperature not exceeding 22 degrees. Body temperature should be carefully monitored. If it rises to 38 degrees, you need to use antipyretics. Beneficial for kids:
- warm (no more than 15 minutes);
- inhalations based on medicinal drugs;
- traditional methods of treatment.
When treating obstruction, it is necessary to use medications only in the case of an allergic type of disease and to get rid of side effects. Compliance with dietary principles has a positive effect:
- eating fresh fruits and vegetables;
- vitamin supplement;
- limiting the inclusion in the baby’s menu of foods that may cause a reaction (chocolate, honey, citrus fruits, spices);
- reducing intoxication through plenty of liquid in the form of fruit drinks, herbal teas, freshly squeezed juices, mineral water.
Treatment of obstruction is carried out on an outpatient and inpatient basis. Indications for urgent hospitalization are the following:
- rapid progression of the disease;
- lack of relief, worsening of condition during treatment at home for several hours;
- early age of the baby;
- severe course of the disease with a high probability of consequences;
- increasing signs of respiratory deficiency.
If there is no threat of complications, it is preferable to treat the disease at home under the supervision of a pediatrician. In case of exacerbation of obstructive bronchitis, urgent measures are needed aimed at regenerating the natural functioning of the bronchi.
First of all, it is necessary to reduce the anxiety that arises in the child during an attack, turning into panic and fear. In such cases, the use of antipsychotic drugs is allowed. An important role is played by the emotional connection with the mother, whose support the baby should feel. Even your favorite toy will help.
Most effective method localization of an attack in children is the use of a nebulizer, with the help of which medications based on salbutamol, as well as glucocorticoids, are administered hormonal agents. The rapidity of the effect is dictated by the administration of the drug directly into the bronchi. The condition improves immediately after taking it.
An additional way to eliminate shortness of breath is the introduction of humidified oxygen. If the baby is in serious condition, complicated by intoxication, fever, dehydration may occur, which is treated with IVs and intravenous infusions solutions of salts with vitamins and hormonal medications.
Antibiotics prescribed by the doctor should be taken strictly at intervals. The indicated three times daily intake means consumption after 8 hours. When prescribing them once a day, it is advisable to take them at the same time. For a dry cough, take antitussive medications recommended by your doctor. If it is wet, you need to switch to expectorant medications. The combination medicine Sinekod is effective.
Inhalations using regular baking soda over hot water, as well as using a nebulizer and inhaler, are effective. Infants who cannot cough on their own are recommended to be turned from one side to the other so that the sputum moves down and causes a reflex cough.
Older children with strong immunity will be given the opportunity to avoid using antibiotics using cups, mustard plasters, and hot foot baths. All these procedures can be done after a year, and you can also rub your feet with warming ointments. At allergic reason For illnesses, rubbing and mustard plasters should not be used so as not to cause a deterioration in the child’s well-being.
Warm oil compresses at night, breathing exercises and physiotherapy, which have an anti-inflammatory effect and promote faster recovery, are considered effective. However, they are not recommended to be carried out more than 2 times a year.
On Dr. Komarovsky’s website you can see videos describing methods of treating the disease and hear reviews from patients.
- black radish juice with honey;
- onion infused with honey;
- tangerine zest;
- ginger tea;
- almonds and chicory;
- decoctions and tinctures of spring primrose root, elecampane, buckwheat and lingonberry flowers, marshmallow.
However, one cannot rely solely on unconventional methods and use them as the only remedy; these forms should be combined with methods recommended by the doctor.
Preventive actions
Prevention of bronchitis in children is to prevent the development of a prolonged runny nose in children, to heal any colds and infectious diseases. It is necessary to strengthen the baby's immune system from a very early age. To do this, you should follow a daily routine, pay attention to regular walks in the fresh air, physical development and hardening, daily consumption of natural vitamins contained in vegetables and fruits.
Children under 3-4 years of age can often experience obstruction as a consequence after suffering from a cold. This is usually considered a complication of a viral illness or an allergic manifestation to irritants. The main symptom of this disease is hoarse respiration with whistling sounds, paroxysmal painful cough.
A doctor diagnoses a disease using various studies. Treat better at home, but for infants it is preferable in a hospital setting. Both medications and folk remedies are used in therapy, and physiotherapy is effective. Obstruction that occurs several times a year serves as a risk factor for the development of bronchial asthma.
Obstructive bronchitis is a disease that occurs quite often in children. The reason for this is the physiological characteristics of the body. The already narrow lumen of the bronchi, when inflammatory processes occur in them, can be blocked almost completely. This is obstruction - “spasm”, “constriction”. With timely diagnosis, this condition is highly treatable. Therapy is carried out using medications and physical procedures. Folk remedies are also effective in the treatment of obstructive bronchitis in children.
What is obstructive bronchitis
Bronchitis is an inflammatory change in the bronchi caused by either an allergic reaction, a viral or bacterial infection, or physicochemical factors. And edema and spasm accompanying inflammation are the main causes of obstruction.
Obstructive bronchitis in children (obstruction, obstructive syndrome) is a narrowing of the lumen of the bronchi and disruption of their patency, in As a result, respiratory failure develops. The condition is complicated by the production of viscous sputum and spasm.
The inflammatory process in the respiratory tract provokes swelling of the bronchial mucosa. And due to its thickening by only 1 mm, the total area of the bronchial lumen in an infant can decrease by 75%, while in an adult it is only 19%.
This is what healthy bronchi and bronchi look like during an attack of bronchial obstruction
Attacks of obstruction usually begin at night. The baby's cough and runny nose are getting worse, the child is capricious, complaining of weakness, chest pain and shortness of breath. Wheezing is clearly audible, and body temperature usually rises.
Home distinctive feature Obstructive bronchitis is that it appears suddenly and proceeds very rapidly. In just a few minutes, the patient's condition can worsen to critical.
The stronger the swelling, the harder it becomes for the baby to breathe and the less oxygen enters the blood. This threatens oxygen starvation and suffocation. Therefore, it is very important to be able to distinguish obstructive bronchitis from ordinary bronchitis, and to come to the aid of a sick little one in time.
Obstructive bronchitis in a child - video by Dr. Komarovsky
Types of disease
Depending on the symptoms and duration of the disease, doctors divide obstructive bronchitis into:
- acute - the attack occurs suddenly and once;
- with an asthmatic component (or simply asthmatic) - it manifests itself most often as a result of the reaction of the bronchial mucosa to an external irritant, an allergen.
- recurrent, which in young children develops again precisely against the background of a viral infection - it is not associated with exposure to non-infectious factors, for example, allergens, and repeats more than 2-3 times a year;
- with regular repetition of attacks over 2–3 years, doctors diagnose chronic obstructive bronchitis. This also includes COPD - chronic obstructive pulmonary disease. A disease characterized by limitation air flow, not completely reversible. They usually get sick in adulthood.
When choosing treatment tactics, the doctor will be guided by the nature of the obstruction. And depending on the form of the disease, prescribe therapeutic measures.
Causes
Causes of development of asthmatic obstructive bronchitis in children
- Viral infection. The most common cause of obstruction. Parainfluenza and respiratory syncytial viruses, cytomegalovirus, adenovirus, etc. can cause inflammation in the respiratory tract.
- Bacterial infection. The causative agents of inflammation in the bronchi are most often staphylococci or streptococci, pneumococci or Haemophilus influenzae, chlamydia or mycoplasma, Proteus or Klebsiella.
- Anatomical features of the structure of the respiratory organs in children. IN early age The glandular tissue of the bronchi is enlarged, and the lumen in them is much narrower than in adults.
- Features of the structure of the diaphragm. It provides depth of inspiration. The shallow breathing of young children is explained by the weakness of their diaphragm contractions.
- Insufficient local immunity. Protective properties of mucous membranes. In children, this type of immunity is in the formative stage.
- Production of viscous sputum. It interferes with the passage of air through the lumen of the bronchi, which are swollen and spasmed due to inflammation.
- Aspiration. Inhalation of small objects or food. This reason is most relevant for young children. Occurs with gastroesophageal reflux, swallowing disorders and some other pathologies of the nasopharynx and esophagus, as well as when foreign bodies, after removal, leave foci of infection in the pharynx.
- Migration of helmites. You can suspect from the age of two.
- Allergic reaction. As a result of the reaction of the immune system to the irritant, allergic bronchitis develops and its complication is the obstructive form of the disease.
- Malformations of the respiratory system. Hypoplasia, aplasia, agenesis, etc.
- Unfavorable living conditions. Failure to comply with hygiene standards, passive smoking, poor environmental background.
It should be borne in mind that bronchial obstruction syndrome in children most often occurs due to swelling of the bronchial mucosa and the accumulation of viscous sputum in them. And in older children, obstruction is usually caused by bronchospasm.
Factors that increase the risk of developing obstructive bronchitis:
- intrauterine infections;
- underweight;
- rickets;
- hereditary predisposition to allergies;
- enlarged thymus (thymus gland);
- artificial feeding or early transition to it;
- viral or colds suffered before the age of one year.
Symptoms
Symptoms of bronchial obstruction usually appear 2–4 days after the onset of an infectious respiratory disease.
Obstructive bronchitis is preceded by a number of catarrhal phenomena:
- runny nose;
- redness, pain and sore throat;
- dry and unproductive cough;
- increased body temperature, chills;
- general weakness.
The main signs of bronchial obstruction are a dry exhausting cough, noisy rapid breathing, expiratory shortness of breath.
An attack of obstruction begins suddenly, progresses quickly, and is characterized by the following manifestations:
- The child shows visible concern. He tries to take a sitting position, supporting himself on his hands.
- Viscous sputum accumulates in the bronchi, which is not expectorated, but only irritates the mucous membrane and provokes a cough.
- Breathing is noisy, wheezing, rapid (70–90 breaths per minute, with the norm for children under 6 months - no more than 60, from 6 months to 1 year - no more than 50, and from 1 to 5 years - no more than 40).
- The cough becomes frequent and severe, exhausting. It even happens that it provokes vomiting.
- Wheezing and bubbling can be heard even from a distance. But they have no obvious localization and pass along with an attack of obstruction.
- Expiratory shortness of breath appears - the baby can hardly exhale.
- During the breathing process, auxiliary muscles are involved, the space under the sternum and intercostal spaces are retracted.
- Body temperature remains at 37.5 ºС.
- Attacks of suffocation appear and become more frequent. It looks as if the baby is constantly in a state of inhalation (to inhale, he needs to exert additional effort). In this case, the baby feels more comfortable on his stomach, hanging his head below body level.
- Nails and nasolabial triangle turn blue. This is acrocyanosis - a clear sign of oxygen starvation. Signs of intoxication of the body appear: nausea, vomiting. You should count how many breaths the child takes per minute. If the amount exceeds the age norm by 10%, you should immediately call emergency medical help.
An attack of obstruction can last up to 2–3 days, and in children with weakened immune systems with a history of rickets and other pathologies, it lasts for a longer time.
Features of the course depending on age
Due to the anatomical features of the child’s body (narrow lumen of the bronchi), obstructive bronchitis most often affects infants and children up to three years. The older the child, the less likely he is to develop this disease.
In children over 3 years of age, the above signs of obstruction may be supplemented by pain between the shoulder blades and the discharge of yellowish sputum. A body temperature above 38 °C indicates complications of the disease.
At an early age, obstructive bronchitis is a physiologically based phenomenon. In children who have crossed the age limit of 3–4 years, attacks of obstruction may indicate the development of chronic respiratory diseases, bronchial asthma.
Diagnostics
Examination and treatment of children susceptible to attacks of obstructive bronchitis can be carried out by a pediatrician and a pediatric pulmonologist.
To exclude a causal relationship between the occurrence of broncho-obstruction and bronchospasm from allergens and diseases of the ear, throat, nose (sinusitis, tonsillitis, pharyngitis, etc.), the small patient is referred for a consultation with an otolaryngologist and an allergist-immunologist. After all, the tactics of treating the disease directly depend on what caused its development.
Spirometry is a method for studying volume and speed parameters of breathing in obstructive bronchitis
To put accurate diagnosis and prescribe appropriate therapy, doctors need the results:
- interviewing the child and parents;
- auscultation (listening to breathing sounds);
- X-ray examination of the respiratory system, which usually shows an enhanced pulmonary pattern;
- sputum culture (allows you to determine the causative agent of the inflammatory process in the respiratory tract);
- blood test (determines the occurrence of inflammation in the baby’s body, shows the degree of oxygen saturation of the blood).
Also, children over 5 years of age undergo spirometry - volume and speed parameters of breathing are measured.
Treatment
Acute obstructive bronchitis without proper treatment can be complicated by pneumonia, metabolic processes, develop into more severe forms. Therefore, at the first sign of obstruction, you should immediately consult a doctor. Only with accurate, detailed diagnosis and qualified therapy is a complete recovery guaranteed without far-reaching consequences.
Bed rest is indicated during acute manifestations. As respiratory function and metabolism normalize, the regime can be semi-bed or free.
When is hospitalization necessary?
Attacks of obstructive bronchitis in a child can be stopped and treated at home, of course, after prior consultation with specialists. First of all, this applies to the chronic and asthmatic forms.
But there are cases when hospitalization is vital:
- Obstruction in a newborn or child up to one year old.
- Risk factors are present in the medical history (enlarged thymus gland, rickets, viral infections)
- The baby’s serious condition before the attack.
- The child experienced bronchospasm for the first time, and the parents do not know how to help him.
- Outpatient treatment for three hours did not give any positive dynamics.
- The inhalation rate is 10% higher than normal for age.
- The appearance of symptoms of respiratory failure: shortness of breath, acrocyanosis.
- The child has obvious signs intoxication: lethargy, loss of appetite, nausea, vomiting, increased body temperature.
- The impossibility of fully caring for a small patient at home.
To avoid causing irreparable harm to the child’s health, children under 3 years of age must be hospitalized at the first signs of bronchial obstruction. For periodically recurring attacks, you should follow the instructions previously given by your doctor.
First aid for an acute attack of obstruction
An acute attack of bronchial obstruction is best relieved by inhalation with bronchodilators, mucolytics, and glucocorticosteroids.
- Provide a flow of fresh air into the room where the baby is.
- Wash the child to remove possible allergens from his face (if the attack is caused by their exposure).
- A hot foot bath at the beginning of an attack will help significantly alleviate the condition.
- Place the baby on his stomach.
- Count the frequency of breaths per minute before starting assistance.
- The best way to relieve an attack of bronchial obstruction today is considered to be inhalation with drugs that dilate the bronchi, promote mucus discharge, relieve inflammation, swelling and irritation of the mucous membrane (Ventolin or Berodual, as well as Lazolvan or Ambroxol). Antitussive drugs are contraindicated for obstructive bronchitis! Inhalations can be carried out using a special device - a nebulizer. Or you can buy an inhaler containing a medicinal mixture at the pharmacy. Inhalations are first done for each bronchospasm, and after relief occurs, before bedtime.
- In cases of severe obstruction, after fifteen minutes of inhalation with the above drugs, a glucocorticoid (Pulmicort or Budesonide) can be added to the solution.
- Count the frequency of breaths after inhalation to ensure the effectiveness of therapy.
- And we should not forget about the drinking regime. Drinking plenty of fluids will facilitate the process of mucus discharge and expectoration. And alkaline mineral water(Borjomi, Essentuki) will soften the throat and relieve irritation.
When the cause of an attack of obstruction is an allergic reaction of the child’s immune system to an external irritant, the attack can be stopped within a few hours. If obstructive bronchitis was caused pathogenic microflora, you won’t be able to overcome it quickly. Relief of the condition after treatment occurs within 2–3 days.
What can't you do?
If you have obstructive bronchitis, mustard plasters should not be applied!
- Rub the child with various balms, turpentine, and aromatic oils. This will only intensify the allergic reaction if it occurs, or bronchospasm will intensify due to the pungent odor of the rub.
- Use any bee products for treatment due to their high allergenicity.
- Put mustard plasters, in this case they will not help.
- Give your baby anything to drink herbal infusions and decoctions. It is unknown what the immune system's reaction to them will be.
- Use cough suppressants.
- First generation antihistamines are also contraindicated: Tavegil, Pipolfen, Suprastin. They dry out the mucous membranes and thereby prevent the discharge of sputum. But it must, on the contrary, be liquefied and removed.
- Self-medicate. Any medications and procedures for a child must be prescribed by a doctor.
Diet and drinking regime
A hypoallergenic diet plays an important role in achieving positive dynamics of treatment.
Hypoallergenic diet for obstructive bronchitis - table
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Dangerous | Potentially dangerous | |
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When treating obstructive bronchitis, adhere to hypoallergenic diet should be at least 3 months. Then you can expand the child’s diet, but gradually. For children with allergies, a food diary is kept, and foods are introduced under the supervision of a doctor.
Still mineral water
To improve the drainage function of the bronchi and quickly remove sputum from them, a child with obstructive bronchitis needs to be given water regularly. Moreover, the baby should drink not just water, but alkaline mineral water.
You can also give him warm milk with butter or goat (badger) fat dissolved in it. But various herbal teas and compotes, although they are useful and have an expectorant effect, can only be given to a child after prior consultation with a doctor, since these drinks can cause allergies in the baby and only worsen his condition.
Microclimate
Another important point is the child’s microenvironment. This is really very important for the health of his respiratory system. The mucous membranes function normally only if they are sufficiently moistened. Dry mucous membranes are the cause of weakened local immunity.
- The room where the patient is located should be ventilated several times a day.
- Do wet cleaning regularly.
- You can purchase a humidifier. This device will be useful for all family members.
- Avoid baby's contact with carpets and soft toys. Replace feather pillows with synthetic padding.
Viruses, microbes and allergens that enter the child’s respiratory tract along with air cause irritation and inflammation - swelling, mucus accumulation, bronchospasm. Therefore, you should protect your baby from contact with external irritants as much as possible.
A humidifier will protect your mucous membranes from dryness.
Medicines
Drug treatment of obstructive bronchitis is aimed at interrupting the attack and eliminating the root cause of its development. Doctors are also working to improve respiratory function, enrich the blood with oxygen, eliminate symptoms of intoxication, and restore metabolism.
Therapy includes measures to improve the cleansing of the bronchi from mucus accumulating in them and to relieve inflammation, for which bronchodilators, expectorants, and anti-inflammatory drugs are prescribed.
- Inhalations. They are carried out with a special device - a nebulizer. It creates cold steam, which, when inhaled, easily reaches the small and medium bronchi without burning or irritating them, and delivers particles of medicinal solutions to them. For inhalation, saline solution or alkaline mineral water with the addition of bronchodilators, mucolytics, antihistamines and corticosteroids is used.
- Medicines to dilate the bronchi and relieve spasms. Berodual, Salbutamol, Fenoterol are second-generation beta antagonists that are most often prescribed to children to relieve bronchospasm. In case of obstruction due to ARVI or ARI, Atrovent will be most effective. Eufillin is used less frequently due to side effects and difficulties in selecting the exact dosage. But it is used when other means do not provide positive dynamics.
- Bronchodilators. Ascoril, Salmeterol, Clenbuterol. If it is not possible to give the child inhalation, he is prescribed syrups based on bronchodilators. But their use is associated with the appearance of side effects: involuntary muscle contractions, rapid heartbeat.
- Mucolytic therapy. Mucolytics are drugs that dilute mucus in the bronchi and promote its removal. They can be used in the form of inhalations, or they can be given to the child in the form of syrup or tablets. Most often, Ambroxol, Lazolvan, and Fluditec are prescribed for obstructive bronchitis. As well as Acetylcysteine (ACC), which is especially effective in the first days of the disease, it is taken only orally.
- Antihistamines. Zyrtec, Claritin, Parlazin. These drugs are prescribed to children whose obstructive bronchitis is caused by a reaction of the mucous membranes to an allergen.
- Antiviral. If obstruction is a consequence of a respiratory viral infection, the underlying disease must be treated and immunostimulating drugs are prescribed: Immunal, Anaferon, Arbidol.
- Anti-inflammatory. Erespal, Fosidal, Inspiron, Bronchomax help relieve inflammation in the bronchi.
- Antibiotics. If the baby heat(38–39 °C) lasts longer than 3–4 days, or it rises again a few days after an attack of bronchial obstruction, the doctor will definitely recommend a course of antibiotics for the child. These are Amoxicillin, Ceftriaxone, Sumamed.
- Glucocorticoids. In case of complicated course of the disease and for rapid relief of the condition, the use of glucocorticosteroids by inhalation is indicated. The most common of them is Pulmicort (Budesonide can be used). Its most effective use will be after inhalation with a bronchodilator drug. From hormone therapy refuse immediately after the onset of relief and replace it with a non-steroidal one.
- Vitamins. To strengthen the body's defenses, complex therapy for obstructive bronchitis necessarily includes a course of multivitamins. This could be Kinder Biovital (gel), Multitabs-Baby, Vitoron, Pangexavit, Pikovit.
Acute obstructive bronchitis is usually caused by viruses and is treated with antiviral and anti-inflammatory drugs, if proven bacterial origin diseases, antibiotics are used.
Medicines used to treat obstructive bronchitis - table
Pharmacological group | Name of the drug | Active substance | Action | Indications | At what age is admission possible? | Contraindications |
Antispasmodics, drugs for dilation of bronchi |
| Has an antispasmodic effect on the bronchial muscles and provides greater latitude therapeutic action for bronchopulmonary diseases. | Prevention and symptomatic treatment of chronic obstructive airway diseases with reversible airway obstruction. | It is used in pediatric practice. Children under 6 years of age should undergo treatment strictly under the supervision of a doctor. |
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Salbutamol sulfate. | Prevents and relieves bronchospastic syndrome, increases vital capacity lungs, complicates the release of histamine into the extracellular space. | In pediatrics, Salbutamol is used to treat broncho-obstructive syndrome. | From two years old. |
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Bronchodilators |
| Combined drug with bronchodilator and expectorant effects. | It is used for the treatment of acute and chronic bronchopulmonary diseases accompanied by the formation of difficult-to-discharge viscous secretions and bronchospastic syndrome:
| From 1 year. |
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Salmeterol | Salmeterol xinofoate. |
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| Hypersensitivity to the drug. |
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Mucolytics | Ambroxol | Ambroxol. | Mucolytic agent with expectorant action. Stimulates the serous cells of the glands of the bronchial mucosa, increasing the content of mucous secretion, and changes the disturbed ratio of serous and mucous components of sputum. |
| Can be used in newborns and premature babies. |
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Fluditek | Carbocysteine. | Normalizes the quantitative ratio of acidic and neutral sialomucins in bronchial secretions, restores the viscosity and elasticity of mucus, and facilitates its discharge. | Acute and chronic bronchopulmonary diseases, accompanied by the formation of viscous, difficult to separate sputum:
| From two years old. |
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Acetylcysteine (ACC) | Acetylcysteine. | Mucolytic agent. It thins mucus, increases its volume, facilitates secretion, and promotes expectoration. | Respiratory diseases and conditions accompanied by the formation of viscous and mucopurulent sputum:
| From two years of age, it can also be used on infants, but under the supervision of a specialist. |
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Antihistamines | Cetirizine dihydrochloride. | Prevents the development and facilitates the course of allergic reactions. |
| From 6 months. |
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Claritin | Loratadine. | Loratadine is a tricyclic compound with a pronounced antihistamine effect. Has a quick and long-lasting antiallergic effect |
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Anti-inflammatory | Fenspiride hydrochloride. | Reduces the effect of a number of factors that contribute to the hypersecretion of proinflammatory factors, the development of inflammation and bronchial obstruction. Fenspiride also has an antispasmodic effect. | Diseases of the upper and lower respiratory tract:
| Increased sensitivity to active substance or any of the components of the drug. |
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Bronchomax | Fenspiride hydrochloride. | It has pronounced antibronchoconstrictor and anti-inflammatory effects. |
| The syrup is prescribed to infants. | Hypersensitivity to any of the components of the drug. |
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Antibiotics | An antibiotic from the group of semisynthetic penicillins with a broad spectrum of action. | Infectious and inflammatory diseases caused by sensitive microorganisms, including bronchitis, pneumonia, sore throat. | Use in children is possible according to the dosage regimen. |
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Azithromycin dihydrate. | Bacteriostatic antibiotic of the macrolide-azalide group. Has a wide spectrum of antimicrobial action. The mechanism of action of azithromycin is associated with the suppression of protein synthesis in microbial cells. | Infectious and inflammatory diseases caused by microorganisms sensitive to the drug. | From 6 months. |
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Glucocorticoids | Budesonide (micronized). | Reduces the severity of edema of the bronchial mucosa, mucus production and hyperreactivity of the respiratory tract. |
| From 6 months. | Hypersensitivity to budesonide. |
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Vitamins |
| A combined preparation containing a complex of vitamins and minerals that are important factors metabolism. | Prevention of vitamin and mineral deficiency in complex therapy diseases accompanied by the prescription of antibiotics. | From 1 year. |
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It is important not to forget that for children under 6 years of age any medicines should be given as syrups, suspensions or drops.
Medicines for the treatment of obstructive bronchitis - photo gallery
Ascoril - bronchodilator Zirtec - antihistamine ACC - mucolytic Pulmicort - solution for inhalation, glucocorticoid Amoxicillin - antibiotic Sumamed - antibiotic 
Salbutamol - bronchodilator Pikovit - multivitamin complex 
Berodual - antispasmodic, bronchodilator 
Erespal - anti-inflammatory drug
Non-drug treatments
Treatment of obstructive bronchitis in children is always complex. In severe cases of the disease, an oxygen mask (oxygen therapy) or artificial ventilation in intensive care wards is indicated for a small patient.
In addition to taking medications orally and inhalations, postural drainage, sound exercises, massage and physiotherapy are quite sufficient.
- Postural drainage. Allows you to significantly facilitate the discharge of sputum from the bronchi. It's not at all difficult to do. The child is placed on his stomach so that his head is located slightly below the level of his legs (you can place a pillow under the baby’s stomach), and with a cupped palm, lightly tap the baby’s back. The duration of the manipulation is 15 minutes.
- Sound gymnastics. This technique involves pronouncing various sound combinations in a certain way so that vibrations are transmitted from the vocal cords to the bronchi, thereby relieving spasms and relaxing the smooth muscles of the respiratory tract.
- Massage. An indispensable assistant in the treatment of broncho-obstructive syndrome in children. It will strengthen the walls of the bronchi, facilitate the passage of secretions and reduce coughing. You need to massage the chest (avoiding the heart area), collar area, back along the spine. The greatest effect will be from a massage while exhaling. An older child can be asked to inhale and hold the breath, and then exhale slowly while you stretch and rub the muscles, alternating these movements with tapping, thereby accelerating blood circulation.
- Physiotherapy. Includes procedures such as ultra-high frequency therapy and electrophoresis. But such treatment is prescribed after the attack has stopped and the cough has become productive.
Massage for obstructive bronchitis at home - video
Folk recipes
They can be used for the treatment of obstructive bronchitis only after mandatory consultation with the attending physician and with his approval.
- Warm milk with figs will help soften the cough (add 2 fruits to the milk and boil the drink for 15 minutes). Take 1 tablespoon during coughing attacks.
- Decoctions and infusions of chamomile, linden, mint, sage, coltsfoot, plantain, ivy, licorice root, and all kinds of breast infusions help relieve inflammation in the bronchi, ease mucus discharge, and soften cough. You can buy herbs at any pharmacy. Medicines should be prepared according to the instructions on the package. But they can be given to a child only if he has no tendency to allergic reactions.
- Teas made from the leaves and fruits of raspberries, currants, viburnum, cranberries, and lingonberries have an antipyretic and tonic effect.
- Warming compresses and rubbing will relieve spasms and relax the bronchi. You can make a compress based on refined vegetable oil. To do this, you should heat the oil, moisten a terry towel in it, wrap the baby in the chest and back area with this towel, cover the compress with plastic wrap, and put warm clothes on top of the baby. Leave the compress in this form overnight. Usually 3-4 wraps are enough for a significant improvement in the condition.
- Rubbing with camphor oil will enhance the effect of massage and postural drainage, activating blood flow to the bronchi, affecting the mucous membrane and relieving spasm. Before rubbing, carefully examine your baby's skin and postpone the procedure if you find wounds or rashes on it.
Traditional medicine in the photo
Possible consequences and complications
- It is very important to diagnose obstructive bronchitis promptly and correctly. After all, bronchial obstruction and bronchospasm may be the first manifestations of bronchial asthma in a child.
- If the disease is not treated, it can take a chronic course and gradually acquire new complications (from COPD to serious metabolic disorders in the body).
- Children prone to allergic reactions may develop recurrent obstructive bronchitis, when attacks are repeated several times a year.
- And the worst thing is that if a child during an attack of bronchial obstruction is not provided with timely and qualified assistance, it can even lead to suffocation and death.
Prognosis and prevention
But subject to accurate diagnosis and correctly selected therapeutic measures, doctors’ prognoses for children with obstructive bronchitis are quite favorable. The disease is completely cured.
But one should not lose vigilance. In the first 6 months after the initial attack of bronchial obstruction, there are risks of relapses, which can be triggered by colds or allergies.
Therefore, it is important at this time to take very seriously measures to prevent acute respiratory viral infections, acute respiratory infections, and various types of allergic reactions.
- The child must be checked by a pediatrician for six months. By the age of four, if there have been no relapses, the child is removed from the register.
- A hypoallergenic diet and lifestyle are mandatory conditions for children who have a history of allergies and cases of bronchial obstruction.
- Maintaining a daily routine, long walks in the fresh air, an active lifestyle - all this contributes to the formation of strong immunity in the baby.
- Mandatory vaccinations during seasonal outbreaks of respiratory viral diseases.
- Dress your child according to the weather.
- Avoid crowded places where he can get the flu.
- Strong odors, passive smoking, heavily polluted and dusty air. All this should be avoided by the child.
And remember, the older the child gets, the lower the risk of repeated attacks of bronchial obstruction.
Obstructive bronchitis is especially dangerous for children at an early age. This is due to the physiological characteristics of the development of the child’s body. But if you seek help from doctors in a timely manner, the chances of a full recovery for the baby are high. Parents whose children are prone to allergic reactions need to be especially careful. But even in this case, the prognosis is quite favorable if you follow all the recommendations of the attending physician.
The term obstructive in modern medical practice refers to damage to the upper respiratory tract. IN pathological process the mucous membranes of the bronchial tree and trachea are involved. In most cases, the disease occurs in an acute form and takes on the features of a chronic one. With obstruction, symptoms characteristic of bronchial asthma may occur. In most cases, the development of pathology can be provoked by viral and bacterial infections.
Now let's look at this in more detail.
What is obstructive bronchitis?
The term bronchi refers to an extensive network of tubes of different diameters. Their main task is air passage. Oxygen penetrates the lungs, passing the larynx and bronchi. When an infection enters the bronchi, an inflammatory process develops, the air circulation process is disrupted, and the movement of air to the lungs becomes difficult. Obstructive can be considered as an acute form of pathology, occurring with symptoms of bronchial obstruction. It is important to remember that this is a pathology that has a predisposition to chronicity, and therefore proper attention should be paid to its treatment. In case of non-compliance simple rules, aggravation of the pathological process is possible. Chronization is quite dangerous and not pleasant. A chronic diagnosis increases the risk of developing various pathologies of the upper and lower respiratory tract; against this background, the entire immune system suffers.
A feature of obstructive is a pronounced narrowing of the bronchi, namely obstruction. This condition can manifest itself as a result of exposure to various provoking factors. The disorder makes it impossible to breathe; when inhaling, a cough appears.
A feature of the inflammatory process is the rapid deterioration of the clinical picture of the disease. Symptoms increase rapidly. A characteristic manifestation is a dry, hacking cough, which leads to various sleep disorders.
By the term obstruction, doctors mean the closure of the lumen between the bronchi. – an inflammatory process that occurs in the mucous membranes and muscular walls of organs. The pathological process often involves the middle bronchi and bronchioles. Against the background of the inflammatory process, their complete or partial blockage occurs.
The mechanism of obstructive development in a child can be presented as follows:
- a viral infection occurs;
- pathogenic microorganisms penetrate the nasopharynx;
- a runny nose appears as a natural immune reaction;
- the pathological process spreads to the throat;
- The upper respiratory tract is involved in the inflammatory process.
The difficulty of treating bronchitis is that such a disease is often provoked by particularly resistant microorganisms that have overcome the natural barriers of the body. After active pathogens enter the mucous membranes of the bronchial tubes, a local reaction occurs; the bronchioles begin the process of producing viscous mucous secretion, which becomes the cause of obstruction.
The main purpose of the bronchi is to protect the lungs from infection. The main bactericidal substance in this case is mucous secretion. The cleansing process proceeds according to the required pattern if the secretion has a liquid consistency. As a result of various factors, the thickness of the mucus may change, and this condition is negative. The reason for thickening of mucus may be the following:
- increased body temperature of the child;
- contact with dust and allergens;
- insufficient air humidity;
- non-compliance with drinking regime.
If the mucus becomes dry, it becomes an ideal place for infection to breed. Mucous masses in this state are not excreted, but remain in the bronchi. Not timely treatment obstructive can cause the development of bronchial asthma.
In this case, a lump of dried mucus is the main cause of obstruction, because it blocks the lumen of bronchi of various diameters. Against the background of such a violation, confident prerequisites are created for development due to disruption of the processes of natural ventilation of the lungs.
Symptoms of obstructive bronchitis in children
A distinctive feature of chronic inflammation is its long duration. A dry, hacking cough that can persist in the absence of other symptoms. General state the child remains unchanged, the decrease in activity is not observed. The danger of the pathology is that a prolonged cough can cause bronchial hypertrophy, which manifests itself due to strong physical activity.
Causes and prevention of obstructive bronchitis
Obstructive – a condition in which bronchospasm is observed. Against the background of such a disease, the mucus accumulated inside cannot come out and 
provokes various disorders breathing.
The list of the main reasons that can provoke development in a child can be presented as follows:
- allergic inflammation of the bronchi;
- introduction of viruses;
- hypothermia of the body;
- severe overheating;
- passive smoking;
- living in a region with an unfavorable environmental situation;
- constant crying that disrupts normal breathing;
- received birth injuries;
- health problems that appeared during the neonatal period;
- increased air humidity in the living area;
- the formation of fungus in a living room.
Parents should remember that a cough that lasts more than 3 days is a reason to contact a pediatrician. Such a symptom cannot be ignored; it may indicate development in the child. This disease is treatable and can be easily corrected if you consult a specialist in a timely manner.
Currently, there is no active vaccine that prevents development in a child. The simplest and most effective method of preventing the onset of the disease is a correct lifestyle. The main forces should be coordinated to activate the protective properties of the immune system. Simple rules will help ensure the restoration of protective properties:
- The child should take a walk in the fresh air every day.
- Doing your best will be beneficial physical activity, eliminating overwork of the body.
- The child's menu should include fruits and vegetables.
- An annual holiday at sea and in the mountains is useful. The duration of the climate change must be at least 21 days.
- Regular intake of complexes containing vitamins and microelements is recommended.
- Regular sanitation of the oral cavity, timely treatment of carious cavities even in baby teeth.
- Treatment and prevention of diseases of the ENT system.
Parents should remember that the manifestation of the disease always indicates that it is necessary to consult a doctor. Inadequate treatment significantly increases the likelihood of developing dangerous complications.
The first signs of obstructive bronchitis
Like any cold, it begins with nasal congestion and cough. A special feature is that with obstructive cough, severe coughing attacks occur at night. The urge to cough, despite its strength, does not provoke the removal of sputum. The child is bothered by severe pain in the chest area. During the period of illness, children become restless, constantly capricious, sleep is often disturbed, and nervous excitability increases.
Scroll additional signs, indicating the development of the disease can be presented in the following form:
- an increase in the frequency of inhalations, the appearance of noise during inspiration;
- whistling breathing;
- increase in size of the chest;
- manifestation of pallor of the skin;
- nonproductive cough;
- manifestation of low-grade body temperature;
- As the disease progresses, moist rales appear;
- manifestation of signs of pulmonary distension on an x-ray;
- redness of the tonsils, their hypertrophy;
- increase in the size of lymph nodes.
In most cases, the diagnosis of obstructive is made to children over 2-3 years of age. At the initial stage of development of the disease, the clinical picture is similar to the symptoms of a cold, which is why parents often ignore the need to seek help. medical care. Symptoms characteristic of obstruction appear 2-3 days after the development of the disease, as a rule, at the moment when parents manage to reduce body temperature with the help of antipyretics.
Treatment of obstructive bronchitis in children
Treatment of obstructive disease in children under 1 year of age is carried out in a hospital setting. This safety measure is taken due to the high risks of developing dangerous complications.
Children over one year of age can be treated at home.
- compliance with bed rest;
- daily walks in the fresh air;
- light, plant-based diet;
- drinking plenty of water;
- regular cleaning of the living space;
- air humidification.
If treatment is carried out in a hospital setting, the ward should be quartzed regularly.
To eliminate spasms, inhalations can be performed using the following drugs:
- terbutaline;
- phenotorel.
At home, you can use a nebulizer.
If treatment with bronchodilators is ineffective, corticosteroids may be used. To speed up the removal of sputum, mucolytics and broncholytics can be used. Alkaline inhalations using Borjomi water will be beneficial. Breathing exercises and drainage massage help to significantly speed up the process of removing mucus accumulated in the bronchi. Basics of conducting drainage massage A physical therapy specialist should explain this to parents. Improper execution of the procedure increases the risk of complications.
Treatment with antibiotics is possible only if there is a secondary infection. The most suitable means are selected individually. Dosages are selected depending on the type of infection and the severity of the patient's condition. The duration of the course of therapy is determined individually.
Probability full recovery without dangerous complications, provided timely seeking medical help reaches 100%. The reason for the development of dangerous consequences of the disease is often the lack of careful attention parents to the health of their own child. does not belong to the category of extreme dangerous diseases subject to timely treatment. Lack of treatment leads to chronicity of the inflammatory process. Chronic course The disease will cause the child to experience a debilitating cough several times a year. It is quite difficult to get rid of chronic obstruction, and in advanced cases it is impossible, therefore it is better to pay timely attention to the treatment of pathology that occurs in an acute form.
