Causes of airway obstruction in children. Airway obstruction: causes, symptoms, treatment

Diseases bronchopulmonary system more commonly diagnosed in children age group from 8 months to 6 years. plays an important role in the development of this pathology. hereditary factor, the child's susceptibility to helminthic invasions, bacterial and viral infections. With a disappointing diagnosis of chronic obstructive bronchitis in children, there is a chance to avoid the occurrence serious consequences. Effective treatment consists in eliminating the inflammatory reaction in the bronchi, restoring their normal patency, using bronchodilators and expectorants.

Infants are characterized by poor development of the upper respiratory tract, bronchi and lungs. glandular tissue inner walls bronchial tree- tender, prone to irritation and damage. Often, in diseases, the viscosity of the mucus increases, the cilia cannot evacuate thick sputum. All this should be considered before treating obstructive bronchitis in a child with medicines and home remedies. It must be remembered that the severity of the disease in babies is influenced by the intrauterine infections, SARS in infancy, underweight, the presence of allergies.

The most important causes of obstructive bronchitis in children are:

• viruses - respiratory syncytial, adenoviruses, parainfluenza, cytomegalovirus;
• ascariasis and other helminthiases, migration of helminths in the body;
• anomalies in the structure of the nasal cavity, pharynx and esophagus, reflux esophagitis;
• microorganisms - chlamydia, mycoplasmas;
• weak local immunity;
• aspiration.

The inflammatory process in obstructive bronchitis causes swelling of the mucosa, resulting in the accumulation of thick sputum. Against this background, the lumen of the bronchi narrows, spasm develops.

The greatest influence on the occurrence of obstructive bronchitis in children of all ages has viral infection. Factors also play a role environment, climatic anomalies. The development of obstructive bronchitis in infants may occur against the background of early withdrawal from breast milk, transition to mixed or artificial feeding. There are spasms of the bronchi in infants, even with frequent hit droplets and pieces of food into the respiratory tract. Helminth migrations can cause bronchial obstruction in children older than 1 year.

Among the reasons for the deterioration of the bronchial mucosa, doctors call the poor environmental situation in the places of residence of children, smoking of parents. Smoke inhalation disrupts natural process cleansing the bronchi from mucus and foreign particles. Resins, hydrocarbons and other components of smoke increase the viscosity of sputum, destroy the epithelial cells of the respiratory tract. Problems with the functioning of the bronchial mucosa are also observed in children whose parents suffer from alcohol dependence.

Obstructive bronchitis - symptoms in children

The bronchial tree of a healthy person is covered with mucus from the inside, which is removed along with foreign particles under the influence of miniature outgrowths of epithelial cells (cilia). Typical obstructive bronchitis begins with attacks of dry cough, the acute form is characterized by the formation of thick, difficult to separate sputum. Then shortness of breath joins due to the fact that the inflamed mucosa thickens in the inflamed bronchi. As a result, the lumen of the bronchial tubes narrows, obstruction occurs.

Manifestations of bronchial obstruction syndrome in children:

• first, catarrhal processes develop - the throat becomes red, painful, rhinitis occurs;
• the intercostal spaces, the area under the sternum are drawn in during breathing;
• breathing becomes difficult, shortness of breath, noisy, rapid, wheezing breathing occurs;
• suffers from a dry cough that does not turn into a productive (wet);
• holding on subfebrile temperature(up to 38°С);
• attacks of suffocation periodically develop.

Wheezing and wheezing in the lungs of a child with obstructive bronchitis can be heard even at a distance. The frequency of breaths is up to 80 per minute (for comparison - average rate at 6-12 months - 60-50, from 1 year to 5 years - 40 breaths / minute). Differences in the course of this type of bronchitis are explained by the age of small patients, the characteristics of metabolism, the presence of hypo- and beriberi. A serious condition in weakened babies can last up to 10 days.

With a recurrent course of the disease, a repeated exacerbation of symptoms is possible. Against the background of ARVI, irritation of the mucous layer occurs, cilia are damaged, bronchial patency is impaired. If a we are talking about an adult, then doctors talk about chronic bronchitis with obstruction. When children get sick again early age and preschoolers, experts cautiously declare the recurrent nature of the disease.

Bronchial obstruction occurs not only with bronchitis

The main symptoms and treatment of obstructive bronchitis in children differ from those of other respiratory diseases. Outwardly, the symptoms resemble bronchial asthma, bronchiolitis, cystic fibrosis. With ARVI, children sometimes develop stenosing laryngotracheitis, when a sick baby speaks with difficulty, coughs hoarsely, and breathes heavily. It is especially difficult for him to take a breath, even at rest there is shortness of breath, the skin triangle around the lips turns pale.

When ascaris larvae migrate into the lungs, a child develops a condition resembling the symptoms of bronchial obstruction.

Attacks of suffocation in completely healthy child can provoke reflux of stomach contents into the esophagus, aspiration of a foreign body. The first is associated with reflux, and the second - with solid pieces of food, small parts of toys, and other foreign bodies that have entered the respiratory tract. With aspiration, changing the position of the baby's body helps him reduce asthma attacks. The main thing in such cases is to remove the foreign object from the respiratory tract as soon as possible.

The causes of bronchiolitis and obstructive bronchitis are similar in many ways. Bronchiolitis in children is more severe, the epithelium of the bronchi grows and produces a large amount of sputum. Bronchiolitis obliterans often takes chronic course, accompanied by bacterial complications, pneumonia, emphysema. The bronchopulmonary form of cystic fibrosis is manifested by the formation of viscous sputum, whooping cough, and suffocation.

Bronchial asthma occurs if inflammatory processes in the bronchi develop under the influence of allergic components.

Main difference bronchial asthma from chronic bronchitis with obstruction lies in the fact that seizures occur under the influence of non-infectious factors. These include various allergens, stress, powerful emotions. In asthma, bronchial obstruction persists day and night. It is also true that over time, chronic bronchitis can turn into bronchial asthma.

Unfortunately, the chronic form of the disease in children is often detected only at an advanced stage. The airways at this point are so narrow that it is almost impossible to completely cure bronchial obstruction. It remains only to contain inflammation, to alleviate the discomfort that occurs in small patients. Used for this purpose antimicrobials, glucocorticosteroids, expectorants and mucolytics.

Massage and feasible gymnastics increase the vital capacity of the lungs, help slow down the development of the disease, improve general well-being sick child.

1. Do inhalations with saline, alkaline mineral water, bronchodilators through a steam inhaler or use a nebulizer.
2. Choose expectorant drugs with the help of a doctor and pharmacist.
3. Give more often herbal tea and other warm drink.
4. Provide your child with a hypoallergenic diet.

When treating acute obstructive bronchitis in children, it must be taken into account that therapy is not always carried out only on an outpatient basis. In the absence of effectiveness, babies with bronchospasm are hospitalized. Often in young children, acute obstructive bronchitis is accompanied by vomiting, weakness, poor appetite or its absence. Also indications for hospitalization are the age of up to 2 years and increased risk complications. Parents should not give up inpatient treatment if the child's respiratory failure progresses despite home treatment.

Features of drug therapy

The relief of seizures in sick children is carried out using several types of bronchodilator drugs. Use drugs "Salbutamol", "Ventolin", "Salbuvent" based on the same active substance(salbutamol). Preparations "Berodual" and "Berotek" also belong to bronchodilators. They differ from salbutamol in their combined composition and duration of exposure.

Bronchodilator drugs can be found in pharmacies in the form of syrups and tablets for oral administration, powders for preparation inhalation solution, aerosols in cans.

Decide on the choice of medicines, decide what to do with them during the period outpatient treatment, advice from a doctor and pharmacist will help. With bronchial obstruction that has arisen against the background of SARS, anticholinergic drugs are effective. Most positive feedback specialists and parents collected the drug "Atrovent" from this group. The agent is used for inhalation through a nebulizer up to 4 times a day. The age-appropriate dose for a child should be discussed with the pediatrician. The bronchodilatory effect of the drug appears after 20 minutes.

Features of the drug "Atrovent":

• exhibits pronounced bronchodilatory properties;
• acts effectively on large bronchi;
• causes a minimum of adverse reactions;
• remains effective in long-term treatment.

Antihistamines for obstructive bronchitis are prescribed only for children with atopic dermatitis, other related allergic manifestations. Use in infants drops "Zirtek" and its analogues, "Claritin" is used to treat children after 2 years. severe forms bronchial obstruction is removed with an inhalation drug "Pulmicort" related to glucocorticoids. If the fever persists for more than three days, and the inflammation does not subside, then apply systemic antibiotics- cephalosporins, macrolides and penicillins (amoxicillin).

Means and methods for improving sputum discharge

A variety of cough medicines for childhood bronchitis also find use. From the rich arsenal of expectorants and mucolytics, preparations with ambroxol deserve attention - "Lazolvan", "Flavamed", "Ambrobene". Doses for single and course intake are determined depending on the age or body weight of the child. The most suitable dosage form is also selected - inhalation, syrup, tablets. Active ingredient It has an anti-inflammatory, expectorant and mucolytic effect faster when inhaled.

It is forbidden to take antitussive syrups and drops (cough reflex blockers) with obstructive bronchitis.

With obstructive bronchitis, various combinations of drugs are used, for example, 2-3 expectorants. First, drugs are given that thin the mucus, in particular, with acetylcysteine ​​or carbocysteine. Then inhalations with solutions that stimulate expectoration - sodium bicarbonate and its mixtures with other substances. The improvement in the child's condition becomes more noticeable after a week, and the full duration of the therapeutic course can be up to 3 months.

Apply to facilitate the discharge of sputum breathing exercises, a special massage. For the same purpose, they perform a procedure that promotes the outflow of sputum: they lay the child on his stomach so that his legs are slightly higher than his head. Then the adult folds his palms in a "boat" and taps them on the baby's back. The main thing in this drainage procedure is that the movements of the hands are not strong, but rhythmic.

Do you know that…

1. The genetic background of lung diseases has been proven as a result of scientific research.
2. Among the risk factors broncho-pulmonary diseases, except for genetics, - developmental anomalies respiratory system, heart failure.
3. In the mechanism of development of respiratory diseases, the sensitivity of the mucous membrane to certain substances plays an important role.
4. Children who are prone to allergic reactions or already suffering from allergies are more susceptible to recurrent forms chronic diseases respiratory organs.
5. Experts from the US have discovered the effect on the lungs of microbes that cause dental caries.
6. Radiography is used to detect lung disease. computed tomography, biopsies.
7. To modern alternative methods The treatment of respiratory diseases includes oxygen therapy - treatment with oxygen and ozone.
8. Of the patients who have undergone lung transplantation, 5% are minors.
9. Reduced body weight often accompanies the progression of lung diseases, so care must be taken to increase the caloric content of the diet of frequently ill children.
10. Frequent obstructive bronchitis - up to 3 times a year - increases the risk of bronchospasm without exposure to infection, which indicates initial signs bronchial asthma.

Preventive measures

The diet and lifestyle of the mother during pregnancy affects the health of the baby. It is recommended to adhere healthy diet, do not smoke, avoid passive smoking. It is very important for a pregnant or lactating woman and her baby to stay away from harmful chemical substances that provoke allergies and toxicosis.

Negative factors that increase the chances of getting obstructive bronchitis:

• the harmful effects of air pollutants - dust, gases, fumes;
• various viral and bacterial infections;
• genetic predisposition;
• hypothermia.

Contributes to the prevention of obstructive bronchitis in children up to a year breastfeeding. It is necessary to regularly clean, ventilate and humidify the air in the room where the child is. The health season in summer is recommended to devote to hardening procedures, relaxation by the sea. All these activities will help protect children and adult family members from bronchitis with obstruction.

Particular attention should be paid to the prevention of SARS and allergies, as the most important reasons development of chronic bronchitis in children.

It is more difficult to protect against various infections, helminthic invasions children attending children's institutions. Recommended with early years constantly form the child's hygiene skills, monitor compliance with the daily regimen, diet. During the period of seasonal infections, it is advisable to avoid visiting crowded places where new viruses quickly attack children's body. As a result, diseases are becoming more frequent - SARS, tonsillitis. The mucosa of the upper respiratory tract, bronchi does not have time to recover, which provokes the development of bronchitis and their complications.

Signs of obstructive bronchitis in children, treatment, risk factors updated: March 21, 2016 by: admin

Airway obstruction also belongs to a condition that is dangerous to human life without emergency care, what is it?

This syndrome occurs when there is a violation of their patency.

The condition can develop both in adults and at an earlier age.

However, in children, pathology is more common due to an insufficiently formed mechanism for secreting mucus, an anatomically narrow lumen of the bronchi.

Depending on the location, obstacles to normal breathing obstruction is distinguished:

• upper respiratory tract (URT), that is, the nasal cavity, mouth, pharynx or larynx;
• lower respiratory tract (trachea and bronchi).

By the nature of the course, such a syndrome can be acute or chronic, when exacerbation and respiratory failure occur against the background of allergies, viral or bacterial disease. All causes of obstruction can be divided into two large groups: infectious and non-infectious.

Non-infectious include:

• obstruction of the airways by a foreign body;
• narrowing due to a tumor, cyst, enlarged thyroid gland;
• injury;
• aspiration of vomit, blood that comes from the nose or oral cavity. In a newborn baby, obstruction may occur when mucus or meconium enters the airways during childbirth;
• burns of the mucous membrane due to inhalation of too hot or, conversely, very cold air, toxins in a gaseous state;
• rapid swelling upon contact with an allergen, and such an irritant does not necessarily enter only when inhaled (for example, pollen, tobacco smoke, Strong smell). A similar syndrome can develop when eating certain foods, intramuscular or intravenous administration medicines, drugs for anesthesia. Often obstruction is the result of insufficient or inadequate therapy for bronchial asthma;
• complications after operations, diagnostic manipulations on the respiratory tract, intubation;
• hidden oncological processes in the lungs and other parts of the respiratory system;
• neurological disorders, in this case, spasm of the muscles of the bronchi or larynx is due to a malfunction nervous system and occurs more frequently in stressful situations;
• retraction of the tongue in people who are unconscious, for example, during a coma, fainting, an attack of epilepsy. Similar cases are not uncommon with alcohol abuse, drugs;
• peculiarities anatomical structure facial skeleton and respiratory organs;
• cardiogenic pulmonary edema.

It is worth noting that the treatment of the syndrome caused by the listed factors in most cases comes down to eliminating the cause. In other words, foreign body, vomit, mucus must be removed, the tumor removed surgically(if possible), avoid contact with the allergen.

Prevention also plays a big role. This is appropriate care for bedridden patients, work with a psychologist with severe neurology, the child should not be given toys with small parts, and allergies require constant intake of appropriate medications. Complex treatment required if any infectious causes for airway obstruction.

A similar condition sometimes occurs with the following diseases:

• laryngitis, inflammation of the larynx, which often leads to pathological narrowing of the glottis;
• bronchitis;
• retropharyngeal abscess, an infectious disease that affects the lymph nodes;
• epiglottitis, inflammation of the epiglottis, extending to the pharynx;
• tracheitis;
• whooping cough;
• respiratory mycoplasmosis and chlamydia.

The principle of development of obstruction in the inflammatory process is different. Violation of inhalation and exhalation occurs due to a disorder of mucociliary clearance, that is, the mechanism of airway clearance. This is provided by the cilia of the ciliated epithelium and the rheological properties of the sputum produced. Its main component is water, in which various proteins are dissolved.

Violation of this balance occurs with both excessive and insufficient secretion of mucus. The first symptom of this condition is noisy breathing called stridor. With inflammation under the influence of bacterial or viral flora, the walls of the bronchi thicken, sputum stagnates and loses antimicrobial activity. As a result of reproduction pathogenic microorganisms continues, leading to further progression of inflammation and obstruction.

Mucus acts on specific receptors, which causes coughing - thus, the body tries to clear the airways. Dr. E.O. Komarovsky believes that such processes are more difficult in children with weakened immunity as a result of dysbacteriosis, a sedentary lifestyle, generalized chronic infections. Among adults, people working in hazardous industries and smokers are more prone to airway obstruction.

Despite the variety of causes of impaired oxygen supply to the lungs, clinical picture such a syndrome is the same. Only the rate of increase in signs of airway obstruction differs. With complete blockage of the lumen of the larynx, trachea or bronchi, symptoms develop within a few minutes, with partial - gradually. If obstruction is caused infectious process, first of all, signs of a viral or bacterial disease attract attention.

Obstruction of the upper respiratory tract is characterized by the following clinical picture:

• superficial respiratory movements in which muscles do not take part chest or abdominal cavity, breathing is usually difficult (inspiratory dyspnea);
• stridor;
• retraction (visible reduction in size) of the neck;
• cough with a specific "croaking" sound;
• signs of acute oxygen deficiency- dizziness, blurred vision, fainting, convulsions;
• bleeding if the obstruction is due to trauma;
• violation of the rhythm of heart contractions, tachycardia is replaced by persistent bradycardia;
• cyanosis of the nasolabial triangle;
• hypertension;
• "cold sweat.

Signs of lower airway obstruction (this condition is more common in infants) are:

• expiratory shortness of breath - difficulty in exhaling, which is associated with a narrowing of the lumen of the bronchi;
• a person can take a breath, but the feeling of lack of air in the lungs does not weaken;
• noisy, wheezing breathing;
• an attempt to take in air with the help of the muscles of the abdomen;
• hoarseness, and then loss of voice;
• spilled blue skin;
• a person reflexively holds on to his throat;
• tachycardia with a simultaneous sharp drop blood pressure;
• loss of consciousness.

Important!

Regardless of the type of obstruction, without emergency medical care, the outcome is the same - cardiac arrest, coma and death.

If difficulty breathing was preceded by infectious inflammation then other symptoms appear first. This is a general malaise, fever. characteristic feature serves as a cough. With laryngitis, it is superficial, often occurs at night, has a barking, tearing sound. Bronchitis is characterized by a persistent, deep, wet or dry cough.

Airway obstruction in children: first aid, treatment, folk recipes

The most common cause of airway obstruction in children is stenosing laryngotracheitis. Recently, in connection with mass failure from vaccinations, such a syndrome also often occurs due to whooping cough.

Almost any viral infection that causes inflammation of the tonsils and adenoids can provoke difficulty in breathing in a child.

It should also be noted that in children of the first months of life, the cough reflex is almost absent. Therefore, at an early age, obstruction can be caused not only by SARS and sputum accumulation, but also by accidental ingestion of liquid food (milk, mixture) into the respiratory tract. In addition to these symptoms, in children, this condition may be accompanied by vomiting, redness of the whites of the eyes due to hemorrhage, and involuntary urination.

Important!

Airway obstruction in children often requires resuscitation- oxygen therapy and artificial lung ventilation (ALV). Therefore, when the first signs appear, it is necessary to call an ambulance, focusing the attention of the dispatcher on the serious condition of the child.

The emergency care algorithm for holding the breath in children under 12 months of age when a foreign body enters is as follows:

1. Lay the child on his knees with his stomach, so that the head is below the level of the waist.
2. Make a few intense claps on the back between the shoulder blades.
3. If these actions have no effect, it is necessary to turn the child over, put him on a flat surface and gently tilt his head back and press several times on the supra-umbilical region (approximately 3-4 cm above the navel).

In children after a year (in the unconscious state, the help is the same as described above):

1. Put the child back to you.
2. Stand behind (or kneel down).
3. Wrap your arms around your body, clasping them at the level solar plexus.
4. Make several intense pushes with an interval of a minute.

It is clear that such measures are ineffective if the airway obstruction in children is caused by an infectious or allergic process.

In this case, before the ambulance arrives, the following medications are needed:

• aerosol Salbutamol (adults and children over 12 years old). 2-4 breaths every 10-15 minutes;
• inhalations with Berodual (for children from birth to 12 years old) using a nebulizer, 2-4 ml per 2 ml of saline.
• injection of Prednisolone intramuscularly or Eufillin 5-6 mg / kg.

From Methods traditional medicine for the prevention of obstruction in bronchitis or laryngitis, a decoction of coltsfoot, St. John's wort, wild rosemary, elecampane root and thyme can be recommended. It is necessary to take 1 tbsp. each plant and pour a liter of boiling water. Infuse for several hours, strain and take 100 ml three times a day.

You can also make a compress on the chest and back (wrap and leave overnight) from dough prepared according to this recipe: 1 tbsp. honey, 1 tbsp. vodka, 3 tbsp. dry mustard, 1 tbsp. vegetable oil.

Since airway obstruction in children is life-threatening, parents are advised to keep Berodual, Prednisolone and Eufillin in the medicine cabinet. Great importance also has timely treatment inflammatory diseases upper and lower respiratory tract. BUT general measures to boost immunity defensive forces organism.

obstructive syndrome- This is a violation of the free flow of air through the respiratory tract. Manifestations of obstructive syndrome are:

• the feeling of the patient lack of air;
• shortness of breath - difficulty breathing in (inspiratory dyspnea) or difficulty exhaling (expiratory dyspnea);
• "common" signs respiratory failure- weakness, lethargy, pallor, sometimes - irritability;
• cough (optional symptom).

Because the classical medicine divides the airways into upper (from the nasal cavity to the larynx) and lower (from the larynx to the alveoli - "breathing sacs" that make up the lungs), it is customary to consider obstructive syndrome what is called, "on the floors."

Upper airway obstruction

It can develop gradually, that is, have a chronic slowly progressive course, or occur acutely, suddenly and be a direct threat to life.

There are mechanical and allergic obstruction in origin.

• mechanical, that is, the overlap of the larynx with some volumetric object. It could be:

1) foreign body

Most often found in children, occurs when accidental or intentional ingestion or inhalation of solid objects (toys, designer parts, nuts, seeds, and more).

2) pharyngeal tissues, for example, enlarged pharyngeal tonsils(with adenoiditis, tonsillitis, pharyngeal abscess). In addition, the “falling” into the larynx of the pharyngeal structures can be a mechanical cause, especially in people who are anatomically predisposed to this (for example, those who are obese, or with a special structure of the neck). Very often, this type of respiratory disorder is observed in older people suffering from severe neurological disorders.

3) retraction of the tongue in patients who are unconscious (after epileptic seizure, as well as those who received a traumatic brain injury)

4) tumors of the tissues of the pharynx and larynx, as well as adjacent tissues of the neck.

• allergic nature(edema)

As a rule, it occurs as a result of ingestion or inhalation of irritants or allergens (pollen, chemicals). In severe cases, it can be combined with swelling of the face, lips and is called.

How can I help you?

Chronic obstruction requires, when it is detected, as soon as possible to see a doctor. Help "on their own" in chronic obstructive syndrome consists in giving the patient the so-called "elevated position of the head" during sleep, with raising the head end of the bed by 20-30 cm.

Unlike chronic, acute obstruction always dictates the need for decisive action. There are mild, moderate and severe degree this state.

Most often in clinical practice meets mild obstruction respiratory tract. This degree of obstruction does not cause a pronounced decrease in airway patency and associated changes in the body. Or it is a transient phenomenon (a short-term presence of a foreign body in the respiratory tract, which comes out with a cough, or a slight swelling of the mucous membrane caused by short-term contact with an allergen).

At moderate obstruction the patient can breathe, cough, responds to questions, is adequate. In this case, most likely, the patient himself will help himself with a cough, the foreign body will jump out.

At severe obstruction the patient can neither speak nor breathe, is restless, tries to grab himself by the throat, wheezes when it comes to acute conditions, consciousness can be inhibited, the concentration of oxygen in the blood is significantly reduced, which worsens the work of all organs and systems. If the obstruction is not removed, the next stage will be loss of consciousness, coma and fatal outcome.

Assistance with airway obstruction in children is provided in accordance with the age of the patient.

1. Babies under one year old are placed on the forearm or thigh face down so that the head is below the level of the body, and 5 vigorous pushes (claps) are performed on the back in the area between the shoulder blades. If this technique turned out to be ineffective, the child should be laid on a flat hard surface face up and, throwing back his head strongly (so that the airways “straighten” as much as possible), 5 times with an interval of 1 second, sharply press on the area of ​​​​the “solar plexus”, that is, on 4 cm above the navel, directing the force inward and upward
2. Children older than a year, with the development of severe obstruction (provided that consciousness is preserved!) go around behind or place with your back to yourself, kneel, grab the body with both hands, clasp the hands of the person helping at the level of the same “solar plexus” and in the same rhythm - 5 pushes with an interval of a minute - to make attempts to push out the foreign body. This is called the Heimlich maneuver. If the obstruction persists and the child loses consciousness, mechanical ventilation should be started immediately.
3. School-age children and adults receive assistance in the same way. The first step is the Heimlich maneuver, but the victim is standing, and the helper is clasping him, and making energetic movements with clasped hands, the direction of the push is towards himself and up. Only if these measures are not effective enough, one can start artificial respiration and indirect massage hearts.
4. If no one is around, then there is an opportunity to provide self-help. To do this, you need to place a fist above the navel (in the area of ​​\u200b\u200bthe solar plexus), clasping it with the other hand. Then, while bending over a chair, sharply lean on its back with a hand clasping a fist. At the same time, he should press hard on the stomach. Such movements should be repeated several times, trying to cough up an object stuck in the airways. There is an instruction for self-help, in which you do not need to put your hands on your stomach, but directly press on it with the back of a chair.

Lower airway obstruction

The causes and severity of this condition are basically the same as in the case of the upper respiratory tract, the difference is that it is unlikely that it will be possible to eliminate the problem on its own, and, in addition, bronchospasm plays an important role in the mechanism of lower respiratory tract obstruction - excessive and very intense contraction of the muscles of the bronchial wall.

1. Mechanical obstruction of the lower airways(foreign body, tumor, etc.).

In fact, this is a blockage of any branch of the bronchial tree. As a rule, it is acute, rather serious clinical situation requiring immediate surgical intervention. Because an entire section of the lung suddenly "turns off" from respiratory process, and this naturally leads to respiratory failure. It is clear that the Heimlich technique here will be completely ineffective: a foreign body that has entered the bronchi can only be removed surgically or with a bronchoscope.

1. Lower airway obstruction due to edema.

In this case, the swollen inner layer of the bronchi or trachea narrows the lumen of the airways, which is manifested by the clinic of obstructive syndrome. This condition may be the result of an allergy, an infection, or a combination of the two.

• allergic obstruction

The reason is the impact of the same factors as with allergic edema of the upper respiratory tract: allergens (both inhaled, penetrated with inhaled air, and food received through the blood), chemicals, dust particles, and so on. It must be borne in mind that airway obstruction in children, which occurs due to edema, proceeds much faster than in adults, and is more pronounced. That is why any, even the most insignificant, manifestation of obstruction should not only alert parents, but encourage them to take the most active actions, first of all, immediately consult a doctor.

• obstruction of an infectious nature

Inflammation caused by a viral, bacterial or fungal infection naturally causes swelling of the inner lining of the bronchi. It is not surprising that obstructive syndrome almost always accompanies bronchitis and pneumonia.

• obstruction of an infectious-allergic nature

As the name implies, this type of obstructive syndrome occurs when there is a combination of infection and reaction to an allergen. In clinical practice, this option occurs most often, but has not yet been studied by scientists. It is still not clear what occurs first: an allergy against the background of an infection or an infection of the mucous membrane irritated against the background of an allergy.

1. Spasm of bronchial muscles

The wall of the bronchi is made up of muscles that contract, narrowing the lumen, disrupting the normal flow of air. Bronchospasm can occur in response to exposure to cold air, smoke, stress ... A long stay in a spasmodic state leads to the fact that the muscles can no longer relax without the help of drugs and chronic obstructive syndrome occurs.

Airway obstruction is called narrowing or occlusion hollow organs carrying air to the lung alveoli. She may be called various reasons foreign bodies, acute inflammatory and allergic diseases, injuries of the larynx and surrounding tissues, decompensation of tumors and volumetric processes located next to it and the airways.

Characteristic signs of the development of airway obstruction

In young children, regardless of the cause that caused them, the manifestations of obstruction (obstruction) of the airways are of the same type - acute expiratory dyspnea that occurs, characterized by:

• Obsessive prolonged cough;
• Noisy breathing with simultaneous bloating of the chest and prolonged forced exhalation;
• Dry and wet rales in the lungs.

X-rays should show symptoms of lung tissue swelling.

According to the time of development of airway obstruction, doctors distinguish two forms of the disease:

• Acute (lightning);
• Chronic.

The disease proceeds in four stages, including compensation, subcompensation, decompensation and the terminal stage of asphyxia.

With complete obstruction of the airways, asphyxia can occur rapidly. It will be accompanied by loss of consciousness, as well as rapid (within a few minutes) circulatory arrest.

Emergency care and treatment of airway obstruction

Partial obstruction can be caused by mucus, blood, vomit, foreign bodies, fluids. If the patient is conscious and has the ability to cough, he may try to remove the foreign body on his own. With an increase in symptoms of obstruction against the background of an ineffective cough, wheezing on inspiration, deterioration in breathing, cyanosis, hypoventilation may occur.

Combination of airway obstruction and hypoventilation (insufficient pulmonary ventilation), leading to hypoxic edema of the brain, lungs and heart failure, followed by cardiac arrest, should be immediately carried out resuscitation.

Due to the existing threat of complete blockage of breathing (a decrease in the lumen of the larynx can rapidly go through all stages of the process and develop into an uncontrollable or unpromising state), the treatment of airway obstruction in children and adults should be adequate, effective and timely. For this, any accessible ways need to quickly restore patency upper divisions respiratory tract.

When airway obstruction by a foreign body is most effective cough. Removal of blood, foreign bodies, mucus from the oral cavity and upper respiratory tract can be done in any way using various improvised means - napkins, a finger, a handkerchief.

Against the background of loss of consciousness, it is necessary to carry out the Heimlich maneuver. To do this, sharply squeeze the chest simultaneously with a push into the epigastric region. This technique should lead to an instant increase in intrapulmonary pressure, due to which the foreign body is pushed out of the respiratory tract. Children older than one year in some cases are taken by the legs, turned upside down and shaken vigorously.

With the ineffectiveness or impossibility of using the described methods against the background of airway obstruction, the following are used:

• Orotracheal tracheal intubation;
• Triple reception Safar;
• Direct laryngoscopy.

In the absence of a result, a conicotomy or an emergency tracheotomy is done.

After normalization of the patency of the upper respiratory tract, it is necessary to provide respiratory support with oxygen, as well as ventilation of the lungs (artificial or assisted).

After these events, the doctor evaluates vital functions: consciousness, hemodynamics, efficiency of oxygenation and ventilation. In addition, if necessary, it is possible to use drugs with a productive effect: hormones (membrane stabilizers), antihypoxants (sodium oxybutyrate, seduxen) and inotropic support (dopamine, norepinephrine).

If a decrease in the lumen of the larynx is observed in the compensation stage with airway obstruction, it is necessary to administer intravenous hormonal drugs, saluretics, antihistamines (Tavegil, Suprastin or analogues) and carry out oxygen therapy. After that, it is important to establish the cause of the airway obstruction.

In the stage of subcompensation for stenosis of the larynx, adults are intravenously injected with the same drugs as in the stage of compensation. In this case, it is necessary to evaluate the parameters of hemodynamics, oxygen saturation and cerebral functions, as well as to conduct constant intensive monitoring of the patient's condition.

In the stage of decompensation or asphyxia against the background of the impossibility of tracheal intubation, it is necessary to ensure the patency of the airways by any possible way described above.

Airway obstruction is a rather dangerous condition that requires a quick and adequate response. Therefore, if symptoms occur, immediately emergency help, after which, to assess the condition, you should consult a doctor.

Bronchitis- it's pretty frequent illnesses bronchopulmonary system. Most often occur from 1 to 6 years, especially among children attending kindergartens.

Bronchitis is understood as inflammatory changes in the bronchi caused by a bacterial or viral infection, allergies, or physicochemical factors.

At obstructive bronchitis there is a violation of the patency of the bronchi (obstruction) and the development of respiratory failure in connection with this.

Forms of obstructive bronchitis:

1. Spicy;
2. recurrent- the disease occurs repeatedly against the background of a viral infection, more often at an early age. At the same time, paroxysmal respiratory failure is not characteristic, there is no connection with the action of non-infectious factors, which distinguishes recurrent obstructive bronchitis from bronchial asthma. The reason for the appearance of obstruction in this bronchitis can be frequent aspiration (inhalation) of food.

Reasons for the development of obstructive bronchitis

Most common cause - viral infection (respiratory syncytial virus, parainfluenza virus, adenovirus, cytomegalovirus). But manifestations of obstructive bronchitis can cause mycoplasmas and chlamydia.

One of the causes of obstructive bronchitis in young children is aspiration in violation of swallowing, gastroesophageal reflux and some other anomalies of the esophagus and nasopharynx.

Second year of life and older helminth migration can serve as a cause of bronchial obstruction.

Symptoms

The leading symptom complex in obstructive bronchitis is broncho-obstructive syndrome. The manifestations of this syndrome include:

• Noisy, wheezing breathing;
• Attacks of suffocation;
• Participation in the breathing of auxiliary muscles (retraction of the intercostal spaces, spaces under the sternum);
• Unproductive cough.

On the 2-4th day from the onset of a respiratory infectious disease, symptoms of bronchial obstruction appear against the background of catarrhal phenomena (runny nose, redness and sore throat, etc.) and an unproductive dry cough. The child exhales with difficulty (expiratory dyspnea), wheezing can be heard at a distance, breathing is noisy, rapid (up to 70-90 per minute). Noticeable retraction compliant places chest (intercostal spaces, infrasternal space). Body temperature is often elevated to subfebrile figures (37.5 ° C).

The child shows anxiety, tries to take a forced position (sitting with support on his hands). This condition lasts more often than 2-3 days, in children with rickets it can be delayed for a longer period.

Predisposing factors for the development of broncho-obstructive syndrome

1. Features of the anatomical structure of the respiratory system in young children:
   • enlarged glandular tissue bronchi;
   • Production of viscous sputum;
   • Features of the structure of the diaphragm;
   • Narrower airways compared to older children and adults
   • Insufficient local immunity.
2. Premorbid background(the state of the child's body before the disease):
   • allergic diseases and hereditary predisposition to them;
   • Rickets;
   • Enlargement of the thymus gland (thymus);
   • Insufficient body weight;
   • Intrauterine infections;
   • Early transition to artificial feeding;
   • Transferred acute respiratory infections under the age of one year.
3. Environmental factors:
   • unfavorable ecological situation where the child lives;
   • Second hand smoke. By inhalation tobacco smoke mucociliary clearance is disturbed (clearing the airways of mucus and foreign particles), the viscosity of sputum increases, the volume of the glands of the bronchial mucosa increases. Under the influence of tobacco smoke, the bronchial epithelium is destroyed, local immune defense is reduced.
4. Parental health and alcoholism in particular. In children with alcoholic fetopathy, there is a violation of the functioning of the mucosa and muscle tissue bronchi.

Features of the development of obstruction in children of different ages

External signs of obstructive syndrome are caused by inflammatory reaction, which leads to swelling of the bronchial mucosa, the appearance a large number viscous sputum, the development of bronchospasm.

In the development of airway obstruction in young children, the main role is played by edema of the mucous membrane and the production of viscous sputum, this is due to the peculiarities of the anatomical structure of the bronchi.

At an older age, bronchospasm comes to the fore.

These features must be taken into account when prescribing the treatment of obstructive bronchitis.

Indications for hospitalization child with obstructive bronchitis:

• Failure of outpatient treatment (at home) within 3 hours;
• Initially serious condition sick child;
• When it is impossible to fully care for a sick child;
• Children with high risk the development of complications.

Treatment of children at home:

1. Hypoallergenic diet;
2. Plentiful warm drink (alkaline mineral water - Borjomi, Essentuki);
3. Expectorant and mucolytic (sputum-thinning) drugs. For this purpose, inhalation of alkaline mineral water using a nebulizer. Of the drugs prescribed ambroxol preparations (Lazolvan, Ambrobene, Flavamed, Halixol, Ambrohexal), which have an expectorant, mucolytic and anti-inflammatory effect. These medicines take in various doses depending on the age and weight of the child, 2-3 times a day by mouth in the form of syrup and tablets or inhalation.
   

   Antitussive drugs are contraindicated in obstructive bronchitis!

4. Massage, postural drainage and breathing exercises. Postural drainage is a method that facilitates sputum discharge. The child is laid on his stomach (the head should be slightly lower than the level of the legs), with a palm folded in the form of a boat, a slight rhythmic tapping on the child's back is performed.
5. Antihistamines are prescribed ONLY in children with concomitant allergies or atopic dermatitis. For this purpose, it is shown the following drugs in children from 6 months - Zirtek or Parlazin, from 2 years old - Claritin, Erius, from 5 years old - Telfast;
6. Bronchodilator therapy;
   • β2-agonists short action used mainly for the relief of acute obstruction, the effect occurs after 5-10 minutes. Multiplicity of appointment - 3-4 times a day. These drugs include salbutamol, fenoterol, terbutaline. From β2-agonists long-acting clenbuterol can be used, but its bronchodilatory effect is less pronounced.
   • anticholinergic drugs show their effect (bronchodilatation) after 20 minutes. They are more effective for obstruction against the background of acute respiratory infections. A representative of this group of drugs is Atrovent. The dose is 8-20 drops of the solution by inhalation through a nebulizer, 3-4 times a day.
   • Combined drugs that combine the functions of β2-agonists and anticholinergic drugs. These include Berodual. Method of application: 1 drop/kg of weight of a child up to 5 years is diluted in 2 ml of physiological solution, inhalation is performed through a nebulizer 3-4 times a day.
   • Short-acting theophyllines such as eufilin are used with caution and under medical supervision. This is justified by the fact that the therapeutic dose of the drug is very close in value to the toxic dose.
7. Anti-inflammatory therapy. For this purpose, fenspiride (Erespal) is widely used.
   At severe course obstructive bronchitis use is shown inhaled glucocorticoids(Pulmicort).
8. If the temperature rise persists for more than 3 days, inflammatory changes in the general blood test show the use of broad-spectrum antibiotics (protected penicillins, cephalosporins, macrolides).

But do not forget that in the treatment of obstructive bronchitis, the state of the environment is also important. It is necessary to regularly ventilate the room, carry out wet cleaning, humidify the air. All this will help your baby breathe easier.

Complications

In children prone to allergies or suffering from allergic diseases recurrent obstructive bronchitis may develop, which is characterized by the appearance on the background of acute respiratory infections of obstructive bronchitis 2-3 times a year and the appearance of symptoms of obstruction without exposure to infectious causes.

In some cases, obstructive bronchitis may be the first manifestation of bronchial asthma.

Prevention

Prevention begins even during pregnancy planning. Healthy lifestyle for mother, smoking cessation, good nutrition are the key to the health of her baby, the proper development of all organs of the fetus.

After the birth of a baby, it is necessary to remember the importance of prolonged breastfeeding, the need to exclude even passive smoking, the careful use of products and chemicals that can cause the development of allergic processes in the child's body.

Need protect the child from various infectious diseases . This does not mean that the baby needs to be wrapped up so as not to get sick, to clog the windows at home so that it does not blow through.

It is enough for this to walk more often on fresh air, carry out hardening procedures, do not go to crowded places (especially during epidemics).

All these activities will help protect your child from developing obstructive bronchitis.