Treatment of bronchitis in children

The proposed treatment protocols for acute bronchitis include necessary and sufficient prescriptions.

Simple acute viral bronchitis: treatment at home.

Drink plenty of warm fluids (100 ml/kg per day), massage the chest, and drainage if the cough is wet.

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

Mycoplasma or chlamydial bronchitis - in addition to the above prescriptions, a course of macrolides is required for 7-10 days. In case of broncho-obstruction, the use of bronchospasmolytic drugs is indicated: salbutamol, ipratropium bromide + fenoterol (berodual), etc. (mainly in the form of a solution for inhalation through a nebulizer).

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

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

In cases of bronchiolitis with repeated episodes, glucocorticoids (metered-dose aerosol or inhalation solution) are indicated for a long period (1-3 months).

In case of hypoxia - oxygen therapy.

Mucolytic and mucoregulatory agents (acetylcysteine group and ambroxol hydrochloride), administered mainly by inhalation through a nebulizer or in the form of tablets and powders.

Chest massage and drainage on the 2nd-3rd day of illness to improve sputum evacuation and reduce bronchospasm.

In case of obliterating alveolitis, the following should be added to antispasmodics:

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

The calculation of the fluid for infusion should not exceed 15-20 ml/kg per day. Additionally, for bronchitis, the following can be prescribed:

• in case of sufficiently pronounced symptoms of intoxication, antiviral drugs (interferon intranasally, interferon suppositories rectally or endonasal ointment, rimantadine, arbidol, etc.);
• expectorants for unproductive cough;
• for viscous sputum, mucolytics;
• anti-inflammatory and antihistamine therapy: fenspiride (erespal) helps reduce swelling of the mucous membrane and hypersecretion, improve bronchial drainage function, mucociliary clearance, reduce cough and bronchial obstruction;
• fusafungine (bioparox) for pharyngitis, foci of infection of ENT organs;
• for RS-virus bronchiolitis in children at risk (very premature babies, children with bronchopulmonary dysplasia), including for prophylactic purposes - palivizumab.

In case of recurrent bronchitis and recurrent obstructive bronchitis, treatment is usually carried out at home. It is necessary to create a special microclimate: humidity of at least 60% at a temperature of 18-19 °C, frequent ventilation, and avoid contact with tobacco smoke. It is necessary to minimize the intake of medications, taking into account the frequency of episodes. Systemic antibiotics are indicated only in case of complications from ENT organs (amoxicillin, macrolides, etc.).

The common thing in the treatment of recurrent bronchitis and recurrent obstructive bronchitis is that children in the interictal period need basic therapy. Non-drug therapy: hardening, sports activity, therapeutic physical training (LFK), spa treatment. Sanitation of chronic foci of infection. Preventive vaccinations.

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

Basic therapy for recurrent obstructive bronchitis: additional inhalations of cromoglicic acid in the form of a metered aerosol or through a nebulizer in the form of a solution (intal, cromoghexal, etc.) or glucocorticoids (metered aerosol or solution for inhalation) - long-term (from 1 to 3 months). Treatment should be started at the next exacerbation.

Additional appointments:

• Antiviral drugs (interferon intranasally, interferon suppositories rectally or endonasal ointment, rimantadine, arbidol, etc.).
• Mucolytic and mucoregulatory agents (acetylcysteine and ambroxol hydrochloride group), administered primarily by inhalation through a nebulizer or in the form of tablets and powders.
• In case of recurrent obstructive bronchitis, the use 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 reduce swelling of the mucous membrane and hypersecretion, improve bronchial drainage function, mucociliary clearance, reduce cough and bronchial obstruction.
• Fusafungin (bioparox) for pharyngitis, foci of infection of ENT organs.
• Non-drug treatment methods: drinking plenty of warm fluids, chest massage, and drainage for wet coughs.

Prognosis for bronchitis

Acute bronchitis (simple). The prognosis is favorable.

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

Acute bronchiolitis. In a favorable course of acute bronchiolitis, obstruction reaches its maximum during the first two days, then dyspnea decreases and disappears by the 7th-14th day. Complications, such as pneumothorax, mediastinal emphysema and bacterial pneumonia, rarely develop. Suspicion of the development of pneumonia should arise with an asymmetric auscultatory picture, persistent temperature, severe intoxication, leukocytosis. The diagnosis is confirmed on an X-ray in the form of infiltrative shadows.

In children who have had acute bronchiolitis of adenovirus etiology with high temperature, obstruction persists for a longer period (14 days or more). Preservation of local wheezing over a section of the lung, increasing respiratory failure, febrile temperature in the late stages of the disease may indicate the process of development of obliteration of the bronchioles, i.e. the formation of obliterating bronchiolitis.

Acute obliterating bronchiolitis (postinfectious obliterating bronchiolitis). With a favorable outcome, on the 14th-21st day of the disease, the temperature usually decreases and the physical symptoms of the disease completely disappear, but sometimes hypoperfusion of the lung lobe of grade I-II persists, without typical signs of McLeod syndrome. In such patients, wheezing over the affected area may be heard for many years against the background of ARVI.

In case of an unfavorable outcome, after the temperature has normalized, bronchial obstruction remains, which indicates that the process has become chronic. On the 21st-28th day of the disease, wheezing and wheezing are heard, which sometimes resembles an attack of bronchial asthma. By the 6th-8th week, the phenomenon of supertransparent lung may develop.

Recurrent bronchitis. In half of patients with recurrent bronchitis, when determining the function of external respiration (FER), obstructive ventilation disorders are determined, mild and reversible, in 20% - during the period of remission, latent bronchospasm is detected.

In 10% of patients, typical bronchial asthma develops following recurrent obstructive bronchitis - in 2% (risk factor - latent bronchospasm).