Bronchial obstruction syndrome (bronchospastic syndrome): causes, symptoms, diagnosis and treatment

At the core bronchospastic syndrome there is a violation of bronchial obstruction. The term “bronchospastic syndrome” has synonyms – “bronchial obstruction syndrome”, “bronchial obstruction syndrome”, bronchial obstruction", "bronchial obstruction syndrome", " asthmatic syndrome or component."

Bronchospastic syndrome is observed in diseases and pathological conditions, occurring with obstruction of bronchial patency. This happens with spasm of their smooth muscles, swelling of the mucous membrane during inflammatory or stagnation V bronchopulmonary system, obstruction of the bronchi with vomit, sputum, tumor, foreign body, as well as cicatricial narrowing of the bronchi and their compression from the outside by the tumor.

The resistance to the air stream flow increases in proportion to the degree of lumen of the bronchus through which the air passes. Therefore, when the lumen of the airways narrows, the work of the respiratory muscles sharply increases. Bronchospastic syndrome determines the obstructive nature of alveolar ventilation disorders in acute and chronic respiratory failure.

Bronchospastic syndrome is divided according to its etiology into primary and secondary (symptomatic), and according to the nature of its course - into paroxysmal and chronic.

Primary bronchospastic syndrome underlies bronchial asthma. Main symptom of this disease is an attack of suffocation caused by bronchial hyperreactivity, and the main pathogenetic mechanisms are spasm of bronchial smooth muscles, hypersecretion of the bronchial glands and swelling of the bronchial mucosa.

Secondary , or symptomatic, bronchospastic syndrome is causally associated with other (except bronchial asthma) diseases or pathological conditions that can lead to bronchial obstruction. It most often occurs in diseases of allergic origin (anaphylactic shock, laryngeal edema), autoimmune and infectious-inflammatory diseases of the bronchopulmonary apparatus, obstructive pathological processes (malignant and benign tumors, bronchostenosis due to tuberculosis, burns of the respiratory tract), diseases of the circulatory system causing hemodynamic disturbances in the bronchopulmonary apparatus (primary pulmonary hypertension, thromboembolism pulmonary artery, congestive left ventricular failure).

Clinical manifestations of bronchospastic syndrome Regardless of the etiology and pathogenetic mechanisms, in most cases the same type - shortness of breath and attacks of suffocation, often of the expiratory type, paroxysmal cough, respiratory sounds audible at a distance (usually dry wheezing).

Paroxysmal bronchospastic syndrome occurs in the form of an attack of suffocation, which develops suddenly or within a short time, often at night. Patients feel a sudden lack of air. Dyspnea is usually expiratory in nature, but can be inspiratory or mixed. During an attack, breathing is noisy, whistling, and can be heard from a distance. Patients usually take a forced position. They prefer to sit leaning forward and resting their hands on their knees, the edge of a table, bed or window sill, which helps to include auxiliary muscles in breathing. The facial expression is pained, speech is difficult (with a severe attack of suffocation, almost impossible). Patients are worried, scared, gasping for air. The face is pale, with a bluish tint, covered with profuse cold sweat.

A cough with bronchospastic syndrome can be dry and wet. A dry cough (irritation cough, nonproductive cough), in which sputum is not expectorated, is observed in the initial period of an acute inflammatory or edematous process in the trachea and bronchi, for example, during an attack of bronchial asthma. When inhaling smoke and other irritating substances, or getting a foreign body or pieces of food into the respiratory tract, an attack of severe dry cough occurs. A constant dry cough is characteristic of stenosis of the trachea and large bronchi, compression by a tumor or enlarged lymph nodes. In these cases, the cough is paroxysmal and has a rattling, nasal tone.

In case of acute inflammatory or edematous process in the larynx, trachea and large bronchi, for example, acute laryngitis or tracheobronchitis, a rough, barking cough, combined with hoarseness or aphonia, sore throat. Attacks of such a cough can lead to suffocation, cyanosis and even result in a short-term loss of consciousness, which often gives rise to misdiagnosis bronchial asthma. A silent, weak and short cough indicates damage to the small bronchi and bronchioles.

In chronic diseases of the larynx and trachea, with prolonged stagnation of blood in the lungs in patients with pathologies of the circulatory system, the cough is usually constant and is provoked by mildly irritating odors and even changes in the temperature and humidity of the inhaled air.

Visual observations of sputum allow us to make an assumption about the nature of the underlying disease or pathological process. For example, a cough with light mucous viscous sputum is observed with tracheitis and acute bronchitis at the beginning of the disease, later the sputum becomes greenish, mucopurulent. At chronic bronchitis with damage to the large bronchi, the sputum is mucopurulent or purulent, the amount is moderate, sometimes very scanty. When the process is localized in the medium-caliber bronchi, the cough is wet, often morning, with mucous discharge purulent sputum. When the small bronchi are affected (obstructive bronchitis) as a result of a painful, dull weakened cough, it is difficult to separate a large number of viscous, thick mucous or mucopurulent sputum. Bloody sputum is observed with pulmonary infarction, tuberculosis, bronchial cancer, and with congestion in the pulmonary circulation. Sputum that looks like “raspberry jelly” is a late symptom of bronchial cancer.

The time of cough onset has a certain diagnostic significance. For chronic inflammation of the upper respiratory tract, especially in smokers, cough is usually observed in the morning. In patients with allergic bronchitis and bronchial asthma, cough appears mainly at night and upon contact with an allergen.

Objective confirmation of bronchospastic syndrome is the expansion of the chest, which is as if in the inhalation position. The veins of the neck swell during inhalation and collapse during exhalation. The muscles of the shoulder girdle, back, abdominal wall and intercostal muscles actively participate in the act of breathing. The rhythm and depth of breathing changes.

If there is difficulty in inhaling, you can detect a predominant contraction of the intercostal muscles and m. sternoclaidomastoidei, which in the chronic course of bronchospastic syndrome become hypertrophied and appear in the form of dense thick cords. With difficulty in exhaling, a predominant contraction of the abdominal muscles is observed, which causes a rise in the diaphragm and an increase in intrathoracic pressure.

If there is a significant obstruction to the flow of air into the lungs and back, a decrease in breathing is observed. If an obstruction occurs in the large bronchi, the duration of inspiration increases (inspiratory dyspnea), and breathing during inspiration becomes noisy (stridor). When the passage of air in the small bronchi and bronchioles is difficult, prolongation of exhalation (expiratory dyspnea) is observed, during which loud, prolonged wheezing can be heard even at a distance. Rare shallow breathing occurs with significant narrowing of the glottis and obstructive form of pulmonary emphysema.

On palpation of the chest its rigidity is revealed, which indicates acute (during an attack of suffocation) or chronic pulmonary emphysema. Vocal tremors are weakened on the side of the obstruction of the conducting bronchus. If the bronchus is clogged with a lump of mucus, then after expectoration the vocal tremor is again determined quite clearly. In case of total bronchospasm, for example, in bronchial asthma, a uniform weakening of vocal tremors may be due to the development of pulmonary emphysema.

With comparative percussion A box sound often appears above the lungs. Topographic percussion allows you to detect prolapse of the lower borders of the lungs. The excursion of the lower pulmonary border decreases.

Auscultation weakened vesicular breathing is determined in patients with widespread (diffuse) narrowing of the airways, with an obstructive form of pulmonary emphysema or obstructive atelectasis. With a sharp and uneven narrowing of the lumen of the small bronchi and bronchioles due to inflammatory swelling of their mucous membrane (bronchitis), hard breathing is heard, i.e. especially increased vesicular respiration. When the passage of air from the small bronchi and bronchioles to the alveoli is difficult and their non-simultaneous expansion, intermittent (saccade) breathing is heard in a limited area of ​​the lungs (usually in the area of ​​the apexes of the lungs). When the trachea or large bronchus narrows (tumor, edema) over the area of ​​stenosis, stenotic breathing (sharply increased physiological bronchial breathing) is heard.

Of the additional respiratory sounds for bronchospastic syndrome, dry wheezing is the most characteristic. They are heard during inspiration and especially during exhalation. Dry wheezing is formed in the bronchi when they are narrowed or when there is a viscous secretion in them in the form of threads or bridges. If low bass dry rales are heard, then the obstructive process is localized in the large and medium bronchi, if voiced, whistling - in the small bronchi and bronchioles. When the trachea and main bronchi are blocked by bronchial secretions or other fluid in the lungs, coarse, often bubbling, moist rales are heard. These wheezes are detected during inhalation and exhalation, and are also clearly audible from a distance. When medium-sized bronchi or small bronchi and bronchioles are blocked by fluid, medium- and fine-bubbly moist rales are detected, respectively.

During an attack, the pulse is rapid, weak in filling, heart sounds are muffled, and there is often an increase in blood pressure (pulmonogenic hypertension).

The attack of suffocation ends with the discharge of thick viscous sputum, often in the form of casts of the bronchi, after which breathing gradually becomes freer and wheezing disappears.

The duration of an attack of suffocation can vary - from several minutes to several hours, but there can be attacks that last up to a day or more, for example, status asthmaticus in bronchial asthma.

The chronic course of bronchospastic syndrome is characterized by a changing nature of shortness of breath depending on various factors - physical and psycho-emotional stress, weather, time of day, the course of the underlying disease that caused bronchial obstruction (dyspnea of ​​the “day after day” type). With a long course of bronchospastic syndrome, chronic pulmonary emphysema develops, and subsequently chronic pulmonary heart disease.

The cause of death in bronchospastic syndrome can be asphyxia, acute heart failure, and paralysis of the respiratory center.

Additional research methods. For diagnosing bronchospastic syndrome, the most important have X-ray examinations and methods for studying the function of external respiration (spirography and pneumotachometry).

Obstructive disorders are characterized by a decrease in speed indicators of spirography and the flow-volume loop - forced vital capacity (FVC) and maximum pulmonary ventilation (MVL), forced expiratory volume in the first second (FEV1), as well as FEV1/VC (Tiffenau index). The level of bronchial obstruction (small, medium, large) is determined by the indicators of the air flow loop - volume.

Obstructive disorders are also confirmed by pneumotachometry (decreased maximum expiratory flow), a positive test with bronchodilators and a test with a match according to Votchal. The last test is considered positive if the patient is unable to blow out (extinguish) a lit match at a distance of 8 cm from the mouth. In the chronic course of bronchospastic syndrome due to developed pulmonary emphysema, vital capacity decreases.

During an attack of suffocation, x-rays often reveal, along with signs of the underlying disease, acute pulmonary emphysema - increased transparency of the lungs, horizontal position of the ribs, widening of the intercostal spaces, low standing of the diaphragm.

The ECG shows signs of increased load on the right side of the heart, which indicates the formation of cor pulmonale.

– a complex of symptoms that is characterized by obstruction of patency bronchial tree functional or organic origin. Clinically, it is manifested by prolonged and noisy exhalation, attacks of suffocation, activation of auxiliary respiratory muscles, and a dry or unproductive cough. The main diagnosis of broncho-obstructive syndrome in children includes the collection of anamnestic data, objective examination, radiography, bronchoscopy and spirometry. Treatment is bronchodilator pharmacotherapy with β2-adrenergic agonists, elimination of the leading etiological factor.

Classification

Depending on the pathogenesis of broncho-obstructive syndrome in children, the following forms of pathology are distinguished:

1. Biofeedback of allergic origin. Occurs against the background of bronchial asthma, hypersensitivity reactions, hay fever and allergic bronchitis, Loeffler's syndrome.
2. biofeedback caused by infectious diseases . Main causes: acute and chronic viral bronchitis, ARVI, pneumonia, bronchiolitis, bronchiectasis.
3. BOS that developed against the background of hereditary or congenital diseases. Most often these are cystic fibrosis, α-antitrypsin deficiency, Kartagener and Williams-Campbell syndromes, GERH, immunodeficiency states, hemosiderosis, myopathy, emphysema and anomalies of bronchial tubes.
4. BOS resulting from neonatal pathologies. Often it is formed against the background of SDR, aspiration syndrome, stridor, diaphragmatic hernia, tracheoesophageal fistula, etc.
5. Biofeedback as a manifestation of other nosologies. Broncho-obstructive syndrome in children can also be triggered by foreign bodies in the bronchial tree, thymomegaly, regional hyperplasia lymph nodes, benign or malignant neoplasms of the bronchi or adjacent tissues.

According to the duration of the course, broncho-obstructive syndrome in children is divided into:

• Spicy. The clinical picture is observed for no more than 10 days.
• Protracted. Signs of bronchial obstruction are detected for 10 days or longer.
• Recurrent. Acute biofeedback occurs 3-6 times a year.
• Continuously relapsing. It is characterized by short remissions between episodes of prolonged biofeedback or their complete absence.

Symptoms of biofeedback in children

The clinical picture of broncho-obstructive syndrome in children largely depends on the underlying disease or provoking factor. this pathology. General state child in most cases is moderate, observed general weakness, moodiness, sleep disturbance, loss of appetite, signs of intoxication, etc. Direct biofeedback, regardless of etiology, has characteristic symptoms: noisy loud breathing, wheezing that can be heard at a distance, a specific whistle when exhaling.

The participation of auxiliary muscles in the act of breathing is also observed, apnea attacks, shortness of breath of expiratory (more often) or mixed nature, dry or unproductive cough. At protracted current Broncho-obstructive syndrome in children may result in the formation of a barrel-shaped chest - expansion and protrusion of the intercostal spaces, horizontal course of the ribs. Depending on the underlying pathology, fever, underweight, mucous or purulent discharge from the nose, frequent regurgitation, vomiting, etc.

Diagnostics

Diagnosis of broncho-obstructive syndrome in children is based on the collection of anamnestic data, objective research, laboratory and instrumental methods. When interviewing the mother, a pediatrician or neonatologist focuses on possible etiological factors: chronic diseases, developmental defects, the presence of allergies, episodes of biofeedback in the past, etc. A physical examination of the child is very informative for broncho-obstructive syndrome in children. Percussion determines the increase in pulmonary sound up to tympanitis. The auscultatory picture is characterized by harsh or weakened breathing, dry, whistling, and in infancy - small-caliber wet rales.

Laboratory diagnostics for broncho-obstructive syndrome in children includes general tests and additional tests. The CBC, as a rule, determines nonspecific changes indicating the presence of a focus of inflammation: leukocytosis, shift leukocyte formula left, increase in ESR, in the presence of allergic component– eosinophilia. If it is impossible to establish the exact etiology, additional tests: ELISA with determination of IgM and IgG to probable infectious agents, serological tests, test with determination of the level of chlorides in sweat for suspected cystic fibrosis, etc.

Among instrumental methods, which can be used for broncho-obstructive syndrome in children, most often use OGK radiography, bronchoscopy, spirometry, and less often - CT and MRI. X-ray makes it possible to see the expanded roots of the lungs, signs concomitant lesion parenchyma, the presence of neoplasms or dilated lymph nodes. Bronchoscopy allows you to identify and remove a foreign body from the bronchi, assess the patency and condition of the mucous membranes. Spirometry is carried out during long-term broncho-obstructive syndrome in children in order to assess the function of external respiration, CT and MRI - with low information content of radiography and bronchoscopy.

Treatment, prognosis and prevention

Treatment of broncho-obstructive syndrome in children is aimed at eliminating the factors causing obstruction. Regardless of the etiology, hospitalization of the child and emergency bronchodilator therapy using β2-adrenergic agonists are indicated in all cases. In the future, anticholinergic drugs may be used, inhaled corticosteroids, systemic glucocorticosteroids. Mucolytic and antihistamines, methylxanthines, infusion therapy. After determining the origin of broncho-obstructive syndrome in children, etiotropic therapy is prescribed: antibacterial, antiviral, anti-tuberculosis drugs, chemotherapy. IN in some cases Surgery may be required. If there is anamnestic data indicating possible entry of a foreign body into the respiratory tract, emergency bronchoscopy is performed.

The prognosis for broncho-obstructive syndrome in children is always serious. The younger the child, the more severe his condition. Also, the outcome of biofeedback largely depends on background disease. In acute obstructive bronchitis and bronchiolitis, as a rule, recovery is observed; hyperreactivity of the bronchial tree rarely persists. Biofeedback in bronchopulmonary dysplasia is accompanied by frequent acute respiratory viral infections, but often stabilizes by the age of two. In 15-25% of such children it transforms into bronchial asthma. BA itself can have a different course: a mild form goes into remission already in the youngest school age, severe, especially against the background of inadequate therapy, is characterized by a deterioration in the quality of life, regular exacerbations with fatal in 1-6% of cases. BOS against the background of bronchiolitis obliterans often leads to emphysema and progressive heart failure.

Prevention of broncho-obstructive syndrome in children implies the exclusion of all potential etiological factors or minimizing their impact on the child’s body. This includes antenatal fetal care, family planning, medical and genetic counseling, rational use of medications, early diagnosis And adequate treatment acute and chronic diseases respiratory system, etc.

Broncho-obstructive syndrome (BOS) - often found in medical practice, difficult to develop respiratory failure. The syndrome occurs in people who often suffer from respiratory ailments, when cardiovascular pathologies, poisoning, diseases of the central nervous system- in general, for more than 100 diseases.

It is especially difficult in children younger age. Why is it developing? this syndrome How to recognize it and start treatment on time - we will consider later in the article.

Brief characteristics and classification of biofeedback

Broncho-obstructive syndrome (BOS) is not an independent medical diagnosis or disease, biofeedback is a manifestation of individual nosological forms. For example, in children under three years of age, half of the cases of bronchial obstruction syndrome are caused by asthma.

Also in children, cases of biofeedback may occur due to congenital anomalies nasopharynx, swallowing disorders, gastroesophageal reflux and others.

Did you know? Anatomically, the bronchi resemble an inverted tree, which is why they got their name - the bronchial tree. At its base, the width of the lumen is up to 2.5 cm, and the lumen of the smallest bronchioles is 1 mm. The bronchial tree branches into several thousand small bronchioles, which are responsible for gas exchange between the lungs and blood.

Bronchoobstruction is a clinical manifestation of bronchial obstruction with further resistance to air flow. When obstruction occurs, a generalized narrowing of the bronchial lumen of the small and large bronchi occurs, which causes their vibration and whistling “sounds”.

The syndrome develops especially often in children under 3 years of age who have a family history, are prone to allergic reactions, and often suffer from respiratory diseases. The basis for the occurrence of biofeedback is the following mechanism: inflammation occurs of various etiologies, which entails spasm and further narrowing of the lumen (occlusion). As a result, compression of the bronchi occurs.

Bronchial obstruction syndrome is classified according to its form, duration and severity of the syndrome.

Depending on the form of BFB, it can be:

1. Infectious (viral and bacterial).
2. Hemodynamic (occurs with cardiac pathologies)
3. Obstructive.
4. Allergic.

Depending on the duration of the course, there are:

1. Acute BOS. Accompanied by a pronounced clinical picture, symptoms appear for more than 7 days.
2. Protracted. Clinical manifestations are less pronounced and the course is long-lasting.
3. Recurrent. Acute periods are abruptly replaced by periods of remission.
4. Constantly recurrent. Periods of incomplete remission are followed by exacerbations of the syndrome.

Reasons for development

Among the diseases that may be accompanied by the occurrence of BOS are:

Functional changes are amenable to conservative treatment, while the elimination of organic changes is carried out only in some cases by surgical intervention and due to the child’s adaptive capabilities.

Among functional changes produce bronchospasm, large selection sputum during bronchitis, swelling of the bronchial mucosa, inflammation and aspiration. Organic changes include birth defects development of the bronchi and lungs, stenosis, etc.

Biofeedback in children is due to physiological features at such a young age - the fact is that the child’s bronchi are significantly narrower, and their additional narrowing as a result of edema, even by one millimeter, will already have a noticeable negative effect.

The normal functioning of the bronchial tree may be disrupted in the first months of life due to crying frequently, staying on your back, sleeping for a long time.
Also an important role is played by prematurity, toxicosis and taking medications during pregnancy, complications during pregnancy. birth process, from the mother and so on.

In addition, the baby’s processes have not yet stabilized until they are one year old. immune defense, which also plays a role in the occurrence of bronchial obstruction.

Signs and symptoms

TO clinical manifestations broncho-obstructive syndrome include the following:

• prolonged inhalation;
• the appearance of whistling and wheezing during breathing;
• lingering unproductive;
• increase breathing movements, participation of auxiliary muscles in the breathing process;
• hypoxemia;
• the appearance of shortness of breath, lack of air;
• chest enlargement;
• breathing becomes loud, weakened, or harsh.

The listed symptoms indicate precisely the occurrence of a narrowing of the bronchial lumen. However, general symptoms are largely determined by the underlying pathology that caused the biofeedback.
When the disease occurs, the child exhibits moodiness, sleep and appetite disturbances, weakness, and symptoms of intoxication occur; the temperature may rise and body weight may decrease.

When contacting a therapist or neonatologist, the doctor will interview the baby’s mother for allergies, recently past diseases, identified developmental disorders, family history.

In addition to presence clinical signs y, to make a diagnosis of BOS, it is necessary to conduct specific physical and functional studies.

The most important test to confirm the diagnosis is spirometry- in this case, the volume of inhaled and exhaled air, lung capacity (vital and forced), the amount of air during forced inspiration, and the patency of the respiratory tract are examined.

TO therapeutic procedures may include:

1. Special breathing exercises.
2. Using breathing simulators.
3. Drainage.
4. Vibration chest massage.
5. Speleotherapy.
6. Balneological procedures.
7. Physiotherapy.

If a child feels satisfactorily, you should not force him to follow bed rest - physical activity promotes better removal of mucus from the bronchi.

Also make sure your baby gets enough fluids per day: these can be herbal teas, infusions, fruit juices and fruit drinks, unsweetened compotes.

Forecast

The prognosis for the development of biofeedback depends on the primary pathology and its timely treatment. Also, the consequences and severity of the disease are determined by the age of the child: the younger the age, the more expressive the manifestations of the disease and the more complex the course of the underlying disease.

With bronchitis, the prognosis is positive, but with pulmonary dysplasia there is a risk of BOS degenerating into asthma (in 20% of cases). Against the background of bronchiolitis, heart failure and emphysema may occur.

Cases of frequent, unproductive, debilitating cough can lead to nausea and expectoration of blood due to damage to the respiratory tract. Therefore, it is important to seek qualified help as early as possible and begin adequate therapy in order to prevent undesirable consequences.

Did you know? During the day we make up to 23 thousand respiratory movements: inhalations and exhalations.

Basic rules of prevention include the following points:

In 80% of cases, BOS occurs from birth to three years. The syndrome causes a lot of trouble for both the child and the parents. However, if pathology is identified in time and therapeutic actions are initiated, serious consequences for the health of the child can be avoided.

It is a fairly common pathology.
There are many known diseases that are accompanied by this syndrome. It can occur with respiratory diseases, pathologies of cardio-vascular system, poisoning, diseases of the central nervous system, hereditary metabolic abnormalities, etc. (about 100 diseases).

With broncho-obstructive syndrome, bronchial obstruction occurs due to narrowing or occlusion of the airways.

The predisposition to obstruction in children is associated with their anatomical and physiological characteristics:
The bronchi in children are smaller in diameter than in adults, which leads to an increase in aerodynamic drag;
The cartilage of the bronchial tree is more pliable compared to adults;
The chest has insufficient rigidity, which leads to significant retraction of compliant areas (above and subclavian fossae, sternum, intercostal spaces);
There are more goblet cells in the bronchial wall than in adults. It leads to more allocation mucus;
Edema of the bronchial mucosa rapidly develops in response to various irritating factors;
The viscosity of bronchial secretions is increased compared to adults (due to the increased amount of sialic acid);
Low collateral ventilation;
The smooth muscle system of the bronchi is poorly developed;
Reduced formation of interferons, secretory and serum immunoglobulin A in the respiratory tract.

For practical purposes, taking into account the etiology of this symptom complex, bronchial obstruction can be divided into 4 options:
Infectious variant which develops as a result of a viral or bacterial inflammation bronchi (obstructive bronchitis, bronchiolitis);
Allergic variant, when bronchospasm predominates over inflammatory phenomena(bronchial asthma);
Obstructive variant - occurs during aspiration foreign bodies.
A hemodynamic variant can occur in heart disease when left ventricular heart failure develops.

In practice, the first two options are most common.
Therefore, let's look at them in more detail.

Broncho-obstructive syndrome infectious origin occurs when obstructive bronchitis and bronchiolitis. The etiology is viral or viral-bacterial.
Among viruses, the leading role belongs to respiratory syncytial viruses (in half of the cases), adenovirus, and parainfluenza virus. Bacteria include mycoplasma and chlamydia.

A characteristic feature of this type of obstruction is the predominance of edema, infiltration and hypersecretion of the mucous membrane over bronchospasm.

For obstructive bronchitis broncho-obstructive syndrome develops 2-4 days from the onset of a respiratory viral infection. Expiratory shortness of breath, distant wheezing, noisy breathing. Percussion above the lungs is a box sound. On auscultation, the exhalation is prolonged, diffuse dry whistling, buzzing rales on both sides. At a younger age, moist rales of various sizes are possible.

Bronchiolitis Children under 2 years of age (usually up to 6 months) are affected. Bronchiolitis affects the bronchioles and small bronchi. Characterized by severe respiratory failure II-III degrees. Tachypnea, acrocyanosis. On auscultation there is an abundance of fine bubbling moist rales on both sides. Intoxication syndrome not expressed.
X-ray shows an increase in the pulmonary pattern, horizontal standing of the ribs, widening of the intercostal spaces, and the dome of the diaphragm is lowered.

Bronchiolitis obliterans — serious disease, which has a cyclic flow. Its reason is predominantly adenovirus infection(can also occur with whooping cough and measles). Children under 3 years old are sick. Acute period proceeds like ordinary bronchiolitis, but with more pronounced respiratory disorders. Obstruction persists for a long time (up to 2 weeks), and may even increase. Characteristically, “cotton shadows” appear on the radiograph.
In the second period, the condition improves, but the obstruction persists and periodically intensifies, as during an asthmatic attack. The phenomenon of “super-transparent lung” is formed. Treatment is very difficult.

Broncho-obstructive syndrome allergic origin occurs in bronchial asthma. Obstruction in this case is caused mainly by spasm of the bronchi and bronchioles, and to a lesser extent by edema and hypersecretion of the mucous membrane of the bronchial tree. There is a burdened allergy history (allergic dermatitis, allergic rhinitis and etc.) Attacks of obstruction are associated with the presence of an allergen, and are not associated with infection. Characterized by the same type of attacks and their recurrence.

Clinically there are no signs of intoxication. The attack occurs on the first day of the disease and is relieved in a short time (within a few days). During an attack, expiratory shortness of breath with the participation of auxiliary muscles. On auscultation, the number of wheezing rales is greater than that of wet rales. With severe bronchospasm, weakened breathing in lower parts lungs. There is a good effect from bronchospasmolytics.

In some children who have suffered obstruction due to a viral infection, broncho-obstructive syndrome may take a recurrent course.

The reason for recurrence may be:
Development of bronchial hyperactivity (most common reason);
Debut of bronchial asthma;
The presence of latent chronic lung diseases (such as cystic fibrosis, malformations of the bronchopulmonary system).

Bronchial hyperactivity develops in more than half of children who have had viral infection or pneumonia with obstructive syndrome. This state of hyperactivity can last from one week to several months (3-8 months).
It was noted that recurrence of obstruction in children under 6 months. - this is most likely bronchial hyperactivity, before 3 years of age, then this is the beginning of bronchial asthma.

Treatment of broncho-obstructive syndrome.
The main directions in the treatment of broncho-obstructive syndrome in children should include:
1. Improving the drainage function of the bronchi;
2. Bronchodilator therapy;
3. Anti-inflammatory therapy.

1. To improve the drainage function of the bronchi, it is necessary to carry out:
Rehydration;
mucolytic therapy;
postural drainage;
massage;
breathing exercises.

Mucolytic therapy is carried out taking into account the amount of sputum, the severity of the process, the age of the child. Its main goal is to dilute the sputum and increase the effectiveness of the cough.

In children with an unproductive cough and thick sputum, inhaled and oral administration of mucolytics is recommended. The best of them are considered to be ambroxol preparations (lazolvan, ambrobene). They have mucolytic, mucokinetic effects, increase the synthesis of sulfactant, and are low-allergenic.

In children with mild and medium degree severity of broncho-obstructive syndrome, acetylcysteine ​​can be used.

In children with an obsessive, hacking cough with no sputum, expectorants (herbal medicines) can be used. They are prescribed with caution in children with allergies. A decoction of coltsfoot and plantain syrup are used.

You can combine mucolytics and expectorants.
At severe course Mucolytics are not prescribed for broncho-obstructive syndrome on the first day.

Antitussive drugs are excluded from all patients with broncho-obstructive syndrome.

Combination drugs with ephedrine (solutan, broncholitin) should be prescribed with caution. They can be used only in cases of hyperproduction of abundant bronchial secretions, since effedrine has a drying effect.

2. Bronchodilator therapy.

For this purpose, children use:
b2 antagonists short acting;
anticholinergics;
short-acting theophylline preparations and their combinations.

Short-acting b2 antagonists include Salbutamol (Ventolin), Fenoterol, etc. They are the drugs of choice for relieving acute obstruction. When administered via a nebulizer, it is given quick effect. They are prescribed 3 times a day.

These are highly selective drugs and therefore side effects they are minimal. However, with uncontrolled and prolonged use, there may be an increase in bronchial hyperactivity (sensitivity to b2 receptors decreases).

In case of a severe obstructive attack, you can inhale Ventolin through a nebulizer 3 times for one hour (every 20 minutes). This is the so-called “emergency therapy”.

Anticholinergic drugs (muscarinic M3 receptor blockers) are also used. These include Atrovent (ipratroprium bromide). It is dosed from 8 to 20 drops through a nebulizer 3 times a day.

In young children therapeutic effect anticholinergic drugs are slightly better than short-acting b2 antagonists. But their tolerability is somewhat worse.

Widely used combination drugs, which include agents acting on these two types of receptors. This is Berodual, which includes ipratroprium bromide and fenoterol. They act synergistically, which gives a good effect. Berodual is prescribed - 1 drop. per kg (single dose) 3 r. per day.

Short-acting theophyllines include aminophylline. It is widely used to relieve bronchial obstruction in children. Its use has both positive and negative sides.

TO positive aspects include: pretty high efficiency; low cost; ease of use;
TO negative aspects– a large number of side effects.

The main reason that limits the use of aminophylline is the proximity of the therapeutic and toxic doses. This requires monitoring the drug in the blood plasma (concentration of 8-15 mg per liter is optimal). An increase in concentration greater than 16 mg per liter can lead to unwanted effects: nausea, vomiting, development of arrhythmia, tremor, agitation.

It is especially necessary to use aminophylline with caution in children who take macrolides (the clearance of aminophylline slows down).However, even therapeutic doses can lead to complications.

Now aminophylline is a second-line drug. It is used when there is no effect from short-acting b2 antagonists and anticholinergic drugs. In case of a severe attack of obstruction, the drug is prescribed at a dose of 4-6 mg/kg every 6-8 hours.

3. Anti-inflammatory therapy.

The goal of this therapy is to reduce the activity of the inflammatory process in the bronchi.
Drugs in this group include Erespal (fenspiril).

Its anti-inflammatory effect is as follows:
Blocks H-1 histamine and alpha adrenergic receptors;
Reduces the amount of leukotrienes;
Reduces the amount of inflammatory mediators;
Suppresses the migration of inflammatory cells.

Erespal, in addition to its anti-inflammatory effect, reduces mucus hypersecretion and bronchial obstruction. It is the drug of choice for bronchial obstruction in children early age infectious genesis. A good effect was observed when the drug was prescribed from the first days of the disease.

In severe obstructive processes, glucocorticoids are used for anti-inflammatory purposes. They are preferred inhalation method administration, as it is highly effective and less dangerous. It is recommended to administer Pulmicort through a nebulizer 1-2 times a day at a dose of 0.25-1 mg. It is better when inhalation is done 20 minutes after inhalation of the bronchodilator. The duration of therapy is usually 5-7 days.

Parenteral corticosteroids are used for bronchiolitis and status asthmaticus. The usual dose is 2 mg per kg per day for prednisolone. For bronchiolitis, the dose is 5-10 mg per kg per day in 4 divided doses (every 6 hours), not taking into account the circadian rhythm.

Antihistamines are used only in the presence of allergic diseases.

Etiotropic treatment consists of the use of antiviral and antibacterial therapy.

Antibiotics should be used as indicated in following cases:
Hyperthermia that lasts more than 3-5 days;
When there is no effect from the treatment;
Asymmetrical wheezing;
The presence of toxicosis, especially when it increases;
Presence of purulent sputum;
Presence of hypoxia;
Leukocytosis, shift of the leukocyte formula to the left, increased COE, neutrophilia.

For respiratory failure, oxygen therapy is administered through a mask or nasal catheters.

In conclusion, I would like to note that it is now widely used in the treatment of broncho-obstructive syndrome. With this inhalation therapy can be provided emergency assistance with obstruction in short time without resorting to parenteral administration medicines.

Broncho-obstructive syndrome is most often observed in children. Typically, the first signs begin to appear at the age of 1-3 years. As soon as the first symptoms appear, the doctor should immediately carry out full examination and identify the cause of the disease. Afterwards a course of treatment is prescribed.

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Most often, the disease is diagnosed in children prone to allergic reactions. Signs of the disease are observed in young children, who are often exposed to respiratory infections.

Broncho-obstructive syndrome is differentiated by specialists into 4 types:

• light form;
• medium shape;
• severe form;
• obstructive form.

Each species is characterized certain symptoms. Manifestations include coughing. Broncho-obstructive syndrome also varies in duration.

• acute form manifests itself with symptoms that are observed for 10 days;
• protracted syndrome manifests itself in unexpressed clinical picture and long treatment;
• during a relapse, symptoms appear and disappear on their own;
• Continuously relapsing syndrome is characterized by noticeable remission and exacerbations.

The pathogenesis of the disease may be hidden in allergic reactions, infectious infection, as a result of low blood flow in the lungs when the bronchial lumens are too full. Also the reasons are as follows:

IN modern world Due to environmental problems, broncho-obstructive syndrome in children appears more and more often every year. The body of a fragile baby is not able to fight infections and viruses, and air pollution leads to problems with respiratory system. The pathogenesis of broncho-obstructive syndrome indicates that in conditions bad ecology the body is more susceptible to such diseases. The disease occurs not only in young children, but also in adults.

Symptoms and complications

Symptoms that indicate the presence of broncho-obstructive syndrome include the following:

1. Dyspnea. Respiratory shortness of breath occurs when the upper respiratory tract is affected. With it, inhalation is much slower. Breathing is difficult. Attacks of suffocation often occur. When they come to an end, sputum begins to leave. Most often, an attack occurs at night or during heavy physical activity. With age, an attack can occur from any physical activity, for example when climbing stairs. At this moment, it is imperative to take a sitting position.
2. Uncharacteristic breathing. It contains wheezing and whistling sounds. It can be heard even over long distances.
3. Cough. This is the first sign of damage to the upper respiratory tract. Usually accompanied by purulent discharge, sputum has the viscosity. The cough may be characterized as persistent and ineffective.
4. Voice. The pronounced voice tone is weakened, sometimes the voice completely disappears.

With long-term and protracted syndrome, there are deficiencies in body weight, changes in chest, nasolabial cyanosis. The patient's condition seems quite normal to him.

If treatment is not started on time, this condition can lead to complications, among which doctors identify the following diseases:

• heart failure;
• arrhythmia;
• paralysis of the respiratory center;
• pneumothorax;
• secondary emphysema;
• pulmonary acute heart;
• suffocation.

All this can occur against the background of prolonged broncho-obstructive syndrome, which has not been properly treated. Therefore, as soon as the first symptoms appear, you must immediately contact a specialist, undergo a full examination and treatment.

Specifics of treatment

Such a syndrome is not a specific disease, but only an indicator that certain problems and disorders are observed in the body. This condition is typical for both adults and children. Before prescribing treatment, the specialist must conduct a complete examination of the patient to establish the cause of broncho-obstructive syndrome.

When installed accurate diagnosis, treatment is prescribed, which usually includes a whole range of measures.

First, anti-inflammatory therapy is carried out, aimed at relieving the syndrome itself, then drainage therapy is carried out to restore the activity of the bronchi. During this procedure, the following activities are prescribed:

• massage;
• mucolytic therapy;
• physiotherapy;
• breathing exercises;
• drainage

All this is aimed at thinning mucus and improving expectoration during coughing. Sometimes as complementary therapy use various inhalations.

good folk remedy In the fight against the disease, plantain syrup or a decoction of coltsfoot can be considered.

Anti-cough drugs occupy a leading position in the fight against broncho-obstructive syndrome.

This video talks about broncho-obstructive syndrome:

Anti-inflammatory measures are carried out to relieve inflammatory process in the bronchi. Erespal is considered the main drug for this. It improves the functioning of the bronchi and controls the secreted fluid. Best effect when taking the drug is achieved at initial stages diseases. Can be used by young children.

To remove acute syndrome Inhalations are usually prescribed. Their effect occurs almost immediately. The most commonly prescribed drug is Pulmicort.

For allergic ailments, antihistamine drugs are prescribed, such as Fenistil, Suprastin, Loratodine. If a sick person cannot breathe on his own, an oxygen mask is put on him.

This video talks about the diagnosis and treatment of broncho-obstructive syndrome:

Treatment should be carried out as soon as the first symptoms are suspected. If this is not done, the disease may become acute or chronic form. In this case, the treatment will be protracted. Broncho-obstructive syndrome can lead to suffocation.