Treatment of bronchitis in children

The proposed protocols for the treatment of acute bronchitis include necessary and sufficient purposes.

Simple acute viral bronchitis: treatment at home.

A plentiful warm drink (100 ml / kg per day), chest massage, with a wet cough - drainage.

Antibiotic therapy is indicated only if the elevated temperature is maintained for more than 3 days (amoxicillin, macrolides, etc.).

Mycoplasmal or chlamydial bronchitis - in addition to the above-mentioned appointments, taking a course of macrolides for 7-10 days is required. In bronchial obstruction, bronchospasmolytic agents are indicated: salbutamol, ipratropium bromide + fenoterol (berodual), etc. (mainly in the form of a solution for inhalation through a nebulizer).

Obstructive bronchitis, bronchiolitis require hospitalization for severe obstruction with respiratory failure, especially in the case of ineffective therapy. Antitussives, mustard plasters are not prescribed.

In cases of severe bronchial obstruction, it is necessary to take bronchospasmolytic drugs: salbutamol, ipratropium bromide + fenoterol (berodual), etc. (mostly in the form of a solution for inhalation through a nebulizer).

When the bronchiolitis with repeated episodes shows glucocorticoids (metered aerosol or solution for inhalation) - for a long time (1-3 months).

At the phenomena of hypoxia - oxygen therapy.

Mucolytic and mucoregulatory agents (a group of acetylcysteines and ambroxol hydrochlorides), administered predominantly by inhalation through a nebulizer or in the form of tablets and powders.

Massage of the chest and drainage on the 2nd-3rd day of the disease to improve the evacuation of sputum and reduce the phenomena of bronchospasm.

When obliterating the alveolitis to antispasmodics, you should add:

• broad-spectrum antibiotics;
• systemic glucocorticoids inside;
• oxygen therapy.

Calculation of fluid for infusion should not exceed 15-20 ml / kg per day. In addition, with bronchitis can be appointed:

• with sufficiently pronounced symptoms of intoxication antiviral drugs (interferon intranasal, suppository of interferon rectal or endonasal ointment, rimantadine, arbidol, etc.);
• expectorants with a low-yield cough;
• with viscous sputum mucolytics;
• anti-inflammatory and antihistamine therapy: fenspiride (erespal) helps to reduce mucosal edema and hypersecretion. Improvement of drainage function of bronchi, mucociliary clearance, reduction of cough and bronchial obstruction;
• fusafungin (bioparox) with pharyngitis, foci of infection of the ENT organs;
• with PC-viral bronchiolitis in children at risk (deep-bowed, children with bronchopulmonary dysplasia), including for the prevention of - palivizumab.

With relapsing bronchitis and relapsing obstructive bronchitis, treatment is usually done at home. It is necessary to create a special microclimate: humidity of at least 60% at a temperature of 18-19 ° C, frequent airing, exclude contact with tobacco smoke. It should minimize the intake of drugs, given the frequency of recurrence of episodes. Systemic antibiotics are indicated only in case of complications from ENT organs (amoxicillin, macrolides, etc.).

Common in the treatment of recurrent bronchitis and relapsing obstructive bronchitis is that children in the interictal period need basic therapy. Non-medicamentous therapy: hardening, sports activity, therapeutic physical culture (LFK), sanatorium-and-spa treatment. Sanitation of chronic foci of infection. Prophylactic vaccinations.

Basic therapy of recurrent bronchitis: ketotifen 0.05 mg / kg per day for a long time (for 3-6 months).

Basis therapy of recurrent obstructive bronchitis: additionally inhalation of cromoglycic acid in the form of a dosed aerosol or through a nebulizer in the form of a solution (intal, cromogexal, etc.) or glucocorticoids (dosed aerosol or inhalation solution) - for a long time (from 1 to 3 months). Begin the treatment should be the next aggravation.

Additional assignments:

• Antiviral drugs (interferon intranasal, suppository of interferon rectal or endonasal ointment, rimantadine, arbidol, etc.).
• Mucolytic and mucoregulatory agents (a group of acetylcysteines and ambroxol hydrochloride), administered predominantly by inhalation through a nebulizer or in the form of tablets and powders.
• With relapsing obstructive bronchitis, the appointment of bronchospasmolytic drugs is indicated: salbutamol, ipratropium bromide + fenoterol (berodual), etc. (mainly in the form of a solution for inhalation through a nebulizer).
• Anti-inflammatory and antihistamine therapy: fenspiride (erespal) helps to reduce mucosal edema and hypersecretion, improve bronchial drainage function, mucociliary clearance, reduce cough and bronchial obstruction.
• Fusafungin (bioparox) with pharyngitis, foci of infection of the ENT organs.
• Non-medicamentous methods of treatment: abundant warm drink, chest massage, with a wet cough - drainage.

Prognosis for bronchitis

Acute bronchitis (simple). The forecast is favorable.

Acute obstructive bronchitis. The outlook is usually favorable. Against the background of therapy, respiratory disorders decrease on the 2-3rd day of the disease, although wheezing wheezing with prolonged exhalation can be heard for a longer time, especially in children with severe rickets or with aspiration syndrome.

Acute bronchiolitis. With a favorable course of acute bronchiolitis, obstruction reaches a maximum within the first two days, then shortness of breath decreases and disappears by 7-14 days. Rarely complications develop, for example pneumothorax, mediastinal emphysema and bacterial pneumonia. Suspicion of the development of pneumonia should occur with asymmetric auscultatory pattern, persistent temperature, severe intoxication, leukocytosis. The diagnosis is confirmed on the roentgenogram in the form of infiltrative shadows.

In children who have experienced acute bronchiolitis of adenoviral etiology with high temperature, obstruction lasts longer (14 days or more). Preservation of local wheezing above the lung site, increasing respiratory insufficiency, febrile temperature in late terms of the disease may indicate the development of bronchioles obliteration, i.e. Formation obliterating bronchiolitis.

Acute obliterating bronchiolitis (postinfection obliterating bronchiolitis). With a favorable outcome on the 14-21th day of the disease, the temperature usually decreases and the physical symptoms of the disease completely disappear, but sometimes hypoperfusion of the lung fraction of I-II degree, without typical signs of MacLeod's syndrome, is preserved. Such patients for many years against the background of acute respiratory viral infection may hear rales over the zone of injury.

In the case of an unfavorable outcome, after normalizing the temperature, bronchial obstruction persists, indicating a chronic process. On the 21-28th day of the illness rattles are heard, wheezing, which sometimes resembles an attack of bronchial asthma. By the 6th-8th week, the phenomenon of a super-transparent lung is possible.

Recurrent bronchitis. Half of patients with recurrent bronchitis in determining the function of external respiration (FVD) determine obstructive ventilation disorders, non-sharp and reversible, in 20% - in the period of remission reveals a hidden bronchospasm.

In 10% of patients subsequently developing relapsing obstructive bronchitis typical bronchial asthma - in 2% (risk factor - hidden bronchospasm).