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Treatment of acute obstructive bronchitis
Last reviewed: 19.10.2021
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Hospitalization is indicated for infants and young children with moderate and severe acute obstructive bronchitis. Sparing regime with exception of external stimuli (unnecessary procedures, examinations) is appointed. Presence of child's mother is necessarily. Maximum of fresh air is required (frequent airing of room in which there is small patient). Diet is physiological based on age of child; he should not be forcibly fed. It is important to provide sufficient water regime taking into account not only needs of age, but also to ensure adequate hydration of sputum to improve its evacuation from respiratory tract. Increase of volume of liquid in 1,3-1,5 times is recommended, taking into account eaten food. Tea, fruit teas, fruit and vegetable juices are recommended.
Antibiotics are not shown unless there are changes in blood tests, pointing on bacterial inflammatory changes. Successful elimination of bronchial obstruction is main treatment of acute obstructive bronchitis. This means use of beta2 - adrenoceptor agonists which are rather beneficial rapidly in most cases. Salbutamol 1 mg per reception for children aged 2-4 months and 2 mg per reception for children aged 2-3 years can be assigned inwardly 2-3 times per day with non-severe obstruction.
Inhaled forms of sympathomimetic through nebulized, or spacer are used with moderate and severe acute obstructive bronchitis. Nebulizers with air compressor are used for children of first years of life. Inhalation is best done through mouth at age of 2-3 years (if child is able), child breathes through mouthpiece.
Following medicine is used for inhalation therapy:
- salbutamol sulphate - selective antagonist of beta-adrenergic receptors. Plastic vials of 2.5 ml containe 2.5 mg of salbutamol.
- fenoterol hydrobromide - selective beta2 - agonist . 1 ml (20 drops) contains 1 mg of active substance. Children under 6 years of age (body weight up to 22 kg) fenoterol is administered at dose of 50 mg per 1 kg of body weight per inhalation, which is 5-20 drops (0.25-1 mg). Nebulizer chamber is filled with saline and appropriate dose of fenoterol is added as total volume of spray should reach 2-3 ml for inhalation via nebulizer;
- ipratropium bromide - blocker of M-Cholinergic receptors, 1 ml (20 drops) contains 250 micrograms of ipratropium bromide. Dose of ipratropium bromide in children of first years of life is 125 mcg (10 drops), older than 1 year 250 mg (20 drops) per inhalation;
- berodual – is combined preparation, 1 mg contains 500 micrograms of fenoterol and 250 mcg of ipratropium bromide. Combination of beta2-agonists, having prompt action through 5-15 min, and ipratropium bromide with maximum-effect in 30-50 minutes allows getting fast and prolonged effect, exceeding action of monocomponent preparations. Children up to 6 years of age (less than 22 kg) are recommended 0.5 ml (10 drops) up to 2-3 times a day.
Single inhalation bronchospasmolitic through nebulizer is enough in less severe acute obstructive bronchitis, if needed it is repeated after 4-6 hours. Inhalations are repeated every 20 minutes within hour (total of 3 doses) with moderate and severe course, then every 4-6 hours up to positive effect. Duration of inhalation through nebulizer is 5-10 minutes (until complete cessation of spraying of drug).
Nebulizer therapy can be done at home with mild and moderate severe obstructive bronchitis.
Salbutamol can be introduced intramuscularly in absence of effect of sympathomimetic (due to poor airway), (0.2 mL for children 2-12 months and 0.4 ml for children 2-3 years), or 0.05% solution of alupent.
Inhaled corticosteroids are shown (Becotide, Ventolin); it is especially so in cases, when process is not completed after 2 weeks. Postural drainage with vibratory massage can begin from 2-3 day of illness to release airways from secretions. Secretolytic means are used. Inhalations with sodium cromoglycate (intal) are effective, especially in patients with allergies, with 0.5% sodium of solutan from 2 to 5 drops together with one ampoule of intalum. Duration of inhalation is 10-15 min.
Treatment strategy involves phasing in use of different means depending on condition and severity of obstruction in infants. Beta2 –agonists are appointed inside with satisfactory condition and I degree of airflow obstruction (mild retraction of compliant places of chest and respiratory rate is up to 50-60 in 1 min). Nebulizer therapy is used with II degree of bronchial obstruction (retraction of compliant places of chest is expressed, child is restless, respiratory rate is more than 60 in 1 min). Nebulizer therapy, inhaled steroids are used at III degree - severe bronchial obstruction (participation of auxiliary muscles in breath is pronounced, respiratory rate is more than 70 in 1 min , child is occasionally sluggish). Continued serious condition during first day is indication for intravenous administration of prednisolone at rate of 1-2 mg / kg of body weight, only once, as a rule.
Physical therapy, massage of chest, breathing exercises are prescribed with moderate course.