Bronchitis - what is this "monster"? How does it happen in children, how does it manifest itself and how can it be cured?

Respiratory diseases are common in children. Of all respiratory diseases in childhood, 50% is acute bronchitis. Bronchitis is manifested by inflammation of the bronchial mucosa, which occurs for various reasons. The peak of bronchitis falls in the spring-autumn and winter seasons, which is directly related to weather conditions and outbreaks of ARVI at this time. A child of any age can get bronchitis. Children are much more likely to get sick at an early age (from birth to 3 years). The main manifestations of bronchitis are cough (dry or wet), fever and wheezing in the bronchi.

Types of bronchitis in children

Acute simple bronchitis.
Acute obstructive bronchitis.
Bronchiolitis.
Recurrent bronchitis.
Recurrent obstructive bronchitis.
Chronical bronchitis.
Allergic bronchitis.

According to the duration of the disease, bronchitis is divided into acute, recurrent and chronic.

Causes of bronchitis in children

Depending on the cause of the occurrence, viral, bacterial and allergic bronchitis are divided.

Among the viruses, the culprits of bronchitis are more often the parainfluenza virus, influenza, adenoviruses, rhinoviruses, mycoplasma.

Among bacterial pathogens, there are staphylococci, streptococci, pneumococci, hemophilus influenzae. Bronchitis of a bacterial nature is often found in children with a chronic infection in the nasopharynx (adenoiditis, tonsillitis). However, the most common cause is opportunistic bacteria (autoflora) in violation of the excretory and protective function of the inner lining of the bronchi due to acute respiratory infection.

These bacteria are constantly circulating in the human body, but do not cause disease in a healthy state.

Allergic bronchitis occurs when various allergens are inhaled - chemicals (detergents and perfumes), house dust, natural components (pollen), wool and waste products of domestic animals.

Hypothermia or sudden overheating, polluted air and secondhand smoke are considered contributing factors in the development of bronchitis. These factors are relevant for children living in big cities.

Acute simple bronchitis

Acute bronchitis in children, as a separate disease, is rare, usually it manifests itself against the background of ARVI phenomena.

Viruses attach themselves to the inner lining of the bronchi, penetrate inside, multiply and damage it, inhibiting the protective properties of the bronchi and creating favorable conditions for bacteria to develop inflammation.

How does acute bronchitis manifest?

Usually, before signs of bronchitis, the body temperature rises, the head and throat begin to ache, general weakness, runny nose, coughing, sore throat appear, sometimes the voice may become hoarse, sore and sore in the chest.

Cough is the leading symptom of bronchitis. At the beginning of the disease, it is a dry cough, on the 4th - 8th day it softens and becomes moist. It happens that children complain of discomfort or soreness in the chest, which becomes stronger during coughing. These are signs of tracheobronchitis.

Children differ from adults in that they usually do not spit, but swallow phlegm. Therefore, it is rather difficult to determine whether it is mucous or purulent. Usually, by the second week of illness, the cough is moisturized and the body temperature drops.

For the most part, acute bronchitis progresses favorably, and recovery occurs after two weeks.

Prolonged bronchitis is bronchitis that can be treated for more than three weeks.

How to treat acute bronchitis and cough in children?

For the entire period of an increase in temperature and for 2 - 3 days after its decrease, bed rest is recommended.
A plentiful warm drink is recommended.
Nutrition, diet for bronchitis must be complete, balanced, enriched with vitamins.
Thorough wet cleaning and airing of the room should be carried out.
Antiviral drugs (Arbidol, Anaferon, Viferon) are prescribed by a doctor. Their use is effective only when you start taking them no later than 2 days from the onset of the disease.
With a fever above 38.5 degrees Celsius, antipyretic drugs are prescribed in an age-specific dosage (Nurofen, Efferalgan, Tsefekon).
Expectorant and mucolytic agents are prescribed that make the sputum less thick and facilitate its excretion (ACC, Bromhexin, Ambroxol, Gerbion, Ascoril). This is the main element of the treatment.
Antitussives (Sinekod) are prescribed only with an obsessive, painful cough.
Antihistamines (antiallergic) drugs are prescribed only to children with severe signs of allergies.
Alkaline inhalations are recommended (with the addition of soda or mineral water).
Physiotherapy for acute bronchitis in a polyclinic is rarely prescribed. In the hospital, in the midst of the disease, UFO, UHF are prescribed to the chest. After the exacerbation subsides, diadynamic currents (DDT), electrophoresis are prescribed.

Antibiotics are not commonly prescribed for the treatment of acute bronchitis.

Antibiotic prescription is indicated:

children under one year old with an average and severe course of the disease;
if the temperature is above 38.5˚Ϲ, it lasts for 3 days.

The bacterial preparation is taken, strictly observing the doctor's prescription and age dosages.

Child care for bronchitis

A sick child needs the care and care of loving relatives who are ready to fulfill the doctor's prescription without question and provide the necessary conditions for recovery.

The care tips are pretty simple:

Do not forget to regularly ventilate the room, the child needs fresh air. It is better to ventilate the room in the absence of the baby. It is necessary to maintain the air temperature within 18 - 22 degrees and humidity at 50 - 70%.
The baby should eat properly and completely, but do not force him to eat. If the baby has a fever and refuses to eat, force-feeding can provoke vomiting. The main thing is to give the baby a drink.
If the child is sweating, it is necessary to change clothes and bedding.
As a drink for acute bronchitis, warm herbal teas, homemade compotes and fruit drinks, plain water are well suited. It is not recommended to drink juices. They are irritating and make coughing worse.
It is not recommended to lower the temperature, which is less than 38.5 degrees. Such a body temperature is not dangerous for the child and indicates the inclusion of the body's defenses in the work, with the exception of children with febrile seizures in the past.
Many parents are interested in whether it is possible to bathe a child with bronchitis. You should not bathe your baby at the height of the disease and at elevated temperatures. When the temperature is normalized and the cough is reduced, you can rinse in the shower.
Walking during the height of the disease and at elevated temperatures is not recommended. You should also refrain from walking in wet, windy, cold weather if residual cough persists.

Acute obstructive bronchitis

This is bronchitis, manifested by obstructive syndrome and expiratory dyspnea (difficulty exhaling). Bronchial obstruction develops when there is a violation of the patency of the bronchi, the cause of which is mainly an infection or allergy. In 25% of children, bronchitis passes with obstruction symptoms.

Especially often, obstructive bronchitis as a manifestation of ARVI occurs in children under the age of three. The development of bronchitis is associated with the fact that in this age period 80% of the airways are small bronchi (less than 2 mm in diameter).

Obstructive bronchitis can be caused by viruses and bacteria. Allergy is often the cause of bronchial obstruction. In children under 3 years of age, obstruction is often caused by cytomegalovirus, parainfluenza virus, adenovirus.

Factors predisposing to the development of obstruction

Smoking mother during pregnancy.
Second hand smoke.
Intrauterine growth retardation.
Allergic predisposition (allergic diseases in mom or dad), the presence of manifestations of allergies in a child.

Pathogenesis (development mechanism) of obstructive bronchitis

As defined by the WHO (World Health Organization), obstruction is the narrowing or closing of the airways that occurs as a result of:

accumulation of mucus inside the bronchi;
edema (thickening) of the bronchial mucosa;
contraction of the muscles of the bronchi, and, as a result, narrowing of the lumen of the bronchus;
squeezing the bronchus from the outside.

In children, predominantly of young age, narrowing of the airways during obstruction is caused by swelling of the mucous membrane, secretion and accumulation of sputum inside the bronchi. This is associated with good blood supply to the bronchial mucosa and the fact that in childhood the lumens of the bronchi themselves are narrow.

Obstructive bronchitis manifestations

At the onset of the disease, the symptoms of a viral infection predominate: the temperature rises, begins to run from the nose, a sore throat appears and the condition is disturbed.
Shortness of breath with bronchitis in a child may appear on the first day of the illness and in the course of its course. Respiration rate and expiration duration gradually increase. The baby's breathing becomes noisy and sibilant. This is due to increased secretion and accumulation of mucus in the bronchi.
As a result of shortness of breath and fever, the mucus in the bronchi dries up and dry, buzzing and wheezing appears. Wheezing and noisy breathing can be heard from a distance. The younger the child, the more often, in addition to dry wheezing, moist, medium-bubble wheezing is heard.
With increased shortness of breath, auxiliary muscles begin to participate in breathing. This is manifested by the retraction of the intercostal space and epigastrium, the appearance of retracted pits above the collarbones, and the swelling of the wings of the nose.
Cyanosis around the mouth and pallor of the skin often develop, the child becomes restless. He tries to sit up, leaning on his hands to facilitate breathing.

Obstructive bronchitis treatment

The general principles of treatment are the same as for simple bronchitis.

Children under the age of two, as well as those with moderate and severe obstructive bronchitis, are treated in a hospital.

To eliminate bronchial obstruction, several categories of drugs are prescribed:

Bronchodilators inhalation (when inhaled, they expand the bronchi, alleviating the condition). For inhalation with bronchitis, spacers with a mask are used, into which the drug is injected from a metered-dose inhaler, and nebulizers. Treatment of bronchitis with a nebulizer allows you to regulate the dose of the inhaled drug and the rate at which it enters the mask. The positive effect occurs within 10 - 15 minutes from the start of inhalation. Older children can use an aerosol inhaler. In children, the use of Berodual gives good results.
Antispasmodics relieve muscle spasm, thereby making the bronchi wider and making breathing easier (No-shpa, Papaverine).
If there is no effect from bronchodilators and shortness of breath increases, the next step in the treatment of obstruction is the appointment of inhalation with glucocorticoids (Pulmicort).
If there is no effect, the hormonal drug is administered intramuscularly or intravenously.
Antiallergic drugs are used if there is a predisposition to allergies.

After removal of obstruction

Antiviral drugs are prescribed.
Antibiotic therapy is indicated for moderate and severe course with the development of complications.
Mucolytics and expectorants are prescribed to remove sputum.
Massage and gymnastics are prescribed after the obstruction has been removed. Vibration massage and breathing exercises have a good effect. For massage, the baby is laid with his stomach on the knees of an adult, hanging his head down, and tapping his fingers on the back in the direction of the head. Older children are best placed on the bed. Massage is done at least 2 times a day, always in the morning for 15 minutes.
From physiotherapy appoint UHF, applications with paraffin and azocerite, electrophoresis with potassium iodide, with calcium.

With obstructive bronchitis, you should not use antitussives that suppress cough (Codeine).

Acute bronchiolitis

Bronchiolitis is a lesion of the bronchi, characterized by a widespread lesion of the bronchioles (the terminal branches of the bronchi with a diameter of not more than 1 mm, passing into the lungs) and small bronchi.

At risk are children aged 5 - 6 months. The disease is severe, in most cases with the development of respiratory failure. Viruses are the cause of the disease.

The mechanism of development of bronchiolitis

Bronchiolitis is manifested by widespread inflammation of the bronchioles on both sides. The destruction of the surface cells on the inner membrane of the small bronchi and bronchioles occurs, severe edema develops, and the secretion of mucus increases. Due to the destroyed epithelium, the excretion of mucus from the bronchioles is disrupted, and dense mucous plugs are formed, which partially or completely cover their lumen.

Dyspnea develops - shortness of breath with difficulty breathing (more on exhalation) and respiratory failure.

A typical manifestation of bronchiolitis is a violation of hemodynamics (movement of blood in the vessels) as a result of hypoxemia (a decrease in the oxygen content in the blood).

The restoration of the bronchial mucosa begins from the 3rd - 4th day of the onset of the disease. Full recovery occurs on day 15.

Clinical signs of acute bronchiolitis

The appearance of signs of acute bronchiolitis is preceded by moderately manifested symptoms of viral diseases (rhinitis, nasopharyngitis).
Suddenly, and sometimes gradually on the 2nd-4th day of illness, the child's condition worsens. Lethargy, irritability appear, appetite decreases.
At first, the cough is dry, obsessive, and soon it quickly dries up.
Shortness of breath increases to 60 - 80 per minute. At the same time, when the child breathes, the intercostal spaces and epigastrium sink, the wings of the nose swell.
The skin turns pale, cyanosis (cyanosis) appears around the mouth.
The child's heartbeat increases.
While listening to the lungs, multiple moist fine bubbling rales on inhalation and dry, wheezing rales on exhalation are found. Parents hear these wheezing even from a distance. If shortness of breath is severe and the child's breathing is shallow, wheezing is almost not heard.
Periods of apnea (lack of breathing) may occur, especially in premature infants.
With severe shortness of breath, dehydration develops, the child loses fluid during rapid breathing.
The patient's temperature is often high, but it can be subfebrile (37.3 - 37.8 ˚Ϲ) or even normal.

The most dangerous are the first 2 - 3 days of the disease. Shortness of breath with attacks of apnea appears, which can lead to the death of the child. After that, the baby's condition either improves (shortness of breath and cough disappears after a few days, and the child recovers), or respiratory failure lasts another 2 to 3 weeks.

Risk factors for severe bronchiolitis

The child's age is under 3 months.
Prematurity, especially less than 34 weeks.

Bronchiolitis treatment

With bronchiolitis, hospitalization is indicated.

The lying child needs to raise the head end of the bed.
He breathes in humidified oxygen through a mask.
If the activities do not bring results, the child is shown artificial ventilation.
Since with shortness of breath the child loses a lot of fluids and dehydration sets in, he needs to drink plenty of fluids. With severe dehydration, intravenous drip of solutions is prescribed.
Bronchodilators are used in aerosol (Salbutamol).
Hormones (prednisone) by aerosol or intravenous injection may be given to relieve obstruction.
When the patient's condition improves, vibration massage is prescribed.Babies are rhythmically tapped with the tips of bent fingers along the intercostal space.

Bronchiolitis is a rather serious disease. About 1 - 2% of children die. Children who have had bronchiolitis are at risk of developing obstruction if they get ARVI. Some children with a tendency to allergies develop bronchial asthma in the future.

Therefore, when a cough appears, and even more so shortness of breath in children under 2 years of age, you should immediately go to the hospital for advice and treatment.

Recurrent bronchitis

Recurrent bronchitis in children is exhibited when an episode of relapse (exacerbation) is repeated at least 3 times a year for 2 years without signs of obstruction. Most often, it manifests itself against the background of an acute respiratory infection and lasts quite a long time, 2 - 3 weeks and even longer.

Recurrent bronchitis is a childhood form of the disease. After the treatment of relapse, the bronchi are restored completely.

The cause of an exacerbation can be viruses and bacteria at the same time. Among the bacteria that cause exacerbation, pneumococcus and Haemophilus influenzae are equally found, and in schoolchildren, mycoplasma is often found.

Factors contributing to the development of recurrent bronchitis

Child's age. Most often, children get sick from birth to seven years.
Chronic tonsillitis, adenoiditis.
The presence of chronic diseases of the ENT organs in households. This serves as a source of infection.
Parental smoking, unfavorable living conditions, climatic factors.
Aspiration syndrome.
Hereditary diseases (cystic fibrosis).
Congenital malformations of the bronchi.

The mechanism of development of recurrent bronchitis

For the first time, recurrent bronchitis usually develops against the background of residual symptoms of ARVI in children who regularly attend kindergartens. The main factor contributing to the development of exacerbation is chronic diseases of the upper respiratory tract (tonsillitis, otitis media, adenoiditis). In this case, the infection spreads from top to bottom, descending into the bronchi.

It has been proven that timely treatment of chronic diseases reduces the number of exacerbations. Therefore, it is important not to start the disease, but to treat it in time.

Recurrent bronchitis symptoms

There are three periods of the disease:

Aggravation.
Incomplete remission.
Complete remission.

Usually exacerbations occur in autumn or spring, much less often in winter and do not occur at all in summer. A relapse begins like a common ARVI with a rise in temperature, nasal discharge, headache and sore throat. The cough joins in 2 - 3 days. At first it is dry and painful, then gradually becomes wet. This is the main symptom of the disease.

The older the child, the more often with the onset of coughing, sputum begins to stand out. As a rule, the cough is the same throughout the day, but worse in the morning. During the examination, the pediatrician listens to dry wheezing and medium-bubble wheezing on inspiration. The exacerbation lasts 3 to 4 weeks.

During the period of incomplete remission against the background of adenoiditis, children may complain of frequent or persistent runny nose, decreased appetite, headache, persistent, periodically intensifying cough and low-grade fever.

Outside of exacerbation, on examination, a sluggish state is often observed along with pallor of the skin and difficulty in nasal breathing, children snore in their sleep. Cervical lymph nodes may be enlarged, sweating of the skin is noted.

Treatment features

Treatment depends on the period of the illness. At the time of an exacerbation, the following measures, procedures and drugs are relevant:

Bed rest for 5 - 10 days.
Antibacterial therapy (Amoxiclav, Augmentin, Sumamed) for a week.
Mucolytics (Mukaltin, Bromhexin, Ambroxol).
Expectorants Herbion, Gedelix).
Alkaline inhalations from the onset of exacerbation, then inhalations with expectorants.
If the child is in the hospital, an ultraviolet irradiation of the chest is prescribed, and then electrophoresis with potassium iodide, calcium.
Therapeutic exercises and massage are well combined with postural drainage (improves sputum excretion). Drainage is mandatory in the morning after waking up and in the evening. The child, lying on the bed, bends his head down and rests his hands on the floor, it is desirable to stay in this position for 10 - 20 minutes.

During the period of remission, it is important to treat chronic infections; drugs that stimulate the immune system are also prescribed (IRS-19, Polyoxidonium, Bronchomunal).

After an exacerbation, it is useful at least once a year for rehabilitation treatment in a sanatorium in your region.

Outside of exacerbation in summer, resort treatment in sanatoriums of the southern coast (Crimea, Anapa) is useful.

During the period of remission, it is also important to follow a number of recommendations:

Provide a hypoallergenic home environment.
Do therapeutic exercises and massage. Children can engage in physical education lessons as part of a preparatory group.
Identify and treat foci of chronic infection.
Herbal medicine and immunomodulators courses.
Morning exercises, hardening, going out into nature on weekends, preferably out of town.

With the right treatment, most people get better or get sick much less often. In some children, the disease progresses into allergic obstructive bronchitis or bronchial asthma.

Aspiration bronchitis

This type of bronchitis develops as a result of fluid entering the respiratory tract. This occurs when swallowing is impaired in premature babies and babies with birth trauma, as well as in congenital malformations of the esophagus (narrowing of the esophagus, esophageal tracheal fistulas).

Factors indicating aspiration bronchitis:

Disease of bronchitis during the neonatal period.
Coughing fits, wheezing. They occur during feeding or when changing body position.
Milk is poured out through the nose.
An exacerbation begins without signs of ARVI with normal body temperature.
Swallowing disorder, neurological disorders in children with repeated bronchitis.

The treatment of aspiration bronchitis is the elimination of the cause of the flow of fluid into the lumen of the child's respiratory tract.

Recurrent obstructive bronchitis

This is bronchitis, periodically recurring against the background of ARVI in babies under 3 years old. In some children, it is the onset of bronchial asthma.

The main factor in the development of recurrent obstructive bronchitis (RBB) is bronchial hyperreactivity as a result of inflammation.

Inflammation is caused by:

infectious factors (chlamydia, mycoplasma);
non-infectious factors (passive smoking, physical activity).

The main links of the development mechanism include a number of factors:

Bronchospasm - narrowing of the bronchi as a result of contraction of the muscles of the bronchi under the influence of an irritant.
Thickening of the inner lining of the bronchi due to edema.
Increased secretion of bronchial mucus and a violation of its secretion.
Partial or complete blockage of the bronchus with viscous mucus.

Predisposing factors for the development of RBB:

maternal smoking during pregnancy and secondhand smoke;
transferred bronchiolitis;
neuroses and vegetative dystonia.

An exacerbation develops with an acute respiratory viral infection and is manifested by symptoms of obstructive bronchitis. The infection can be present in the body for several weeks and months and become more active in ARVI, manifested by bronchial obstruction.

Treatment of a patient during an exacerbation is similar to the treatment of acute obstructive bronchitis.

During the period of remission, prophylactic anti-relapse treatment is prescribed. For this purpose, aerosol inhalation is used (Fenoterol, Berodual, Seretide). If the exacerbation is caused by physical factors (cold air, physical activity), Intal, Tayled are prescribed.

Allergic bronchitis

In children, it begins as a consequence of the inflammatory process in the bronchus when exposed to a variety of allergens. Allergens irritate the inner surface of the bronchi when inhaling, and a cough appears. This cough is called allergic bronchitis.

Allergists believe that allergic diseases cannot be completely cured, but it is possible to identify and, if possible, eliminate the allergen from the child's environment, reduce the number of exacerbations and achieve a sufficiently long remission.

Causes leading to the development of allergic bronchitis

The leading cause of development is the ingress of allergens into the child's body when breathing.

The most common allergens:

pollen of wild and indoor plants;
wool and other particles of domestic animals (feathers, food, secretions);
household chemicals (detergents, cosmetics, perfumery);
house and book dust;
medicines.

Manifestations

Allergic bronchitis manifests itself:

persistent, paroxysmal, predominantly nocturnal cough (at first, it is usually dry, later turns into wet);
Difficulty breathing or shortness of breath
dry, moist or wheezing rales that the doctor hears on auscultation;
deterioration in condition and well-being when an allergen enters the body.

Symptoms of bronchitis can be combined with manifestations of other allergic diseases (nasal congestion, watery eyes and redness of the eyes, skin rashes).

Differences between allergic bronchitis and bronchial asthma:

Wheezing is heard on inhalation.
Asthma attacks are not characteristic of bronchitis.

How is allergic bronchitis treated?

The main thing is to identify and eliminate the effects of the allergen.
Antihistamines (Suprastin, Tavegil). They can be taken in pill form or injections. Eliminate or reduce the manifestations of allergies.
Expectorants (Bromhexin, Pertussin, Mukaltin, herbal preparations). Promote the elimination of phlegm.
Bronchodilators (Intal, Salbutamol). Eliminate bronchial spasm, thereby making breathing easier.
In some cases, courses of inhaled glucocorticoids (Flixotide, Seretide) are prescribed. Eliminate inflammation and allergies.
ASIT. This is a specific immunotherapy that reduces the child's sensitivity to the effects of allergens.

For the child's health, it is important to identify and eliminate the allergen from the environment in time, as well as to treat the baby correctly, following the recommendations of the allergist.

Diagnosis of bronchitis in children

If there are complaints of coughing, shortness of breath, the child is examined by a pediatrician. The doctor performs auscultation of the lungs, determining the presence and nature of wheezing.

After examination, if necessary, appoint:

general blood analysis. Inflammatory changes are determined in it;
radiography of the lungs. An enhanced pulmonary pattern is visible;
sowing sputum to determine the pathogen;
bronchoscopy.

Based on the results of the examination, a conclusion is made, a diagnosis is made and treatment is prescribed at home or, if necessary, in a hospital.

Why is bronchitis in children dangerous?

With the correct treatment started on time, bronchitis does not pose a danger to children, and babies recover after a few weeks.

However, in young children, due to the peculiarities of the respiratory tract, there is a danger of acute bronchitis becoming obstructive, as well as the risk of developing bronchiolitis and pneumonia (pneumonia).

In young children with obstructive bronchitis, bronchial obstruction may occur and the child may suffocate.

With bronchiolitis, the danger lies in the development of apnea (respiratory arrest), the lack of emergency assistance leads to the death of the child.

In a baby with a tendency to allergies, recurrent obstructive bronchitis can develop into bronchial asthma.

How to quickly cure bronchitis in a child?

Unfortunately, bronchitis cannot be quickly cured. This disease does not go away on its own. Parents will have to try to cure the child. With simple bronchitis without complications, recovery occurs after two weeks. Exacerbations of recurrent bronchitis can last even longer - up to 2 to 3 months.