Obstructive bronchitis, the main symptom of which is the narrowing (obstruction) of the bronchi and the resulting difficulty in exhalation, is a very common variant of lesion of the lower respiratory tract among children, especially younger ones. Prerequisites for the development of obstruction in children, even against the background of relatively easy-flowing ARVI, create a physiologically narrow bronchial lumen in children under 3 years of age.
In addition to the anatomical and physiological features, the predisposing factors for the formation of obstructive bronchitis are:
- allergies and susceptibility to allergic reactions;
- smoking – both passive and active.
With its high prevalence, obstructive bronchitis has a very bright clinic, often frightening the parents, which leads to the healing of the child with potent and not always necessary medicines.
Main symptoms of obstructive bronchitis
- Loud, distant wheezing or wheezing;
- swelling of the chest and intercostal spaces during breathing;
- paroxysmal excruciating cough, sometimes vomiting.
What is dangerous obstructive bronchitis?
Bronchitis is usually mild and well treatable at home. However, the accession of the obstruction aggravates the condition of the child, and in some cases may pose a serious threat to his life.
When emergency hospitalization is required
But even in cases where the child receives treatment at home, this should not mean the absence of medical advice. Even if the baby is prone to frequent obstructions and you are perfectly familiar with the treatment regimen, you should not neglect the examination of the doctor. The doctor will determine the need of the child in certain medicines, adjust their dosage depending on the severity of the condition. In addition, do not forget that under the guise of obstructive bronchitis can hide pneumonia, and often repeated obstruction often lead to the formation of bronchial asthma.
Treatment of obstructive bronchitis
Bed rest is shown to the child only on the background of temperature. In its absence, the mode is relatively free, but it is desirable to control the physical activity of the child: most children tolerate obstruction well and can run and play well before the onset of severe shortness of breath.
Walking in the fresh air is not only allowed, but even recommended – you can walk for 1–1.5 hours twice a day. You should walk with your child daily, dressing him according to the season and weather conditions (in case of strong wind and frost, walks are excluded). Places for walking should be chosen according to the following rules:
- away from dusty roads and highways;
- away from playgrounds and other clusters of children, so as not to provoke the child to active games.
In the period of fever, readily assimilated fortified food is shown in a warm form, liquid and semi-liquid consistency (soups, mashed potatoes). For the entire period of the disease, it is recommended to drink plenty of liquids, which promotes the removal of intoxication and liquefaction of sputum: compotes and fruit drinks from fresh berries, decoctions of dried fruits, freshly squeezed juices (not from citrus fruits), weak tea, alkaline mineral water. Honey, chocolate, citrus fruits (except tea with lemon) are excluded from the diet, spices are highly allergenic products that can cause bronchospasm.
Home hygiene and other features of care for a sick child
Be sure to air the room daily, especially at bedtime (in the absence of the child). It is desirable to carry out daily wet cleaning, at least partially, but without the use of detergents and disinfectants, especially chlorine-containing. Control the humidity of the air: in the summer and winter in well-heated rooms, use humidifiers or replace them with improvised means (spray windows and curtains with a nebulizer, put a container with water in the room, etc.). Excessively dry air weights and delays the disease, contributes to the occurrence of exacerbations.
Avoid contact of the child with synthetic detergents and protect him from passive smoking.
Antibiotics and Antivirals
Antiviral drugs are indicated in the early days of the disease. For younger children, use candles (Genferon), nasal drops (Grippferon), syrups (Orvirem), from the age of 3, tablets can be used (Arbidol, Kagocel, etc.).
Antibacterial therapy is not a mandatory component of the treatment of obstructive bronchitis, and the appointment and choice of the drug should be made only by a doctor. Indications for the connection of antibiotics are:
- high fever longer than 3 days;
- severe intoxication;
- inflammatory changes in blood tests;
- purulent (yellow, yellow-green) sputum – a sign of bacterial lesion of the bronchi;
- Pediatricians listened for wet rales or other signs of possible pneumonia.
A prerequisite for effective treatment is the provision of sputum discharge, for which modern mucoregulatory drugs are used, which contribute to the liquefaction of viscous sputum and its early discharge. These include drugs based on Ambroxol (Ambrobene, Ambroxol, Lasolvan) and carbocysteine (Bronhobos, Fluditec, Mucosol). Ambroxol is also very effective in the form of inhalation through a nebulizer. The duration of treatment with these drugs is 7-10 days.
When the cough from the painful paroxysmal goes into a wet one, and the sputum becomes less viscous, but still does not move well, the mucoregulators are replaced with expectorant drugs of plant origin (Bronhikum, Bronchossan, Gedelix, Gerbion, Tussin, Prospan, Bronhipret, Dr. Mom, Dr. Tayss, pectoral fees № 1-4, and others.). They are prescribed a course for another 5-10 days.
Anti-cough codeine-containing drugs are not shown and can be recommended (only by a doctor) for an obsessive paroxysmal dry cough with mandatory monitoring of the child’s condition and treatment correction.
Preparations for the relief of obstruction and removal of bronchospasm
The best option to remove the obstruction – inhalation through a nebulizer. Young children are recommended Berodual solution for inhalation in dilution with saline. Inhalation spend 2-3 times a day (if necessary, and more often) to remove the pronounced obstruction, then continue to perform them at night. Dosage, frequency of inhalation and the duration of the course in each case is agreed with the attending physician.
In the absence of a nebulizer in young children, syrups containing bronchodilators are used: Clenbuterol, Ascoril, Salmeterol, etc. Their main drawback is the frequent occurrence of side effects in the form of heartbeat, tremor.
For older children, metered dose inhalers, aerosols (Salbutamol, Berodual, etc.) can be used.
Until now prescribed tablets of theophylline (Eufillin, Teopek), especially for the treatment of children with recurrent obstructive bronchitis. However, as compared with inhalation forms, they are more toxic, causing more undesirable side effects.
Erespal is a modern drug with anti-inflammatory activity, which reduces excessive sputum formation and contributes to the removal of bronchial obstruction. His appointment from the first days of the disease reduces the likelihood of complications, speeds up the process of treatment.
Antihistamines are indicated for children with allergic manifestations and a tendency to allergic reactions. In children older than 6 months, they use second-generation drugs (Zyrtec, Claritin). With abundant liquid sputum, antihistamines from the first generation (Suprastin, Tavegil) can be prescribed for “drying”.
Hormonal drugs can quickly relieve inflammation and bronchial obstruction. They are shown in severe and moderate obstructive bronchitis and are usually prescribed by inhalation (via a nebulizer). Pulmicort is most commonly used.
Against the background of high temperature, it is imperative to use antipyretic drugs. At the end of treatment (when the number of concurrently taken drugs does not exceed 3-4), multivitamins are recommended. A good effect is sometimes given by the connection of homeopathic medicines.
Physiotherapy and heating procedures
In the acute period, physiotherapy is ineffective. When prolonged coughing after stopping the obstruction, electrophoresis, UHF, laser are recommended. At home, you can perform neutral-heat compresses, warming with salt, buckwheat, potatoes. The use of mustard plasters, ointments and balms on a plant basis, inhalations with essential oils and other means with a strong odor for the treatment of obstructive bronchitis is strictly prohibited, especially in children under 3 years old – they often provoke bronchospasm.
Massage and physiotherapy
To improve sputum discharge, massage, gymnastics and special body positions (postural drainage) are used. The massage is vibrating: tapping on the back of a child with palms folded in a “boat”. Older children are asked to take a deep breath, a smooth long exhalation and on the exhale carry out tapping. The babies are laid with a pillow under the tummy (head down) and they are massaged, quickly tapping with their fingertips.
Postural drainage is carried out as follows: in the morning, the child, without getting out of bed, hangs his head and body from the bed, resting his palms or forearms on the floor, and remains in this position for 15–20 minutes.
Gymnastics should be performed while performing breathing exercises for enhanced exhalation. As a separate breathing exercises suitable blowing candles, inflating balloons.
What else do you need to know
It is important to remember that obstructive bronchitis can be caused by a combination of infectious and non-infectious factors, or only by non-infectious causes. Young children may develop obstruction by a foreign body, in adolescents – bronchitis during smoking, obstructive bronchitis of allergic origin is often found.
Distinctive signs of obstruction by a foreign body:
- Someone around saw a child swallowed or inhaled a small object.
- Cough and shortness of breath appeared suddenly, while playing or eating. Before that, the child was completely healthy.
In such situations, immediate hospitalization is necessary with consultation of the ENT doctor, X-ray examination, if necessary, bronchoscopy and other procedures.
Obstructive bronchitis during smoking can be suspected when the child’s condition is relatively satisfactory, but the cough is strong, with a whistle, especially in the morning, for a long time.
Allergy obstruction is a frequent occurrence. Bronchitis in children prone to allergies, occur as a result of infection, and without it, when the obstruction cause triggers or contact with the allergen. Obstructive bronchitis prolonged, recurring, high risk of forming bronchial asthma.
Prevention of obstructive bronchitis
With repeated episodes of obstructive bronchitis, measures must be taken to prevent its development. Allergy-free children require maximum restraint from contact with allergens and precipitating factors, which may be tobacco smoke; excessively dry air in the room; sharp odors from new toys, furniture, during repairs, etc.
In case of recurrent obstructive bronchitis, it is obligatory to consult a pulmonologist in order to exclude bronchial asthma and to develop a detailed rehabilitation plan. All children need normalization of the day regimen, adequate sleep, daily walks, hardening. A good effect is given by trips to the sea (in the absence of contraindications), acupuncture, aeroinotherapy. In some cases, shown immunostimulants.
Which doctor to contact
When a child has wheezing, coughing, shortness of breath, you must call an ambulance or pediatrician at home. If hospitalization is carried out, the pulmonologist also examines the child. Advice from an allergist will be of added value. In the treatment of obstructive bronchitis takes part physician, physiotherapist, a specialist in physical therapy and massage.
The program “School of Doctor Komarovsky!” Tells about the treatment of bronchitis in children: