Daily Archive 02.01.2020

Lingering bronchitis

The prolonged course of bronchitis should include those cases when recovery does not occur within 2 to 3 weeks. Protracted bronchitis is most often observed in children with an unfavorable premorbid background (hyportrophy, rickets, exudative diathesis, the presence of foci of chronic infection in the ENT organs, etc.). The disease is characterized by diffuse damage to the bronchi and is accompanied by the release of serous or serous-purulent sputum. The main symptom is a persistent cough. In the lungs, large and medium-bubbly moist rales are heard on both sides. A separate type of disease is protracted bronchitis, localized in one zone of the lung. Such bronchitis occurs as a result of transferred, most often segmental (polysegmental) pneumonia, ending with the resorption of infiltrative changes in the lung parenchyma. In the bronchial tubes of the affected segment, functional disorders or even structural (deformations) remain that support the inflammatory process for a long time. These changes are reversible – the inflammatory process in the bronchi over time completely disappears and recovery occurs (S.V. Rachinsky et al., 1978). This form of prolonged localized metapneumonic bronchitis should be considered as secondary bronchitis. Long-term localized bronchitis should not be attributed to chronic forms, since it differs in a cyclic course and a favorable outcome. However, in some patients, bronchographic (bronchial deformity) and endoscopic (endobronchitis) changes can be determined. The duration of the course of localized prolonged bronchitis can be different, sometimes it reaches 1 – 1.5 years. One form of protracted bronchitis is aspiration bronchitis, which occurs in connection with acute or chronic aspiration of fluid. Acute aspiration of a small amount of liquid is accompanied by a coughing fit, in which the aspirated material is removed. Separately, it is necessary to indicate the possibility of aspiration of the contents of the stomach in violation of the anesthesia technique (without preliminary evacuation of the eaten food). The contents of the stomach due to the action of acid and pepsin can be the cause of chemical damage to the bronchi with serious consequences. The most common cause of food aspiration in children is a violation of the act of swallowing (dysphagia) and sucking, which occurs in the pathology of the central nervous system and congenital defects of the soft and hard palate. Violation of swallowing is observed with paresis of the swallowing muscles or a violation of the coordination of their function, resulting from birth trauma or systemic diseases of the neuromuscular system (myasthenia gravis, progressive muscular dystrophy). Aspiration of food in case of esophageal dysfunction (regurgitation of food from the esophagus to the pharynx and nasopharynx due to a pathological cardioesophageal reflex, the presence of stenosis or hernia of the esophagus, etc.). Clinically, these children from the first weeks of life are revealed symptoms of bronchitis and repeated pneumonia. In the history of most cases, a connection is established between coughing fits and feeding. In the neonatal period, apnea attacks may occur. In some children, coughing and wheezing appear (or become more pronounced during feeding). For aspiration bronchitis, the persistence of physical changes and their diffuse character is characteristic. However, the disease often takes on a wave-like character. In the period of relative remission, moderate dyspnea (respiratory rate up to 60 in 1 min), moderate bloating of the chest, participation in the respiratory tract of its compliant parts are noted. Above the lungs, mainly on the entire surface of the chest, many different-sized dry and wet rales are heard. They are unstable and usually change after coughing. More persistent, small bubbling rales are determined over areas of the lungs in which the next pneumonic process was localized. Percussion over the lungs revealed boxed sound. The exhalation is usually elongated, often wheezing. In the period of exacerbation, a sharp deterioration in the general condition occurs: shortness of breath, cough intensifies, pronounced signs of respiratory failure appear. Due to the activation or attachment of a bacterial infection, pneumonia develops, which has a tendency to a protracted course. Often with aspiration bronchitis, an obstructive syndrome occurs that resembles an asthmatic attack in the period of exacerbation. In the mechanism of its development, bronchospasm, hypersecretion and swelling of the bronchial mucosa are important. X-ray in the period of improvement revealed an increase in the transparency of the pulmonary fields, diffuse enhancement and deformation of the bronchovascular pattern. A bronchoscopic examination reveals bilateral catarrhal-purulent endobronchitis. When diagnosing aspiration bronchitis, it is important to consider the presence of primary signs leading to food aspiration (violation of the act of swallowing and sucking), the appearance of cough or respiratory failure during feeding, the recurrent nature of the course of bronchitis and pneumonia. Children with a recurring course of bronchitis and pneumonia of an unclear nature are shown a contrast study of the esophagus in different positions: on the back, side, stomach. It is necessary to exclude cystic fibrosis, obliterating bronchio it, foreign bodies of the bronchi and bronchial asthma. For therapeutic purposes, when indicated, surgery is performed to eliminate the cause leading to aspiration. Most children with a violation of the act of swallowing are not subject to surgical treatment. Therefore, it is important for such children to find a position in which the possibility of aspiration is reduced, to feed the child with a spoon, the food should be a thicker consistency. It is recommended to reduce the amount of food by one sip. Children whose cause of aspiration is food regurgitation, its quantity decreases by one feeding and the number of feedings increases, thicker mixtures are used, sleep in a position with the head end of the crozat raised. Children with paresis are prescribed oral proserin with dibazole at the rate of 1 mg per year of life per day in 2 to 3 doses before meals or 2 hours after meals for a month. With severe hypersecretion, antihistamines are used internally, combining them with eufillin (2–4 mg / kg taken 2–3 times a day). Assign postural drainage, combining it with vibration massage 4-6 times a day. Antibiotics – during an exacerbation. The prognosis in most cases is favorable. However, with massive aspirations, conditions are created for frequently recurring pneumonia, which worsens the prognosis.