Daily Archive 29.12.2019

Acute bronchiolitis

This is an acute respiratory disease, mainly in children of the first year of life, accompanied by obstructive damage to the bronchi and bronchioles.

Etiology of acute bronchiolitis

The causative agent is a virus, especially respiratory syncytial, less often – parainfluenza virus, adenovirus, influenza virus and pneumonia mycoplasma. The etiological role of bacteria is also taken into account. There is an opinion that bronchiolitis is the result of an allergic reaction similar to that in bronchial asthma (a meeting of the respiratory syncytial virus with circulating immunoglobulins). It is impossible to exclude the importance of allergy, since more than 50% of children who have undergone bronchiolitis, subsequently experience bronchospasm and many develop bronchial asthma. A high frequency of allergic manifestations in the immediate family is also detected.

The pathogenesis of acute bronchiolitis

The disease is characterized by the development of respiratory failure due to obstruction in the small bronchi and bronchioles. There is a narrowing of their lumen as a result of thickening of the wall, swelling and infiltration of the mucous membrane. In addition, a large amount of pathological secretion is contained in the lumen of the small bronchi and bronchioles. In the development of obstruction, bronchospasm is also important, although it is not dominant.

Clinic of acute bronchiolitis

The disease begins suddenly, but there is a gradual development. Rhinitis, sneezing and coughing, sometimes paroxysmal, appear.
The general condition of the child can be severe from the first days, sleep worsens, appetite decreases, the child becomes irritable, and sometimes vomiting occurs. Body temperature can be febrile, subfebrile, even normal, but often from the first days of the disease reaches 39 ° C and above. The main symptoms are respiratory failure with an extended expiration (breathing quickens to 60 – 80 in 1 min) and tachycardia (pulse 160 – 180 in 1 min). When examining a patient, cyanosis of the nasolabial triangle, bloating of the wings of the nose, participation in the act of breathing of the supple parts of the chest are determined. In connection with bloating, a boxed shade of pulmonary sound is determined, a decrease in the area of ​​blunting of percussion sound over the liver, heart and mediastinum. Sometimes when examining the chest, it is possible to detect an increase in its anteroposterior diameter. The liver and spleen protrude 2-4 cm below the costal arches, which, apparently, is associated with their displacement as a result of bloating of the lungs.

Auscultation against the background of weakened breathing of both lungs, both on inspiration and on exhalation, multiple finely bubbly are determined, less often – in other parts of the lungs – medium or large bubbly rales. Sometimes wet rales disappear and dry, sometimes whistling, appear instead.

With bronchiolitis, there are violations of water-electrolyte metabolism due to intoxication and vomiting, increased water loss, and often develop exsicosis.

In the blood, usually pronounced changes, with the exception of the sometimes detected lymphopenia, are not determined. The presence of leukocytosis with a shift in the leukocyte count to the left is suspicious of pneumonia.

An X-ray examination reveals bloating, which is manifested by an increase in the transparency of the pulmonary fields. In contrast to pneumonia, there are no areas of continuous infiltration with bronchiolitis.

Differential diagnosis of acute bronchiolitis

Differential diagnoses of bronchiolitis are carried out with pneumonia, which is characterized by the identification of bronchial breathing, bronchophony, crepitating wheezing and localization of the pathological process in any part of the lung.
To distinguish bronchiolitis from attacks of bronchial asthma, anamnestic data are taken into account (history of asthma attacks, their occurrence unrelated to infection, etc.). Use bronchodilators (0.1% solution of adrenaline, etc.), which relieve or alleviate an attack of bronchial asthma and almost do not affect obstruction in bronchiolitis.

Treatment of acute bronchiolitis

Antibiotics are prescribed (methicillin, oxacillin, carbonicillin, kefzol, gentamicin, etc. – p. 232), since from the first hours of the disease it is possible to attach a secondary bacterial infection. The use of interferon is also shown. To reduce the swelling of the mucous membrane of small bronchi and bronchioles, inhalations of 0.1% adrenaline solution (0.3 – 0.5 ml in 4 – 5 ml of isotonic sodium chloride solution) are used 1-2 times a day.
Oxygen therapy is shown, best with the use of an oxygen tent DKP-1. In its absence, oxygen is introduced using the Bobrov apparatus (for the purpose of moisturizing) every 30 to 40 minutes for 5 to 10 minutes with moderate pressure on the oxygen cushion. In order to liquefy the secretion in the bronchi, 2% sodium bicarbonate solution, isotonic sodium chloride solution, etc. are simultaneously administered as aerosols.
When signs of exicosis appear, intravenous drip of liquids is indicated.
Sometimes it is effective to use antispasmodics – aminophylline, ephedrine and antihistamines – glycocorticoids.
Tachycardia, dull heart sounds, enlarged liver are the basis for intravenous use of strophanthin, corglycon.
Of great importance are rational nutrition and sanatorium-hygienic regimen.

The prognosis of acute bronchiolitis

The outcome is almost always favorable. Of the complications, bacterial pneumonia is most common.
Prevention SARS warning.