Recurrent bronchitis is one of the most common clinical forms of bronchitis. Its frequency per 1000 children aged 1 year to 15 years ranges from 1.8 – to 3.7. The disease is characterized by recurrence of bronchitis recurring at least 3-4 times a year, proceeding without clinical signs of bronchospasm. Relapses of bronchitis are prone to a protracted course, however, in the bronchopulmonary system there are no irreversible changes in the sclerotic nature.
Etiology of viral bacterial bronchitis
An etiological relationship has been established for recurrent bronchitis with acute respiratory viral infection. In many patients, the etiological significance of pathogenic staphylococcus, sown from sputum and the contents of the tonsils lacunae of patients with recurrent bronchitis, is confirmed. The level of serum anti-a-toxin titers is increased to 3 AE in 1 ml and higher. The virus, apparently, is one of the reasons for the activation of staphylococcus, causing the onset of relapse of bronchitis. Relapses of bronchitis are observed mainly in the cold season – autumn-winter-spring period.
Pathogenesis of viral bacterial bronchitis
Recurrent bronchitis develops mainly in children with a burdened premorbid background (repeated SARS, the presence of foci of chronic infection in the nasopharynx – tonsillitis, adenoiditis, especially sinusitis, etc.). The values of allergic heredity, genetically determined insufficiency of the immune response to infection, dysammoglobulinemia and lr cannot be ruled out. In the mechanism of relapse of bronchitis, the development of viral and bacterial allergies, especially staphylococcal, is essential.
Clinic of viral and bacterial bronchitis
Relapse of bronchitis is delayed up to 3 to 4 weeks or more. The disease begins with signs of acute respiratory viral infection, possibly provoking a relapse of bronchitis. After 5 – 6 days, the signs of acute respiratory viral infection disappear, and changes in the bronchi remain. Relapse of bronchitis begins with moderate fever, lasting 2 to 4 days, body temperature can be normal. The main symptom is a cough of a diverse nature. More often wet, rough, sometimes dry, paroxysmal. In children of early and preschool age, cough more often at night and in the morning, school – in the afternoon and evening. The duration of the cough is 3-4 weeks. Wet and dry rales are heard on both sides of the lungs, characterized by variability in the nature of sound and localization. Wheezing in the lungs disappears sooner than a cough. During remission, changes in the bronchopulmonary system are not detected. Only increased cough preparedness (cough after physical exertion, hypothermia, etc.) is noted. Radiological comparison with acute bronchitis reveals a longer duration and stability of reactive enhancement of the pulmonary pattern, a slow normalization of this reaction. When bronchoscopy on the bronchial mucosa, lumps of mucous or mucous membranes are found purulent sputum. When bronchography is often not detected changes in the bronchi. Some patients show signs of deforming bronchitis or bronchospasm.
Treatment of viral bacterial bronchitis
In the acute period of the disease, antibiotics are prescribed orally for 5 to 7 days (ampicillin, oxycillin, erythromycin, oleandomycin, fusidin sodium), bactrim in tablets or in suspension. Of the agents that contribute to the improvement of sputum production, bromhexine 1 tablet is used for 7-12 days to Zleg – 1 time per day; 4 – 6 years – 2 times, 7 – send – Zraza and older – 1 – 2 tablets 2 times a day. The drug is not recommended in the presence of profuse sputum. For inhalation, trypsin or chymotrypsin, deoxyribonuclease, N-acetylcysteine, etc. are used. If pathogenic staphylococcus is found in the sputum after repeated inoculation and the level of anti-a-toxin titers in the blood serum is increased, treatment with staphylococcal toxoid is indicated during microdoses, it is better to use it during microdoses. If indicated after 4-6 months, the course of treatment is repeated.
During remission, hardening procedures, therapeutic exercises, especially respiratory, are indicated. Children with recurrent bronchitis are subject to follow-up. It is possible to remove a child from the dispensary registration for a duration of a relapse-free period for 2 years.
Observations of 150 children with recurrent bronchitis over 4 – 5 years by S. V. Rachinsky et al. (1978), the following was established: 9.32% of children generally stopped having any respiratory diseases, 43.21% had no bronchitis, ARVI was not noted, 30-50% of children continued to have bronchitis, and 12.69% had recurrent bronchitis transformed into asthmatic and in 1.69% of children – into bronchial asthma.