Bronchiolitis in newborns. Bronchiolitis in young and older children - treatment and causes

Respiratory diseases are very common in children, infants and newborns are especially susceptible to them, which is explained by the immune system not yet being fully formed. One of the diseases that affects the lungs is bronchiolitis. How to quickly recognize pathology and provide qualified assistance to a child?

Bronchiolitis is an acute inflammatory disease of the lower respiratory tract, which affects the bronchioles - the final tiny bifurcations of the bronchi in the pulmonary lobules. The pathology is accompanied by symptoms of respiratory failure, or broncho-obstruction, and clinical signs similar to the manifestations of ARVI.

Bronchoobstruction is a clinical syndrome characterized by impaired pulmonary ventilation and difficulty in clearing mucus.

Bronchiolitis is an inflammatory process that occurs in the bronchioles

Most often, the disease is provoked by viruses, and the peak incidence of its development occurs in the autumn-winter period. Diagnosing bronchiolitis today is not difficult, but ignoring the disease can lead to serious complications.

Classification and causes of the disease

Depending on the cause that provoked the development of the disease, the following types of bronchiolitis are distinguished:

post-infectious. It is most often diagnosed at an early age. Infection occurs by airborne droplets;
inhalation Found in children who are forced to constantly inhale tobacco smoke;
drug. May develop after a course of antibiotic therapy;
obliterating. It has the most severe course. It is extremely rare in children;
idiopathic. Combined with other pathological conditions, such as lymphoma, idiopathic pulmonary fibrosis and others.

Children prone to allergic reactions are more susceptible to bronchiolitis than others.

Based on the nature of the disease, it is customary to distinguish:

Acute bronchiolitis - develops within 2–3 days after infection, and a pronounced clinical picture is observed. The acute period of the disease lasts 5–7 days.
Chronic - as a result of prolonged exposure to negative factors, the tissues of the bronchioles undergo destructive changes. In most cases it develops in older children.

Causes and causative agents of the disease at an early age - table

Risk factors

There are a number of factors that significantly increase the risk of developing bronchiolitis in children:

child's age up to 3 months;
prematurity;
low weight of the newborn;
improper treatment of respiratory diseases in a baby;
the presence of other lung diseases or pathologies of the cardiovascular system;
immunodeficiency states;
hypothermia.

The fact that this disease mainly affects young children is explained by the following:

The bronchial tree in infants is not yet fully formed, so inflammation of even a small number of bronchioles can lead to serious consequences for the child.
Unprotected immune system. Interferon and immunoglobulin A are produced in insufficient quantities in the respiratory organs.

Symptoms and signs

The first manifestations of acute bronchiolitis are:

runny nose:
nasal congestion;
cough.

Then the disease spreads to the small bronchi, and the following symptoms appear:

irritability;
lethargy;
rapid breathing;
dry wheezing;
weight loss associated with the child’s refusal to eat;
shortness of breath, which is very disturbing when eating.

The patient's condition deteriorates very quickly.

Early bronchiolitis is the easiest to treat, and in late forms of the disease, symptoms can persist for more than 3 months

As for chronic bronchiolitis, shortness of breath is its constant companion. Body temperature constantly rises and falls. There is weakness, coughing produces sputum, and the skin has a bluish tint. The fingers become like drumsticks.

Features of the disease in infants and newborns

Most often, children under the age of one year suffer from bronchiolitis. Infants suffer from this disease much more severely, so when the first signs appear, it is necessary to seek medical help.

Babies, including newborns, experience the following symptoms:

attacks of asphyxia (temporary cessation of breathing);
watery nasal discharge;
cough;
difficulty breathing (a sick child makes considerable efforts to exhale);
lack of appetite;
retraction of the large fontanel (against the background of dehydration);
increase in body temperature up to 39 degrees;
excessive excitement or, conversely, drowsiness.

Diagnostics

The diagnosis is made by a pulmonologist based on a physical examination and auscultation (listening).

When examining patients with bronchiolitis, the doctor pays attention to the frequency and nature of breathing, the presence of cyanosis of the skin, the retraction of yielding places in the chest (the spaces between the ribs and near the collarbones), and the duration of exhalation.

If there is an increased risk of complications, additional examinations are prescribed, in particular:

biochemical and general blood tests (with bronchiolitis there is an increase in the number of leukocytes);
general urinalysis;
bacteriological examination of mucus from the nose and throat (to exclude the bacterial nature of the disease);
computed tomography;
spirometry, or spirography (allows you to measure the volume of the respiratory system);
blood gas test (carried out to detect insufficient oxygen supply to the body);
chest x-ray (to exclude pneumonia, acute emphysema).

Treatment of bronchiolitis in children

The essence of therapy is to eliminate respiratory failure and overcome infection. In acute cases of the disease, it is necessary to hospitalize the child in the hospital.

Treatment of bronchiolitis requires an integrated approach and includes:

Bed rest (until body temperature normalizes).
Limiting the amount of liquid the child consumes.
Drug therapy, in particular:
- antiviral agents (Ribavirin);
- expectorant medications (Lazolvan, Bromhexine);
  
  Such drugs cannot be used in the treatment of infants, as this can lead to blockage of the bronchi with mucus.
- saline solutions (Otrivin Baby);
- bronchodilators;
- inhalations with corticosteroids;
- antibacterial drugs (Sumamed, Macropen, Clarithromycin).
  
  Antibiotic therapy is indicated only if the bacterial nature of bronchiolitis is identified. Prescribed at the discretion of the attending physician.
Breathing exercises. It is necessary to apply light pressure on the baby's chest and tummy as you exhale.
Vibration massage, which consists of light tapping movements with the edge of the palm in the direction from the bottom of the chest to the top. The baby is placed in such a way that the butt is slightly higher than the head.
Oxygen therapy (to eliminate respiratory distress syndrome).

Since bronchiolitis is transmitted by airborne droplets, the patient should be isolated. As a rule, when the baby’s appetite is restored, body temperature returns to normal and there is no need for oxygen therapy, the child is allowed to go home from the hospital.

Drugs for the treatment of the disease - gallery

Prognosis and possible complications

With timely diagnosis of the disease and compliance with all doctor’s recommendations, treatment has a favorable prognosis. Otherwise, the following complications may occur:

pulmonary hypertension;
cardiovascular failure;
prolonged pauses in breathing;
emphysema;
renal failure;
bronchial asthma;
pneumonia.

Complications from bronchiolitis are most often observed in premature babies, as well as in those who suffer from chronic heart or lung diseases.

Prevention

To avoid bronchiolitis, you must:

exclude contacts of healthy children with sick ones;
harden the child, provide him with adequate nutrition and organize a healthy daily routine;
monitor the condition of the baby’s nasopharynx, clean it of crusts and remove mucus;
avoid hypothermia;
promptly treat infectious and viral diseases;
Avoid crowded places during ARVI outbreaks.

Doctor Komarovsky about cough in children - video

Bronchiolitis is a serious disease that often occurs in young children. Timely diagnosis and proper treatment will help avoid serious complications. Therefore, if the first symptoms occur, consult a doctor immediately. Health to you and your baby!

Hello! My name is Elizaveta, I'm 21 years old. An economist by education. I write about children because it is important to me personally. Rate this article:

The inflammatory process occurring in the small bronchi and bronchioles is called “bronchiolitis” in medical practice. Most often, the disease develops as a complication against the background of existing influenza and ARVI. The greatest danger is not the inflammation itself, but the signs of respiratory failure, manifested by shortness of breath, severe attacks of coughing and suffocation. Therefore, it is important for parents to know what bronchiolitis is in children and what the manifestations of this disease are. After all, by recognizing it in time, you can save your child’s life.

Dangerous age

Young children are most at risk for developing bronchiolitis, so this diagnosis is more often found in the medical records of children under three years of age.. The highest risk group includes infants from one month old. This is due to the imperfection of the immune system, which is unable to resist infections. And if the virus does enter the body, it begins its attack from the most “secluded corners” of the respiratory system:

Newborns. At the age of up to a month, babies receive passive immunity from their mothers. So the likelihood of inflammation of the bronchioles during this period is quite low. But if the disease could not be avoided, then bronchiolitis is the most difficult for such babies to endure. Treatment of newborn babies is carried out only in a hospital, in the intensive care unit.
According to statistics, the most common cases of bronchiolitis occur in children aged one month to one year.. Six-month-old babies with inflammation are also hospitalized. For children seven months and older, home treatment is allowed, subject to regular examinations by a doctor.
By strengthening the immune system and developing the respiratory system, the risk of bronchiolitis in children over one year of age is reduced. And cases of illness after three years practically do not occur.

Bronchiolitis is most dangerous for premature babies, as well as for newborns with various developmental defects. In the absence of qualified assistance, the likelihood of death is very high.

Main causes of the disease

The occurrence of bronchiolitis as a response to an allergen is rare, and the exact relationship between the two diseases has not yet been established. But timely treatment of ARVI and influenza in children significantly increases the likelihood of avoiding serious complications in infants.

So, the main reasons why bronchiolitis develops in young children:

Respiratory diseases of viral and bacterial etiology. Including rhinovirus, adenovirus, influenza, mumps, pneumococcal infection, mycoplasmosis and others. Infectious diseases are transmitted primarily through the respiratory route through contact with an infected person. This can happen in a kindergarten, a hospital, or any other public place. Infection from family members who have contracted one of these viruses is possible.
Smoking around a child. Tobacco smoke has an irritating effect on the baby's mucous membranes, reducing resistance to other infections. The possibility of an allergic reaction cannot be ruled out.
General decrease in the body's defenses. Regardless of the cause, any decrease in immunity increases the risk of infection.
Underweight. Children who gain little weight have always been at risk. Weight is an indicator of a baby's health. And its lack indicates a deficiency of vitamins in the body.
Artificial feeding. Together with breast milk, the child receives from the mother all the necessary antibodies, which allow the still imperfect immune system to resist infections. Not breastfeeding increases the risk of developing bronchiolitis.

Any diseases of the respiratory and cardiovascular systems can also cause an inflammatory process.

Types of bronchiolitis

In medical practice, there are two forms of the disease: acute and chronic. Acute bronchiolitis is characterized by pronounced symptoms and impaired respiratory function. The acute period lasts approximately 4 weeks. If the diagnosis is incorrect and, accordingly, treatment is not prescribed, the disease becomes chronic.

With chronic bronchiolitis, the child is usually sick for more than two to six months. During this period, the manifestations of the disease decrease, the signs of respiratory arrest weaken and become less noticeable. At this stage, most often we are talking about the so-called bronchiolitis obliterans.

Signs of acute bronchiolitis

If a newborn child has contracted a viral disease, treatment does not produce tangible results, and the baby’s condition only worsens, this is a serious reason to undergo additional examination. Acute bronchiolitis in children is manifested by the following symptoms:

loss of appetite, up to complete refusal to eat;
pale skin, cyanosis that developed due to lack of oxygen;
emotional agitation, sleep disturbance;
slight increase in temperature (distinguishes bronchiolitis from pneumonia);
dry non-productive cough, sputum difficult to separate in small quantities;
respiratory distress, shortness of breath, shallow, whistling inhalation;
when listening, pronounced moist rales are noted;
dry mouth and rare trips to the toilet due to dehydration;
A clinical blood test shows a slight increase in leukocytes and ESR.

Respiratory failure is the main symptom of bronchiolitis. In severe forms of the disease, breathing becomes more frequent and can exceed 70-80 breaths per minute. At this stage, breathing may stop. The child needs qualified help immediately!

The clinical manifestations of bronchiolitis are similar to pneumonia with obstruction syndrome and bronchitis with an asthmatic component. Therefore, do not interfere with the work of doctors, but if possible, consult other specialists. This will help avoid confusion with the diagnosis.

Characteristic symptoms of bronchiolitis obliterans

Bronchiolitis obliterans is a chronic form of the disease that develops against the background of an acute inflammatory process. At this stage, partial blockage occurs and, as a consequence, narrowing of the lumen of the bronchioles. This condition interferes with normal blood flow in the lungs and bronchi, causing the development of respiratory and heart failure.

Bronchiolitis obliterans in children is manifested by the following symptoms:

frequent attacks of dry non-productive cough, sputum is released heavily and in small quantities;
difficulty breathing after any physical activity, as it progresses, shortness of breath begins to bother you even at rest;
The baby is breathing with a whistling sound, and moist wheezing is clearly audible.

Treatment of acute bronchiolitis

Acute bronchiolitis takes a long time to treat, sometimes it may take several months to completely relieve the inflammatory process and accompanying symptoms of respiratory failure. The treatment regimen is based on normalizing the baby’s breathing, eliminating the cause of the disease and ensuring the discharge of viscous secretions from the bronchi. The following drugs are used for this purpose:

Antiviral drugs. The advisability of using interferon and other similar drugs is determined by the doctor. But with a viral etiology of the disease, you cannot do without them.
Antibacterial drugs. Antibiotics are prescribed when a secondary bacterial infection occurs. If the bacterial nature of bronchiolitis is suspected, microflora culture is carried out immediately after admission to a medical institution. Most often, preference is given to broad-spectrum drugs.
Mucolytic and expectorant agents. These are drugs for symptomatic treatment, diluting sputum and facilitating the process of its removal. Antitussives are not used in pediatrics. And their use in this situation is unjustified, since this can aggravate the inflammatory process.
Antihistamines. In this case, allergy medications help relieve swelling from the tissues and make breathing easier. It is also advisable to prescribe them as part of antibacterial therapy to prevent the development of adverse reactions. Preference is given to drugs of the latest generation that have a minimum of side effects.

In severe cases, Dexamethasone injections may be prescribed. The use of glucocorticosteroids is also effective in the form of solutions for inhalation. Due to the large number of side effects, their prescription is possible only in hospital treatment.

At home, before doctors arrive, it is forbidden to give the child any medications, perform warming physiotherapy procedures and do steam inhalations, as all this can provoke laryngospasm. Parents are required to provide comfortable environmental conditions (temperature 20-220 and air humidity 50-70%) and plenty of fluids to prevent dehydration.

Treatment of bronchiolitis obliterans

Chronic bronchiolitis in infants is treated according to a similar scheme:

For frequent attacks of shortness of breath, bronchodilators may be prescribed in accordance with the age-specific dosage. Drugs in this category should be taken with caution, so only the attending physician should select the appropriate drug.
To ensure liquefaction of viscous secretions, mucolytics are prescribed. When the sputum begins to disappear, mucolytic syrups are replaced with expectorants.
If a bacterial infection is confirmed, antibiotics are prescribed. It is recommended to combine a course of antibacterial therapy with taking lactobacilli to normalize the intestinal microflora.

As an adjuvant therapy in the treatment of bronchiolitis obliterans, massage courses, breathing exercises, and exercise therapy are recommended and various physiotherapeutic procedures.

Forecasts

Both forms of the disease are treatable. There are risks of developing serious complications and even death, but if you go to a medical facility in a timely manner, serious consequences can be avoided.

After complete recovery and discharge from the hospital, parents should closely monitor the baby’s health, ensuring comfortable living conditions. For some time, residual effects (wheezing, shortness of breath) may still be observed. The condition of the respiratory system completely stabilizes after a few months.

Pay attention! Infants who have previously been diagnosed with acute bronchiolitis should be registered with a pulmonologist. Since the likelihood of repeated damage to the bronchi remains over the next five years, such children are at risk of developing bronchitis and bronchial asthma.

Bronchiolitis in children occurs as a result of complications of diseases such as ARVI or influenza. This disease most often affects babies under one year of age. The peak of infection is from the second to the sixth month. The reason is quite simple - the immune system is not yet strong enough to resist all viruses. Once in the body, the infection penetrates the bronchioles.

First warning signs

If bronchiolitis is observed in children, the following symptoms can be found:

spasmodic cough, in some cases it is dry;
body temperature does not rise much;
whistling sounds appear during breathing;
there is a runny nose or, on the contrary, the nose is stuffy.

The disease develops quickly, and if nothing is done during this time, a complication may arise in the form of respiratory failure.

How to define a disease?

Suspicions of bronchiolitis in young children can be confirmed in this simple way. Place your ear on the baby's back, and if gurgling sounds are heard, this most likely means that the diagnosis will be confirmed. It is worth noting that it is not necessary to have frequent coughing attacks and fever.

Acute bronchiolitis: symptoms

For a cold, treatment does not give a positive result for a long time? Perhaps this is manifested by acute bronchiolitis in children. Its symptoms:

appetite decreases or disappears altogether;
the skin turns pale, and in some places appears cyanotic;
if you refuse to drink water and food, dehydration may occur, the signs of which are as follows: decreased urination, dry mouth, no tears when crying, pulse increases;
the child is more capricious, irritable, sleeps poorly;
body temperature is increased, but not much;
the presence of a dry cough, sometimes with a small amount of sputum;
there may be difficulty breathing - sounds arise from grunting and groaning, the wings of the nose swell, the chest retracts a little more, shortness of breath is pronounced;
in more complex cases, respiratory arrest may occur;
in case of complications, breathing occurs more than 70 times per minute;
after examination, the doctor can diagnose clear moist rales;
After taking a blood test, it is clear that the ESR and leukocyte levels are low.

It is important not to make a mistake!

Bronchiolitis in children is characterized by respiratory failure, which, if severe, can lead to suffocation. In this case, medical care is urgently needed, but it must be qualified, since sometimes there are cases that this disease is confused with asthmatic bronchitis or pneumonia with obstructive syndrome.

Conditions for a small patient

While the doctor has not yet arrived, it is necessary to create all the conditions so as not to aggravate the baby’s serious condition. To do this, you need to adhere to two basic rules:

The air in the room should not be hot and dry, as this provokes drying out of the mucous membranes and heavy sweating, which can lead to rapid loss of moisture from the body. The temperature should not be higher than 20 degrees, and the humidity should be from 50 to 70 percent.
Ensure your child drinks plenty of fluids. Newborns should be brought to the breast more often, and older ones should be given drinks that they can drink. This must be done in order to prevent dehydration of the child's body.

It is prohibited to perform these actions

carry out any physiotherapy in the chest area;
do hot inhalations;
use any pharmaceutical drugs without medical prescription.

Bronchiolitis obliterans: symptoms

What can happen when the acute form of the disease starts? Bronchiolitis obliterans can be observed in children. This means that the bronchioles and small bronchi narrow, after which there is a violation of pulmonary blood flow. After some time, pathological processes in the lungs and pulmonary-heart failure may begin to develop.

The following symptoms will help recognize the disease:

the occurrence of a dry, unproductive cough, which is accompanied by a small amount of sputum;
shortness of breath is observed not only after physical activity, but also (with a progressive disease) in a state of calm;
you can distinguish moist wheezing, breathing as if whistling.

Such signs can be observed for a long time - even more than six months.

Bronchiolitis in children, especially young ones, is very common. It is on a par with pneumonia, which is also one of the complications after ARVI. Infants with this diagnosis are immediately sent to hospitalization. But with premature babies, as well as those children who have congenital cardiac and bronchopulmonary defects, which is fraught with dehydration and hypoxia, it is more difficult. In some cases it ends in death.

Treatment methods

When bronchiolitis is observed, treatment in children may take more than a month. Several methods are used for this:

Rehydration therapy, which means replenishing the child’s body with glucose and saline solutions. This can be done either intravenously or orally. It is carried out in cases where emergency assistance is needed.
Emergency measures are taken when respiratory failure occurs. In this case, they use both an acid mask and inhalation with medications, the actions of which help relieve an attack of suffocation.
Antiviral drugs are used, since the disease occurs virally. The basis of drugs, in most cases, is interferon.

Drugs

When bacterial infections, which include pneumococcal or streptococcal, are also observed with this disease, antibiotics are prescribed, mainly the following:

"Amoxiclav".
"Macropen".
"Sumamed."
"Augmentin".
"Amosin" and many others.

To relieve swelling of the bronchi and ease breathing, antihistamines are prescribed.

Chronic bronchiolitis

The disease itself develops very quickly. Although its symptoms may be present for less than five months. The result will be either complete recovery, or it will develop into chronic bronchiolitis in children. It is divided into several forms of inflammatory processes:

panbronchiolitis;
follicular;
respiratory.

Inflammations can also be of the following types:

constrictive;
proliferative.

Constrictive (or narrowing) are characterized by the fact that fibrous tissue gradually grows between the muscle and epithelial layers and bronchioles. After some time, the lumen not only narrows, but can also close completely. Respiratory structures are no longer so pliable, and this is fraught with emphysema, as well as breathing problems.

Proliferative ones are characterized by the fact that they damage the mucous membrane, and granulomatous and connective tissues appear - Masson's bodies. The respiratory department significantly reduces its diffusion capacity, and external respiration is impaired.

Treatment of a chronic disease

Chronic obliterating bronchiolitis in children is treated by two methods:

drug therapy;
auxiliary.

In the first option, mucolytic, bronchodilator or expectorant drugs can be prescribed. If there is inflammation of a bacterial nature, then in addition to all this there are also antibiotics.

Auxiliary therapy includes chest massage, breathing exercises, physical therapy, climatotherapy, speleotherapy and physiotherapy.

Consequences

If bronchiolitis was observed in young children, the consequences can be very diverse (this is the case when there was no timely treatment). Now we will look at them

Pneumonia. It affects tissues in the respiratory system, resulting in a severe cough. This disease, if advanced, may be accompanied by a slightly high temperature. Complications with the breathing process are often observed. If in this case you do not undergo a course of antibiotic treatment, then this is fraught with even more harmful complications.
Bronchiectasis. This process is characterized by the fact that it expands and further damages the walls of the bronchi.
Heart and respiratory failure. Due to the disease, gas exchange is disrupted, and many of the internal organs do not receive enough oxygen. This primarily affects the heart muscles. As a result, this organ is overworked, and blood no longer circulates in the volume necessary for the body. And this, in turn, disrupts the performance of other organs and systems of the child’s body.
Chronic bronchitis. If left untreated, the consequences can be severe. In this case, harmful factors such as dust, gases and various allergens play an important role.
Bronchial asthma, which passes from the advanced stage of allergic bronchitis. The disease is characterized by swelling of the mucous membrane and periodic spasms. This consequence of bronchiolitis is dangerous because it causes attacks of suffocation.
Pulmonary emphysema. This consequence is extremely rare in children. It is characterized by the fact that gas exchange and elasticity are impaired in the lungs. In the early stages, this manifests itself as shortness of breath in cold weather. But if deterioration occurs, then in any other season.
Bronchoobstruction. It is characterized by heavy breathing, which is accompanied by impaired exhalation. The child does not have time to exhale the air completely before he inhales again. As a result, the accumulation of these residues provokes high blood pressure.
But the rarest consequence is cor pulmonale. It provokes constant high blood pressure. As a result, gas exchange is disrupted and the child is unable to do any physical activity.

To prevent bronchiolitis from occurring in children, you need to try to protect them from communicating with already sick children. Also, do not ignore antiviral measures, hardening procedures and proper food consumption.

It is advisable to create a hypoallergenic lifestyle, since allergies and bronchiolitis have much in common. Don't forget to keep an eye on your child's nasopharynx. It is necessary that it is always clean and there are no accumulations.

When a child is sick, parents always worry. Particular concern arises if the doctor makes a diagnosis that is not the most popular, for example, bronchiolitis. What is this disease and how does it manifest itself?

Causes of the disease

Experts consider respiratory syncytial virus to be the leading causative agent of acute bronchiolitis.

Bronchiolitis is an inflammation of the smallest branches of the bronchi - bronchioles. This disease most often affects children under 3 years of age. More than 60% of young patients are boys.

Depending on the nature of the disease, it can be:

acute – lasts no more than 5 weeks,
chronic – lasts for 3 months or longer.

The culprit of acute bronchiolitis in most cases is respiratory syncytial virus (RSV). Like ARVI, this infection likes to “walk around” during the cold season - from October to April. However, unlike the common cold, RSV hits the lower respiratory tract rather than the upper respiratory tract.

Infection usually occurs by airborne droplets. This means that the virus is transmitted from sick people to healthy people by sneezing, coughing, or communicating. Less commonly, the infection is transmitted through dirty hands, shared towels, and toys.

In a small number of children, other microorganisms become causative agents of the disease:

influenza viruses,
adenoviruses,
parainfluenza,
pneumococci,
mycoplasma.

Chronic bronchiolitis can develop as a consequence of acute bronchiolitis, but usually it is an independent disease caused by prolonged inhalation of irritating gases. Very often this disease is found in children living in smoking families.

The rapid development of inflammation is promoted by:

low baby weight,
weakened immunity,
age under 3 months,
diseases of the cardiovascular system,
congenital defects of the respiratory tract,
visiting a nursery/kindergarten,
smoking by parents in the presence of the baby.

Among newborns, children who are bottle-fed are more likely to get sick. Their body is more susceptible to infections due to the fact that it does not receive antibodies from mother's milk.

Clinical picture

The initial symptoms of the disease are similar to bronchitis or a cold. Children develop a dry cough and runny nose, and the temperature rises. After a few days the condition worsens. The temperature continues to rise (up to 39 degrees), appetite decreases. But the main thing is that respiratory failure develops.

Inhaling air, the child wheezes, the wings of his nose swell and the nasolabial triangle turns blue. Shortness of breath and rapid heartbeat are added. Vomiting may occur after severe coughing attacks. It is most difficult for infants, because due to the anatomical features of the chest, they are not able to cough properly.

In severe cases:

"bloating of the chest,
sudden holding of breath (apnea),
swelling.

A dangerous complication of the disease can be the development of bronchial asthma.

Diagnostics

To make a diagnosis, the doctor only needs to examine the child and listen to the parents’ complaints. To distinguish bronchiolitis from other pathologies (for example, pneumonia), the doctor may order a chest x-ray.

The causative agent of the disease is identified by a general blood test. In viral infections, results show increased numbers of lymphocytes and monocytes. The neutrophil content is below normal. With bacterial infections, the number of leukocytes and neutrophils increases.

To detect respiratory syncytial virus, rapid diagnostic methods are used. Swabs from the nasal cavity are taken as material for analysis. They are applied to special test systems that react to the presence of RSV by changing color.

In case of severe shortness of breath, pulse oximetry is performed - a test that helps determine the degree of oxygen saturation in the blood. Values below 95% indicate respiratory failure.

Therapy methods

The child is prescribed ultrasonic inhalations with saline solution, and in severe cases - with corticosteroids.

In case of bronchiolitis, the child must be hospitalized. Treatment tactics are aimed at maintaining normal breathing and preventing complications.

If RSV is detected, a specific antiviral drug, Ribavirin, is prescribed. It blocks the reproduction of the pathogen and prevents the further development of the disease.

If a bacterial infection has been established, the child is prescribed antibiotics. Preference is given to drugs from the group of penicillins and cephalosporins (Ampicillin, Cefotaxime). Medicines are administered intramuscularly for 7–10 days.

If necessary, the doctor recommends sputum thinners (mucolytics - Ambroxol, Bromhexine). To facilitate the removal of mucus, ultrasonic inhalations with sodium chloride solution are also prescribed. In severe cases, inhalations with corticosteroids (Dexamethasone) are added, which have an anti-inflammatory effect.

In addition to medications, a mixture of oxygen and helium is given through a mask. This allows you to reduce the manifestations of respiratory failure and improve the patient’s well-being.

Since babies lose a lot of fluid due to rapid breathing, they are advised to drink plenty of fluids. Liquids are given 2 times more than the daily requirement. If the child refuses to drink, he is given saline solution through an IV.

For 5 years after bronchiolitis in children, the bronchi remain highly susceptible to the action of negative factors. Such babies are more susceptible to bronchitis and bronchial asthma, and therefore require long-term monitoring by a specialist.

First warning signs

If bronchiolitis is observed in children, the following symptoms can be found:

spasmodic cough, in some cases it is dry;
body temperature does not rise much;
whistling sounds appear during breathing;
there is a runny nose or, on the contrary, the nose is stuffy.

The disease develops quickly, and if nothing is done during this time, a complication may arise in the form of

How to define a disease?

Suspicions of bronchiolitis can be confirmed in this simple way. Place your ear on the baby's back, and if gurgling sounds are heard, this most likely means that the diagnosis will be confirmed. It is worth noting that it is not necessary to have frequent coughing attacks and fever.

Acute bronchiolitis: symptoms

For a cold, treatment does not give a positive result for a long time? Perhaps this is manifested by acute bronchiolitis in children. Its symptoms:

appetite decreases or disappears altogether;
the skin turns pale, and in some places appears cyanotic;
if you refuse to drink water and food, dehydration may occur, the signs of which are as follows: decreased urination, dry mouth, no tears when crying, pulse increases;
the child is more capricious, irritable, sleeps poorly;
body temperature is increased, but not much;
the presence of a dry cough, sometimes with a small amount of sputum;
there may be difficulty breathing - sounds arise from grunting and groaning, the wings of the nose swell, the chest retracts a little more strongly, shortness of breath is pronounced;
in more complex cases, respiratory arrest may occur;
in case of complications, breathing occurs more than 70 times per minute;
after examination, the doctor can diagnose clear moist rales;
After taking a blood test, it is clear that the ESR and leukocyte levels are low.

It is important not to make a mistake!

Conditions for a small patient

While the doctor has not yet arrived, it is necessary to create all the conditions so as not to aggravate the baby’s serious condition. To do this, you need to adhere to two basic rules:

The air in the room should not be hot and dry, as this provokes drying out of the mucous membranes and heavy sweating, which can lead to rapid loss of moisture from the body. The temperature should not be higher than 20 degrees, and the humidity should be from 50 to 70 percent.
Ensure your child drinks plenty of fluids. Newborns should be brought to the breast more often, and older ones should be given drinks that they can drink. This must be done in order to prevent dehydration of the child's body.

It is prohibited to perform these actions

carry out any physiotherapy in the chest area;
do hot inhalations;
use any pharmaceutical drugs without medical prescription.

Bronchiolitis obliterans: symptoms

The following symptoms will help recognize the disease:

the occurrence of a dry, unproductive cough, which is accompanied by a small amount of sputum;
shortness of breath is observed not only after physical activity, but also (with a progressive disease) in a state of calm;
you can distinguish moist wheezing, breathing as if whistling.

Such signs can be observed for a long time - even more than six months.

Treatment methods

When bronchiolitis occurs, it can last for more than a month. Several methods are used for this:

Rehydration therapy, which means replenishing the child’s body with glucose and saline solutions. This can be done either intravenously or orally. It is carried out in cases where emergency assistance is needed.
Emergency measures are taken when respiratory failure occurs. In this case, they use both an acid mask and inhalation with medications, the actions of which help relieve an attack of suffocation.
Antiviral drugs are used, since the disease occurs virally. The basis of drugs, in most cases, is interferon.

Drugs

When bacterial infections, which include pneumococcal or streptococcal, are also observed with this disease, antibiotics are prescribed, mainly the following:

"Amoxiclav".
"Macropen".
"Sumamed."
"Augmentin".
"Amosin" and many others.

To relieve swelling of the bronchi and ease breathing, antihistamines are prescribed.

Chronic bronchiolitis

panbronchiolitis;
follicular;
respiratory.

Inflammations can also be of the following types:

constrictive;
proliferative.

Treatment of a chronic disease

Chronic obliterating bronchiolitis in children is treated by two methods:

drug therapy;
auxiliary.

In the first option, mucolytic, bronchodilator or expectorant drugs can be prescribed. If there is inflammation of a bacterial nature, then in addition to all this there are also antibiotics.

Auxiliary therapy includes chest massage, breathing exercises, physical therapy, climatotherapy, speleotherapy and physiotherapy.

Consequences

If bronchiolitis was observed in young children, the consequences can be very diverse (this is the case when there was no timely treatment). Now we will look at them

Pneumonia. It affects tissues in the respiratory system, resulting in a severe cough. This disease, if advanced, may be accompanied by a slightly high temperature. Complications with the breathing process are often observed. If in this case you do not undergo a course of antibiotic treatment, then this is fraught with even more harmful complications.
the process is characterized by the fact that it expands and further damages the walls of the bronchi.
Heart and respiratory failure. Due to the disease, gas exchange is disrupted, and many of the internal organs do not receive enough oxygen. This primarily affects the heart muscles. As a result, this organ is overworked, and blood no longer circulates in the volume necessary for the body. And this, in turn, disrupts the performance of other organs and systems of the child’s body.
Chronic bronchitis. If left untreated, the consequences can be severe. In this case, harmful factors such as dust, gases and various allergens play an important role.
Bronchial asthma, which passes from the advanced stage of allergic bronchitis. The disease is characterized by swelling of the mucous membrane and periodic spasms. This consequence of bronchiolitis is dangerous because it causes attacks of suffocation.
Pulmonary emphysema. This consequence is extremely rare in children. It is characterized by the fact that gas exchange and elasticity are impaired in the lungs. In the early stages, this manifests itself as shortness of breath in cold weather. But if deterioration occurs, then in any other season.
Bronchoobstruction. It is characterized by heavy breathing, which is accompanied by impaired exhalation. The child does not have time to exhale the air completely before he inhales again. As a result, the accumulation of these residues provokes high blood pressure.
But the rarest consequence is It provokes constant high blood pressure. As a result, gas exchange is disrupted and the child is unable to do any physical activity.

Clinical recommendations of the Union of Pediatricians of Russia
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Respiratory diseases in children: a practical guide. V.K. Tatochenko. New edition, add. M.: "Pediatr", 2015: 396 p. 14. Patrusheva Yu.S., Bakradze M.D. Etiology and risk factors for acute bronchiolitis in children. Diagnostic issues in pediatrics. 2012: (4) 3; 45 - 52. 15. Patrusheva Yu. S., Bakradze M.D., Kulichenko T.V. Diagnosis and treatment of acute bronchiolitis in children: Diagnostic issues in pediatrics. T.Z, No. 1.-2011. With. 5-11. 16. Doan QH, Kissoon N, Dobson S, et al. A randomized, controlled trial of the impact of early and rapid diagnosis of viral infections in children brought to an emergency department with febrile respiratory tract illnesses. J Pediatr 2009; 154:91. 17. Doan Q, Enarson P, Kissoon N, et al. Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department. Cochrane Database Syst Rev 2014; 9:CD006452. 18. UpToDate.com. 19. Orphan Lung Diseases Edited by J-F. Cordier. European Respiratory Society Monograph, Vol. 54. 2011. P.84-103 Chapter 5. Bronchiolitis. 20. Spichak T.V. Post-infectious obliterating bronchiolitis in children. M. Scientific world. 2005. 96p. 21. Providing inpatient care to children. Guide to the treatment of the most common diseases in children: a pocket guide. – 2nd ed. – M.: World Health Organization, 2013. – 452 p. 22. Wu S, Baker C, Lang ME et al. Nebulized hypertonic saline for bronchiolitis: a randomized clinical trial. JAMA Pediatr. 2014 May 26 23. Chen YJ, Lee WL, Wang CM, Chou HH Nebulized hypertonic saline treatment reduces both rate and duration of hospitalization for acute bronchiolitis in infants: an updated metaanalysis. Pediatr Neonatol. 2014 Jan 21. pii: S1875-9572(13)00229-5. doi: 10.1016/j.pedneo.2013.09.013. 24. Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2013 Jul 31;7:CD006458. doi: 10.1002/14651858.CD006458.pub3. 25. Committee on infectious diseases and bronchiolitis guidelines committee: Updated Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection. Pediatrics 2014 Vol. 134 No. 2 August 1, 2014 pp. e620-e638. 26. Palivizumab: four seasons in Russia. Baranov A.A., Ivanov D.O., Alyamovskaya G.A., Amirova V.R., Antonyuk I.V., Asmolova G.A., Belyaeva I.A., Bokeria E.L., Bryukhanova O A.A., Vinogradova I.V., Vlasova E.V., Galustyan A.N., Gafarova G.V., Gorev V.V., Davydova I.V., Degtyarev D.N., Degtyareva E.A. ., Dolgikh V.V., Donin I.M., Zakharova N.I., L.Yu. Zernova, E.P. Zimina, V.V. Zuev, E.S. Keshishyan, I.A. Kovalev, I.E. Koltunov, A.A. Korsunsky, E.V. Krivoshchekov, I.V. Krsheminskaya, S.N. Kuznetsova, V.A. Lyubimenko, L.S. Namazova-Baranova, E.V. Nesterenko, S.V. Nikolaev, D.Yu. Ovsyannikov, T.I. 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Sapa Irina Yurievna

Bronchiolitis obliterans is a rare disease from the group of “diseases of the small respiratory tract”, which is associated with a gradual disruption of air flow in the smallest branches of the bronchi - the bronchioles. In the article “Acute bronchiolitis in children” it was already discussed that bronchioles have a diameter of 1 to 3 mm and lack a cartilaginous base. The term “obliteration” means pathological closure, closure of the lumen of any excretory canal, vessel or cavity due to filling them with dense masses. Many people are probably very familiar with the name of one of the vascular diseases - endarteritis obliterans. With bronchiolitis obliterans, the lumen of the bronchioles and arterioles of the lung tissue is blocked due to dense inflammatory masses, desquamated mucosal cells and fibrin. Gradually, this leads to a sharp limitation of gas exchange in the affected area of the lung, emptying of the smallest vessels of the lungs and the development of respiratory failure.

Reasons

Most often in young children, bronchiolitis obliterans develops after respiratory syncytial (RS), adenovirus infection, or influenza. Isolated cases of this disease have been described in whooping cough and measles. In adults, older and middle-aged children, there is usually an association with poisoning from inhalation of nitric oxide and other chemical compounds. Congenital bronchiolitis of newborns caused by intrauterine infection has been described. In adults, a connection has also been established with diffuse connective tissue diseases (collagenosis), transplant rejection, radiation damage, and treatment with penicillin. Rarely, infectious bronchiolitis obliterans is caused by the mold Aspergillus fumigatus.

The consequence of viral bronchiolitis can be McLeod syndrome (sometimes written McLeod) or Swyer-James syndrome: the development of a unilateral “super-transparent” lung according to X-ray data, hypoplasia of the pulmonary artery and bronchiectasis. In McLeod syndrome, the lesion is often left-sided with the formation of a peculiar x-ray picture of a “light” lung.

Development mechanism

The inflammatory process in the bronchioles leads to thickening of the mucous membrane, its scaly degeneration and gradual replacement of the mucosa with other granulation tissue. In this regard, a kind of cicatricial stenosis (obliteration) of the lumen of the bronchioles develops. Secondary impairment of pulmonary blood flow, dystrophy and sclerosis of the lung tissue occurs. In this case, pulmonary blood flow in the affected lung can be reduced by 25-50% and even 75% compared to normal. Disturbances in pulmonary blood flow lead to increased pressure (hypertension) in the pulmonary circulation, increased load on the right heart and even the formation of the so-called “pulmonary heart” (hypertrophy and/or expansion of the right ventricle, decreased myocardial contractility and tone of large arterial vessels). In the future, such children may develop bronchiectasis and chronic pneumosclerosis.

Clinical picture The disease is characterized by cyclicity. In the first (acute) period, against the background of high temperature, clinical signs characteristic of acute bronchiolitis are observed: paroxysmal obsessive dry cough, bluishness of the skin (cyanosis), severe increased respiratory movements (tachypnea), swelling of the chest (emphysema), distant whistling or wet wheezing (oral crepitus). But these symptoms are accompanied by more severe respiratory disorders than in acute bronchiolitis, persist for a long time and even increase over the next two weeks. On auscultation, harsh or weakened breathing is heard, small bubble moist rales alternating with dry wheezing. For bronchiolitis obliterans, a unilateral lesion is more typical.

Then comes a phase of relative calm, lasting from 4 to 6 weeks. At this time, the child is bothered by minimal manifestations of respiratory dysfunction: prolonged wheezing exhalation, isolated wheezing on the affected side during auscultation.

In the third period, 1-2 months after the onset of the disease, a clinical manifestation of bronchial obstruction develops, as during attacks of bronchial asthma.

Diagnosis

The disease is diagnosed on the basis of clinical and radiological data, results of scintigraphy, computed tomography and, if necessary, lung biopsy. When examining the function of external respiration, a persistent decrease in tidal volumes is detected. There is a disturbance in gas exchange and a decrease in the level of blood oxygenation. A valuable diagnostic test is rheopulmonography, the results of which can be used to draw conclusions about the blood supply to individual areas of the lungs and the type of ventilation impairment. Changes in peripheral blood are nonspecific; very rarely an increased number of eosinophils is detected. When purulent complications or pneumonia occur, the blood test becomes inflammatory in nature (increased number of leukocytes, accelerated ESR).

Forecast

If limited areas of the lungs are affected, then as the child grows, the respiratory function is completely compensated at the expense of healthy segments. With unilateral widespread damage to the bronchioles, most patients gradually develop respiratory failure of varying degrees of severity. With diffuse bilateral obliteration of bronchioles, the prognosis is serious.

Treatment

In the acute period, therapy is carried out according to the principles set out in the article “Acute bronchiolitis in children,” but they combine this with the administration of glucocorticoids by inhalation (beclomethasone dipropionate solution through a nebulizer or spacer) and by injection. For viral infections, specific antiviral drugs are used: ribavirin in the form of inhalations, Laferon and others. As symptomatic, drugs are used that improve blood circulation in the capillaries of the lung tissue - pneumorel, erespal, trental. They use multivitamins, anti-sclerotic agents (omega-3-polyunsaturated fatty acids), venotonics (endothelon, troxevasin). According to indications, drugs of the theophylline group and bronchodilators that affect bronchial receptors (salbutamol, ipratropium bromide) are prescribed for a long period. Inhaled hormonal drugs are sometimes prescribed for several months under the monitoring of respiratory function indicators. In older children and adults, hirudotherapy (treatment with leeches) can be effective as an option for normalizing blood circulation in the smallest capillaries and preventing microthrombosis. After stopping the acute period of bronchiolitis obliterans, the use of homeopathic medicines, herbal medicine, and various nutritional supplements with anti-sclerotic effects is recommended.

Acute bronchiolitis in children is a variant of the course of obstructive bronchitis in children (most often they get sick) with generalized damage to the small bronchi, bronchioles, alveolar ducts, often characterized by bronchial obstruction and severe respiratory failure. In 60-85% of cases, acute bronchiolitis is caused by respiratory syncytial virus, especially in children of the first year of life. Along with it, parainfluenza virus type 3 is involved in the damage to bronchioles at this age, and adenovirus predominates in the second or third year of life. Factors contributing to this are described: allergic constitutional abnormality, food allergy (to cow's milk), paratrophy, artificial feeding.

The pathogenesis of acute bronchiolitis in children is similar to the pathogenesis. This is explained by the fact that local immune protection in the upper first two years of life is insufficient; viruses penetrate deeply, reaching the small bronchi and bronchioles. Desquamation of the epithelium occurs, infiltration of the peribronchial space with lymphocytes, swelling of the mucous membrane, submucosa and adventitia, multinuclear papillary growths of the epithelium occupying most of the lumen, accumulation in the lumen of small bronchi and bronchioles of mucus, which, together with fibrin and desquamated epithelium, forms “plugs” inside the bronchi with their partial or even complete obstruction with subsequent development of atelectasis. Due to the anatomical narrowness of this section of the bronchial tree in young children, swelling of the bronchial mucosa causes an increase in resistance to air movement by 50%. As a result of these processes, obstruction of the respiratory tract occurs, which leads to impaired gas exchange, respiratory failure, hypoxemia, hypercapnia, pulmonary vasospasm, and acute cor pulmonale. In case of respiratory failure, compensatory swelling occurs in parts of the lungs that are partially affected through the resulting valve mechanism. It should be noted that the proportion of bronchospasm in the mechanisms of obstruction is insignificant due to the small number of muscle fibers in the walls of small bronchi and bronchioles in young children, therefore, the proper clinical effect is not observed when using bronchodilators.

Acute bronchiolitis symptoms in children

Acute bronchiolitis in children develops more often on 2-3 days from the onset (prolonged and high fever is observed with adenoviral bronchiolitis). The condition worsens, the child becomes lethargic and his appetite decreases. Acute bronchiolitis manifests symptoms sharply and violently. First, an obsessive dry cough appears, which quickly becomes productive, expiratory shortness of breath increases with swelling of the wings of the nose, with the participation of auxiliary muscles, pallor, cyanosis of the nasolabial triangle or the entire face. There is an anteroposterior expansion of the chest and a box percussion sound above it. Auscultation is heard during inhalation, numerous fairly stable wheezing over various parts of the lungs, on exhalation it is dry and whistling. Tons of the heart - often weakened, severe tachycardia. The severity of the bronchiolitis condition is associated with respiratory failure (can decrease to 55-60 mm Hg), with attacks of apnea, especially in premature infants, when the child may die.

Analysis of peripheral blood in acute bronchiolitis in children reveals changes consistent with a viral infection. During an X-ray examination, increased transparency of the pulmonary fields is noted, especially at the periphery, a low position of the diaphragm (in a third of cases), increased bronchial pattern and expansion of the roots, and occasionally small areas of compaction of the lung tissue due to subsegmental atelectasis.

Obstruction reaches a maximum within 1-3 days, then gradually decreases and completely disappears by 7-10 days. With adenoviral and parainfluenza bronchiolitis, recovery lasts 2-3 weeks. Risk factors for severe bronchiolitis include the patient's age up to 3 months, prematurity - less than 34 weeks of pregnancy, severe hypoxemia and hypercapnia, and atelectasis on x-ray. Differential diagnosis is usually carried out with obstructive bronchitis and pneumonia.

Bronchiolitis obliterans in children

The severe course of bronchiolitis deserves attention. This is bronchiolitis obliterans in children, which usually has an adenoviral (types 3, 7 and 21) etiology. It can also occur as a consequence of cow's cough, whooping cough, and influenza bronchiolitis and is characterized by extreme severity and a high frequency of chronicity.

The process is based on damage to the bronchioles and small bronchi, accompanied by effusion of intercellular fluid and the appearance of characteristic large cells in the lung parenchyma (adenoviral pneumonia). In the affected area, endarteritis develops with narrowing of the branches of the pulmonary and sometimes bronchial arteries with a decrease in blood flow by 25-75%.

The consequence of the process is sclerosis of a lobe or the entire lung, but more often obliteration of bronchioles and arterioles occurs with the preservation of an area of dystrophic non-ventilated lung tissue with radiological signs of “supertransparent lung” (can form in 6-8 weeks). The symptoms of the acute period of bronchiolitis obliterans are characterized by severe respiratory distress against the background of a stable febrile temperature. Auscultation reveals numerous fine bubbling rales, often asymmetrical, against a background of prolonged and difficult exhalation.

According to the results of a clinical blood test, there was an increase in ESR, a neutrophil shift, and moderate leukocytosis. The radiograph in this period shows large, often one-sided fusions of the lesion without clear contours - a “cotton lung”, with a picture of increased airiness. Respiratory failure occurs within 1-2 weeks, which often requires mechanical ventilation. Prognostically unfavorable is the persistence of obstruction after normalization of temperature.

Treatment of bronchiolitis in children

Features of treatment of bronchiolitis in children: oxygen therapy, additional fluid administration, antibacterial therapy, cardiotonic drugs and glucocorticoids. Treatment of bronchiolitis in children is carried out only in a hospital; it is aimed primarily at correcting respiratory failure. It is indicated to use oxygen therapy (humidified oxygen at a concentration of no more than 40%, oxygen tent) for 10-20 minutes every 2 hours or 2-3 times a day for 5-8 days; if it is ineffective, assisted ventilation with constant positive pressure is performed on the exhale.

Presence of cyanosis when breathing 40% oxygen, hypercapnia (PC02 55 mm Hg and above), hypoxemia (p02 below 60 mm Hg) are serious indications for transfer to artificial ventilation. Be sure to mechanically remove mucus from the upper respiratory tract using an electric pump, postural drainage and vibration massage, followed by inhalation therapy with alkaline solutions.

Shortness of breath is accompanied by dehydration, so rehydration is required in the form of plenty of fluids (oralite, rehydron), infusion therapy taking into account blood pH and electrolyte composition, the need to prescribe antibiotics (parenteral administration of cephalosporin antibiotics) is dictated by severe respiratory failure, in which it can be difficult to exclude pneumonia.

According to the pathogenesis, with the development of acute bronchiolitis in children, the myocardium is affected and cardiovascular failure appears, therefore, in therapy, cardiotonic drugs are administered in a 0.05% solution of strophanthin, 0.06% solution of corglycone intramuscularly before and per year, 0.1-0 .15 mg., from 1 to 6 years - 0.2-0.3 ml. patients with severe respiratory failure. If adrenal insufficiency is suspected and in the case of bronchiolitis obliterans, it is indicated to prescribe glucocorticoids (2-3 mg per 1 kg of body weight per day parenterally and locally in the cheekbones through a nebulizer or spacer). When the dose of glucocorticoids is reduced, aminophylline is prescribed. In the case of obliterating bronchitis, the administration of heparin is justified.

The drug ribaverin (Virazol) is etiotropic, suppressing RNA viruses, primarily respiratory syncytial virus (RS virus). It is effective in aerosols (20 mg of ribaverin in 1 ml) with inhalations for 3-7 days. The drug is expensive and has distinct side effects (nausea, vomiting, agitation, agranulocytosis, allergic reactions), therefore it is indicated for extremely severe bronchiolitis, for bronchiolitis against the background of chronic bronchopulmonary diseases or tumors. A drug made from monoclonal antibodies to the P-protein of the RS virus, Svai-zumab (Synajiz), has similar indications.

Forecast and prevention of bronchiolitis in children

Even after effectively treated bronchiolitis in children, long-term persistence of external respiratory function disorders is observed through the formation of bronchial hyperreactivity. Almost 50% of children who have had bronchiolitis develop broncho-obstructive syndrome with subsequent acute respiratory infections. Mortality in acute bronchiolitis in children is lower than in pneumonia and is 1-2%, and in bronchiolitis obliterans up to 30-50% in the acute period. Those who survive after bronchiolitis obliterans develop various types of chronic bronchopulmonary pathology.

Prevention of bronchiolitis in children comes down to hardening, a balanced diet, prevention of contact with a viral infection, and early use of antiviral drugs. Secondary prevention is similar to that.