The capriciousness of small children is so characteristic of many of them, and it is not always possible to find out the reason for the restless behavior, because it is clear to say that the baby is not always able / able. One of these causes of childhood anxiety is bronchiolitis. Consider this disease in more detail and find out how to distinguish it, and what are the means for treating bronchiolitis.
Bronchiolitis – what is this disease?
Bronchiolitis is an inflammatory disease of bronchioles, characterized by their overlapping and, accordingly, a violation of the respiratory function of a person.
Other names for the disease are obliterating bronchiolitis (used in medical practice).
Bronchiolitis in children is diagnosed more often than in adults, and viral infection predominates among the causes , especially adenoviruses, influenza viruses, measles and others.
The bronchiole is the connecting link between the bronchi and alveoli, in which gas exchange of the lungs occurs. With inflammation of the walls of the bronchioles, their lumen narrows, which in the normal state is up to 1 mm in diameter. In addition, the bronchioles are clogged with the pathological secret released during inflammatory processes. Because of this, blood cannot transfer carbon dioxide through the alveolus and does not in turn take oxygen, which leads to oxygen starvation of various organs and systems.
The main symptoms of bronchiolitis are pain behind the sternum, shallow breathing and shortness of breath, fever, cough. The severe course of inflammation in children up to 2-3 years old can even lead to suffocation
The severe course of bronchiolitis is more typical for infants, as well as babies up to 3 years. This is due to shorter branches of the bronchial tree, as well as incompletely formed immunity.
The seasonality of the disease falls in November – April.
It is also noted that among patients acquires masculine sex.
Severe lethal disease occurs in 1% of infants, among those with bronchiolitis.
The incubation period of bronchiolitis depends on the pathogen that provoked inflammation of the bronchial tree. It can range from several hours (influenza viruses, streptococci) to several days (measles, rubella viruses).
On average, a complete clinic in children develops in 2-3 days.
The onset of the disease is similar to a common cold.
The first signs of bronchiolitis
- A persistent increase in body temperature to 37.2 – 37.8 ° C;
- Weakness amid anxiety, nervousness;
- Loss of appetite;
- Nasal congestion, runny nose;
- Headaches, sleep disturbance;
- Desire to clear his throat.
At the first signs of illness in children aged 1-2 years, it is urgent to seek specialized medical help.
Symptoms of bronchiolitis
- A feeling of stuffiness in the chest and dull pain behind the sternum, which also becomes swollen, and to facilitate and improve breathing, a person tries to raise his shoulders as if;
- The appearance of shortness of breath, even at rest and when exhaling;
- A painful cough of a spasmodic nature, in which thick, viscous sputum in small quantities can separate;
- Breathing becomes shallow and rapid, with wheezing rattling heard from a distance;
- Body temperature can rise to levels of 39-40 ° C, which is typical for secondary bacterial infection;
- Swelling of the face and fingers;
- Enlarged liver (hepatomegaly) and spleen (splenomegaly);
- Bronchiolitis in children is manifested by moodiness, insomnia, lack of appetite and a desire to play games familiar to them.
Here, more and more depends on the causative agent of the disease:
- Bouts of vomiting;
- Swelling of the eyelids and lacrimation;
- Fatigue and / or sore throat;
- Rhinitis (runny nose).
The development of the disease (pathogenesis)
A few words about anatomy in an accessible language.
The bronchioles are the connecting link between the bronchi and the alveoli. Actually, these are the same bronchi, just with a smaller lumen, up to 1 mm in diameter. Unlike bronchi, bronchioles do not have cartilaginous tissues, various glands in their structure, but consist only of smooth muscle fibers (terminal type) and epithelial cells from alveolocytes (respiratory type). The main functions of bronchioles are the distribution of air into the alveoli, the removal of carbon dioxide from the alveoli, the production of surfactant (mucous membrane of the alveoli) and the removal of excess mucus from the alveoli.
The alveoli are the endpoint of the airways where air exchange occurs. It is in the alveolus that blood vessels with air are found where oxygen is taken and carbon dioxide is given off. And, as we know, even air does not burn without air, especially the cells of living organisms, which in the absence of oxygen begin to deform and die.
Now about the processes taking place in the body with inflammation of the bronchioles.
In the pathogenesis of bronchiolitis, the usual inflammatory response of the body in response to the penetration of infectious pathogenic microorganisms into it is visible.
So, in the place of infection sedimentation, an inflammatory infiltrate is formed from immune cells with multiple cell division (proliferation), which make up the mucous membrane of the bronchioles. These processes lead to thickening of the walls, swelling and narrowing of the lumen of the bronchiole, increased production of mucous secretions.
Further, the secret of mixing with the cells of the immune system becomes more dense, which further complicates the air exchange between the bronchi and alveoli. Violation of gas exchange in combination with oxygen starvation of the inflamed area leads to the destruction of the epithelial cover of the bronchioles and the proliferation of connective tissue.
The progression of bronchiolitis begins to affect the larger elements of the respiratory tract – the bronchi, contributing to the overlap and their lumen (bronchial obstruction).
As a result, the patient has problems with exhalation, pulmonary hyperair, lung atelectasis with impaired functioning. Bronchospasms develop.
At the same time, the product of the processed air, carbon dioxide, is not removed from the blood, which together with an insufficient supply of oxygen leads to a permanent disruption of the functioning of the entire respiratory system.
In addition, a decrease in local blood circulation leads to an increase in blood pressure in the pulmonary arteries (pulmonary hypertension), which additionally loads the heart and contributes to hypertrophy of the heart muscle in the right ventricle.
Lack of air causes hypoxia not only of the heart, but also of the brain, other organs and systems.
With adequate treatment, the clinical manifestations of the acute stage of bronchiolitis go away within 3-4 days, with further symptoms persisting for 14-21 days.
- Impaired functioning of the bronchial tree and lungs for a long time;
- Substitution of lung parenchyma with connective tissue;
- Pulmonary hypertension;
- Pulmonary dystrophy;
- Chronic obstructive pulmonary disease (COPD);
- Bronchial asthma;
- Pulmonary insufficiency;
- Heart failure;
- Choking, death.
Causes of bronchiolitis
The development of bronchiolitis is usually due to a combination of two or more factors, for example, infection, which is the leading cause of inflammation of the bronchioles and weakening of the immune system, or, as in the case of infants that have not yet formed immunity.
The causative agents of bronchiolitis in most cases:
Viral infections – respiratory syncytial virus (up to 80% among children), adenoviruses, coronaviruses, rhinoviruses, measles virus, influenza virus, parainfluenza virus, enteroviruses, mumps virus, chickenpox virus, cytomegalovirus and other representatives of herpes viruses.
Bacterial infection – mycoplasmas, legionella, chlamydia, Klebsiella, aspergillus, pneumococci and other streptococci.
Fungal infection – pneumocyst.
- The presence of respiratory diseases – pneumonia, alveolitis, tracheitis, bronchitis, laryngitis, sinusitis, abnormalities of the respiratory system at birth, or acquired;
- Autoimmune diseases – vasculitis, lupus, rheumatism;
- Pathologies and diseases of the neuromuscular system;
- Diseases of the cardiovascular system, congenital heart defects;
- Other diseases – lymphoma, histiocytosis, allergies, enteritis, colitis, HIV infection;
- Hypothermia of the body;
- The negative effect on the body of certain groups of drugs – antibacterial drugs (penicillin, cephalosporin, bleomycin), antiarrhythmics (amiodarone), immunomodulators (interferon), chemotherapy drugs, drugs with the addition of gold;
- Irritation of the respiratory tract with toxic substances – gas, dust, varnishes, paints, nicotine, combustion products, smoking, drugs;
- Poor and / or inadequate nutrition, with a lack of sufficient vitamins and microelements with other useful substances in the diet ;
- Prematurity of the child;
- Hereditary predisposition.
- Breasts and babies up to 3 years old;
- Kursk lovers and drink strong drinks;
- Persons who work in places and / or premises with adverse environmental conditions, for example, manufacturing enterprises;
- Persons of advanced age;
- Persons who have weakened immunity.
Classification of bronchiolitis is as follows:
- Post-infection – caused by various types of pathogenic infection;
- Inhalation – caused by irritation of the respiratory tract with various gases (CO, NO2, SO2), dust, smoke (tobacco smoking, etc.), fumes of acids and other substances (paints and varnishes);
- Medication (drug) – various drugs caused by poisoning and / or an allergic reaction;
- Idiopathic – unexplained etiology.
Diagnosis of bronchiolitis
Diagnosis of bronchiolitis includes:
- Collection of complaints, anamnesis, auscultation (fine bubbling rasping is heard, longer expiration), percussion;
- X-ray of the lungs (it is better to give preference to CT, which better reveals the disease) – there is a restriction in the movement of the diaphragm, proliferation of fibrous tissue, accumulation of free fluid in bronchial tissue;
- Computed tomography (CT) – shows a narrowing of the bronchioles, in the lumen of which there is a pathological secret, an increase in their outer shell and deformation of the bronchioles;
- Spirometry, in which there is a decrease in FEV1 / FVC indicators to 75% and below;
- Pulse oximetry – helps to identify the gas composition in the blood;
- Polymerase chain reaction (PCR) from a smear from the nasopharynx – is carried out to identify the causative agent of the inflammatory process;
Additionally, you may need:
- Electrocardiography (ECG) and EchoECG;
- Lung biopsy.
Bronchiolitis must be differentiated from other diseases similar in symptoms – bronchitis, bronchial asthma, pneumonia, emphysema.
How to treat bronchiolitis? The treatment of the disease depends on the causative agent of inflammation of the bronchioles, the presence of concomitant diseases and characteristics of the body, the age of the person (child / adult).
The treatment regimen for bronchiolitis includes the following items:
1. Anti-infective therapy.
2. Infusion-detoxification therapy.
3. Anti-inflammatory therapy.
4. Symptomatic treatment.
5. General recommendations for treatment.
Treatment of bronchiolitis in children is carried out in a hospital, severe cases in intensive care / resuscitation, adults on an outpatient basis.
1. Anti-infection therapy
As we said, the main causes of bronchiolitis are the penetration into the body of an infection, most often of a viral nature, less often of a bacterial, extremely rarely fungal nature.
Antiviral therapy. The fight against viruses is usually carried out by the immune system, which directs its cells to the site of infection, and these, with the help of local and general reactions, somehow increase the body temperature stops the virus particles and blocks the replication of viruses. Of course, if the body is weakened, then it is difficult for the immune system to fight viruses, and the doctor may prescribe antiviral drugs. These include immunomodulators, which either stimulate the reactivity of the immune system, or contribute to its restructuring to combat pathogens.
The choice of antiviral agent may also depend on the type of viral infection that has damaged human health.
Popular antiviral agents are Acyclovir, Ribavirin, Valtrex.
Antibiotic therapy. The body carries out the fight against pathogenic bacteria in the same way as in the case of viruses. Involved are immune cells, in fact, which cause an inflammatory reaction, an increase in body temperature, an increase in regional lymph nodes, and other mechanisms. However, in the case of bacteria, the body’s strength is often not enough, so humanity has come up with drugs called antibiotics.
Antibacterial drugs for bronchiolitis are prescribed only if the bacterial nature of the disease is detected. Otherwise, they can further weaken the reactivity of the immune system and complicate the course of the disease.
Popular antibiotics for bronchiolitis are cephalosporins (Ceftriaxone, Cefazolin), fluoroquinolones (Ofloxacin, Ciprofloxacin) or macrolides (Azithromycin, Erythromycin).
2. Infusion-detoxification therapy
Weakness, loss of appetite, nausea, bouts of vomiting – all these manifestations are present in case of poisoning. You may ask, what does poisoning have to do with, for example, products for the disease considered today? So, a pathogenic infection, being in the body, throws out the products of its vital activity into the blood, which, like spoiled food products, also poison the body itself.
To cleanse the body of infectious toxins, infusion-detoxification therapy is carried out, which includes:
- Abundant fractional drink;
- The use of sorbents that bind toxins and through the urine remove them from the body – Atoxil, Polysorb, Enterosgel;
- The introduction of infusion solutions (in severe condition of the patient) – crystalloids (sodium, potassium, chlorides), colloids (“Albumin”, “Dextran”). Be sure to control blood counts and blood pressure levels.
3. Anti-inflammatory therapy
To remove the inflammatory process in bronchioles, anti-inflammatory therapy is prescribed, which is mainly based on the use of anti-inflammatory and hormonal drugs.
To an anti-inflammatory drug to a greater extent include a large group – non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs).
Popular NSAIDs for bronchiolitis are Indomethacin, Nimesil, Nurofen, Ibuprofen, Acetylsalicylic Acid. Please note that aspirin, ibuprofen and some other NSAIDs are not approved for use in children. Ibuprofen is also banned for use in the United States and some other states.
Pay attention to the fact that taking NSAIDs lowers body temperature to normal levels in case of fever. This is not recommended in the early days of the disease, since an increase in temperature is aimed at destroying the protein of pathogenic microflora, i.e. it is a natural defensive reaction of the body. By lowering it, you will practically disarm it. An exception is if the temperature does not drop within 5 days from 39 ° C (adults) and 38.5 ° C (children).
To enhance the anti-inflammatory effect, the doctor may prescribe the use of hormonal drugs from the group of glucocorticosteroids (GA) – “Dexamethasone”, “Prednisolone”.
4. Symptomatic treatment
Symptomatic treatment is aimed at reducing the severity of the disease and accelerating the recovery of a person. For this, the following medication methods of therapy are used.
Bronchodilators (bronchodilators) – a group of drugs that have the property of relaxing the muscle fibers of the bronchial tree, thereby expanding the lumen of the bronchi. In this case, the relaxation of bronchioles helps relieve bronchospasm, facilitate air exchange. Popular medicines are Eufillin, Berotek, Salbumatol.
Immunosuppressants – are used for a severe inflammatory process and other signs of a violent reaction of the immune system to infection. Among the drugs isolated – “Metatrexate”.
Mucolytics are a group of drugs that thin the thick secretion in the respiratory tract, which helps to remove it from the body faster, thereby improving breathing. Popular mucolytics are Mukaltin, Prospan, Ambroxol.
Expectorants – help to remove secret from the body liquefied by mucolytic agents. Among the drugs can be distinguished – “ACC”, “Doctor IOM”, “Lazolvan”, “Licorice root”, “Bromhexine”.
Many drugs for the removal of sputum have a cross-action – mucolytic and expectorant at the same time – “ACC”, “Bromhexine”, “Ambroxol” and others.
Mucus from the respiratory tract can also be obtained using an electric aspirator.
Antitussive drugs – used for severe painful cough. Among the drugs emit – “Codeine”, “Sinecode.”
To normalize body temperature, if it rises to very high levels and does not pass, NSAIDs are prescribed, which we wrote about the essence of earlier in the article, in the section “Anti-inflammatory therapy”.
In some cases, especially in children, oxygen therapy is prescribed to patients – the use of an oxygen mask, ward, mechanical ventilation.
Vitamin and mineral complexes and antioxidants (Actovegin, Coenzyme Q10).
Among physiotherapeutic methods of treatment, massage of the chest, as well as inhalation based on a hypertonic solution, will be useful.
5. General treatment recommendations
To facilitate the respiratory function of the patient, create a favorable indoor microclimate – humidity of about 60%, air temperature – from 18 to 21 ° C. If there is an active heating system, if possible, screw the taps, as batteries usually dry the air.
Ventilate the room regularly with the patient.
Do not forget about a plentiful drink, which, firstly, will help to quickly remove infectious toxins from the body, and secondly, will help in thinning sputum, from which the body will be easier to cleanse.
The prognosis for bronchiolitis is favorable. Most often passes independently within 2-3 weeks. A bit longer residual effects may occur in the form of a cough.
Mortality is about 1% among infants with bronchiolitis.
Bronchiolitis – folk remedies
Mother and stepmother. This plant has a good expectorant effect, which helps to remove sputum from the respiratory tract. For the preparation of healing tools fill a few leaves mother and stepmother cup of boiling water, cover and let infusions for 40 minutes. Strain and take 5-6 tbsp. tablespoons 3 times a day, after meals.
Onion. Mix 500 g of chopped onions and 400 g of granulated sugar with each other in a bowl, add 1 liter of water and put on a stove, bring to a boil and simmer for another 3 hours. Set aside coolant and infusion. Next, add 50 g of natural honey. Drink the drug for 4-6 tbsp. tablespoons 3 times a day, after eating.
Black radish. Dice 1 large black radish fruit, sprinkle sugar in a bowl and put in the oven for baking for a couple of hours. Next, drain the separated juice into a glass container for storage. Drinking the drug is recommended for 2 teaspoons 3-4 times a day, before meals and at bedtime. This tool is suitable for the treatment of bronchiolitis in children.
Carrot. Squeeze the juice out of the carrots, add 2 teaspoons of natural honey (if not sugar) to it, mix and drink 1 tbsp. spoon before meals, 4 times a day.
Raspberry. Tea with raspberries is an excellent remedy for various acute respiratory infections.
Soda. Soda has an excellent anti-infectious property. Add in a half-liter teapot with boiling water 1 tbsp. spoon of soda, after inhale the steam through the spout of the kettle.
Prevention of bronchiolitis
Prevention of bronchiolitis includes compliance with the following rules and recommendations:
- Compliance with personal hygiene;
- Keep a distance of 1.5-2 meters from people with signs of acute respiratory infections, i.e. coughing and sneezing people;
- When working in dusty places, or with various substances that emit a toxic smell / gas, use personal protective equipment, especially respiratory organs (respirators, etc.);
- If there is a patient in the house, allocate him for personal use kitchen items, bath accessories;
- Teach your children not to drink different drinks from someone else’s dishes / bottles, as this is the main way to infect many people in large enterprises where people neglect sanitary standards;
- Stop smoking and drinking alcohol;
- In the period of acute respiratory diseases, take additional vitamin and mineral complexes;
- Grudnichkov WHO recommends feeding mother’s milk in the first 6 months of life, which contributes to the normal development of the baby’s immune system.