Daily Archive 26.10.2019

Obliterate bronchiolitis

Obliterating bronchiolitis is rarely observed, mainly in children in the first months of life, and can occur as a complication of ARVI.

Clinic of obliterating bronchiolitis

At the onset of the disease, symptoms of acute bronchiolitis or bronchopneumonia appear. At a blood test neutrophilia, sometimes moderate leukocytosis is noted. After the acute period of the disease, relative remission sets in, lasting 3 to 4 weeks. However, in this period auscultatory changes are detected (rales of different sizes, wheezing exhalation), localized on the side of the lesion.
Then comes the third period in which, at an unstable febrile body temperature, bronchopulmonary changes intensify and respiratory failure increases. With bilateral damage during the next exacerbation, a fatal outcome is possible. With a unilateral lesion, a rapid decrease in the lung occurs due to atrophy of the alveolar tissue and a significant secondary violation of the functional pulmonary blood flow. Patients develop symptoms characteristic of McLeod’s syndrome (signs of chronic bronchitis in the affected lung and severe respiratory failure).
Radiologically, in the initial period of the disease, massive shadow formations due to the presence of atelectasis are detected mainly on one side . In the period of remission, these changes disappear, however, after such relative well-being, a rapidly progressive decrease in the lung occurs with the development of pneumosclerosis.
The deformity of the proximal parts of the bronchi, ending blindly (non-filling of peripheral branches with contrast medium), is bronchographically detected.
Diffuse endobronchitis of the affected lung is bronchoscopically detected.

Treatment of obliterating bronchiolitis

In the initial period of the disease, the use of antibiotics and glycocorticoids is indicated, symptomatic therapy (oxygen, with indications – antispasmodic and antihistamine drugs). Inhalations of semisynthetic penicillins in combination with other drugs, physical therapy, chest massage, etc. are effective. The
prognosis for diffuse obliterating bronchiolitis is serious and more favorable in children in whom obliteration is limited to a small number of bronchioles.