Acute respiratory infections in children are a significant problem of modern pediatrics . The primary pathogens of respiratory infections are various viruses and bacteria that contribute to the development of mucosal inflammation and the launch of a whole complex of pathophysiological reactions aimed at eliminating the pathogen, toxic substances and pathologically altered secretion from the respiratory tract. In some cases, for respiratory infections accompanied by the development bronhoobstruk tive syndrome.
Broncho-obstructive syndrome is a symptomatic complex , the clinical manifestations of which consist of an extended exhalation, wheezing, noisy breathing, attacks of breathlessness, cough, etc.
The term ” broncho-obstructive syndrome” should not be used as an independent diagnosis.Along with it, the term “acute obstructive composition of the respiratory tract” is often found in modern literature quite often .
In the pathogenesis of bronchial obstruction in children with ARI basic importance mucosal edema, inflammatory infiltration and disruption of mucus properties.The mechanism of true bronchospasm , which is caused by increased sensitivity of the interoreceptors of the cholinergic component of the autonomic nervous system (ie, primary or secondary hyperactivity ) or blockade of beta-2 adrenoreceptors in ARI, is less pronounced.
With these factors in children, especially young children, it is often linked to the inefficiency of the beta-2 agonist (beta-2-agonists), short-acting, causing expansion of the bronchial tubes and is the most effective of the existing bronholiti Cove in biofeedback therapy in adults.
Inflammatory response at FCL in children with acute respiratory infections initiated about five inflammatory cytokines and, in particular, interleukin-1 which promotes the release of neurotransmitters in the peripheral blood of type 1: histamine, serotonin, which are always present in the granules of mast cells and basophils.Despite the fact that the release of histamine is more characteristic of the reaction of the interaction of the allergen with the allergen specificInfectious agents can also cause IgE antibodies , mast cell degranulation .
During the early inflammatory response with ARI is generated eicosanoids (Mediate of 2nd type moat), the source of which is arachidonic acid, from which subsequently synthesized prostaglandins and leukotrienes.
Under the influence of these products, a symptom complex is formed with edema of the bronchial mucosa, hypersecretion and bronchospasm , and later – damage to the epithelium and the formation of hyperreactivity.The subsequent violation of ventilation and mucociliary clearance leads to stagnation of sputum and concentration in the bronchial mucosa of infectious agents, oxygen free radicals and other active mediators that increase inflammation, which in turn again provokes bronchospasm , leading to a superinflation and a protracted inflammatory process.
The development of bronchial obstruction in children also contributes to a number of such anatomical and physiological features, such as hyperplasia of glandular tissue, the predominant release of viscous sputum, the relative narrowness of the respiratory tract, a small amount of smooth muscle, low collateral ventilation, and a lack of local immunity.Also important factors predisposing to bronchial obstruction are features of the structure and function of the diaphragm.In young children, the length of the muscular part of the diaphragm is larger than the tendon, but due to the fact that the muscle bundles are poorly developed and their innervation is not complete, the function of the diaphragm is markedly limited .
The majority of researchers recognize the influence of a number of factors of premorbid background on the development of the broncho-obstructive syndrome .This is an aggravated allergic history, bronchial hyperreactivity, hereditary predisposition to atopy , prematurity, malnutrition, thymus hyperplasia, early artificial feeding, early debut of respiratory diseases (aged 6 to 12 months), etc.
Adverse environmental factors can provoke an increase in the incidence of bronchial obstruction in acute respiratory infections , among which adverse environmental conditions and passive smoking in the family are of particular importance .Thus, exposure to tobacco smoke violates the properties of bronchial secretions and mucociliary clearance, inhibits the synthesis of antibodies of the main classes, stimulates the synthesis of immunoglobulins E and contributes to the destruction of the bronchial epithelium.Tobacco smoke is an inhibitor of neutrophil chemotaxis and phagocytic activity.
Obstructive syndrome is most common in ARIs caused by a respiratory syncytial virus (about 50%), parainfluenza virus , less frequently – influenza viruses and adenovirus.
It is important to note that a number of authors recognize broncho-obstructive syndrome as one of the most informative clinical criteria for the differential diagnosis of the etiology of respiratory infection along with respiratory insufficiency, weakening breathing during auscultation, rhinitis, and familial nature of the disease, in particular for the differential diagnosis of pneumonia caused typical and atypical pathogens.
With a high probability (up to 90%), we can say that for pneumonia caused by atypical pathogens (mycoplasma and chlamydia), broncho-obstructive syndrome is a characteristic symptom, whereas pneumococcal pneumonia is respiratory failure and respiratory failure during auscultation .
In the treatment of respiratory infection, the key element is the correctly chosen etiotropic treatment.A differentiated approach requires the correction of a cascade of pathogenetic disorders, especially in the presence of broncho-obstructive syndrome .
To do this, it is first necessary to normalize the drainage function of the respiratory tract: the use of mucolytics and expectorant drugs, oral rehydration .The main purpose of the use of expectorant and mucolytic drugs is to thin the sputum and increase the effectiveness of cough.
It is important to note that in case of severe obstruction, bronchial drainage is disturbed and the massive use of mucolytics and expectorant drugs can lead to the accumulation of mucus in the terminal sections of the bronchi and the effect of “waterlogging”.
Thus, a dynamic auscultatory is necessary.child control and timely correction.When expressed secretion can be recommended based preparations carbocisteine, mukoregulyatornym possess conductive properties.Appointment antitussives Wed dstv etc., and the treatment of broncho-obstructive syndrome th and should be avoided.Combined preparations containing ephedrine should be used only in cases of overproduction of abundant liquid bronchial secretion, due to their “drying” effect.
Own experience has shown that the appointment of antihistamines in the treatment of broncho-obstructive syndrome th and the children is justified.
With their help, it is possible to better control the severity of obstructive syndrome, temperature reactions and possible allergic manifestations when using drugs.In children at the present stage, it is advisable to use antihistamines of the 2nd generation.Although in some cases it turns out to be useful “drying” effect of antihistamine drugs of the 1st generation.
To combat acidosis, the child’s body needs an alkaline valence subsidy (milk-vegetable diet, drinking mineral water).
Currently, inhalation administration of drugs is widely used, providing a rapid therapeutic effect and selectivity of exposure, it should be remembered that the broncho-obstructive syndrome significantly reduces the penetration of aerosol into the respiratory tract .
The inhalation route of administration is widely used to conduct bronchodilator therapy in children (short-acting beta-2 agonists, an anticholinergic drugs) .
The drugs of choice for reducing acute bronchial obstruction are beta-2 short-acting agonists ( salbutamol , terbutaline , fenoterol), which, when inhaled, give a rapid bronchodilatory effect.
An important aspect of the pathogenetic correction of obstructive syndromeis the use of anti – inflammatory drugs .In severe BOS , inhaled glucocorticosteroids are widely used , such as Budesonide ( Pulmicort ) and others.
The need for a complex effect on individual pathogenesis of biofeedback in many cases makes it reasonable to use complex drugs that have a combined mechanism of action.
Currently, in the treatment of broncho-obstructive syndrome, complex preparations have found wide use, which simultaneously reduce the viscosity and adhesive properties of bronchial mucus, as well as normalize bronchial permeability.
Thus, the treatment of obstructive syndrome in children poses the pediatrician a responsible task, consisting in the rational selection of drugs.The choice of specific drugs, whose arsenal on the drug market is quite wide, should be pathogenetically justified, taking into account the individual characteristics of the child, as well as based on knowledge of the mechanism of their action and pharmacokinetics .