How to treat broncho-obstructive syndrome in adults. Respiratory system of a child. What diseases are found

Causes of broncho-obstructive syndrome

In ARI, inflammation is usually caused by viruses, more often influenza viruses (cough accompanies up to 93% of influenza cases), coronavirus, adenovirus, rhinovirus, respiratory syncytial virus, or bacterial infection (more often Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordetella pertussis, Streptococcus pneumoniae ).

Nevertheless, in a person with an uncomplicated anamnesis and the absence of chronic respiratory diseases, BOS in acute bronchitis, as a rule, does not require medical intervention and resolves within 1-2 weeks without special treatment. However, the doctor must be sure that the patient does not have more serious clinical situations, primarily pneumonia.

But sometimes cough and manifestations of biofeedback in a patient with acute bronchitis are delayed for several weeks and even months. The cause of this condition is almost always some kind of chronic disease that either existed before, but was not diagnosed in a timely manner, or was initiated by the transferred ARI, which acted as a trigger. More often this situation develops in patients with bronchial asthma (BA) or chronic obstructive pulmonary disease (COPD).

Bronchial asthma often develops in childhood, although this diagnosis is not always made, but the child is treated for chronic bronchitis, viral bronchitis or asthmatic bronchitis. With a detailed questioning of adult patients about bronchitis suffered in childhood, the doctor often assumes that these bronchitis were a manifestation of asthma, which by the age of 16-18, even in the absence of treatment, went into a state of spontaneous remission.

Nevertheless, in adulthood, after an episode of another ARI, bronchial asthma may "return", because respiratory viruses are powerful triggers for asthma exacerbations. In such cases, broncho-obstructive syndrome against the background of ARI may indicate an exacerbation of the patient's previously, albeit undiagnosed, bronchial asthma.

In this situation, the first step to making a diagnosis is detailed analysis anamnestic data: presence similar symptoms against the backdrop of ARI in the past, frequent bronchitis in childhood. The likelihood of bronchial asthma (BA) increases if such a patient has other allergic diseases.

Another option is when respiratory viruses initiate the appearance of asthma in an adult who did not have this disease before. According to the results published in 2011 by A. Rantala et al. population-based case-control study, the risk of developing bronchial asthma in adults within 12 months after ARI of the upper respiratory tract increases by more than 2 times, after ARI of the lower respiratory tract, including acute bronchitis, by more than 7 times.

According to the authors, people with allergic diseases or predisposition to them, lower respiratory tract infection acts synergistically with atopy, leading to inflammation in the bronchi in different ways. Such cases are more difficult to diagnose, since the appearance of broncho-obstructive syndrome (BOS) in an adult who did not have a history of chronic respiratory diseases requires differential diagnosis with other possible causes.

Similarly, ARI can exacerbate COPD in smoking person who previously had minimal clinical symptoms of this disease, which long time remained unrecognized, or ARI can cause an exacerbation of the disease in a patient with an already known diagnosis of COPD. In this situation, the diagnosis also begins with the collection of anamnesis: long-term tobacco smoking or long-term contact with fumes and toxic gases in the absence of clinical and radiological indications of other chronic bronchial diseases. pulmonary system.

In addition to these situations, the cause of BOS, which first developed against the background of ARI in an adult, may be other diseases. In 2007, India conducted a cause analysis of 268 cases of BOS in the pulmonary department of a hospital, among which 63% of cases were due to bronchial asthma, 17% to COPD, 6% to bronchiectasis, 13% to bronchiolitis obliterans and 1% to occupational disease respiratory organs.

Thus, among the variety of causes of broncho-obstructive syndrome (BOS) in acute respiratory infections in adults, the most common are bronchial asthma and chronic obstructive pulmonary disease.

Diagnosis of broncho-obstructive syndrome

If cough and other symptoms of broncho-obstructive syndrome (BOS) persist for more than 3 weeks, the reasons for this course of the disease should be clarified. In this situation, the examination of the patient begins with a fluorography or radiography of the lungs, a clinical blood test and spirometry with a bronchodilation test. The results of these studies, together with clinical and anamnestic data, will determine further diagnostic search.

To confirm the diagnosis of bronchial asthma, bronchoprovocation tests are often used, and in the absence of such an opportunity, peak flowmetry for 2-3 weeks. The diagnosis of COPD is made in the presence of relevant risk factors, primarily smoking, and the exclusion of other causes of BOS.

Preparations for the treatment of broncho-obstructive syndrome

Antibiotics for broncho-obstructive syndrome . According to the literature, 65-80% of patients with acute bronchitis in the world are treated with antibiotics, despite the evidence that antibiotics are ineffective in the vast majority of cases in this situation. Given that the etiology of acute bronchitis is predominantly viral, antibiotics are not recommended for uncomplicated bronchitis (Level of Evidence A).

Appearance purulent sputum in the uncomplicated course of acute bronchitis is also not evidence of accession bacterial infection if the duration of the disease does not exceed 3 weeks. However, many patients with acute bronchitis insist on antibiotics. In this case, the doctor's task is to explain to the patient why this is not necessary.

Antibiotics will not affect the duration of the disease and the severity of cough, and the unreasonable use of these drugs increases the resistance of pathogens in the general population and is associated with an unjustified risk of developing side effects in this patient, primarily dysbacteriosis and allergic reactions. An exception may be acute bronchitis caused by Bordetella pertussis (whooping cough), which requires the administration of macrolides.

Bronchodilators in bronchial obstructive syndrome also not shown en masse. There are few studies on the effectiveness of these drugs in acute bronchitis in the world, but in most of them B2-agonists did not affect either the severity or duration of cough. However, there are exceptions to any rule. In patients with dry rales in the lungs and other signs of biofeedback, the administration of B2 agonists can reduce the duration of cough and speed up recovery (level of evidence C).

In addition, it should not be forgotten that patients with chronic diseases respiratory organs can also carry ARI, which are accompanied by an increase in cough and bronchial obstruction, and at a later date can cause an exacerbation of existing chronic bronchopulmonary diseases. In such situations, the abolition of long-acting B2 agonists is often required and temporary transfer patient on inhalation of short-acting bronchodilators: salbutamol or fenoterol.

At the same time, it is appropriate to prescribe the combined drug Berodual (Boehringer Ingelheim), since, in addition to the B2-agonist fenoterol, it contains the anticholinergic ipratropium bromide, which can reduce the severity of cough in patients with chronic bronchitis and/or ARI.

Fenoterol and ipratropium bromide cause bronchodilation in different ways and, when simultaneously introduced into the bronchial tree, enhance each other's effects. At the same time, it is more convenient for the patient to inhale combination drug from one inhaler than to use two inhalers separately.

Berodual can be prescribed both as a metered-dose aerosol inhaler and as a solution through a nebulizer. This makes it possible to choose therapy for patients with different severity diseases and different ability to learning. Thus, it can be difficult for the elderly and children to master the technique of inhalation through a metered-dose aerosol inhaler (MAI), even with a spacer, and it is easier for them to inhale the medicine through a nebulizer, the use of which does not require special skills.

Mucolytics and antitussives. Antitussive drugs are prescribed for acute bronchitis only with persistent prolonged cough on the a short time(level of evidence C). Mucolytics and expectorants can be used for increased volume and difficult expectoration of sputum to facilitate its expectoration, but should not be prescribed in without fail, since their effect in acute bronchitis has not been proven.

Therapy of broncho-obstructive syndrome

Treatment of broncho-obstructive syndrome (BOS) is recommended to start with the use of B2-agonists (for example, fenoterol), while in order to obtain additional therapeutic effect it is advisable to combine them with an anticholinergic (ipratropium bromide). Such a fixed combination active ingredients It is represented in Russia by Berodual in two forms - PDI and solution for inhalation.

Antitussive drugs may be used to reduce coughing. If necessary, to improve the expectoration of viscous sputum, mucolytics and expectorants can be used. Antibiotics in most cases are not indicated for a patient with acute bronchitis.

© Svetlana Chikina

The widespread dissemination of medical information available to ordinary people has done the latter a disservice. And if earlier with certain symptoms we went to the doctors, now in search of advice, patients study resources world wide web. As a result, some unique individuals, who actually know nothing about medicine, consider themselves smarter than a qualified doctor with many years of experience. A good confirmation of the above is broncho-obstructive syndrome. According to such know-it-alls, this most dangerous disease”, almost an emergency condition that requires immediate treatment. This statement sounds solid and intimidating, but if you give yourself the trouble to understand the issue, the picture will turn out to be completely different. Which? Let's figure it out together!

Terms and Definitions

Broncho-obstructive syndrome (BOS) is a complex of symptoms of organic origin, characterized by various violations in the work of the respiratory system, and to be more precise - problems with bronchial patency. This is how the topic of our conversation is interpreted in reputable specialized sources. We especially focus your attention on the expression "complex of symptoms": not "disease", not "pathology" and not "condition".

In other words, the diagnosis of "broncho-obstructive syndrome" is about the same as the entry " toothache" in your medical card. BOS is a combination of various clinical manifestations and external symptoms, the treatment of which is no more effective than headache therapy. After all, it is not necessary to fight with external manifestations problems, but with the reasons that caused it. Simply put, a doctor who has encountered BOS must first determine what caused the syndrome, and only when the root cause has been identified and all necessary measures have been taken. diagnostic measures prescribe the necessary treatment.

Possible types of biofeedback

In this section, we originally planned to talk about the intricacies of classification. But it quickly became clear that biofeedback, despite its prevalence, has not yet acquired a generally accepted classification. Because in this case we will have to confine ourselves to listing the criteria that can serve as the basis for identifying biofeedback.

According to the main pathology

1. Disease of the respiratory system

• infectious infection of the respiratory tract (bronchiolitis, bronchitis, pneumonia, tuberculosis);
• blockage (aspiration) of the airways;
• congenital malformations;
• bronchial asthma of any kind;
• bronchopulmonary dysplasia;
• obliterating bronchiolitis.

2. Diseases of the digestive tract

• problems with the esophagus (achalasia and chalazia);
• GER (gastroesophageal reflux);
• tracheoesophageal fistula;
• peptic ulcer;
• diaphragmatic hernia.

3. Genetic and hereditary pathologies

• cystic fibrosis;
• deficiency of certain proteins (alpha-1 antitrip, AAT);
• mucopolysaccharidosis;
• rickets, cerebral palsy.

5. Diseases of the central nervous system and PNS (central and peripheral nervous system)

6. Negative impact on the body of environmental factors

• polluted atmosphere;
• poor quality water;
• solar radiation, etc.

7. Diseases of cardio-vascular system

8. Immunodeficiency states in any manifestations

9. Other causes (systemic vasculitis, thymomegaly, endocrine disorders, etc.)

By shape

1. infectious (generated by various pathogens);
2. allergic (an abnormal reaction of the body to certain substances);
3. obstructive (arising from the narrowing of the lumen of the bronchi with a viscous secret);
4. hemodynamic (due to decreased pulmonary blood flow and the resulting problems).

By duration

1. spicy: critical symptoms and clinical manifestations that last no more than 10 days;
2. protracted: a long course with blurring of the clinical picture;
3. recurrent: symptoms may appear and disappear after a while for no apparent reason;
4. continuously relapsing: an undulating course with sudden periods of exacerbations and visible (but not actual) remission.

By degree of damage

There are 4 types of BOS: mild, moderate, severe and latent obstructive. The main criteria for the severity of the course and their impact on the body are wheezing, cyanosis, shortness of breath, respiratory function (respiratory function) and laboratory-determined composition of blood gases. It is worth noting that cough in one form or another is characteristic of any form of biofeedback.

Possible symptoms and clinical manifestations

1. Light (mild) manifestations of biofeedback:

• signs of wheezing (difficulty) breathing;
• cyanosis and shortness of breath at rest are not observed;
• the gas composition of the blood is within the conditional norm;
• respiratory function indicators (inspiratory rate, expiratory volume per second, etc.) are reduced, but do not cause much concern;
• the patient's state of health is conditionally good (since broncho-obstructive syndrome occurs in children, this equally applies to any age category).

2. Moderate manifestations of biofeedback:

• shortness of breath even at rest (both mixed and expiratory);
• cyanosis of the nasolabial zone;
• retraction of individual sections of the chest;
• wheezing is clearly audible even at a fairly large distance;
• indicators of respiratory function are somewhat reduced;
• almost normal acid-base state (CBS): PaO 2 > 60, PaCO 2< 45.

3. Strong manifestations BOS / acute attack (urgent care required!):

• difficult and noisy breathing with the involvement of auxiliary muscles;
• pronounced cyanosis;
• a sharp decrease in the main indicators of respiratory function;
• generalized bronchial obstruction: PaO 2< 60, PaCO 2 > 45.

Some clinical manifestations can occur with any degree of obstructive pulmonary disease:

1. "Long" exhalation.
2. Chronic unproductive cough that does not bring relief.

Principles of clinical diagnosis

Here, first of all, you should important note: newly diagnosed BOS (and equally bronchial obstruction syndrome), if its symptoms and clinical manifestations are insignificant, and the body is weakened by a respiratory infection, no special diagnostic methods are required. However, this does not mean that patients with biofeedback are left alone with their problems, since along with the treatment of the underlying disease, their well-being improves, and negative effects syndrome are reduced. If there is a recurrent course of biofeedback, diagnostic methods necessarily include the following types laboratory research:

• peripheral blood;
• a group of serological tests (immunoglobulins G, M and IgA), and if there are no IgM / IgG titers, a second test is prescribed after 2-3 weeks;
• allergy test (general and specific IgE, scarification tests);
• the presence of mycoplasma, chlamydial and cytomegalovirus infection, herpes and pneumocystis;
• the presence of helminths (ascariasis, toxocariasis).

X-ray examination is carried out in the following cases:

1. Suspicion of severe form BOS (in the presence of atelectasis).
2. Acute pneumonia must be ruled out.
3. There may be a foreign body in the airways.
4. BOS passed into a chronic (recurrent) form.

Broncho-obstructive syndrome in children has some diagnostic features associated with the age of patients.

1. The study of respiratory function for children with suspected BOS is mandatory. The most informative indicators are FEV1 (forced expiratory volume), PSV (peak expiratory flow rate), MOS25-75 - maximum expiratory flow rate.
2. Specialized tests with histamine, methacholine and dosed loading can determine bronchial hyperactivity.
3. In the first years of life, children are shown studies of the peripheral resistance of the entire respiratory system (the so-called flow interruption technique) and body plethysmography.
4. Oscillometry and bronchophonography, despite all their effectiveness, have not yet become widespread and are, in a sense, experimental.

Differential Diagnosis

1. Pneumonia

• signs: lung damage, wet rales, voice trembling;
• Diagnosis: chest x-ray.

2. Whooping cough

• signs: cough for at least 14 days, which in some cases may result in vomiting and inspiratory scream;
• diagnostics: smears from the nasopharynx and sputum analysis.

3. Chronic sinusitis

• signs: mucus in the airways, discomfort with nasal breathing;
• diagnosis of CT of the paranasal sinuses.

4. Bronchial asthma

• signs: symptoms characteristic of asthma are undulating, marked relief with the use of specific drugs;
• diagnostics: test with a bronchodilator, hyperreactivity phenomena.

5. Chronic obstructive pulmonary disease (COPD)

• signs: years of smoking, morning cough with sputum, progressive shortness of breath;
• diagnostics: spirometry, pulse oximetry.

6. Tuberculosis of the respiratory organs

• signs: decreased appetite, weight loss, subfebrile temperature, at night - severe sweating;
• diagnostics: chest radiography, microbiological examination.

7. Gastroesophageal reflux disease (GERD)

• signs: cough after eating or lying down;
• diagnostics: esophagogastroscopy, daily pH-metry.

Treatment

Broncho-obstructive syndrome in children and adults (as well as bronchial obstruction syndrome) is not an independent disease, but a manifestation of certain pathological changes in the body. Consequently, effective help in this case is impossible without determining the root cause and setting correct diagnosis(see previous sections). Moreover, bronchial obstruction can successfully disguise itself as a “harmless” cold or acute respiratory disease, therefore, we repeat, it is not only pointless, but also dangerous, to start therapy for clinical manifestations alone.

On the other hand, identification of the pathogen (if the doctor is dealing with an infectious form of BOS) can take several weeks. During this time, the patient's condition will deteriorate significantly (and he may need emergency care), and the syndrome itself will go into chronic form which is very difficult to treat. Because in recent times has become widespread symptomatic treatment to improve the patient's condition and clarify provisional diagnosis. What drugs can be used for this?

1. Bronchodilators with a short duration of action

• beta-2 agonists;
• a combination of a beta-2 agonist and an anticholinergic drug (ACP);
• combined bronchodilators.

2. Antibiotics

• beta lactams;
• beta-lactams and beta-lactamase inhibitors;
• macrolides;
• respiratory fluoroquinols.

3. Glucocorticosteroids

List of the most used drugs

1. Fenoterol

• single dose: 0.1 to 1 mg (inhaler/nebulizer);

2. Ipratropium bromide

• single dose: 0.04 to 0.5 mg (inhaler/nebulizer);
• maximum effect: after 45 minutes;
• duration of action: 6 to 8 hours.

3. Combination of fenoterol and ipratropium bromide

• single dose: 0.04 to 1 mg (inhaler/nebulizer);
• maximum effect: after 30 minutes;

4. Salbutamol

• single dose: 0.1 to 5 mg (inhaler/nebulizer);
• maximum effect: after 30 minutes;
• duration of action: 4 to 6 hours.

5. Combination of salbutamol and ipratropium bromide

• single dose: 0.5 to 2 mg (nebulizer only);
• maximum effect: after 30 minutes;
• duration of action: 6 hours.

Additional therapeutic measures

• air humidification;
• drugs that stimulate cough (ciliokinetics, mucolytics);
• chest massage;
• the use of immunostimulants and antiviral drugs;
• intravenous infusion of saline;
• prednisolone (short courses in severe BOS);
• oxygen therapy;
• use of equipment for artificial ventilation lungs (in infants a few weeks old).

Broncho-obstruction in adults is a clinical symptom complex caused by a violation of the patency of certain sections of the bronchial tree of a functional or organic nature, typical manifestations which is paroxysmal cough and expiratory. This syndrome is based on a partial decrease in the lumen or complete occlusion respiratory tract.

Why does

The causes of impaired patency of the respiratory tract at the level of the bronchi are diverse. Among them, the main ones are:

• swelling and inflammation of their walls of various origins (allergic, infectious, toxic);
• excessive secretion of bronchial secretions and its accumulation in the respiratory tract;
• spasm of smooth muscle fibers of the bronchi;
• tracheobronchial dyskinesia;
• loss of elasticity lung tissue and the formation of "air traps" (collapse of small bronchi on exhalation);
• bronchial remodeling due to excessive growth of connective tissue;
• blockage of small or large bronchi by foreign bodies, purulent discharge or blood;
• their compression from the outside (malignant or benign neoplasm).

What happens in the body

Pathological changes in the bronchus wall occur under the influence of provoking environmental factors ( tobacco smoke, dust, toxic gases, allergens) and repeated respiratory infections. On the early stages such changes are reversible. The wall of the bronchus thickens due to edema, proliferation of muscle fibers, an increase in the number of glands responsible for the production of mucus. Gradually, functional insufficiency of the mucociliary apparatus develops. Such a restructuring of the bronchial tree is accompanied by autonomic disorders. At the same time, the tone of the parasympathetic nervous system prevails, which contributes to the spastic readiness of the smooth muscles of the bronchi. As a result, the lumen of the airways narrows and viscous, difficult-to-separate sputum accumulates in the bronchi.

For more late stages pathological process in the wall of the bronchi, connective tissue grows, and changes in them become irreversible.

What diseases are found

Broncho-obstruction in adults is detected in many diseases and has a significant impact on their clinical course and treatment efficacy. These include:

• respiratory organs;
• benign, malignant tumors, etc.

Possible variants of bronchial obstruction

AT clinical practice depending on the etiopathogenetic mechanisms of broncho-obstructive syndrome, the following types of it are distinguished:

• infectious-inflammatory (based on infectious process; observed with bronchitis, pneumonia, bronchial lesions with, tuberculosis, fungal diseases);
• obstructive (associated with obstruction of the lumen of the bronchus by any substrate; accompanies the course, neoplasms of the bronchi, penetration of foreign bodies into the respiratory tract);
• allergic (due to a hypersensitivity reaction to various foreign substances; occurs when drug allergy, bronchial asthma, hay fever);
• autoimmune (is a consequence of impaired functioning of the immune system; occurs with, vasculitis, pneumoconiosis);
• dyskinetic (associated with disorders motor activity and tone of the respiratory tract; represented by tracheobronchial dyskinesia);
• neurogenic (characterized by the absence of organic changes in the bronchi; observed with hysteria,);
• hemodynamic ( pathological process trigger circulatory disorders; detected in congestive heart failure,);
• toxic (develops as a result of accumulation in the body toxic substances cholinergic action).

Clinical picture

Despite the variety of etiological factors and mechanisms for the development of obstruction, clinical manifestations this syndrome at various diseases are of the same type:

• shortness of breath (usually expiratory in nature, aggravated after exercise or at night; with pathology of large bronchi, it can be inspiratory);
• acute attacks of shortness of breath;
• obsessive cough (dry or with the separation of viscous mucopurulent sputum);
• wheezing that can be heard from a distance;
• participation in the act of breathing auxiliary muscles;
• percussion sound with a box shade;
• weakened vesicular breathing and scattered dry rales (during auscultation).

With similar symptoms, tracheobronchial dyskinesia of a congenital or acquired nature proceeds. Its typical manifestations are:

• asthma attacks in the supine position;
• bitonic cough with impaired sputum discharge;
• short-term loss of consciousness at the height of a hacking cough;
• lack of effect from bronchodilators.

In bronchial asthma, bronchial obstruction is variable and reversible. Its symptoms occur suddenly under the influence of provoking factors (inhalation of allergens, exercise stress), have different severity and quickly disappear under the influence of bronchodilator therapy. With a severe attack of suffocation, an acute respiratory failure.

In chronic obstructive pulmonary disease, bronchial obstruction increases every year and is quite persistent. The course of the disease is aggravated in case of accession of a respiratory infection. Patients gradually develop chronic respiratory failure and symptoms appear.

Sometimes seizures expiratory dyspnea meet at . Its presence should be assumed in a patient with repeated pneumonia of the same localization, which is accompanied by fever, cough with a large amount of sputum purulent nature, hemoptysis.

Acutely emerging and repeatedly recurring broncho-obstructive syndrome may be associated with a mechanical obstruction to the movement of air in the respiratory tract (tumor, foreign body). With similar symptoms, lung cancer occurs, affecting the large bronchi. In this case, obstruction is preceded by a long period of poor health with subfebrile temperature, painful cough, excretion of blood with sputum.

Aspiration of small foreign bodies can irritate a certain section of the bronchial tree and cause coughing, shortness of breath, and wheezing. In the case of obstruction of the lobar or segmental bronchus, a convulsive cough may appear in a person, which increases with a change in body position.

Neurogenic bronchial obstruction occurs in hysteria, neurasthenia in the form of attacks of psychogenic shortness of breath. Usually this condition is observed in young women in response to stressful influences, mental overload. When examining patients pathological changes in the respiratory organs are not detected. Such disorders are never accompanied by the participation of auxiliary muscles in the act of breathing and cyanosis of the skin.

Fundamentals of diagnosis

Identification of broncho-obstructive syndrome in adults is the reason for complete examination which includes:

• sputum analysis (including mycobacteria and atypical cells);
• testing with bronchodilators;
• electrocardiography;
• (according to indications), etc.

The presence of obstruction must be confirmed by spirometry. This is evidenced by a decrease in forced expiratory volume in 1 second (FEV₁), as well as a decrease in the ratio of this indicator to the forced vital capacity of the lungs. According to the results of this study, the severity of this pathology is determined.

• If air passes through a narrower bronchus and leaves it back in the same volume, but as a result, hypoventilation occurs, then they speak of mild degree bronchial obstruction. At the same time, FEV₁ is more than 70% of the due values ​​(but less than 80%).
• With an average degree of obstruction, a valve mechanism is observed - when inhaling, air enters the alveoli, and when exhaling, the bronchus that has lost its elasticity collapses, which significantly complicates the exit of air into the external environment. In such patients, emphysema develops and indicators of the function of external respiration change significantly: FEV₁ is 69-50% of the due value.
• With a severe degree of obstruction, complete blockage of the bronchial lumen occurs. FEV₁ will be below 49%.

An important step in making a diagnosis is differential diagnosis. It should be carried out with pathological conditions that have similar symptoms:

• inflammatory diseases upper divisions respiratory tract;
• stenosis of the trachea and larynx;
• dysfunction of the muscles of the larynx;
• paralysis of the vocal cords;
• tumors of the upper respiratory tract;
• cicatricial stenosis of the trachea after its intubation and mechanical ventilation.

Principles of treatment

The tactics of managing people suffering from broncho-obstructive syndrome can differ significantly depending on its cause. Each nosological form has its own treatment features. Thus, anti-inflammatory therapy is recommended for bronchial asthma, antibacterial therapy for pneumonia, and a combination of chemotherapy and surgical methods treatment for psychogenic disorders sedatives and psychotherapy.

However, for all patients to alleviate their condition, eliminate unpleasant symptoms and prevention of complications, bronchodilator therapy is prescribed according to general principles. For this are used.

The broncho-obstructive syndrome is not a disease, but a set of symptoms that cannot act as an independent diagnosis. Symptoms show a clear picture of the problems of the respiratory system, namely, a violation bronchial patency caused by either organic or functional formation.

BOS (abbreviated name) is often diagnosed in children of early age group. Approximately 5-50% of all children aged one to three years show some signs of broncho-obstructive syndrome. The doctor should focus on these symptoms and immediately begin to detect the cause of BOS, and then prescribe the necessary diagnostic measures and appropriate treatment.

In children prone to allergic ailments, BOS is diagnosed more often - in about 30-50% of all cases. Also, this complex of symptoms often manifests itself in young children who are repeatedly attacked by respiratory infections every year.

Kinds

According to the degree of damage, there are four types of biofeedback:

• light;
• average;
• heavy;
• obstructive severe.

Each type is characterized by a certain symptomatology, and such a manifestation as coughing is an integral feature of any type of biofeedback.

According to the degree of duration, acute, protracted, recurrent and continuously recurrent types of broncho-obstructive syndrome are distinguished.

• acute form appears insidious symptoms and clinical aspects that prevail in the body for more than ten days;
• protracted syndrome is characterized by an unexpressed clinical picture and long-term treatment;
• with a relapsing form, symptoms can both appear and disappear without any reason;
• finally, continuously relapsing biofeedback is characterized by visible remission and periodic manifestations of exacerbations.

Broncho-obstructive syndrome is of four types: allergic, infectious, hemodynamic and obstructive.

• allergic biofeedback occurs due to an abnormal reaction of the body to the intake of certain substances;
• infectious - as a result of penetration into the body of pathogens;
• hemodynamic - due to low blood flow in the lungs;
• obstructive - due to the filling of bronchial gaps with an excessively viscous secret.

The reasons

According to the main pathology, the causes of the appearance of BOS can be divided into categories such as:

Gastrointestinal diseases include:

• ulcers;
• achalasia, chalazia and other problems with the esophagus;
• diaphragmatic hernia;
• tracheoesophageal fistula;
• HPS (or gastroesophageal reflux).

Respiratory problems include:

• airway aspiration;
• obliterating bronchiolitis;
• infectious diseases of the respiratory tract;
• congenital anomalies development;
• various types.

Genetic as well as hereditary pathologies include cerebral palsy, cystic fibrosis, rickets, mucopolysaccharidosis, deficiency of proteins such as AAT, alpha-1 antitrypsing, etc.

Solar radiation, polluted atmosphere, poor quality drinking water- these and many other environmental factors negatively affect the body, weakening the immune system and making it very susceptible to various diseases.

Symptoms

There are a lot of symptoms of broncho-obstructive syndrome.

Complications

With poor-quality, untimely or incomplete treatment for broncho-obstructive syndrome, the following complications are most common:

• acute heart failure;
• life-threatening disturbances in the work of the heart rhythm;
• paralytic state of the respiratory center;
• pneumothorax;
• with very frequent asthma attacks - the occurrence of secondary pulmonary emphysema;
• lung atelectasis;
• the formation of a pulmonary acute heart;
• asphyxia (suffocation), which has arisen, for example, as a result of aspiration of viscous sputum of the lumen of small bronchi.

Diagnostics

As mentioned above, broncho-obstructive syndrome is not a disease, but a kind of indicator of any disturbances in the body. This applies to both adults and children. As a result, before proceeding with the treatment of the patient, the doctor must establish the true root cause of these symptoms, as well as make a correct diagnosis.
The fact is that it is able to perfectly “disguise” itself as a common cold. That is why it is not enough to diagnose exclusively clinical indicators; it is necessary to form an extended examination of the patient.

As a rule, with BOS, the following diagnostic studies are prescribed for the patient:

Treatment

Treatment includes several main areas, such as bronchodilator and anti-inflammatory therapy, as well as therapy aimed at improving the drainage activity of the bronchi. In order to improve the efficiency of the drainage function, it is important to carry out procedures such as:

• mucolytic therapy;
• rehydration;
• massage;
• postural drainage;
• therapeutic breathing exercises.

Mucolytic therapy is aimed at thinning sputum and improving cough productivity. It is carried out taking into account such patient factors as age, BOS severity, sputum amount, etc. In case of ineffective cough and viscous sputum in children, oral and inhaled mucolytics are usually prescribed. The most popular among them are Ambrobene, Lazolvan and others.
The combined use of mucolytic agents with expectorants is acceptable. Often they are prescribed to children with a long-lasting, dry cough, without sputum. Good effect also give folk remedies- plantain syrup, coltsfoot decoction, etc. If a child is diagnosed with an average degree of biofeedback, he may be prescribed acetylcysteine, if severe, the baby should not take mucolytic drugs on the first day.

All patients, regardless of age and severity of broncho-obstructive syndrome, are prescribed antitussives.

Bronchodilator therapy

Bronchodilator therapy in children includes short-acting beta-2 antagonists, theophylline preparations
also short-acting and anticholinergics.

Beta-2 antagonists give more quick effect if administered via a nebulizer. These drugs include Fenoterol, Salbutamol, etc. These drugs must be taken three times a day. They have minimal side effects, however, with long-term use of beta-2 antagonists, their therapeutic effect decreases.

Theophylline preparations include, first of all, Eufillin. It is intended primarily to prevent bronchial obstruction in children. Eufillin has both positive and negative qualities. To the virtues this tool can be attributed to low cost, fast therapeutic result and a simple circuit use. The disadvantages of aminophylline are numerous side effects.

Anticholinergics are drugs that block muscarinic M3 receptors. One of them is Atrovent, which is preferably taken through a nebulizer three times a day in the amount of 8-20 drops.

Anti-inflammatory therapy

Anti-inflammatory therapy focuses on the suppression inflammatory course in the bronchi. The main drug in this group is Erespal. In addition to relieving inflammation, it is able to reduce bronchial obstruction in children and control the amount of mucus secreted. Excellent effect remedy for children when taken on initial stage diseases. Suitable for use by children of an early age group.

To relieve inflammation in severe BOS, a doctor prescribes glucocorticoids. The method of administration is preferable, again, inhalation - the effect of it comes quickly enough. Among glucocorticoids, Pulmicort is recognized as the most popular.

If the patient is diagnosed with allergic ailments, he is prescribed antihistamines. As an antibacterial and antiviral therapy, the patient is prescribed a course of antibiotics.

If the patient is not able to breathe well on his own, he is given oxygen therapy through nasal catheters or a special mask.

Sometimes doctors write down incomprehensible abbreviations and diagnoses in case histories or patient cards. If some people are not interested in reading medical documentation, it is important for others to know about their diagnosis. This is especially true for parents or people who are worried about their health. Let's take a closer look at what broncho-obstructive syndrome (BOS) is in children and adults.

Features of pathology9

Broncho-obstructive syndrome is not independent disease, this pathology occurs as a result of certain diseases and is a whole complex symptoms that worsen a person's life. It occurs as a result of a deterioration in the passage of air masses through bronchial tree. It is believed that broncho-obstructive syndrome is mostly a childhood disease. After all, it is diagnosed in 35-45% of children, especially under the age of 3 years, but it also happens in adults.

The prognosis for recovery is directly proportional to the primary cause of the syndrome. In some cases, bronchial obstruction is completely curable, in others it leads to irreversible consequences.

Broncho-obstructive syndrome (BOS) is a complex of symptoms of organic origin, characterized by various disorders in the respiratory system.

Causes of biofeedback

According to studies, the main causes of broncho-obstructive syndrome, both in children and adults, are infectious, viral, allergic and inflammatory diseases.

BOS can also be called:

• diseases of the cardiovascular system (heart defects, hypertension, cardiac arrhythmias);
• diseases of the pulmonary system (ARVI, influenza, pneumonia, congenital anomalies in the development of organs, bronchial asthma, bronchopulmonary dysplasia, neoplasms);
• helminthiases;
• pathology of the gastrointestinal tract (hernia of the esophagus, ulcers, frequent heartburn);
• psychological disorders ( nervous breakdowns, stress, overwork);
• getting into Airways foreign bodies, chemical substances, household chemicals;
• medicines ( side effect some groups of drugs).

Violation of air permeability through the bronchial tree can be caused by spasm smooth muscle, accumulation of thick mucus in the bronchi, the presence of fluid in the lungs, mechanical compression of the bronchi (due to the growth of neoplasms, atypical tissues), edema of the mucous membrane, destruction of the epithelium in large bronchioles.

In children, the causes of broncho-obstructive syndrome may also be:

• diseases of the thymus;
• second hand smoke;
• intrauterine pathologies of development;
• artificial feeding;
• deficiency of vitamins, in particular D.

Each type is characterized by a certain symptomatology, and such a manifestation as coughing is an integral feature of any type of biofeedback.

Varieties of this complex of symptoms

There are many classifications of broncho-obstructive syndrome in adults, ranging from the severity of symptoms (mild, moderate, severe) and ending with the initial causes of pathology:

• infectious - caused by various inflammatory processes in the body;
• allergic - in this case, biofeedback is the body's reaction to drugs and various allergens (pollen, dust, animal hair);
• hemodynamic - develops as a result of a decrease in blood flow pressure in the lungs (this may be associated with bleeding, disorders of the cardiovascular system);
• obstructive - the bronchi are filled with a too viscous secret that interferes with the passage of air.

BOS can be classified by duration and frequency of occurrence, namely:

1. Sharp form. It is characterized by the manifestation of symptoms for no more than 10 days.
2. Tight form. Signs of pathology persist for 10-17 days.
3. Chronic form. The syndrome recurs 2-4 times a year, mainly due to infectious or allergic factors.
4. Continuously relapsing. Periods of exacerbation and remission very often alternate, and remission is hardly noticeable or absent altogether.

In children prone to allergic ailments, BOS is diagnosed more often - in about 30-50% of all cases.

Symptoms

Signs of broncho-obstructive syndrome in children and adults are the same, and may vary only slightly depending on the initial cause of the pathology.

The symptoms are:

• noisy, loud breathing;
• dyspnea;
• wheezing, they can be heard at a distance;
• dry, debilitating cough that does not bring relief to the patient;
• coughing fits followed by viscous, thick sputum;
• cyanosis (blue) of the lower face and neck;
• exhalation is longer than inhalation, it is difficult.

Complications

If the pathology is not identified and no measures are taken to treat it, it is possible irreversible consequences especially when it comes to a child.

The patient may experience the following negative effects:

1. Change in the shape of the chest. It becomes more rounded. There is an increase in the tone of the intercostal muscles.
2. The development of cardiovascular pathologies, heart failure arrhythmias.
3. Asphyxia (impaired breathing, suffocation) occurs due to blockage with sputum or liquid, compression of small and medium bronchioles by tumors.
4. Paralytic state of the respiratory center.

There are a lot of symptoms of broncho-obstructive syndrome

Diagnostics

BOS can be diagnosed by collecting a general history of the patient and using research:

• spirometry;
• bronchoscopy;
• radiography;
• CT and MRI (used in rare cases when there is a suspicion of a malignant process in the lung tissue).

The doctor may prescribe general analysis blood, urine and feces. This is necessary to identify various inflammatory processes in the body, helminthiasis. Also, the doctor will write out a referral for allergy tests, a smear from the mucous membrane of the throat and nose, and sputum analysis (if any).

Differential diagnosis of broncho-obstructive syndrome, including a comprehensive examination of the patient, makes it possible to exclude other diseases similar to broncho-obstructive syndrome and identify the immediate cause of its occurrence. Remember that the sooner you see a doctor, the more effective the therapy will be, the more favorable the prognosis.

Treatment of the disease

Any therapy is aimed primarily at eliminating the cause of BOS, but it is necessary to alleviate the symptoms of this syndrome.

Treatment includes several main areas, such as bronchodilator and anti-inflammatory therapy, as well as therapy aimed at improving the drainage activity of the bronchi

Doctors are appointed by the following clinical guidelines with broncho-obstructive syndrome:

mucolytic therapy. This is a reception of drugs that thin sputum and contribute to its easy removal - Ambroxol, Bromhexine, Acetylcysteine.

1. Rehydration. In order for the sputum to thin and the medicines to work, it is necessary to drink enough liquids during the day. It is desirable that this be mineral water- Essentuki, Borjomi, Polyana Kvasova.
2. Massage. Light healing massage of the chest and back helps to improve blood circulation, oxygenate the blood, easy excretion sputum.
3. Healing breath.
4. If the cough is allergic character, take antiallergic drugs - Erius, Claritin, Suprastin, Loratadin.
5. With an unproductive dry cough that exhausts the patient, the use of codeine-containing drugs or drugs that block the cough center in the brain is indicated - Codesan, Kofeks, Libeksin, Glauvent.
6. If it is difficult to expectorate sputum, expectorant medications are used - plant-based syrups (Plantain, Licorice, Ivy).
7. Means for expanding the bronchi are used - Aerophyllin, Neophyllin, Theophylline.

Treatment should be prescribed by your attending physician, after diagnosing and establishing a diagnosis, the cause of BOS. Most often, patients take hormone therapy, antibiotics and anti-inflammatory drugs. If neoplasms in the lungs have become the cause of bronchial obstruction, you should consult with an oncologist, he will consider ways to solve this problem.

All patients, regardless of age and severity of broncho-obstructive syndrome, are prescribed antitussives.

Alternative methods of treatment of brocho-obstructive syndrome

Before using folk remedies, you should consult with your doctor in order to avoid complications. Such therapy is auxiliary and is used only in combination with other methods of treatment.

broncho-obstructive syndrome prehospital stage can be treated using the best recipes of traditional healers:

1. To facilitate breathing, soften it, you need to do inhalations with oil 2 times a day. tea tree and eucalyptus. To do this, heat 2 liters of water in a water bath and add 0.5 ml of oils. When the mixture begins to actively evaporate, inhale the warm vapor through your mouth.
2. Used internally to improve expectoration badger fat in the form of capsules or oil 4 times a day. The course of treatment is up to a month.
3. Chest and back need to be rubbed goat fat to improve microcirculation in tissues and bronchi.
4. With persistent pneumonia, you need to mix 0.5 liters of honey and 0.5 kg of aloe leaves. The plant is ground in a meat grinder and thoroughly mixed with liquid honey. It is necessary to take the mixture 1 teaspoon 2 times a day before meals.
5. Softens hard breathing and removes an unproductive dry cough decoction of thyme herb with the addition of peppermint.

The doctor may prescribe inhalation drugs to improve the patient's condition. As a rule, the prognosis for timely treatment is good, although they depend on the underlying disease that caused the broncho-obstructive syndrome. Only in 20% of patients, the pathology develops into a chronic form. Contact your doctor in a timely manner and do not self-medicate.