Recurrent obstructive bronchitis in children

Recurrent obstructive bronchitis in children is obstructive bronchitis, episodes of which are repeated in young children against the background of acute respiratory viral infections. Unlike bronchial asthma, obstruction is not paroxysmal in nature and is not associated with the effects of non-infectious allergens. Sometimes repeated episodes of obstruction are associated with chronic aspiration of food. In some children, recurrent obstructive bronchitis is the debut of bronchial asthma (risk groups: children with signs of allergy in personal and family history, as well as with 3 or more episodes of obstruction.

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Causes of recurrent obstructive bronchitis in children

In the etiology of recurrent obstructive bronchitis, the persistence of respiratory viruses plays a role - RS, adenoviruses; in recent years, the importance of mycoplasma and chlamydial infections in the development of recurrent obstructive bronchitis has increased.

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Pathogenesis of recurrent obstructive bronchitis

Broncho-obstructive syndrome is largely due to the anatomical and physiological characteristics of the respiratory system in young children: narrow airways, looseness and hydrophilicity of the bronchial tree mucosa, its tendency to edema and hypersecretion against the background of an inflammatory process of any nature. Recent studies have shown that ARVI can provoke the development of temporary (transient) bronchial hyperreactivity for 4-6 weeks from the onset of the disease (viruses penetrate the submucosal layer of the bronchi and irritate the nerve endings). Thus, even after the patient's recovery from ARVI, signs of bronchial hyperreactivity (BHR) may be observed for 1 month and the risk of recurrence of obstructive bronchitis may persist. Foci of chronic respiratory infection can lead to the formation of more persistent bronchial hyperreactivity. Risk factors predisposing to the development of bronchial hyperreactivity are: unfavorable heredity to broncho-obstructive diseases; possible immunological abnormalities of general and local nature; diseases of the nervous system; atopic "tune-up"; hyperplastic changes in the upper respiratory tract. Consequently, in some patients, recurrent obstructive bronchitis may subsequently transform into bronchial asthma or be its debut. In this sense, it is certainly a high-risk factor for the development of bronchial asthma. The diagnosis of bronchial asthma in such children should be made if there are signs of atopy in the anamnesis and if 3 or more episodes of broncho-obstruction are repeated.

Symptoms of recurrent obstructive bronchitis in children

Exacerbation of recurrent obstructive bronchitis occurs against the background of acute respiratory viral infection and the clinical picture corresponds to acute obstructive bronchitis. With chlamydial infection, there may be conjunctivitis, pharyngitis with pronounced "granularity" on the back wall of the pharynx and enlargement of the lymphatic cervical nodes, persistent cough against the background of moderate fever, and then broncho-obstructive syndrome develops. Mycoplasma infection is characterized by an increase in body temperature to 38-39 C, intoxication (lethargy, possibly vomiting), symptoms of vegetative dystonia (paleness, "marbling" of the skin, sweating); locally - mild hyperemia of the pharynx, dry mucous membranes, poor mucus production in rhinitis and pharyngitis, difficulty breathing through the nose, 70% of patients have radiological changes in the sinuses, although the clinical picture of sinusitis is weakly expressed. One of the leading symptoms of recurrent obstructive bronchitis in mycoplasma infection is a dry cough, painful, it can cause vomiting and leads to sleep disturbances in the child. Then obstructive syndrome develops with all its inherent manifestations. In 50% of cases of mycoplasma infection, obstructive recurrent bronchitis resolves slowly, bronchodilators have an insufficient effect.

Treatment of recurrent obstructive bronchitis in children

During the period of exacerbation (relapse), the tactics are the same as for acute obstructive bronchitis, and in the inter-relapse period, as for recurrent bronchitis.