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CLINICAL ASPECTS AND RISK FACTORS OF RECURRENT
BRONCHITIS IN CHILDREN
Azizova N. D.
Republican Specialized Scientific and Practical Medical Center of
Pediatrics of the Ministry of Health of the Republic of Uzbekistan.
Kabilova D.K.
Medical Faculty of the Central Asian Medical University. Fergana.
Zokirov B.K.
Andijan State Medical Institute.
Relevance:
Bronchopulmonary pathology in childhood is diverse and includes acute and chronic,
infectious-inflammatory and allergic diseases, congenital and hereditary lung diseases. Some
nosological forms of respiratory
Recurrent obstructive bronchitis in young children, as a condition preceding bronchial
asthma, is one of the pressing issues in pediatric pulmonology and allergology. Most authors
acknowledge that, in terms of its etiological, pathogenetic, and clinical essence, recurrent
obstructive bronchitis (ROB) sets the stage for the development of bronchial asthma, which
provides grounds for considering children with recurrent obstructive bronchitis as a group at risk
for this disease [1,2,3]. Bronchial obstructive syndrome (BOS) clinically manifests as difficulty
and prolongation of exhalation, lung hyperinflation, involvement of accessory respiratory muscles,
and wheezing during exhalation. The onset of bronchial obstruction usually occurs gradually,
more often on the second or third day of ARI, which distinguishes it from an asthma attack that
develops suddenly. The highest frequency of bronchial obstructive syndrome occurs in early
childhood, which is due to the relative narrowness of the airways, weakness of the respiratory
muscles, abundant blood supply, and hypersecretion of bronchial glands (115).
Thus, the trend of increasing acute respiratory diseases (ARD) in children and their role
in the development of bronchial obstruction, the high risk of recurrent obstructive bronchitis and
the possibility of developing bronchial asthma, the variety of immune disorders in this pathology
determine the relevance of studying the factors and mechanisms of bronchial obstruction
syndrome formation in children with respiratory tract infections.
Keywords:
Recurrent bronchitis, Pediatric bronchitis, Clinical aspects, Risk factors, Prevention,
Treatment strategies
Objective of the work:
study the clinical features and risk factors for the development of
recurrent bronchitis in children.
Materials and methods.
Bronchoobstructive syndrome in young children manifests in
two clinical variants: acute obstructive bronchitis (AOB) - an episode of bronchial obstruction that
usually occurs for the first time in life against the background of an acute respiratory infection,
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and recurrent bronchitis with bronchial obstruction (RB with BO) - the recurrence of episodes of
bronchial obstruction 2-3 or more times over 1-2 consecutive years.
During the course of our work, 90 children aged from 3 months to 3 years were examined.
The material for observations and studies consisted of the following groups of children:
I group - 45 patients with recurrent bronchitis with bronchial obstruction.
II group - 45 patients with recurrent bronchitis.
During the work, a questionnaire was used, which included questions accessible to
parents about the child's history of BO, its frequency, clinical manifestations, hereditary
predisposition to allergic and bronchopulmonary diseases, increased sensitivity to food, drug,
vaccine allergens and antigens, as well as information about the number of pregnancies the mother
had, the presence of gestosis, nephropathy, preeclampsia, and data on the ecological condition of
the place of residence.
Results of the study and their discussion.
Analyzing these indicators, we found that in
cases of RB with BO, patients were mainly admitted on the 3rd to 5th day of the illness (67.3%);
in cases of RB with recurrent course, children were mainly admitted on the 5th to 7th day of the
illness - 24 (48.0%) children after unsuccessful home treatment.
It is known that the health and development of a child are influenced by important
aspects such as the specifics of obstetric history, the condition of the newborn, and its
development up to the moment the current disease arises. Analyzing the complete medical history
data of the examined children, we identified the most frequently encountered risk factors (Table 1).
As can be seen from the table, the majority of RB patients with BO were born from II-III
pregnancies 20 (45.3%) and, respectively, II-III births 17 (38.5%). RB patients 22 (49.2%) were
born from the first pregnancy, from II-III pregnancies in 17 (38.5%) cases, and from IV and more
– 5 (12.3%) children. In the majority of the observed mothers of the examined patients, there were
various complications during pregnancy, and this was highest in the group of mothers of patients
with BA, 39 (87.7%). Acute respiratory infections during pregnancy were most common in the
group of mothers of children with RB, 36 (80.0%). During pregnancy, mild or moderate anemia
was diagnosed in mothers of children with RB with BO in 64 (85.3%) cases, RB with BO in 45
(75.0%), and RB in 54 (83.1%). In the group of patients with RB, in 37 (83.1%) cases, the
mothers had a history of pathological labor. Prematurity and birth asphyxia were identified with
the highest frequency in the RB patient group – 2 (6.2%) and 6 (14.7%), respectively, while in the
non-RB group, they were 2 (6.2%) and 9 (21.5%).
Table 1.
Factor analysis of examined children
Risk factors
RB
n=45
RB with BO
n=45
Р
аbc
%
аbc
%
Born from: I am pregnant
22
49,2
18
41,3
>0,05
II-III pregnancy
17
38,5
20
45,3
>0,05
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IV and more pregnant.
5
12,3
5
13,3
>0,05
Born from: I births
24
53,9
19
44,0
>0,05
II-III degrees
17
38,5
15
45,3
<0,01
IV and more births
3
7,7
3
10,7
>0,05
Complications
of
the
current
pregnancy: toxemias of the first and
second halves
39
87,7
21
46,7
>0,05
Anemia grade I-II
37
83,1
38
85,0
>0,05
Maternal diseases during pregnancy:
ORI
36
80,0
17
38,7
>0,05
Pathological course of labor
18
40,0
12
28,3
<0,01
Born: premature
2
6,2
6
14,7
<0,01
in asphyxiation
9
21,5
13
30,0
<0,01
Nutrition up to one year:
- natural
20
46,6
18
66,6
<0,01
- artificial
10
22,3
4
10,0
>0,05
- mixed
15
35,3
10
23,3
>0,05
In the clinical picture of recurrent bronchitis (Table 1), all 45 children (100%) exhibited
signs of intoxication: subfebrile temperature in 14 (32.5%) children, fever (above 38.1 °C) in 6
(14.5%), weakness, adynamia in 34 (76.9%), decreased appetite in 33 (73.5%), emotional lability
in 25 (57.3%) children. In 32 (72.6%) children, difficulty in nasal breathing was noted, mucous
nasal discharge in 22 (47.9%). In 100% of children, the dominant symptom was cough, of which
20 (45.3%) had a non-productive cough, and the rest had a productive cough. Signs of expiratory
difficulty in breathing, noisy or wheezing in nature, were present in 11 (25.6%) children,
involvement of accessory muscles in the act of breathing in 4 (9.4%), nasal flaring in 23.9%.
Additionally, pallor of the skin was observed in 28 (62.4%) children, dry skin in 8 (19.6%), oral
cyanosis in 17 (39.3%) children.
Table 2.
The frequency of clinical symptoms in the examined children, (%)
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The clinical picture in 43 (95.7%) patients with recurrent bronchitis was characterized
by the enlargement of lymph nodes in various groups, hypertrophy of the tonsils in 35 (79.5%).
Percussion over the lungs revealed a boxy shade of percussion sound in 11 (25.6%).
Auscultation revealed scattered dry wheezes in 20 (45.3%) children, moist, varied in caliber in
37 (82.6%), in 3 (8.5%) there was dullness of heart sounds, and in 5 (11.9%) a systolic murmur
was heard at the apex of the heart. Hepatomegaly was present in 23 (52.9%) patients, and
hepatosplenomegaly in 14 (32.7%).
When examining peripheral blood, pronounced shifts were not characteristic: in 11
(25.6%) cases, the erythrocyte sedimentation rate (ESR) was moderately accelerated, slight
leukocytosis was observed in 7 (17.1%), anemia in 14 (32.5%), lymphocytosis in 45 (100%),
and lymphomonocytosis in 28 (62.4%). Radiologically, bilateral enhancement of the lung
pattern was determined in 45 (100%), enlargement of the lung roots in 45 (100%), increased
transparency of the lung fields in 14 (32.5%), and thickening of the pattern in the root sections
in 11 (25.6%). In 4 (10.3%) children, signs of incomplete blockade of the right bundle branch
of the His bundle were detected on electrocardiography (ECG).
Gastrointestinal disturbances manifested as changes in appetite: an increase in 6
(15.0%) children with recurrent bronchitis or a decrease in 23 (51.7%) children with RB. Thirst
was increased in 21 (47%) patients with RB, decreased in 23 (51.7%) with RB.
Changes in the urinary system in the form of nocturnal enuresis were identified in
patients with RB in 10 (23.3%) cases.
Clinical manifestations of allergic reactions of various etiologies were observed 9
times more frequently in children with recurrent bronchitis 1 (3.3%).
Conclusions:
thus, the comparison of clinical observations of children in all study
groups showed that in RB, there is a longer duration of oral wheezing, wet cough, and wet
wheezing in the lungs. X-rays of patients in all groups revealed bilateral enhancement of the
lung pattern, enlargement of the lung roots, and increased transparency of the lung fields,
which are characteristic of BO syndrome. The main prognostic risk factors for the development
of recurrent bronchitis in children are: perinatal factors, a complicated premorbid background,
concomitant and past illnesses.
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