Chronic bronchiolitis obliterans

In childhood, chronic obliterating bronchiolitis develops after acute bronchiolitis, which usually has a viral or mycoplasmal etiology (more often in older children). The morphological substrate is obliteration of the bronchioles and arterioles of one or more sections of the bronchi, leading to impaired pulmonary blood flow and the development of pulmonary emphysema. In the development of chronic obliterating bronchiolitis, a large role is given to the respiratory syncytial virus, adenovirus infection, influenza and measles viruses.

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Symptoms of Chronic Obliterating Bronchiolitis

Wet cough, recurrent episodes of wheezing, shortness of breath, fine bubbling moist rales that persist for a long time - 5-7 months or more. At an early age, the frequency of detection of typical signs of obstructive damage to the small airways is higher than in older children. In adolescents, a decrease or disappearance of wheezing is noted, which can complicate the diagnosis of the disease.

Diagnosis of chronic obliterating bronchiolitis

Diagnostic criteria for chronic obliterating bronchiolitis: characteristic clinical data in the presence of radiological signs of increased transparency of the lung tissue and scintigraphic evidence of a sharp decrease in pulmonary blood flow in the affected areas of the lungs.

A method that allows detecting 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 lumen narrowing of small bronchi and bronchiectasis. Indirect signs include non-homogeneity of ventilation (mosaic oligemia) or areas of increased transparency associated with decreased perfusion and ventilation of the lung and air trapping as a result of bronchiolar obstruction, alternating with unchanged lung tissue.

High-resolution computed tomography is considered a more sensitive method for detecting morphologic features of emphysema even when pulmonary function tests remain normal.

When studying the respiratory function, a significant increase in the residual volume of the lungs is revealed with a normal average value of the total lung capacity.

All patients are characterized by hypoxemia and hypercapnia. According to ECG, echocardiography, and Doppler cardiography, signs of pulmonary hypertension and chronic pulmonary heart disease are determined.

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Treatment of chronic obliterating bronchiolitis

During an exacerbation, antibiotics are prescribed taking into account the sensitivity of the isolated microflora. Aerooxygen therapy. Bronchodilators. Prescription of mucolytics and expectorants. Chest massage, exercise therapy.

Forecast

In case of unilateral damage, it is relatively favorable. By the age of 7-10, 35% of patients had a constant cough, 22% had episodes of wheezing. By the age of 15, the number of wheezes decreased and the predominant symptom was widespread weakening of breathing (Boitsova E.V.).

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

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