Obstructive syndrome in the elderly diagnosis. Bronchial obstruction syndrome (bronchospastic syndrome)

It is a fairly common pathology.
There are many known diseases that are accompanied by this syndrome. It can occur in diseases of the respiratory system, pathology of the cardiovascular system, poisoning, diseases of the central nervous system, hereditary metabolic abnormalities, etc. (about 100 diseases).

With broncho-obstructive syndrome, bronchial obstruction occurs due to narrowing or occlusion respiratory tract.

The predisposition to obstruction in children is associated with their anatomical and physiological characteristics:
The bronchi in children are smaller in diameter than in adults, which leads to an increase in aerodynamic drag;
The cartilage of the bronchial tree is more pliable compared to adults;
The chest has insufficient rigidity, which leads to significant retraction yielding places(above and subclavian fossae, sternum, intercostal spaces);
There are more goblet cells in the bronchial wall than in adults. This leads to more mucus production;
Edema of the bronchial mucosa rapidly develops in response to various irritating factors;
The viscosity of bronchial secretions is increased compared to adults (due to the increased amount of sialic acid);
Low collateral ventilation;
The smooth muscle system of the bronchi is poorly developed;
Reduced formation of interferons, secretory and serum immunoglobulin A in the respiratory tract.

For practical activities Taking into account the etiology of this symptom complex, bronchial obstruction can be divided into 4 options:
An infectious variant that develops as a result of a viral or bacterial inflammation bronchi (obstructive bronchitis, bronchiolitis);
Allergic variant, when bronchospasm predominates over inflammatory phenomena(bronchial asthma);
Obstructive variant - occurs during aspiration of foreign bodies.
A hemodynamic variant can occur in heart disease when left ventricular heart failure develops.

In practice, the first two options are most common.
Therefore, let's look at them in more detail.

Broncho obstructive syndrome infectious origin occurs when obstructive bronchitis and bronchiolitis. The etiology is viral or viral-bacterial.
Among viruses, the leading role belongs to respiratory syncytial viruses (in half of the cases), adenovirus, and parainfluenza virus. Bacteria include mycoplasma and chlamydia.

A characteristic feature of this type of obstruction is the predominance of edema, infiltration and hypersecretion of the mucous membrane over bronchospasm.

For obstructive bronchitis broncho-obstructive syndrome develops 2-4 days from the onset of a respiratory viral infection. Expiratory shortness of breath, distant wheezing, noisy breathing. Percussion above the lungs is a box sound. On auscultation, the exhalation is prolonged, diffuse dry whistling, buzzing rales on both sides. At a younger age, moist rales of various sizes are possible.

Bronchiolitis Children under 2 years of age (usually up to 6 months) are affected. Bronchiolitis affects the bronchioles and small bronchi. Severe respiratory failure of II-III degree is characteristic. Tachypnea, acrocyanosis. On auscultation there is an abundance of fine bubbling moist rales on both sides. Intoxication syndrome is not expressed.
X-ray shows an increase in the pulmonary pattern, horizontal standing of the ribs, widening of the intercostal spaces, and the dome of the diaphragm is lowered.

Bronchiolitis obliterans- a serious disease that has a cyclical course. Its reason is predominantly adenovirus infection(can also occur with whooping cough and measles). Children under 3 years old are sick. The acute period proceeds like ordinary bronchiolitis, but with more pronounced respiratory disorders. Obstruction persists for a long time (up to 2 weeks), and may even increase. Characteristically, “cotton shadows” appear on the radiograph.
In the second period, the condition improves, but the obstruction persists and periodically intensifies, as during an asthmatic attack. The phenomenon of “super-transparent lung” is formed. Treatment is very difficult.

Broncho-obstructive syndrome allergic origin occurs in bronchial asthma. Obstruction in this case is caused mainly by spasm of the bronchi and bronchioles, and to a lesser extent by edema and hypersecretion of the mucous membrane of the bronchial tree. There is a burdened allergy history(allergic dermatitis, allergic rhinitis etc.) Attacks of obstruction are associated with the presence of an allergen, and are not associated with infection. Characterized by the same type of attacks and their recurrence.

Clinically there are no signs of intoxication. The attack occurs on the first day of the disease and is relieved in a short time (within a few days). During an attack, expiratory shortness of breath with the participation of auxiliary muscles. On auscultation, the number of wheezing rales is greater than that of wet rales. With severe bronchospasm, weakened breathing in the lower parts of the lungs. There is a good effect from bronchospasmolytics.

In some children who have suffered obstruction due to a viral infection, broncho-obstructive syndrome may take a recurrent course.

The reason for recurrence may be:
Development of bronchial hyperactivity (most common reason);
Debut bronchial asthma;
The presence of latent chronic lung diseases (such as cystic fibrosis, malformations of the bronchopulmonary system).

Bronchial hyperactivity develops in more than half of children who have had viral infection or pneumonia with obstructive syndrome. This state of hyperactivity can last from one week to several months (3-8 months).
It was noted that recurrence of obstruction in children under 6 months. - this is most likely bronchial hyperactivity, before 3 years of age, then this is the beginning of bronchial asthma.

Treatment of broncho-obstructive syndrome.
The main directions in the treatment of broncho-obstructive syndrome in children should include:
1. Improving the drainage function of the bronchi;
2. Bronchodilator therapy;
3. Anti-inflammatory therapy.

1. To improve the drainage function of the bronchi, it is necessary to carry out:
Rehydration;
mucolytic therapy;
postural drainage;
massage;
breathing exercises.

Mucolytic therapy is carried out taking into account the amount of sputum, the severity of the process, the age of the child. Its main goal is to dilute the sputum and increase the effectiveness of the cough.

In children with an unproductive cough and thick sputum, inhalation and oral administration mucolytics. The best of them are considered to be ambroxol preparations (lazolvan, ambrobene). They have mucolytic and mucokinetic effects, increase the synthesis of sulfactant, and are low-allergenic.

In children with mild to moderate broncho-obstructive syndrome, acetylcysteine can be used.

In children with an obsessive, hacking cough with no sputum, expectorants (herbal medicines) can be used. They are prescribed with caution in children with allergies. A decoction of coltsfoot and plantain syrup are used.

You can combine mucolytics and expectorants.
At severe course In cases of broncho-obstructive syndrome, mucolytics are not prescribed on the first day.

Antitussive drugs are excluded from all patients with broncho-obstructive syndrome.

Combination drugs with ephedrine (solutan, broncholitin) should be prescribed with caution. They can be used only in cases of hyperproduction of abundant bronchial secretions, since effedrine has a drying effect.

2. Bronchodilator therapy.

For this purpose, children use:
b2 antagonists short acting;
anticholinergics;
short-acting theophylline preparations and their combinations.

Short-acting b2 antagonists include Salbutamol (Ventolin), Fenoterol, etc. They are the drugs of choice for relieving acute obstruction. When used through a nebulizer, they give a quick effect. They are prescribed 3 times a day.

These are highly selective drugs and therefore their side effects are minimal. However, with uncontrolled and prolonged use, there may be an increase in bronchial hyperactivity (sensitivity to b2 receptors decreases).

In case of a severe obstructive attack, you can inhale Ventolin through a nebulizer 3 times for one hour (every 20 minutes). This is the so-called “emergency therapy”.

Anticholinergic drugs (muscarinic M3 receptor blockers) are also used. These include Atrovent (ipratroprium bromide). It is dosed from 8 to 20 drops through a nebulizer 3 times a day.

In young children, the therapeutic effect of anticholinergic drugs is slightly better than that of short-acting b2 antagonists. But their tolerability is somewhat worse.

Combination drugs are widely used, which include agents that act on these two types of receptors. This is Berodual, which includes ipratroprium bromide and fenoterol. They act synergistically, which gives a good effect. Berodual is prescribed - 1 drop. per kg ( single dose) 3 rub. per day.

Short-acting theophyllines include aminophylline. It is widely used to relieve bronchial obstruction in children. Its use has both positive and negative sides.

TO positive aspects include: fairly high efficiency; low cost; ease of use;
On the negative side, there are a large number of side effects.

The main reason that limits the use of aminophylline is the proximity of the therapeutic and toxic doses. This requires monitoring the drug in the blood plasma (concentration of 8-15 mg per liter is optimal). An increase in concentration greater than 16 mg per liter can lead to unwanted effects: nausea, vomiting, development of arrhythmia, tremor, agitation.

It is especially necessary to use aminophylline with caution in children who take macrolides (the clearance of aminophylline slows down).At the same time, even therapeutic doses may lead to complications.

Now aminophylline is a second-line drug. It is used when there is no effect from short-acting b2 antagonists and anticholinergic drugs. At severe attack obstruction, the drug is prescribed at a dose of 4-6 mg/kg every 6-8 hours.

3. Anti-inflammatory therapy.

The goal of this therapy is to reduce the activity of the inflammatory process in the bronchi.
Drugs in this group include Erespal (fenspiril).

Its anti-inflammatory effect is as follows:
Blocks H-1 histamine and alpha adrenergic receptors;
Reduces the amount of leukotrienes;
Reduces the amount of inflammatory mediators;
Suppresses the migration of inflammatory cells.

Erespal, in addition to its anti-inflammatory effect, reduces mucus hypersecretion and bronchial obstruction. It is the drug of choice for bronchial obstruction in children early age infectious genesis. Good effect noted when prescribing the drug from the first days of the disease.

In severe obstructive processes, glucocorticoids are used for anti-inflammatory purposes. Their inhalation route of administration is preferred, as it is highly effective and less dangerous. It is recommended to administer Pulmicort through a nebulizer 1-2 times a day at a dose of 0.25-1 mg. It is better when inhalation is done 20 minutes after inhalation of the bronchodilator. The duration of therapy is usually 5-7 days.

Parenteral corticosteroids are used for bronchiolitis and status asthmaticus. Usual dose 2 mg per kg per day for prednisolone. For bronchiolitis, the dose is 5-10 mg per kg per day in 4 divided doses (every 6 hours), not taking into account the circadian rhythm.

Antihistamines are used only in the presence of allergic diseases.

Etiotropic treatment consists of the use of antiviral and antibacterial therapy.

Antibiotics should be used as indicated in following cases:
Hyperthermia that lasts more than 3-5 days;
When there is no effect from the treatment;
Asymmetrical wheezing;
The presence of toxicosis, especially when it increases;
Availability purulent sputum;
Presence of hypoxia;
Leukocytosis, shift leukocyte formula to the left, increased SOE, neutrophilia.

For respiratory failure, oxygen therapy is administered through a mask or nasal catheters.

In conclusion, I would like to note that it is now widely used in the treatment of broncho-obstructive syndrome. With this inhalation therapy you can provide emergency assistance with obstruction in short terms without resorting to parenteral administration medicines.

Broncho-obstructive syndrome- a clinical manifestation of acute respiratory failure of the ventilation type, in the pathogenesis of which the first place is occupied by spasm of the small bronchi, swelling of their mucous membrane and excessive production of sputum.

Reasons

Broncho-obstructive syndrome is a consequence of inflammation of the bronchial mucosa caused by a virus. Symptoms of bronchiolitis appear in patients up to 4 months of age and the clinic of obstructive bronchitis in older children. Allergic inflammation bronchial mucosa can manifest as bronchial asthma, which is usually found in patients over 3 years of age, but in medical practice Cases of this disease have been recorded even in infants.

The disease in question is found mainly in young children. Bronchiolitis occurs between 0 and 5 months of age due to respiratory syncytial infection. MS infection mainly affects lower sections human respiratory tract. Before broncho-obstructive syndrome, any acute respiratory viral infection can develop, which will become the cause of the disease.

Symptoms and diagnosis

The child develops expiratory shortness of breath, which means that exhalation is prolonged. In the lungs, doctors record whistling dry rales, which are heard symmetrically in the inter- and subscapularis space. Percussion diagnostic methods can reveal a box-like sound in the chest, which is the result of expiratory closure of bronchioles and acute emphysema. X-rays are also used, which reveal an increase in the pulmonary pattern, expansion of the roots of the lungs against the background of their emphysematous swelling.

Treatment of broncho-obstructive syndrome

It is necessary to relieve bronchospasm. For this, theophylline preparations are effectively used:

optifillin, etc.

When prescribing a medicine, it is worth considering that it stimulates the central nervous system, although to a lesser extent when compared with caffeine. It also has an effect on the heart muscle, enhancing its contractile activity. To a small extent it expands the coronary, peripheral vessels and kidney vessels, has a diuretic effect, although not great. But its most important feature (the reason for its use in broncho-obstructive syndrome) is its bronchodilator effect.

The doctor may prescribe Theophylline in combination with other bronchodilators and antispasmodics. The dosage for children should be lower than for adults. The drug is also available in the form rectal suppositories(which are inserted into the patient's rectum). Often it is with this form of administration that the best results are observed. therapeutic effect(the person recovers faster). This is explained by the fact that medicinal substances with this route of administration are less susceptible to metabolism (conversion) in the liver. The course of treatment is chosen by the attending physician.

The dose for children 2-4 years old is usually 0.01-0.04 g, for 5-6 year old patients - 0.04-0.06 g, for 7-9 years old - 0.05-0.075 g, for 10 -14 years - 0.05-0.1 g per dose. For children under 2 years of age, the prescription of the drug is in the vast majority of cases unacceptable.

As for the side effects of Theophylline, there may be:

nausea and/or vomiting
headache
frequent loose stools
burning sensation in the rectum (when taking the drug in the form of rectal suppositories)

Overdose (prescribing too high a dose for a particular patient) often leads to epileptoid (convulsive) seizures. Long courses of treatment are not recommended.

Theophylline and the drugs listed above (in which the same active substance), are contraindicated in patients with:

individual intolerance
acute myocardial infarction
hyperfunction of the thyroid gland
subaortic stenosis
convulsive conditions
epilepsy
pregnancy

Caution in prescribing is observed when peptic ulcer stomach and duodenum.

Bronchospasm can be relieved not only with theophylline, but also with modern selective inhaled sympathomimetics:

salbutamol
fenoterol

Synonyms salbutamol:

Salbuvent
Ventolin
Astalin
Salbupart
Aerolyn
Astakhalin
Asmatol
Albuterol
Proventil
Hungary
Sultanol
Salbumol, etc.

It has a strong and long-lasting (5-8 hours) bronchodilator effect and stimulates the beta-adrenergic receptors of the bronchi. On cardiovascular system When properly prescribed and taken, it does not have a strong effect. For children from 6 to 12 years old, the dose should be 2 mg, taken 3-4 times a day; for patients aged 2-6 years - 1-2 mg 3 times. per day. Children over 12 years of age and adults take 2-4 mg 3-4 times a day. In severe cases, the dosage is increased as prescribed by the attending physician.

Salbutamol can be administered by inhalation, which affects the chosen dosage. The aerosol is used to relieve bronchospasm once: 0.1 mg for children, 0.1-0.2 mg for adults. The drug is used for preventive purposes, for children the dosage is 0.1 mg, taken 3-4 times a day; adults for this purpose are prescribed 0.2 mg 3-4 times a day. The drug in the form of powder for inhalation is prescribed according to a similar scheme, but the dose is 2 times larger.

Probable side effects from taking Salbutamol:

moderate tachycardia
peripheral vasodilation
muscle tremors

Salbutamol should be used with caution for the following diseases:

arterial hypertension
pregnancy
paroxysmal tachycardia

The medicine is available in the form of tablets, syrup, metered-dose aerosol, powder for inhalation, solution for inhalation, solution for injection.

Fenoterol has a rapid bronchodilator effect (expands the lumen of the bronchi). Used to prevent and quickly relieve bronchospasm caused by any reason. This drug increases the frequency and volume of breathing. Increases the function of the ciliated epithelium of the bronchi. The duration of the bronchospasmolytic effect is 8 hours maximum.

The dosage is selected by the doctor in each specific case. Often to remove acute attack for choking, adults and children over 6 years of age are given the medicine in a single dose of 0.2 mg (1 breath of an aerosol containing 0.2 mg in 1 dose or 2 breaths of an aerosol containing 0.1 mg in 1 dose). If ineffective, inhalation is repeated after 5 minutes. Then the drug can be used again only after 6 hours, not earlier.

To prevent bronchospasm, one breath of aerosol (containing 0.2 mg in one breath) is prescribed to children from 6 to 16 years old 2 times a day, adults three times a day. Children 4-6 years old should take no more than 1 breath 4 times a day. No one should take Fenoterol more than 4 times a day.

Possible side effects:

anxiety
hand tremors
feeling tired
increased heart rate
maybe a headache
sometimes sweating

When side effects the dose needs to be reduced. Contraindications to taking the drug in question are arrhythmia and severe atherosclerosis. Fenoterol is available not only as an aerosol, but also in tablets and ampoules. Preparations with the same active ingredient:

Berotek
Fenoterol hydrobromide
Dosberotek
Aerum
Partusisten
Aruterol
Segamol

Selective bronchodilators

These drugs are relevant for nebulizer therapy in young children. To relieve an attack of bronchial asthma, the child must take 1-2 breaths from standard inhalers, repeat them after 5-10 minutes. The total should be no more than 10 breaths. If the patient’s health has improved, repeated inhalations should be carried out after 3-4 hours.

Improving the drainage function of the bronchi and the rheological properties of sputum

This is another goal of therapy for broncho-obstructive syndrome. To do this, restore VEO by introducing liquid inside or intravenous infusion saline solution. The air inhaled by the patient must be humidified using inhalation ultrasound devices and spraying saline solution. Medicines are prescribed that relieve and stimulate coughing: ciliokinetics and mucolytics.

Inhaled saline or bronchodilators are often followed by vigorous chest massage. Greatest effect This method is effective in cases of bronchiolitis in children. Etiotropic treatment includes taking antiviral drugs:

RNAase
DNAase

Etiotropic treatment also includes taking immune drugs if a person has a severe form of viral obstructive syndrome. If the disease is caused by bacteria, the patient must be prescribed antibiotics; the same drugs are relevant in the presence of bacterial complications.

In severe OS and degree II-III ARF, short courses of prednisolone are needed. The course lasts from 1 to 5 days, the daily dose is 1-2 mg per 1 kg of patient weight. For all forms of OS, oxygen therapy is relevant. But it is recommended to avoid long courses high concentrations(>60 vol. %).

In severe broncho-obstructive syndrome (especially in infants from 0 to 4 months of age), severe hypoxemia may occur. Then the doctor usually prescribes respiratory support. Artificial ventilation of the lungs is carried out in the mode of moderate hyperventilation with selection of the inhalation-exhalation time ratio (1:E = from 1:3 to 1:1 or 2:1). Synchronization of the patient and the ventilator using diazepam, GHB (gamma-hydroxybutyric acid) is mandatory.

– a complex of symptoms that is characterized by impaired patency of the bronchial tree of functional or organic origin. Clinically, it is manifested by prolonged and noisy exhalation, attacks of suffocation, activation of auxiliary respiratory muscles, and a dry or unproductive cough. The main diagnosis of broncho-obstructive syndrome in children includes the collection of anamnestic data, objective examination, radiography, bronchoscopy and spirometry. Treatment is bronchodilator pharmacotherapy with β2-adrenergic agonists, elimination of the leading etiological factor.

Classification

Depending on the pathogenesis of broncho-obstructive syndrome in children, there are following forms pathologies:

Biofeedback of allergic origin. Occurs against the background of bronchial asthma, hypersensitivity reactions, hay fever and allergic bronchitis, Loeffler's syndrome.
biofeedback caused by infectious diseases . Main causes: acute and chronic viral bronchitis, ARVI, pneumonia, bronchiolitis, bronchiectasis changes.
BOS that developed against the background of hereditary or congenital diseases . Most often these are cystic fibrosis, α-antitrypsin deficiency, Kartagener and Williams-Campbell syndromes, GERH, immunodeficiency states, hemosiderosis, myopathy, emphysema and anomalies of bronchial tubes.
BOS resulting from neonatal pathologies. Often it is formed against the background of SDR, aspiration syndrome, stridor, diaphragmatic hernia, tracheoesophageal fistula, etc.
Biofeedback as a manifestation of other nosologies. Broncho-obstructive syndrome in children can also be triggered by foreign bodies in the bronchial tree, thymomegaly, regional hyperplasia lymph nodes, benign or malignant neoplasms of the bronchi or adjacent tissues.

According to the duration of the course, broncho-obstructive syndrome in children is divided into:

Spicy. The clinical picture is observed for no more than 10 days.
Protracted. Signs of bronchial obstruction are detected for 10 days or longer.
Recurrent. Acute biofeedback occurs 3-6 times a year.
Continuously relapsing. It is characterized by short remissions between episodes of prolonged biofeedback or their complete absence.

Symptoms of biofeedback in children

The clinical picture of broncho-obstructive syndrome in children largely depends on the underlying disease or provoking factor. this pathology. General condition child in most cases is moderate, observed general weakness, moodiness, sleep disturbance, loss of appetite, signs of intoxication, etc. Direct biofeedback, regardless of the etiology, has characteristic symptoms: noisy loud breathing, wheezing that can be heard at a distance, a specific whistle when exhaling.

Also observed is the participation of auxiliary muscles in the act of breathing, attacks of apnea, shortness of breath of an expiratory (more often) or mixed nature, dry or unproductive cough. With a prolonged course of broncho-obstructive syndrome in children, a barrel-shaped rib cage– expansion and protrusion of intercostal spaces, horizontal course of the ribs. Depending on the underlying pathology, fever, underweight, mucous or purulent discharge from the nose, frequent regurgitation, vomiting, etc.

Diagnostics

Diagnosis of broncho-obstructive syndrome in children is based on the collection of anamnestic data, objective research, laboratory and instrumental methods. When interviewing the mother, a pediatrician or neonatologist focuses on possible etiological factors: chronic diseases, developmental defects, the presence of allergies, episodes of biofeedback in the past, etc. A physical examination of the child is very informative for broncho-obstructive syndrome in children. Percussion determines the increase in pulmonary sound up to tympanitis. The auscultatory picture is characterized by harsh or weakened breathing, dry, whistling, and in infancy - small-caliber wet rales.

Laboratory diagnostics for broncho-obstructive syndrome in children includes general tests and additional tests. The CBC, as a rule, determines nonspecific changes indicating the presence of a focus of inflammation: leukocytosis, shift of the leukocyte formula to the left, increase in ESR, if available allergic component– eosinophilia. If it is impossible to establish the exact etiology, additional tests are indicated: ELISA to determine IgM and IgG to probable infectious agents, serological tests, a test to determine the level of chlorides in sweat if cystic fibrosis is suspected, etc.

Among instrumental methods, which can be used for broncho-obstructive syndrome in children, most often use OGK radiography, bronchoscopy, spirometry, and less often - CT and MRI. X-ray makes it possible to see the enlarged roots of the lungs, signs of concomitant parenchymal damage, the presence of neoplasms or enlarged lymph nodes. Bronchoscopy allows you to identify and remove a foreign body from the bronchi, assess the patency and condition of the mucous membranes. Spirometry is performed when long term broncho-obstructive syndrome in children in order to assess the function of external respiration, CT and MRI - with low information content of radiography and bronchoscopy.

Treatment, prognosis and prevention

Treatment of broncho-obstructive syndrome in children is aimed at eliminating the factors causing obstruction. Regardless of the etiology, hospitalization of the child and emergency bronchodilator therapy using β2-adrenergic agonists are indicated in all cases. In the future, anticholinergic drugs may be used, inhaled corticosteroids, systemic glucocorticosteroids. As auxiliary drugs mucolytic and antihistamines, methylxanthines, infusion therapy. After determining the origin of broncho-obstructive syndrome in children, etiotropic therapy is prescribed: antibacterial, antiviral, anti-tuberculosis drugs, chemotherapy. In some cases, surgery may be required. If there is anamnestic data indicating a possible exposure foreign body into the respiratory tract, emergency bronchoscopy is performed.

The prognosis for broncho-obstructive syndrome in children is always serious. The younger the child, the more severe his condition. Also, the outcome of biofeedback largely depends on background disease. In acute obstructive bronchitis and bronchiolitis, as a rule, recovery is observed; hyperreactivity of the bronchial tree rarely persists. Biofeedback in bronchopulmonary dysplasia is accompanied by frequent acute respiratory viral infections, but often stabilizes by the age of two. In 15-25% of such children it transforms into bronchial asthma. BA itself may have different course: light form goes into remission already in the younger age school age, severe, especially against the background of inadequate therapy, is characterized by a deterioration in the quality of life, regular exacerbations with fatal in 1-6% of cases. BOS against the background of bronchiolitis obliterans often leads to emphysema and progressive heart failure.

Prevention of broncho-obstructive syndrome in children implies the exclusion of all potential etiological factors or minimizing their impact on the child’s body. This includes antenatal fetal care, family planning, medical and genetic counseling, rational use medicines, early diagnosis and adequate treatment of acute and chronic diseases respiratory system etc.

Broncho-obstructive syndrome (BOS) - often found in medical practice, progresses severely with the development of respiratory failure. The syndrome occurs in people who often suffer from respiratory ailments, cardiovascular pathologies, poisoning, diseases of the central nervous system - in general, with more than 100 diseases.

It is especially difficult in young children. Why is it developing? this syndrome How to recognize it and start treatment on time - we will consider later in the article.

Brief characteristics and classification of biofeedback

Broncho-obstructive syndrome (BOS) is not an independent medical diagnosis or disease, biofeedback is a manifestation of individual nosological forms. For example, in children under three years of age, half of the cases of bronchial obstruction syndrome are caused by asthma.

Also in children, cases of biofeedback can occur due to congenital anomalies of the nasopharynx, swallowing disorders, gastroesophageal reflux and other things.

Did you know? Anatomically, the bronchi resemble an inverted tree, which is why they got their name - the bronchial tree. At its base, the width of the lumen is up to 2.5 cm, and the lumen of the smallest bronchioles is 1 mm. The bronchial tree branches into several thousand small bronchioles, which are responsible for gas exchange between the lungs and blood.

Bronchoobstruction is a clinical manifestation of bronchial obstruction with further resistance to air flow. When obstruction occurs, a generalized narrowing of the bronchial lumen of the small and large bronchi occurs, which causes their vibration and whistling “sounds”.

The syndrome develops especially often in children under 3 years of age who have a family history, are prone to allergic reactions and often suffer respiratory diseases. The basis for the occurrence of biofeedback is the following mechanism: inflammation occurs of various etiologies, which entails spasm and further narrowing of the lumen (occlusion). As a result, compression of the bronchi occurs.

Bronchial obstruction syndrome is classified according to its form, duration and severity of the syndrome.

Depending on the form of BFB, it can be:

Infectious (viral and bacterial).
Hemodynamic (occurs with cardiac pathologies)
Obstructive.
Allergic.

Depending on the duration of the course, there are:

Acute BOS. Accompanied by a pronounced clinical picture, symptoms appear for more than 7 days.
Protracted. Clinical manifestations are less pronounced and the course is long-lasting.
Recurrent. Acute periods abruptly give way to periods of remission.
Constantly recurrent. Periods of incomplete remission are followed by exacerbations of the syndrome.

Bronchial obstruction syndrome can occur in mild, moderate and severe forms, which differ in the number of clinical manifestations and indicators of analysis of the composition of gases in the blood. By the way, in practice, syndromes of an allergic and infectious nature are most often encountered.

Reasons for development

Among the diseases that may be accompanied by the occurrence of BOS are:

Functional changes respond well to conservative treatment, while elimination of organic changes is carried out only in some cases by surgical intervention and due to the child’s adaptive capabilities.

Among functional changes emit bronchospasm, large sputum production during bronchitis, swelling of the bronchial mucosa, inflammation and aspiration. TO organic changes include birth defects development of the bronchi and lungs, stenosis, etc.

Biofeedback in children is due to physiological features at such a young age - the fact is that the child’s bronchi are significantly narrower, and their additional narrowing as a result of edema, even by one millimeter, will already have a noticeable negative effect.

The normal functioning of the bronchial tree can be disrupted in the first months of life due to frequent crying, lying on the back, and prolonged sleep.
Also an important role is played by prematurity, toxicosis and taking medications during pregnancy, complications during pregnancy. birth process, from the mother and so on.

In addition, the baby’s processes have not yet stabilized until they are one year old. immune defense, which also plays a role in the occurrence of bronchial obstruction.

Signs and symptoms

TO clinical manifestations broncho-obstructive syndrome include the following:

prolonged inhalation;
the appearance of whistling and wheezing during breathing;
lingering unproductive;
increase breathing movements, participation of auxiliary muscles in the breathing process;
hypoxemia;
the appearance of shortness of breath, lack of air;
chest enlargement;
breathing becomes loud, weakened, or harsh.

The listed symptoms indicate the occurrence of a narrowing of the bronchial lumen. However general symptoms are largely determined by the underlying pathology that caused the biofeedback.
When the disease occurs, the child exhibits moodiness, sleep and appetite disturbances, weakness, and symptoms of intoxication occur; the temperature may rise and body weight may decrease.

When contacting a therapist or neonatologist, the doctor will interview the baby’s mother for allergies, recent illnesses, identified developmental disorders, and family history.

In addition to the presence of clinical signs in, to make a diagnosis of BOS, it is necessary to conduct specific physical and functional studies.

The most important test to confirm the diagnosis is spirometry- in this case, the volume of inhaled and exhaled air, lung capacity (vital and forced), the amount of air during forced inspiration, and the patency of the respiratory tract are examined.

Therapeutic procedures may include:

Special breathing exercises.
Using breathing simulators.
Drainage.
Vibration chest massage.
Speleotherapy.
Balneological procedures.
Therapeutic exercise.

In the child’s room, it is necessary to maintain the temperature at +18-19°C, and the air humidity must be at least 65%. Regular ventilation of the room will not be superfluous.

If the child feels well, you should not force him to remain in bed - physical activity promotes better discharge mucus from the bronchi.

Also provide your baby sufficient quantity drinks per day: these can be herbal teas, infusions, fruit juices and fruit drinks, unsweetened compotes.

Forecast

The prognosis for the development of biofeedback depends on the primary pathology and its timely treatment. Also, the consequences and severity of the disease are determined by the age of the child: what younger age, the more expressive the manifestations of the disease and the more complex the course of the underlying disease.

With bronchitis, the prognosis is positive, but with pulmonary dysplasia there is a risk of BOS degenerating into asthma (in 20% of cases). Against the background of bronchiolitis, heart failure and emphysema may occur.

Cases of frequent, unproductive, debilitating cough can lead to nausea and expectoration of blood due to damage to the respiratory tract. Therefore, it is important to apply for qualified help and start adequate therapy to prevent unwanted consequences.

Did you know? During the day we make up to 23 thousand respiratory movements: inhalations and exhalations.

Basic rules of prevention include the following points:

In 80% of cases, BOS occurs from birth to three years. The syndrome causes a lot of trouble for both the child and the parents. However, if you identify the pathology in time and begin therapeutic actions, serious consequences for the health of the child can be avoided.

Currently, obstructive bronchial syndrome is increasingly being diagnosed. It is characterized by their complete or partial obstruction, as a result of which a person’s breathing becomes difficult.

During an attack, patients experience strong fear death due to the inability to take a full breath. The disease occurs equally in adults and children.

This condition requires periodic monitoring by a doctor, as well as compliance with all recommendations and elimination of provoking factors.

What happens in the body

Bronchial obstruction is a spasm of them smooth muscle, which appears due to blockage of the lumen of the organ.

Swelling occurs during an attack lung tissue, which is accompanied by the release large quantity mucous secretion from the lungs. Phlegm obstructs air circulation, causing a person to feel severe shortness of breath and fear of death.

This can happen for a number of reasons. It is impossible to cure the disease completely. First aid involves relieving the spasm, after which it is necessary to undergo a course of treatment and carry out lifelong prevention of relapses.

Reasons for appearance

A condition such as bronchial obstruction can develop due to many reasons. The appearance of spasms is influenced by diseases of the respiratory system, as well as chronic diseases not directly related to the lungs. Many predisposing factors contribute to obstructive syndrome.

The appearance of primary broncho-obstructive syndrome is always associated with the patient’s history of bronchial asthma, the main manifestation of which is a narrowing of the bronchopulmonary lumen.

Secondary broncho-obstructive syndrome is caused by:

various allergic reactions;
infectious diseases (for example, pneumonia, tuberculosis, cystic fibrosis and any respiratory infection);
entry into the lumen of the bronchus of a foreign body, liquid or vomit;
malignant and benign neoplasms lungs;
diseases of the cardiovascular system;
occupational hazards (for example, working with dust, gases, etc.).

Treatment will never give the desired result if there are situations in the patient’s life that predispose to obstructive syndrome. Concomitant diseases should also be cured or their stable remission achieved.

Predisposing factors

If there are factors in a person’s life that can cause bronchial obstruction syndrome, the person must eliminate them. This is especially true for patients who already have other pulmonary diseases or are genetically predisposed to them. Also, attention should be paid to predisposing factors in cases where pulmonary spasm has already been observed previously.

What indirectly affects the development of broncho-obstructive syndrome:

Smoking. Smoke entering the lungs causes them to secrete more viscous secretion to get rid of foreign particles. Besides myself smoke is a strong allergen that can cause tissue swelling.
Alcohol abuse. Regular entry into the body ethyl alcohol significantly undermines the immune system. Due to this, the body cannot fully resist the infections that enter it. A person begins to suffer from respiratory diseases more often, which subsequently cause bronchospasm.
Polluted air, unsuitable living and working conditions. If a patient has to regularly deal with dust, mold or exhaust fumes, this will definitely affect the health of his respiratory system.
Childhood. In this case, the syndrome is explained by the immaturity of the respiratory system and weak immunity. In many ways, the appearance of bronchial obstruction in a baby is influenced by the mother’s failure to comply with all recommendations during pregnancy.

When a patient has a history of chronic diseases and several predisposing factors are present, it is only a matter of time before lung problems appear.

Symptoms of the disease

Bronchial obstruction differs in the severity of the clinical picture and the symptoms that appear. They grow rapidly, causing a person to experience fear. Reception certain drugs quickly removes all signs of the disease, leaving no trace of it.

What indicates bronchospasm:

expiratory shortness of breath - during it a person cannot fully exhale, while inhalation is carried out almost unhindered;
cough - accompanied by poorly separated sputum or occurs without it;
forced position of the body - the victim finds relief only while sitting, in a horizontal position the symptoms intensify;
secondary signs - headache, increased heart rate, pallor or cyanosis skin, swelling of the veins in the neck.

Treatment of broncho-obstructive syndrome should be carried out by a pulmonologist after examining the patient and carrying out all necessary tests. Otherwise, taking inappropriate medications can cause increased spasm.

Diagnostics

A competent specialist can make a diagnosis already at the stage of collecting anamnesis, examination and auscultation. Expiratory shortness of breath almost always indicates bronchial obstruction. If there are several predictive factors in the patient's life, the pulmonologist can be almost confident in his assumptions.

However, to confirm the diagnosis and carry out differential diagnosis X-ray studies are carried out, as well as the function external respiration(FVD). This helps eliminate more serious illnesses pulmonary system.

If the spasm is caused allergic reaction, a blood test will indicate a significant increase in eosinophils. After all necessary examinations the specialist makes a final conclusion.

Treatment

Treatment of bronchial obstruction syndrome involves relieving spasms to make breathing easier.. Some medications will have to be taken in a course. As a rule, it does not last more than 2 weeks. Then maintenance therapy is prescribed, which consists of preventive measures.

All predisposing factors are excluded from a person’s life, and breathing exercises are prescribed. The victim must comply with all clinical guidelines, otherwise episodes of suffocation will be repeated on a regular basis.

First aid

When a person nearby begins to choke, anyone will become bewildered and begin to experience horror. However, at this moment the victim can and should be helped. Moreover, you don’t need to do anything supernatural for this.

How to help a patient with bronchial obstruction:

A window should be opened indoors. Remove suffocating clothing items and unfasten the top buttons.
The victim should not be placed in horizontal position . It is better to put pillows under his back and sit him in them, preferably near a window.
If the attack was caused by an allergy, you should eliminate its source and take an antihistamine, which was prescribed in advance by an allergist.
You can take the medicine by inhalation if it is recommended by a pulmonologist.

A patient who has had a bronchospasm needs to calm down, because nervous tension may intensify symptoms.

If after all the manipulations done there is no improvement or the cause of the obstruction is a foreign body in the bronchi, it is necessary to call for medical help.

Bronchoobstruction syndrome in children

Bronchial hyperactivity syndrome in young children is not as rare a disease as it might seem at first glance. Its appearance is influenced by many various reasons. Most of them appear due to parental misbehavior or ignorance.

Possible causes of broncho-obstructive syndrome in children:

imperfection of the respiratory system;
allergic diseases the child or his genetic predisposition to them(parental history is burdened with allergies or bronchial asthma);
severe pregnancy of the mother, her smoking or chronic diseases affecting the proper development of the baby;
smoking near the baby;
heart defects and other cardiovascular diseases;
previous bronchitis, pneumonia;
entry of a foreign body into the bronchi;
various respiratory diseases, especially in the first year of life.

It is known that bronchial obstruction in children may occur due to artificial feeding, the presence of rickets or dystrophy, as well as immaturity of the immune system due to prematurity.

Symptoms that parents should pay attention to:

the appearance of wheezing;
extended exhalation;
dry cough.

The child's breathing changes, becomes frequent and shallow. As a rule, shortness of breath appears only in severe forms of the disease. The baby may have difficulty falling asleep or wake up in the middle of the night, take a forced position and cry in fear. In this case, parents should not panic, as this may frighten the baby even more.

Diagnosis and treatment

The child must be examined for the presence concomitant diseases, especially if he has a regular cough and shortness of breath, which bother him in the evening and at night.

To do this, you need to undergo examination by a therapist and pulmonologist, and you may need consultations with other specialized doctors. The specialist will prescribe blood and urine tests, chest x-rays, and a respiratory function test..

Obstructive syndrome in children is easily eliminated by inhalation with various drugs. The action of the medications is aimed at relieving swelling of the mucous membrane of the lung tissue and unhindered removal of accumulated sputum.

If the baby has already experienced bronchospasm, it is necessary to pay due attention to it. further prevention. Parents should monitor the air in their child's bedroom. The recommended humidity is at least 40%.

To control the atmosphere in your home, you can purchase a special air washer or humidifier.. Such a device purifies the air space in the room, eliminates volatile allergens, dust, wool and even respiratory infection if someone in the house is sick.

The pulmonologist will also prescribe physiotherapy, which is treatment with ultrasound, current or light. To facilitate the discharge of sputum, it is recommended to percussion massage. You can do it yourself at home or in the hospital.

Prevention

Bronchial obstruction is the lungs' response to external stimuli . Therefore, in order to carry out high-quality prevention, these irritants should be completely or at least partially eliminated from the patient’s life.

What can be done for prevention:

Forget about smoking. The sick person should not smoke himself or be in a room where others are doing so. It is especially prohibited for pregnant women or relatives who are at a distance of several meters from the child to smoke.
Provide supportive therapy if there is a history of allergic diseases. You should be regularly monitored by a specialist, and exclude as much as possible from usual life all factors that irritate the immune system.
Do not accept any medicines without consulting a doctor, as they can also cause bronchospasm.
Try to breathe sea or forest air more often, walk after rain, when environment maximally saturated with ozone.
Do breathing exercises, exercise, or at least do exercises.
Treat respiratory diseases promptly and completely.

The lack of quality therapy and prevention aggravates the further course of the disease. Relapses begin to appear more often, last much longer, and more and more serious medications are required to eliminate the symptoms. Subsequently, this can lead to the development of bronchial asthma, heart failure, pneumothorax, asphyxia and other serious conditions.

In most cases, high-quality preventive measures guarantee a stable, long-term relapse.