Bronchitis

   Acute bronchitis - inflammation of the bronchi of any caliber of various etiologies (infectious, allergic, toxic), which developed in a short period of time. Distinguish acute bronchitis, acute obstructive bronchitis, acute bronchiolitis. 

Causes of Acute Bronchitis

    Most often the causative factor of acute bronchitis - different viruses, bacteria rarely. Irritatsionnye bronchitis occur during exposure to toxic and chemical substances and physical factors. Allergic acute bronchitis. Bronchitis is often accompanied by a diphtheria, typhoid fever, whooping cough. The etiology of bronchitis and clinical features often depend on the age of the children.

The pathogenesis of acute bronchitis

    The pathogenesis of bronchial obstruction in obstructive bronchitis and bronchiolitis complicated and caused, on the one hand, the influence of respiratory viruses themselves, on the other - anatomical and physiological characteristics of children, their propensity to allergic reactions. Influence of respiratory viruses on bronchopulmonary system of the child is diverse:

they damage the respiratory epithelium, increased mucosal permeability, contribute to the development of edema and inflammatory cell infiltration of elements violate mucociliary clearance. Bronchial spasm can be a part of release of biologically active substances. A significant proportion of children with bronchial obstruction episodes recur in the future on the part of developing asthma.   Acute bronchitis (simple) - an acute inflammatory disease of the bronchial tubes, occurring with no signs of bronchial obstruction. 

Symptoms of acute bronchitis

    In acute bronchitis is generally body temperature rises. Duration of fever varies and depends on the type of pathogen. Thus, with respiratory syncytial virus and parainfluenza infections, duration of fever is 2-3 days, and when mycoplasma and adenovirus - 10 days or more. The main symptom of bronchitis - coughing, dry and haunting at the beginning of the disease in the future - wet and productive. Auscultation reveals widespread diffuse coarse dry and wet medium and large bubbling rale. 

Laboratory tests

    In peripheral blood changes may not be. Virus infection detected leukopenia, lymphocytosis. It may be a slight increase in erythrocyte sedimentation rate, and with a bacterial infection - neutrocytosis, a small shift of the leukocyte to the left. Chest X-ray is performed to exclude pneumonia, bronchitis usually detect mild diffuse increased lung markings.   Acute bronchiolitis - an acute inflammation of the small bronchi and bronchioles, occurring with respiratory failure and an abundance of finely wheezing. The disease develops mainly in children in the first year of life. The most common cause of bronchiolitis respiratory syncytial virus, parainfluenza viruses, less often - adenoviruses, even more rarely - mycoplasma and chlamydia. 

The clinical picture of acute bronchiolitis

    Fever usually lasts 2-3 days (adenovirus infection - up to 8-10 days). The condition of children is quite heavy, presented signs of respiratory failure nosogubnogotreugolnika cyanosis, dyspnea expiratory or mixed, tachypnea. Often observed swelling of the chest, breathing part auxiliary muscles, retraction compliant places the chest. When percussion reveal box note, auscultation - scattered wet finely wheezing while inhaling and exhaling. Much less often listen to the medium and krupnopuzyrchatye crackles, the amount of which varies after coughing.   Complications can occur with the progression of respiratory disorders. Increase RaS02, the development of hypercapnia, indicating a deterioration can lead to apnea and asphyxia, very rarely occur pneumothorax and mediastinal emphysema. 

Laboratory tests

    When chest radiography determine signs of swelling of the lungs, including increased transparency of the lung tissue. Possible atelectasis, increased basal pulmonary pattern, the expansion of the roots of the lungs. In the study of blood gases reveal hypoxemia, reduced Ra02i RaS02 (the latter due to hyperventilation). Spirographic examination at an early age is usually not possible to carry out. Of peripheral blood can not be changed or reveal unexpressed increased erythrocyte sedimentation rate, leukopenia, and lymphocytosis.   Acute obstructive bronchitis - acute bronchitis, flowing with the syndrome of bronchial obstruction. Usually develops in children at 2-3-year life. 

The clinical picture of acute obstructive bronchitis

 Signs of bronchial obstruction often develop on the first day of SARS (earlier than with bronchiolitis), at least - on the 2-3rd day of illness. The child is observed noisy wheezing with prolonged expiration, audible at a distance (distance wheezing). Children may be restless, often changing body position. However, their general condition, despite the severity of obstructive phenomena remains satisfactory. The body temperature is normal or low-grade. Expressed tachypnea, mixed or expiratory dyspnea, may participate in the breath support muscles, chest swollen, retracted her compliant sites. Percussion sound boxed. Auscultation reveals a large number of scattered wet medium and krupnopuzyrchatyh and dry wheezing. 

Laboratory tests

    On radiographs of the chest presented signs of swelling of lungs: increasing the transparency of lung tissue, horizontally spaced ribs, low position of the dome of the diaphragm. In the study of blood gases show a moderate hypoxemia. In the analysis of peripheral blood may be a slight increase in erythrocyte sedimentation rate, leukopenia, lymphocytosis, with an allergic background - eosinophilia. 

Diagnostics

    Most often, acute bronchitis should be differentiated from acute pneumonia. For bronchitis is characterized by diffuse physical findings in a satisfactory general condition of children, whereas in pneumonia physical changes are asymmetric, presented signs of infectious toxicosis, significantly impaired general condition. Fever is a long one, expressed in the peripheral blood inflammatory changes: neutrophilic leukocytosis, increased erythrocyte sedimentation rate. Radiologically determined by local infiltrative changes of lung tissue.   With repeated episodes of bronchial obstruction is necessary to carry out differential diagnosis of bronchial asthma. 

Treatment

 Treatment of acute bronchitis in most cases symptomatic.

• Bed rest is up to the normalization of body temperature.

• Lacto-vegetarian, vitamin-rich diet.

• Drink plenty of liquids (tea, juice, broth hips, alkaline mineral water, hot milk.

• Restoration of nasal breathing. Use various vasoconstrictor drugs [oxymetazoline, tetrizolin (tizin) Xylometazoline] including combined (with antihistamines, corticosteroids). Using droplet especially vasoconstrictor should not be long, because it can lead to atrophy or alternatively hypertrophy of the mucosa.

• Antipyretics in age dosage body temperature rises above 38,5-39,0 ° C. The drug of choice - paracetamol. A single dose of paracetamol is 10-15 mg / kg orally, 10-20 mg / kg in the candlelight. From the list of excluded use of fever-reducing drugs aminopyrine, antipyrine, phenacetin. Not recommended because of the potential side effects of use of acetylsalicylic acid (aspirin) and sodium metamizol (analgin).

• Antitussives [butamirat (sinekod) glaucine, prenoxdiazine (libeksin)] is used only in the case of dry cough intrusive. Hypersecretion of mucus and bronchoconstriction - a contraindication to antitussives.

• Expectorants (drugs Thermopsis, marshmallow, licorice, essential oils, Terpin hydrate, sodium, and potassium iodide, sodium bicarbonate, salt solutions) and mucolytics (cysteine, acetylcysteine, chymotrypsin, bromhexine, ambroxol) drugs are indicated for all clinical variants of the bronchitis. Means to facilitate the evacuation of sputum, are usually prescribed orally or by inhalation using a nebulizer or an aerosol inhaler. Currently, there are a large number of effective combination therapies that have different effect: muko and sekretoliticheskoe, expectorant, anti-inflammatory, reduces swelling of the mucous membranes (bronhikum, etc.).