Obstructive syndrome in the elderly diagnosis. Syndrome of bronchial obstruction (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 anomalies, etc. (about 100 diseases).

With broncho-obstructive syndrome, there is a violation of bronchial patency 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 cartilages of the bronchial tree are more pliable compared to adults;
The chest has insufficient rigidity, which leads to significant retraction compliant places(above and infraclavicular fossae, sternum, intercostal spaces);
There are more goblet cells in the bronchial wall than in adult goblet cells. This leads to more mucus secretion;
The edema of the bronchial mucosa develops rapidly, in response to various annoying factors;
The viscosity of the bronchial secretion 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 in the respiratory tract of interferons, secretory and serum immunoglobulin A.

For practical activities, given the etiology of this symptom complex, it is possible to divide bronchial obstruction 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 prevails over inflammatory phenomena(bronchial asthma);
Obstructive variant - occurs when foreign bodies are aspirated.
The hemodynamic variant can occur with heart disease, when left ventricular heart failure develops.

In practice, the first two options are most often encountered.
Therefore, we will consider 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, 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 after the onset of a respiratory viral infection. There is expiratory dyspnea, remote wheezing, noisy breathing. Percussion over the lungs box sound. Auscultatory exhalation is elongated, diffuse dry whistling, buzzing rales on both sides. At a younger age, various wet rales are possible.

bronchiolitis sick children up to 2 years (usually up to 6 months). Bronchiolitis affects the bronchioles and small bronchi. The expressed respiratory insufficiency of the II-III degree is characteristic. Tachypnea, acrocyanosis. On auscultation, there is an abundance of small bubbling moist rales on both sides. Intoxication syndrome is not expressed.
Radiographically, there is an increase in the lung pattern, horizontal standing of the ribs, expansion of the intercostal spaces, the dome of the diaphragm is lowered.

Obliterating bronchiolitis- a serious disease that has a cyclic course. Its reason is mainly adenovirus infection(may also occur with whooping cough and measles). Children under 3 years of age are sick. The acute period proceeds like a normal bronchiolitis, but with more pronounced respiratory disorders. Obstruction is retained for a long time (up to 2 weeks), it can even increase. Characteristically on the radiograph - "cotton shadows".
In the second period, the condition improves, but the obstruction is retained, periodically intensifying, as in an asthmatic attack. The phenomenon of "supertransparent 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 allergic history(allergic dermatitis, allergic rhinitis and etc.) Attacks of obstruction are associated with the presence of an allergen, and are not associated with infection. Characterized by the uniformity of seizures and their recurrence.

Clinically, there are no signs of intoxication. The attack occurs on the first day of the disease and is removed in short lines (within a few days). During an attack, expiratory dyspnea involving accessory muscles. On auscultation, the number of wheezing wheezes is more than wet. With severe bronchospasm, weakened breathing in the lower parts of the lungs. There is a good effect of bronchospasmolytics.

In some children who have undergone obstruction against the background of a viral infection, broncho-obstructive syndrome may take a relapsing course.

The cause of recurrence may be:
The development of bronchial hyperactivity (the most common cause);
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 undergoing 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 the recurrence of obstruction in children under 6 months. - this is most likely bronchial hyperactivity, up to 3 years, then this is the beginning of bronchial asthma.

Treatment of bronchial obstructive syndrome.
The main directions in the treatment of broncho-obstructive syndrome in children should include:
1. Improvement of 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 thin the sputum, increase the effectiveness of coughing.

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

Acetylcysteine can be used in children with mild to moderate broncho-obstructive syndrome.

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

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

All patients with broncho-obstructive syndrome exclude antitussive drugs.

Combined preparations with ephedrine (solutan, broncholithin) should be administered with caution. They can be used only in cases of hyperproduction of abundant bronchial secretions, since ephedrine has a drying effect.

2. Bronchodilator therapy.

For this purpose, children use:
b2 antagonists short action;
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 applied through a nebulizer, they give a quick effect. Assign them 3 times a day.

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

With a severe obstructive attack, you can do inhalations with Ventolin through a nebulizer 3 times for one hour (every 20 minutes). This is the so-called "first aid therapy".

Anticholinergic drugs (blockers of muscarinic M3 receptors) 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 somewhat better than that of short-acting b2 antagonists. But their portability is somewhat worse.

Combined preparations 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 cap. per kg ( single dose) 3 p. per day.

Eufillin is a short-acting theophylline. It is widely used to relieve bronchial obstruction in children. Its use has both positive and negative sides.

To positive moments include: rather high efficiency; low cost; ease of use;
On the negative side - 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 of the drug in the blood plasma (concentration of 8-15 mg per liter is optimal). Increasing the concentration of more than 16 mg per liter can lead to unwanted effects: nausea, vomiting, development of arrhythmia, tremor, agitation.

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

Now eufillin belongs to the second-line drugs. It is used when there is no effect from short-acting b2 antagonists and anticholinergics. 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 purpose of this therapy is to reduce the activity of the inflammatory process in the bronchi.
This group of drugs includes Erespal (fenspiril).

Its anti-inflammatory action 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 anti-inflammatory action, 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 process, with an anti-inflammatory purpose, glucocorticoids are used. 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. With bronchiolitis, the dose is 5-10 mg per kg per day in 4 doses (every 6 hours), not taking into account the daily rhythm.

Antihistamines are used only in the presence of allergic diseases.

Etiotropic treatment consists in the use of antiviral and antibiotic therapy.

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

In case of respiratory failure, oxygen therapy is carried out 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. This inhalation therapy can provide emergency assistance with obstruction in short time 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 spasm of small bronchi, swelling of their mucous membrane and excessive sputum production are in the first place.

The reasons

Broncho-obstructive syndrome is a consequence of inflammation of the bronchial mucosa caused by a virus. There are symptoms of bronchiolitis in patients up to 4 months of age and a clinic of obstructive bronchitis in older children. allergic inflammation bronchial mucosa can be manifested by bronchial asthma, which is usually found in patients from 3 years of age, but in medical practice cases of such a disease have been recorded even in infants.

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

Symptoms and Diagnosis

The child develops shortness of breath of the expiratory type, which means that the exhalation is lengthened. In the lungs, physicians fix whistling dry rales, which are heard symmetrically in the inter- and subscapular space. Percussion diagnostic methods can reveal a box tone of sound in the chest, which is the result of expiratory closure of bronchioles and acute emphysema. X-rays are also used, which reveals an increase in the pulmonary pattern, an 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 drug, it is worth considering that it stimulates the central nervous system, although to a lesser extent when compared with caffeine. It also affects the heart muscle, increasing its contractile activity. To a small extent, it expands the coronary, peripheral vessels and vessels of the kidneys, has a diuretic effect, although not great. But its most important feature (the reason for its use in broncho-obstructive syndrome) is its bronchodilatory 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 appointment that the best therapeutic effect(the person recovers faster). This is due to the fact that medicinal substances in this route of administration are less susceptible to metabolism (transformation) 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 old - 0.05-0.1 g per 1 dose. For children under 2 years of age, the appointment of the drug in the vast majority of cases is 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 large a dose for a particular patient) often leads to epileptoid (convulsive) seizures. Long courses of admission 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 states
epilepsy
pregnancy

Caution in the appointment is observed when peptic ulcer stomach and duodenum.

Bronchial spasm can be relieved not only with theophylline, but also with modern selective inhalation sympathomimetics:

salbutamol
fenoterol

Synonyms salbutamol:

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

It has a strong and long-lasting (5-8 hours) bronchodilatory effect and stimulates bronchial beta-adrenergic receptors. On the cardiovascular system when properly administered 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 r. per day. Children from 12 years old 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 dosage chosen. The aerosol is used to relieve bronchospasm once for children at 0.1 mg, for adults at 0.1-0.2 mg. The drug is used for prophylactic purposes, for children the dosage is 0.1 mg, taken 3-4 times a day; adults for these purposes are prescribed 0.2 mg 3-4 times a day. The drug in the form of a powder for inhalation is prescribed according to a similar scheme, but the dose is 2 times more.

Probable side effects from taking Salbutamol:

moderate tachycardia
expansion of peripheral vessels
muscle tremor

Salbutamol is used with caution in such diseases:

arterial hypertension
pregnancy
paroxysmal tachycardia

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

Fenoterol has a rapid bronchodilator effect (expands the lumen of the bronchi). It is 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 action is 8 hours maximum.

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

As a prophylaxis of bronchospasm, one breath of an aerosol (with a content of 0.2 mg per breath) is prescribed for children from 6 to 16 years old 2 times a day, for adults three times a day. Children 4-6 years old should take no more than 1 breath 4 times a day. Fenoterol should not be taken more than 4 times a day.

Possible side effects:

anxiety
hand tremor
feeling tired
increased heart rate
could be 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 should 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 feels better, 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, VEO is restored by introducing liquid into or intravenous infusion physiological saline. The air inhaled by the patient must be moistened with the help of inhalation ultrasonic devices and spraying with saline. Prescribe drugs that relieve and stimulate cough: ciliokinetics and mucolytics.

After inhalation of saline or bronchodilators, vigorous chest massage is often performed. Greatest effect this method renders in cases of bronchiolitis in children. Etiotropic treatment includes taking antiviral drugs:

RNAse
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, it is necessary to prescribe antibiotics to the patient, the same drugs are relevant in the presence of bacterial complications.

In severe OS and ARF II-III degree, 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 the patient's weight. Oxygen therapy is relevant for all forms of OS. But it is recommended to abandon long courses high concentrations(> 60 vol. %).

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

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

Classification

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

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

The clinical picture of broncho-obstructive syndrome in children largely depends on the underlying disease or the factor provoking this pathology. General state the child in most cases is moderate, there is general weakness, capriciousness, sleep disturbance, loss of appetite, signs of intoxication, etc. Directly BOS, regardless of etiology, has characteristic symptoms: noisy loud breathing, wheezing, which are heard at a distance, a specific whistle when exhaling.

There is also the participation of auxiliary muscles in the act of breathing, apnea attacks, expiratory dyspnea (more often) or mixed nature, dry or unproductive cough. With a protracted course of broncho-obstructive syndrome in children, a barrel-shaped rib cage- expansion and protrusion of the intercostal spaces, the horizontal course of the ribs. Depending on the underlying pathology, fever, underweight, mucosal 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 a mother is interviewed by a pediatrician or neonatologist, attention is focused on possible etiological factors: chronic diseases, malformations, the presence of allergies, episodes of BOS in the past, etc. Physical examination of the child is very informative for bronchial obstructive syndrome in children. Percussion is determined by the amplification of pulmonary sound up to tympanitis. The auscultatory picture is characterized by hard or weakened breathing, dry, wheezing, in infancy - small-caliber moist rales.

Laboratory diagnostics for broncho-obstructive syndrome in children includes general analyzes and additional tests. In the KLA, as a rule, non-specific changes are determined that indicate the presence of a focus of inflammation: leukocytosis, shift of the leukocyte formula to the left, increase in ESR, in the presence of allergic component- eosinophilia. If it is impossible to establish the exact etiology, additional tests are indicated: ELISA with the determination of IgM and IgG to probable infectious agents, serological tests, a test with the determination of the level of chlorides in sweat with suspicion of cystic fibrosis, etc.

Among instrumental methods, which can be used for broncho-obstructive syndrome in children, most often use chest X-ray, bronchoscopy, spirometry, less often - CT and MRI. Radiography makes it possible to see the expanded roots of the lungs, signs of concomitant lesions of the parenchyma, 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 done with long course 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 bronchial obstructive syndrome in children is aimed at eliminating the factors that cause obstruction. Regardless of the etiology, hospitalization of the child and emergency bronchodilator therapy using β2-agonists are indicated in all cases. Later, 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. In the presence of anamnestic data indicating a possible hit 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 worse 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. BOS in bronchopulmonary dysplasia is accompanied by frequent acute respiratory viral infections, but often stabilizes by the age of two. In 15-25% of these children, it transforms into bronchial asthma. The BA itself can have different course: mild form goes into remission at a young age school age, severe, especially against the background of inadequate therapy, is characterized by a deterioration in the quality of life, regular exacerbations with lethal outcome in 1-6% of cases. BOS against the background of obliterating bronchiolitis 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 genetic counseling, rational use medicines, early diagnosis and adequate treatment of acute and chronic diseases respiratory system etc.

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

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

Brief description and classification of BOS

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 old, half of the cases of bronchial obstruction syndrome are caused by asthma.

Also in babies, 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, for which 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 the blood.

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

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

The syndrome of bronchial obstruction is classified according to the form, duration of the course and the severity of the manifestation of the syndrome.

According to the form of BOS flow, it happens:

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, the course is long.
Recurrent. Acute periods abruptly followed by periods of remission.
Constantly recurrent. Periods of incomplete remission are replaced 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 the analysis of the composition of gases in the blood. By the way, in practice, syndromes of an allergic and infectious nature are most common.

Reasons for development

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

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

Among functional changes secrete bronchospasm, large sputum production in bronchitis, swelling of the bronchial mucosa, inflammation and aspiration. To organic change relate birth defects development of the bronchi and lungs, stenosis, etc.

BOS in babies is due to the peculiarities of physiology at such a young age - the fact is that the bronchi of the child are significantly narrower, and their additional narrowing as a result of edema, even by one millimeter, will already have a tangible negative effect.

The normal functioning of the bronchial tree can be disturbed in the first months of life due to frequent crying, staying on the back, and prolonged sleep.
Also an important role is played by prematurity, toxicosis and medication during gestation, complications during birth process, mother and so on.

In addition, the baby's processes have not yet stabilized until a year old. immune protection, which also plays a role in the occurrence of bronchial obstruction.

Signs and symptoms

To clinical manifestations bronchial obstruction syndrome include the following:

extended breath;
the appearance of whistling and wheezing during breathing;
protracted unproductive;
increase respiratory movements, participation of auxiliary muscles in the process of breathing;
hypoxemia;
the appearance of shortness of breath, lack of air;
chest enlargement;
breathing becomes loud, weak, or hard.

These symptoms indicate precisely the occurrence of a narrowing of the bronchial lumen. However general symptoms are largely determined by the underlying pathology that caused BOS.
In case of illness, the child shows capriciousness, sleep and appetite disturbances, weakness, 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 diseases, identified developmental abnormalities, and a family history.

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

The most important test to confirm the diagnosis is spirometry.- at the same time, 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.
The use of breathing exercises.
Drainage.
Vibration chest massage.
Speleotherapy.
Balneological procedures.
Physiotherapy.

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

If the child feels satisfactorily, you should not force him to observe bed rest - physical activity promotes better discharge mucus from the bronchi.

Also, make sure your baby enough drinks per day: it 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 course of the disease are determined by the age of the child: less age, the more expressive the manifestations of the disease and the more difficult the course of the underlying disease.

With bronchitis, the prognosis is positive, however, with pulmonary dysplasia, there are risks of BOS degeneration into asthma (in 20% of cases). Against the background of bronchiolitis, heart failure, emphysema may occur.

Cases of frequent unproductive, debilitating coughing can lead to nausea, blood spitting due to damage to the airways. Therefore, it is important to apply for qualified help and start adequate therapy to avoid undesirable consequences.

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

The 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 the pathology is detected in time and proceed to therapeutic actions, serious consequences for the health of the child can be avoided.

Currently, obstructive bronchial syndrome is being diagnosed more and more often. 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 intense fear death due to the inability to take a full breath. The disease is equally common 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 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 a large number mucous secretion from the lungs. Phlegm makes it difficult for air to circulate, causing a person to feel severe shortness of breath and fear of death.

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

Reasons for the appearance

A condition such as bronchial obstruction can develop due to many reasons. The occurrence of spasm is affected 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 presence of a patient's history of bronchial asthma, the main manifestation of which is the 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);
getting 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 proper result if there are situations predisposing to obstructive syndrome in the patient's life. It is also necessary to cure concomitant diseases or achieve their stable remission.

Predisposing factors

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

What indirectly affects the development of broncho-obstructive syndrome:

Smoking. Smoke entering the lungs provokes them to secrete large quantity viscous secretion to get rid of foreign particles. Besides, myself smoke is the strongest allergen that can cause tissue swelling.
Alcohol abuse. Regular ingestion ethyl alcohol significantly undermines the immune system. Due to this, the body cannot fully resist the infections that enter it. A person begins to get sick more often with respiratory diseases, which later cause bronchospasm.
Polluted air, unsuitable living and working conditions. If a patient has to regularly deal with dust, mold or exhaust gases, this will definitely affect the health of his respiratory system.
Childhood. In this case, the syndrome is explained by the immaturity of the respiratory organs and weak immunity. In many ways, the appearance of bronchial obstruction in a baby is affected by the mother's non-compliance with all recommendations during pregnancy.

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

Symptoms of the disease

Bronchial obstruction is characterized by the severity of the clinic and symptoms. 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 make a full exhalation, 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 increase;
minor signs - headache, increased heart rate, pallor or cyanosis skin, swelling of the veins in the neck.

The treatment of broncho-obstructive syndrome should be carried out by a pulmonologist after examining the patient and conducting all necessary analyzes. Otherwise, taking inappropriate drugs can cause an increase in spasm.

Diagnostics

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

However, to confirm the diagnosis and conduct differential diagnosis studies are carried out using x-rays, as well as the function external respiration(FVD). This helps eliminate more serious illness lung 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 the final decision.

Treatment

Treatment of bronchial obstruction syndrome involves the removal of spasm to facilitate breathing. Some drugs will have to be taken in a course. As a rule, it does not exceed 2 weeks. Then maintenance therapy is prescribed, which consists of preventive measures.

All predisposing factors are excluded from a person’s life, respiratory gymnastics is prescribed. The victim must comply with all clinical guidelines otherwise episodes of choking will be repeated on a regular basis.

First aid

When a person begins to choke nearby, anyone will be perplexed and begin to experience horror. However, at this moment, the victim can and should be helped. And to do something supernatural for this is not required.

How to help a patient with bronchial obstruction:

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

A patient who has a bronchospasm needs to calm down, as nervous tension can exacerbate symptoms.

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

Syndrome of bronchial obstruction 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 the wrong behavior of parents or their ignorance.

Possible causes of broncho-obstructive syndrome in children:

imperfection of the respiratory system;
allergic diseases in a child or his genetic predisposition to them(the anamnesis of the parents is aggravated by allergies or bronchial asthma);
severe pregnancy of the mother, her smoking or chronic diseases that affect the proper development of the crumbs;
smoking near the baby;
heart defects and other diseases of the cardiovascular system;
transferred 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 the immaturity of the immune system due to prematurity.

Signs parents should watch out for:

the appearance of wheezing;
prolonged exhalation;
dry cough.

The child's breathing changes, becomes frequent, superficial. As a rule, shortness of breath appears only with a severe form of the disease. The baby may not fall asleep well or wake up in the middle of the night, take a forced position and cry out of fear. Parents in this case should not panic, as this can even more frighten the baby.

Diagnosis and treatment

The child should be examined for 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 be examined by a general practitioner and pulmonologist, you may need to consult other specialized doctors. The specialist will prescribe blood and urine tests, x-rays of the lungs, a study of the function of external respiration.

Obstructive syndrome in children is easily eliminated by inhalation with various drugs. The action of medicines is aimed at removing the swelling of the mucous membrane of the lung tissue and the unimpeded 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 the child's bedroom. The recommended humidity is at least 40%.

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

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

Prevention

Bronchial obstruction is the response of the lungs 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, as well as be in a room where others do it. It is especially forbidden to smoke for pregnant women or relatives who are at a distance of several meters from the child.
Carry out maintenance therapy if there is a history of allergic diseases. It should be regularly observed by a specialist, as much as possible to exclude from habitual life all factors that irritate the immune system.
Do not accept any medications without consulting a doctor, as they can also cause bronchospasm.
Try to breathe sea or forest air more often, take a walk after the rain, when environment rich in ozone.
Perform breathing exercises, exercise, or at least do exercises.
Timely and to the end to treat respiratory diseases.

The lack of quality therapy and prevention aggravates the further course of the disease. Relapses begin to appear more often, last much longer, and increasingly serious medications are required to eliminate 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 persistent, long-term relapse.