Recurrent bronchitis (according to ICD-10 code - J 20) is a re-developing protracted inflammation of the mucous membrane of the bronchi, which repeats up to 3 or more times during the year, but does not lead to irreversible functional impairment of the respiratory system. The disease in most cases is accompanied by subfebrile condition, a rough wet cough, sometimes - wheezing and bronchospasm. The diagnosis is made according to bronchography, X-ray of the lungs, HPF, allergoprob, bacterial sputum culture. For relapses of bronchitis, medication (bronchodilators, mucolytics, antihistamines) and rehabilitation measures (vibration massage, breathing exercises, physiotherapy) are used. If necessary, antiviral and antibacterial drugs are prescribed.
General characteristics of pathology
Recurrent bronchitis - episodes of bronchitis, repeatedly repeated (up to 3-4 times) throughout the year with a duration of up to 2-3 weeks. They occur most often with the phenomena of bronchospasm, however, difficulty breathing, the disease may not be accompanied. In addition, there are reversible changes in the bronchopulmonary system. Recurrent bronchitis is more common in children than in adult patients. This disease most often affects preschool children. By maturity in such patients, chronic bronchitis is already forming, proceeding with persistent damage to the structures of the bronchial walls and periodic exacerbations.
At what age does it arise?
Recurrent bronchitis usually occurs in the second year of life, and this clinical manifestation accounts for up to 1/3 of all early respiratory pathologies. The highest incidence is observed among children aged 4-6 years, then gradually decreases in the pre- and puberty period.
Symptoms of Obstruction
This disease generally does not cause symptoms of obstruction. There is recurrent bronchitis with obstructive syndrome, not mediated by allergens. Relapses of the disease more often occur in cold periods, with the second option - at any time of the year.
Recurrent bronchitis does not have a tendency to progress and the occurrence of sclerosis in the lungs and bronchi, however, this pathological process creates favorable conditions for the development of chronic bronchitis, acute pneumonia and bronchial asthma.
Causes
The connection between this disease and acute respiratory infections of viral, chlamydial, mycoplasma, less often the bacterial nature of origin (pertussis, tuberculosis) is obvious. Episodes of bronchitis are often repeated against the background of acute viral infections (rhinovirus, parainfluenza, RSV, measles) and pneumonia. Predisposition is observed in frequently ill children. The causes of recurrent obstructive bronchitis are important to find out.
Damage to the mucous membrane of the tracheobronchial tree by viruses leads to a diffuse inflammatory process, a decrease in the functionality of the ciliated epithelium, neuroregulatory disorders, mucociliary clearance deficiency, and the development of nonspecific bronchial reactivity. They begin to react pathologically to quite familiar irritants (cold air, pungent smell, physical activity).
Predisposing factors
Predisposing factors are essential in the formation of recurrent bronchitis. This is, first of all, the characteristics of the child's body - immaturity of the structures of the bronchi and immunity, frequent chronic pathologies of lymphoid tissue, allergic mood, the presence of immunodeficiency states of respiratory tract defects (secondary and congenital). The development of bronchial hyperreactivity is caused by alcoholic fetopathy, aspiration syndrome, maternal smoking during pregnancy and during breastfeeding, mechanical ventilation. Cystic fibrosis and foreign bodies in the airways are also accompanied by signs of recurrent bronchitis. Repetition of bronchitis can occur under the influence of negative climatic conditions (temperature extremes, high humidity), domestic and industrial air pollution.
70-80% of pediatric patients have an obstructive form, which occurs in the absence of other bronchopulmonary diseases. Due to the narrowness of the lumen of the respiratory canals observed in this disease in children, bronchial obstruction is caused by inflammatory changes in the mucous membrane against the background of frequent SARS. The presence of allergies (positive skin tests, skin rashes) and connective tissue dysplasia in the patient allows these patients to be at risk for obstructive bronchitis. RSV infection can disrupt the formation of a normal immune response and form an atopic immune response and sensitization to air allergens. With recurrent bronchitis with obstruction without allergic signs and a low level of Ig E, the majority of episodes of obstruction occur at the age of 3-4 years.
Symptoms
With recurrent bronchitis, annual periodic exacerbations occur, usually lasting 2-4 weeks. Symptoms of relapse, as a rule, are much easier than initially acute inflammation, and begin with clinical signs of acute respiratory viral infections. At the same time, there is a slight increase in temperature and some catarrhal phenomena: rhinitis, nasal congestion, sore throat, headache. Gradually, over a period of 3-6 days, a cough occurs: first painful and dry, subsequently moist and rough, less often paroxysmal. In this case, viscous mucopurulent sputum is released. Throughout the day, the patient has a cough, which gradually dominates the clinical picture of pathology. Coughing during physical exertion is possible.
Breathing pattern
With a relapse of obstructive bronchitis, the patient’s breathing becomes whistling with severe wheezing, and the cough is obsessive. With sluggish recurrent bronchitis, exacerbation can take quite a long time (up to 3 months) with scanty sputum production and normal temperature. During remission, the patient is completely healthy.
Diagnostics
When making a diagnosis of “Recurrent bronchitis” (according to ICD-10 code - J 20), the anamnesis is specified, radiography, bronchography, HPF, a general blood test, skin allergy tests, and sputum culture on bacterial flora are performed. Exacerbation of this pathology is characterized by hard breathing, wet and dry rales of various sizes, which have an unstable character and localization. Paravertebral can determine the shortening of percussion tone on both sides, the extension of the exhale. During remission, there is an increased cough readiness with slight hypothermia, overwork and physical exertion.
Radiography of the lungs with relapsing-type bronchitis demonstrates a long-term stable increase in the pulmonary pattern in the basal areas, its preservation during the period of remission, and a gradual return to normal.
Bronchoscopy allows you to evaluate changes in the bronchial tree and the presence of a secret. With a relapse of bronchitis, minor fibrinous deposits or elongated filaments and individual lumps of sputum mucosa form on the walls of the bronchi. Diffuse changes in the contour of bronchial lumens, most pronounced in the upper zones of the main bronchi, are also visible. With FVD, fuzzy obstructive disorders of a reversible nature, latent bronchospasm, weak bronchial hyperreactivity can be determined.
What will the blood test show?
In the composition of peripheral blood, a slight increase in the number of leukocytes, an increase in ESR can be detected, with the allergic nature of the origin of recurrent bronchitis - eosinophilia. In order to assess the sensitivity to infectious pathogens, skin tests with bacterial (streptococcal and staphylococcal) allergens are performed. In addition, the patient is referred for consultation with an allergist and pulmonologist. Relapsing acute bronchitis is recommended to be differentiated from bronchial asthma, pneumonia, cystic fibrosis, tuberculosis, obliterating bronchiolitis, the presence of a foreign body in the bronchi.
Treatment and clinical recommendations for this pathology
Treatment of recurrent bronchitis is carried out on an outpatient basis with the appointment of an abundant drinking regimen, rest, and a fortified diet. For ARVI symptoms, patients are prescribed antiviral medications (Umifenovir, Remantadin), in the case of chlamydial or mycoplasma genesis of this form of bronchitis, antibiotic therapy (macrolides) is used in combination with immunomodulators (Tiloron, tincture of echinacea), as well as some anti-inflammatory "Fenspiride").
What else is used in the treatment of recurrent bronchitis in children and adults?
Inhalation
With a strong productive cough, inhalation with alkaline solutions and mucolytic drugs (Ambroxol, Carbocysteine), UHF, vibration massage, therapeutic breathing exercises, postural drainage is recommended. In the period of exacerbation of the disease in the presence of bronchial obstruction, it is recommended to use inhaled bronchodilators (Fenoterol, Salbutamol), in severe cases, glucocorticoids (Prednisolone, Dexamethasone) are prescribed systemically or aerosol. In children with a history of allergic symptoms, antihistamines are used. Inhalation with a nebulizer is also recommended. Treatment of recurrent obstructive bronchitis in children should be comprehensive and timely.
Prevention and prognosis
It is advisable for people with such bronchitis to conduct clinical monitoring until the relapse is completely stopped within 2 years, and spa treatment is also indicated. With a recurring form of bronchitis, the prognosis is relatively favorable, since this pathology is in most cases reversible. The risk of converting it into bronchial asthma or into an asthmatic form is determined by the occurrence of bronchospasm and the age of the patient. Children are more likely to experience such complications. Relapse prevention covers the prevention of viral diseases, early initiation of antiviral therapy, elimination of allergic causes, physical activity and hardening, as well as timely vaccination against measles, influenza and pneumococcal infection.
Children with a tendency to inflammation of the bronchi are advised to avoid hypothermia, staying in groups during seasonal exacerbations of respiratory diseases. In addition, doctors consider the normalization of lifestyle, improving nutritional quality, moderate physical activity, and prophylactic antiviral medications to be mandatory prevention. If the first signs of the disease occur or are suspected of them, urgent medical attention is recommended. We reviewed clinical guidelines for recurrent bronchitis in children and adults.