Airway hyperresponsiveness in children. Causes of asthmatic syndrome. Causes, symptoms and treatment of yeast fungus in men

Bronchial hyperactivity is considered one of the most common problems respiratory system both in young children and adults. This sharp spasm smooth muscles of the bronchi, caused by many various reasons, starting from frequent attacks allergies before hereditary factor. With an incorrect or untimely approach to therapy, excessive hyperreactivity respiratory tract may lead to the development bronchial asthma.

This syndrome is dangerous in its manifestation especially in young children. At this time, ventilation of the lungs increases greatly, which indicates an excessive increase in the amount of oxygen and a decrease in carbon dioxide in blood. It is quite easy to suspect it due to a number of signs similar to an asthmatic attack, such as chest pain, shortness of breath and weakness. But before you panic, you should find out the reason for such dangerous manifestations and eliminate it if possible.

This condition may be a consequence of the presence of the following pathologies:

• Lung obstruction.
• Infection with viral or bacterial infections.
• Manifestation of an allergic reaction.
• Obstructive inflammatory processes in the bronchi.
• Heredity or predisposition to this syndrome.
• Congenital or acquired pathologies of the respiratory tract.
• Unsuccessfully transferred respiratory diseases.

If there are several reasons, and they work long time, depressing breathing, may develop this syndrome. Also this manifestation may be specific, that is, caused specific pathogen or a factor such as an allergy. Or nonspecific, when such an attack appears as a consequence stressful situation or nervous breakdown.

Characteristic symptoms

Bronchial hyperreactivity has its own characteristics of manifestation, noticing which can almost 100% confirm or at least suspect a problem. This is very important, because the reaction to excessive amounts of oxygen, shortness of breath and tightness in the sternum can have disastrous consequences, if the patient is not quickly helped.

The attack has the following distinctive manifestations:

• Periodic mild symptoms difficulty breathing.
• The appearance of a whistling sound from the lungs when exhaling.
• Shortness of breath or, conversely, suffocation.
• Pallor or Blue colour skin.
• Feelings of panic, fear, fright.

Periodic manifestations specified symptoms allow you to think about problems in the body, especially in children. Therefore, symptoms should be eliminated as quickly as possible and possible reasons such a syndrome.

Pathogenesis

Bronchial hyperreactivity can be inherited, but cases of such a defect in the parents themselves are rare. Often one of the close relatives has problems with the endocrine system, allergic reactions or disruptions in metabolic processes. However physiological changes airways can also lead to shortness of breath and a further increase in such attacks.

The following phenomena may also serve as risk factors:

• Constant exposure to external allergens, for example, pollen, dust, animal hair. This is the most common reasons, due to which a child or adult may suffer from bronchial hyperactivity.
• Allergies to various medications or their components.

The transmission may be different, but the most important thing to remember is long and common problems with breathing, especially if there are a lot of them, sooner or later can lead to the development of shortness of breath, difficulty breathing and, as a consequence, to bronchial asthma.

Treatment options

Before you self-medicate, you should visit a doctor and tell him what specifically is bothering you. Based on the collected history and tests performed, the doctor will be able to identify the causes and try to eliminate them. Treatment and relief of seizures - important detail, which should be started immediately. After all, for example, a child is very sensitive to this kind of manifestation of pathology. He may not be able to withstand hyperventilation and get scared, which will only worsen the situation.

First of all, it is necessary to select drugs that quickly stop the attack and prevent it from developing:

• Sodium cromoglycate.
• Theophylline.
• Omalizuab.
• For inhalation it is good to use glucocorticosteroids.

To reduce bronchial hypersensitivity, you can use medications for allergy sufferers or other medications. The difference in the treatment of small and large patients depends only on the selection of dosage. Only the doctor treating you can solve this problem; it is not recommended to do this on your own, since breathing problems can lead to suffocation and instant death.

Prevention

No less important are preventive actions, which should be observed systematically, especially if there is a tendency to this kind of trouble. To do this, you should adhere to the following elementary rules, namely:

1. Observe personal hygiene rules, especially for young children.
2. Rinse the nasopharynx.
3. Engage in daily physical activity, at least in minimal quantities.
4. Eat a balanced diet.
5. Sleep at least 8 hours.
6. Use constantly medicines to stop the development of possible attacks.

Doctors recommend visiting wooded areas and avoiding seas or mountain peaks, since the air is saturated with excessive amounts of oxygen, and with such a pathology there is already enough of it. Bronchial hyperreactivity cannot be cured, but it is quite possible to live with this disease, just follow the doctor’s recommendations and take medications on time. Inhalers to restore breathing should also always be carried with you; the substances included in their composition will help to quickly relieve an attack.

Bronchial hyperreactivity – dangerous phenomenon, which can be prevented preventive measures. This is better than turning a blind eye to the development of the disease or self-medicating.

Few people are familiar with the concept of bronchial hyperactivity. What it is? Often this disease manifests itself in children in unmotivated coughing attacks. This reaction occurs to some allergens or medications. Often it may indicate the development of asthma.

Causes of asthmatic syndrome

For what reasons do children develop asthmatic syndrome? Here doctors identify two main reasons:

1. Genetic predisposition. One or both parents have a disorder endocrine system, metabolic processes or allergies. This naturally passed on to the baby.
2. Features of the structure of the respiratory tract. No one can cancel the cases when parents do not suffer from anything, but their child develops pathological reactions. It is often noted that the baby was born with pathologies in the structure of the respiratory system, which provokes an unmotivated reaction.

Among other things, the following causes of asthmatic syndrome are distinguished:

• Allergic reaction to pollen, dust, wool, substances, etc.
• Allergic reaction to certain group medicines.
• Respiratory infections.

The overlap of several causes increases the risk of developing the disease. The syndrome is divided into specific and nonspecific. A special case arises when we're talking about about an allergy to a specific irritant. A nonspecific case occurs when attacks occur not due to allergies, but due to a nervous breakdown, physical exertion, mental stress, respiratory diseases, etc.

Characteristic symptoms

An attack of bronchial hyperactivity has its own distinctive characteristic symptoms:

• An attack of difficulty breathing that is episodic.
• Whistle when inhaling air.
• Feeling of suffocation.

These symptoms do not indicate healthy condition person, especially when it comes to a child. Here you need to start quick elimination symptoms and causes of their occurrence.

Treatment

Treatment should be carried out under the guidance of a doctor, who will first identify the allergen and then prescribe the necessary doses of a particular medicine. Self-medication may be ineffective or useless. Therefore, readers of bronhi.com should consult a doctor, especially if it is about the health of a child.

Elimination of bronchial hyperactivity does not occur without

• Sodium cromoglycates.
• Theophylline.
• P2-agonists.
• Omalizuaba.
• Glucocorticosteroids in inhalations.

Treatment for children differs from adults only in dosage, but the drugs themselves remain the same. The method of avoiding contact with the allergen becomes effective. The doctor can identify what a person is allergic to, which will allow the patient to further avoid situations where the irritant may cause an allergic reaction in him.

Autumn and spring become the seasons when the body's reactions become especially acute. IN in this case Prevention should be carried out, which consists of:

1. maintaining personal hygiene;
2. rinsing the nasopharynx;
3. moderate exercise;
4. proper nutrition;
5. maintaining a daily routine;
6. using medications to control the disease.

It is recommended to spend frequent holidays in sanatoriums located in the forest area. Sea holidays and mountain peaks should be avoided, since special weather may provoke an unhealthy condition.

In any case, the disease is not curable, but it is effectively stopped. Periodic treatment helps in eliminating situations when allergic reaction. It is important to always have inhalation devices on hand that can calm an attack.

A situation where a cough occurs without clear visible reasons, is familiar to many people. Sometimes these are long-term residual effects after an acute respiratory viral infection, which seemed to have happened quite a long time ago. In other cases, there has been no illness in the recent past, but the cough is still present. One explanation for this mystery is bronchial hyperreactivity (BHR) - pathological condition lower respiratory tract.

Overprotection

The respiratory tract is designed to bring oxygen into the body - and in performing this function, they obviously come into contact with the external environment. And outside there is not only oxygen, but also dust, insects, irritating substances that damage the delicate mucous membrane, and even ordinary crumbs that fall “in the wrong throat” due to chatter while eating.

To protect the bronchi from what should not enter them, two ways have emerged. The first is mucociliary clearance: a system of special cells that secrete mucus and bronchial cilia, which, with their movement, “drive” this mucus from the inside out. The second is a reflex response to irritation: mechanical (conditional “crumbs”), chemical (irritating substances), thermal (cold/hot air). The main reflexes are the cough impulse and the ability of the bronchi to sharply narrow in response to an irritant.

The narrowing of the bronchi sharply limits the intake of irritants; what has already entered “settles” on the mucus, the cilia expel this mucus from the bronchi, and a reflex cough helps to finally get rid of it (coughing up phlegm). This is how everything happens normally. But if for some reason the cells that perceive irritation (irritative receptors) have a “misplaced reference”, false positives begin - the bronchi react to irritants that actually do not pose a danger to the body: a small number of dust particles, low concentrations of chemicals, small temperature changes. This is how an unreasonable cough occurs.

There are two main reasons why irritative receptors turn into paranoids. Firstly, there is an imbalance in the work of the sympathetic and parasympathetic divisions nervous system. The first is responsible for the expansion of the bronchi, the second - for the narrowing. If parasympathetic activity is higher than normal, the receptors are always on alert and narrow the lumen of the bronchi with or without reason.

The second option is damage to the “ciliary” layer of the bronchial mucosa, which has a beautiful name: ciliated epithelium. As a result adverse effects(respiratory tract burn, viral infection, chemical substances) some of its cells die. This has two consequences: firstly, mucus is no longer expelled from the bronchi so effectively; secondly, irritative receptors are “naked” and become more sensitive.

Variants of the course of BHR

There are three main options for the course of bronchial hyperreactivity: non-infectious obstructive bronchitis, broncho-obstructive syndrome physical stress and recurrent paroxysmal cough.

Symptoms of the first are an obsessive dry cough, repeated many times a day, sometimes to the point of nausea, and dry wheezing when listening with a stethoscope. This condition can be distinguished from infectious bronchitis by normal picture blood. In addition, when infectious bronchitis wheezing is usually concentrated in one part chest, and in case of non-infectious obstruction, they “walk” along it depending on which bronchi reacted at the moment.

Bronchoobstruction of physical activity occurs, obviously, during physical stress. In this case, the irritant for the receptors is rapid cooling associated with increased breathing.

Recurrent paroxysmal cough differs from bronchitis in that it does not constantly haunt a person. Attacks usually occur in response to the same stimuli (the smell of perfume or household chemicals, going out into the cold from a warm room, cigarette smoke etc.). In such cases, it is recommended to keep a diary of attacks to identify a pattern.

The specialist you should contact if you suspect you have BHR is a pulmonologist, and the best examination is spirography. This is a completely safe method for the body, so in this situation you can start with an independent examination in order to come to the doctor with the result. So, if you are tormented by a cough, you should not buy another package of antibiotics - it is better to sign up for a diagnosis. Be healthy!

Lidiya Kulikova

Photo istockphoto.com

Chronic lung diseases CM. Gavalov
Novosibirsk State Medical Academy

The article presents the author's original point of view on the significance of bronchial hyperreactivity in the occurrence of relapses bronchopulmonary diseases in children. Twenty years of experience in monitoring children with bronchial hyperreactivity using clinical-functional indicators of aminophylline test and provocative tests with acetylcholine and histamine allows us to identify independent syndrome bronchial hyperreactivity in convalescents who have suffered pneumonia and acute respiratory viral infections. A close relationship has been shown between the presence of bronchial hyperreactivity and bronchial asthma.

Bronchial hyperreactivity is a condition of the irritative receptors of the bronchi when they react sharply with bronchospasm and the appearance of dry wheezing in the lungs (not always) to the influence of very low concentrations acetylcholine, methacholine or histamine, whereas with normal bronchial reactivity, these mediators in the same concentrations do not cause any reactions. According to the nature of the onset of bronchospasm on the impact different concentrations acetylcholine and histamine, the following groups of threshold sensitivity (TS)* to these substances have been identified (Fig. 1).

I - high IF, II - average IF, III - moderate IF, IV - normal IF (health)
Threshold sensitivity (TS) is considered the smallest dose of a substance that causes a decrease in FEV1 and vital capacity by 20% or more, and the appearance of dry wheezing in the lungs (not always).
Rice. 1. Variants of bronchial hyperreactivity in response to inhalation of acetylcholine (ACCh) and histamine (His).

Since 1972, the object of our attention has been children who are often and long-term ill. Many of them experienced 5-8 or more episodes of recurrent illnesses over the course of a year. respiratory system. In the hypothesis we put forward, it was assumed that some children who have had pneumonia or ARVI develop bronchial hyperreactivity, which can be considered as one of the leading pathophysiological mechanisms in the development of recurrent diseases of the respiratory system.

Possible mechanism for the development of bronchial hyperreactivity during viral infection presented in table. 1. In conditions of altered threshold sensitivity of the bronchi various factors external environment of a nonspecific nature (temperature of inhaled air, air pollution, changes in weather conditions, exercise stress, passive smoking) can be triggers that contribute to the appearance of a symptom complex similar to inflammation (shortness of breath, cough, dry and moist rales), which causes diagnostic errors, since doctors interpret this condition as a relapse infectious disease. In this regard, children are prescribed antibiotics unreasonably and repeatedly.

Table 1. Mechanisms of development of bronchial hyperreactivity syndrome during viral infection

Table 2. Frequency of occurrence (%) of children with various IF who had pneumonia, acute bronchitis or ARVI

The results of a survey of 229 children conducted by L.F. Kaznacheeva are presented in table. 2, from which it can be seen that 53% of children who suffered an acute respiratory disease had bronchial hyperreactivity. To test the hypothesis about the causes of repeated diseases of the respiratory system, 229 children were divided into two groups: the first included 92 children who first became ill with an acute respiratory disease, and the second included 137 frequently and long-term ill children. Among children of the first group, bronchial hyperreactivity was detected in 28%, and among children of the second group - in 70%.

The next fundamental question, based on the data obtained, is the importance of the bronchial infarction in the prognosis of recurrent diseases of the respiratory system after recovery. The frequency of the latter was determined by the level of IF: with a high threshold sensitivity in 100% of children, repeated diseases of the respiratory system appeared 10-30 days after recovery, with an average - in 58% after 1.5-2 months, with a moderate - in 23% of children after 2 ,5-3 months. In children with normal threshold sensitivity, recurrent diseases did not occur during these periods.

Observing children who suffered acute respiratory diseases over the next 36 months, we were convinced of the following: in children with normal threshold sensitivity of the bronchi, single episodes of repeated diseases of the respiratory system were observed during this time, while in children with hyperreactivity of the bronchi in the first 12 months they appeared often (Fig. 2); in subsequent months, as the threshold sensitivity of the bronchi normalized, repeated diseases of the respiratory system began to occur less frequently. Thus, the role of bronchial hyperreactivity in the occurrence of repeated diseases of the respiratory system after pneumonia and ARVI was shown.

Frequency of bronchopulmonary diseases among “norm” - (square) and “hypersensitive” children - (triangle) for 12 months. post-hospital period.
Rice. 2. Prognostic value of threshold sensitivity indicators of bronchial irritative receptors.

Recurrent diseases of the respiratory system in these two groups differed not only in frequency, but also in nature. clinical manifestations(Table 3). In the group of children with normal threshold sensitivity, all repeated diseases of the respiratory system were acute, while in children with increased threshold sensitivity they developed against the background normal temperature and in the absence of symptoms of intoxication. From clinical signs the most characteristic symptoms were obstructive bronchitis without signs of inflammation from the peripheral blood, infiltrative changes on the radiograph.

Table 3. Comparative characteristics clinical and paraclinical indicators for broncho-obstructive syndrome of non-infectious and infectious origin

The experience of observing children with threshold sensitivity of the bronchi made it possible to identify an independent clinical and pathogenetic variant - bronchial hyperreactivity syndrome in convalescents who have had pneumonia and ARVI, including three main forms: 1 - clinical symptom complexes simulating obstructive bronchitis of infectious origin; 2 - broncho-obstructive syndrome of physical exertion; 3 - recurrent paroxysmal cough. What is this statement based on? It is based on the clinical and functional indicators of the aminophylline test, which we proposed in 1976 (Table 4), and provocative tests with acetylcholine and histamine, in which, along with bronchospasm, dry and moist rales appear (not in everyone).

Table 4. Euphylline test according to S.M. Gavalov (1976)

A legitimate question is: why do we use the term “mimicking” obstructive bronchitis? To do this, you need to refer again to the table. 3, which presents a comparative description of the leading symptoms of broncho-obstructive syndrome caused by bronchial hyperreactivity. What makes them different? The onset of the disease, lability or persistence of the auscultation pattern, paraclinical examination data, results of the aminophylline test. Recurrent paroxysmal cough and broncho-obstructive physical exertion syndrome are currently assessed as small equivalents of bronchial asthma in children and adults. Pediatricians pay little attention to this fact, however, it is one of the reasons for the late diagnosis of bronchial asthma. In Russia, the diagnosis of bronchial asthma is delayed by 4-6 years from the onset of the disease. We believe that all patients with manifestations of recurrent paroxysmal cough and broncho-obstructive exercise syndrome, having an atonic history and a hereditary predisposition to allergic diseases, with careful examination and exclusion of other causes, should be included in the risk group for bronchial asthma. They should carry out all therapeutic measures that are recommended for children with mild forms of bronchial asthma.

In conclusion, the heterogeneity of bronchial hyperreactivity should be emphasized: 1 - bronchial hyperreactivity is the leading pathophysiological link in bronchial asthma, and it is observed in all those suffering from this disease; 2 - bronchial hyperreactivity can be a consequence of viral-bacterial aggression against the mucous membrane of the respiratory tract, be temporary and manifest in three different clinical forms; 3 - bronchial hyperreactivity can be detected in healthy people and not manifest itself in any way.

Literature

1. Sears M.R. et al. Relation between Airway Re.sponsiveness and lgE in Children with Asthma and in Apparantly Normal Children, N Engl J Meet, 1991, Vol. 325, pp. 1067-1071.
2. Szentivani A. The beta-adrcnergic Theory of the Atopic Abnormality in Bronchial Asthma, J Allergy, 1968, Vol. 42, N. 4, P. 203-232.
3. Gavalov S.M. Allergoses of the respiratory system in children, Healthcare of Belarus, 1976, N10, pp. 3-9.
4. Gavalov S.M., Kaznacheeva L.F. Pathogenetic basis of relapses after acute pneumonia in children, In the book; Issues of reactivity and adaptation in pediatrics, Sat. Stachey, Sverdlovsk, 1979, pp. 36-42.
5. Gavalov S.M., Kaznacheeva L.F. New concepts of relapses after acute bronchopulmonary diseases in children, GRM, P.V. 1983, p. 19.
6. Gavalov S.M. Acute pneumonia in children, Novosibirsk: NSU Publishing House, 1990, 273 p.
7. Gavalov S.M. Often and long-term ill children, Novosibirsk: NSU Publishing House, 1993, 283 p.

Today, not all parents know what bronchial hyperactivity in children is. Due to the deteriorating environmental situation, children are increasingly experiencing unmotivated coughing attacks. Any allergens, some medications can cause spasm of the smooth muscles of the bronchi, which leads to coughing. Such a reaction of the bronchi to irritants (susceptibility to their effects) is called “bronchial hyperactivity” and may indicate the presence of a disease such as asthma.

How is the disease transmitted?

Asthmatic syndrome can manifest itself with a hereditary predisposition. Moreover, it is extremely rarely transmitted directly from parents; more often, one of the relatives has diseases associated with the endocrine system, metabolic processes or allergies. Another point that leads to bronchial hyperactivity is the physiological features of the structure of the respiratory tract. Also among the risk factors for the occurrence of bronchial disease in children (and, as a consequence, the development of bronchial asthma) can be noted:

Distinctive symptoms of pulmonary hyperactivity: episodic attacks of difficulty breathing, accompanied by a whistling sound when exhaling. There are two types of bronchial hyperactivity:

• specific;
• nonspecific.

Specific hyperactivity is caused by exposure to allergens through inhalation of them in the surrounding air. Nonspecific manifests itself under the influence of factors unrelated to allergies (endocrine system disorders, increased physical activity, nervous breakdowns, mental influences, respiratory viral diseases, and so on).

Naturally, if one cause overlaps with another (allergies to hereditary predisposition), the risk of developing bronchial hyperactivity increases.

Return to the topic The need for adequate treatment of pathology

This disease requires constant medical supervision.

Prescribing adequate treatment is necessary first. For this purpose, pharmacological drugs such as:

In general, the treatment of bronchial hyperactivity in children differs from that in adults in the doses of drugs. If the cause of the attacks is allergic reactions, then medical research reveals one or more allergens. In the future, they try to avoid their influence on the child or minimize it.

Most often, exacerbation of pathology in children occurs in the autumn-spring period. At this time, it is advisable to carry out a set of additional measures that serve as protection against respiratory viral diseases:

• personal hygiene (mandatory hand washing after walking and visiting public places);
• rinsing the nasopharynx;
• proper nutrition;
• moderate exercise;
• adherence to daily routine;
• use of drugs to control the disease.

Children with hyperactive lungs are treated in sanatoriums located in the forest area. Holidays in mountainous areas and on sea coasts are undesirable due to high humidity, which leads to attacks of illness.

In any case, medications to relieve an attack should always be on hand. Almost all drugs for the treatment or prevention of bronchial hyperactivity are sold in inhalation form, which facilitates their use in children.

Lung hyperactivity in children is treatable. The key to the success of treatment measures is early detection of the disease.