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Sindrome Bronquial en Niños
Sindrome Bronquial en Niños
Sindrome Bronquial en Niños
4.
5.
DEFINITION
Bronchoobstructive syndrome (BOS) is a symptom
complex associated with impaired bronchial patency
of functional or organic origin.
Environmental Factors:
unfavorable environmental conditions
passive smoking
smoke inhalation promotes disruption of mucociliary clearance, causes
hypertrophy of bronchial mucous glands, destruction of bronchial
epithelium, reduces phagocytic activity of macrophages, reduces the
activity of T- lymphocytes, stimulates IgE synthesis, increases the activity
of the vagus nerve
in children with alcohol fetopathy atopy develops, mucociliary clearance is
broken, protective immunological reactions are slowed.
Etiology of BOS
Acute stenosing laryngotracheobronchitis of viral, bacterial
and viral etiology of diphtheria.
Peritonsillar abscess, retropharyngeal abscess, epiglotit,
congenital stridor, hypertrophy of the tonsils and adenoids,
cysts, hemangioma and papillomatosis of the larynx.
In infants - aspiration caused by swallowing disorders,
congenital abnormalities of the nasopharynx, chalasia and
achalasia of the esophagus, tracheobronchial fistulas,
gastroesophageal reflux disease.
infectious
allergic
obstructive
hemodynamic
wheezing
dyspnea of expiratory character
cyanosis
auxiliary muscles participating in breathing
lung function (LF) and blood gases indices
cough is seen with any degree of BOS
Mild BOS
wheezing on auscultation
no breathlessness and cyanosis at rest
indices of blood gases are within the normal range
ERF indices (FEV1, PSV) are moderately reduced
state of health of the child, as a rule, does not suffer
Acute bronchiolitis
is observed in children under 2 years old. Most often it is caused by RSinfection.
affects small bronchi, bronchioles and alveolar passages.
The narrowing of the bronchi and bronchioles occurs due to edema and cell
infiltration of the mucosa, which leads to the development of severe RF.
At the same time bronchoconstriction does not really matter, as is
evidenced by the lack of effect of bronchospasmolytic means.
Bronchial asthma
manifest during early childhood in the majority of patients . The initial
symptoms are usually those of BOS character on the background of ARVI.
BA is often not recognized in time and patients are not treated properly.
The course and prognosis of BA depend to a large extent on the timely
diagnosis and adequate treatment, so you must pay close attention to the
early diagnosis of the disease.
If the child of the first 3 years of life has:
- more than 3 episodes of BOS on the background of ARVI,
- atopic diseases in the family,
- the presence of allergic diseases,
it is necessary to observe the patient as a patient with bronchial asthma,
including allergic additional survey and the decision on the administration
of basic therapy.
Antihistamines
The use of antihistamines is indicated only at the occurrence
or at worsening of any allergic reactions.
Second-generation drugs having no effect on the viscosity of
sputum are favored. Beginning from 6 months of age
Ceterizinum ("Zyrtec") is allowed by 0.25 mg / kg 1-2 times
per day.
For children over 2 years old, Loratadinum ("Claritine"),
Desloratadinum ("Aerius") can be prescribed, over 5 Fexofenadinum ("Telfast").
Bronchodilator therapy
Anti-inflammatory therapy
For the treatment of severe BOS ICS (Dexamethasone and Budesonide
"Pulmicort") are used. Beginning with 6 months of age they are
administered by inhalation through a nebulizer in a daily dose of 0.25-1 mg
/ day (the amount of inhaled solution is adjusted to 2-4 ml by saline
solution). The drug is administered 2 to 4 times a day 15-20 minutes after
inhalation of bronchodilators.
The duration of ICS therapy depends on the nature of the disease, duration
and severity of obstruction, as well as the effect of the therapy.
In children with acute obstructive bronchitis with severe bronchial
obstruction, duration of treatment is usually 5-7 days, and in children with
croup - 2-3 days.
Good effect:
1. Inhalation of short-acting 2-agonist
through a nebulizer, 1 dose every 6-8
hours
2. Inhalation of nebulized
corticosteroids 1-2 times a day
3. Inhalation of mucolytics nebulized
4. Abundant alkaline drink
A good answer
Unsatisfactory effect:
1. Inhalation of short-acting 2-agonist
through a nebulizer, 1 dose every 6-8
hours
2. I/v introduction of methylxanthines
(2.4% solution of aminophylline)
3. I/v introduction of GCS
4. Infusion therapy
5. Oxygen therapy
An unsatisfactory answer:
Transfer to the emergency
department
ALV
Conclusions
1. Bronchial obstruction syndrome in children is common and
takes a severe course, accompanied by signs of severe
respiratory failure.
2. It manifests, as a rule, against a background of acute
respiratory infection, BOS may be a manifestation of many
pathological states.
3. The prognosis of the BOS course is serious and depends on
the form of the disease that caused the bronchial obstruction,
and timely conducting of pathogenetic schemes of therapy and
prevention.
Bibliography