Chronic obliterating bronchiolitis

In childhood, chronic obliterating bronchiolitis is formed after acute bronchiolitis, which usually has a viral or mycoplasmal etiology (usually in older children). Morphological substrate is the obliteration of bronchioles and arterioles of one or several sections of the bronchi, leading to a violation of pulmonary blood flow and development of emphysema of the lungs. In the development of chronic obliterating bronchiolitis, respiratory syncytial virus, adenovirus infection, influenza and measles viruses play a large role.

[1], [2], [3], [4], [5], [6], [7]

Symptoms of chronic obliterating bronchiolitis

Wet cough, recurring episodes of wheezing, dyspnea, finely bubbling wet wheezing, persisting for a long time - 5-7 months or more. At an early age, the incidence of typical signs of obstructive small airway disease is higher than in older children. Teenagers noted a decrease or disappearance of wheezing, which can make diagnosis more difficult.

Diagnosis of chronic obliterating bronchiolitis

Criteria for the diagnosis of chronic obliterating bronchiolitis : characteristic clinical data in the presence of X-ray signs of increased transparency of lung tissue and scintigraphic - a sharp decrease in pulmonary blood flow in the affected parts of the lungs.

A method that can detect changes at the level of bronchioles and acini is computed tomography. Computer diagnostics of chronic obliterating bronchiolitis is based on direct and indirect signs of bronchial obstruction.

Direct signs include wall thickening and narrowing of the lumen of small bronchi and bronchiectasis. Indirect inhomogeneity of ventilation (mosaic oligemia) or areas of increased transparency associated with reduced perfusion and ventilation of the lung and an air trap due to obstruction of bronchioles alternating with unchanged pulmonary tissue are considered indirect signs.

High-resolution computed tomography is considered to be a more sensitive method for detecting the morphological features of emphysema, even when functional pulmonary tests remain normal.

In the investigation of HPD, a significant increase in the residual volume of the lungs is observed with a normal mean value of the total lung capacity.

All patients are characterized by hypoxemia and hypercapnia. According to the ECG, EchoCG, Doppler cardiography determine the signs of pulmonary hypertension, chronic pulmonary heart.

[8], [9], [10], [11],

Treatment of chronic bronchiolitis obliterans

During an exacerbation, antibiotics are prescribed taking into account the sensitivity of the isolated microflora. Aero-oxygen therapy. Bronchodilator funds. Appointment of mucolytics and expectorants. Chest massage, exercise therapy.

Forecast

With unilateral damage, a relatively favorable one. By 7-10 years, 35% of patients had a persistent cough, 22% had episodes of wheezing. K15 years - the number of wheezing decreased and the prevailing symptom was a widespread weakening of breathing (Boytsova EV).

In the presence of bilateral lesions and severe ventilation disorders in children early chronic pulmonary heart failure is formed.

[12], [13], [14]