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PREVALENCE AND RISK FACTORS OF BRONCHO-OBSTRUCTIVE
SYNDROME IN YOUNG CHILDREN
Tursinbekova Xamida Kuanishbaevna
Kdirniyazova Sarbinaz Aybosinovna
Medical Institute of Karakalpakstan
Relevance of the topic:
The article is devoted to the clinical and pharmacological
audit of the use of antibiotics in the treatment of broncho-obstructive syndrome (BOS)
in premature infants living in the Aral Sea region, using the Republic of Karakalpakstan
as an example. Broncho-obstructive syndrome is one of the most common and
clinically significant problems among premature infants today. According to a
retrospective analysis, the frequency of CF in patients is 1.9% of the total number of
children with bronchopulmonary pathology in Tashkent, 1.0% in the Khorezm region
and 1.0% in the Republic of Karakalpakstan. Among the social risk factors that have
the greatest impact on the development of cystic fibrosis in children, marriage between
relatives is considered (26.6%). The main factors aggravating the course of the
pathology are: medical and biological factors - complicated pregnancy (91.1%),
diseases during pregnancy (73.3%), anemia of I-II degree during pregnancy (100.0%),
aggravated premorbid background in the child (anemia of I-II degree - 100.0%, AEE -
91.6%, residual complications of rickets - 63.8%, atopic dermatitis - 91.6%).
Broncho-obstructive syndrome (BOS)
is a clinical symptom complex
characterized by narrowing or occlusion of bronchi of various calibers due to
accumulation of bronchial secretions, thickening of the wall, spasm of smooth muscles,
decreased mobility of the lung or compression by surrounding structures. BOS is a
common pathological condition in pediatrics, especially among children under 3 years
of age. According to various statistics, BOS occurs in 5-45% of cases against the
background of acute respiratory diseases. In the presence of an aggravated anamnesis,
this figure is 35-55%. The prognosis for BOS varies and directly depends on the
etiology. In some cases, clinical manifestations completely disappear against the
background of adequate etiotropic treatment, while in others, the process becomes
chronic, disability or even death occurs.
The main cause
of broncho-obstructive syndrome in children is infectious
diseases and allergic reactions. Among ARVI, bronchial obstruction is most often
provoked by parainfluenza viruses (type III) and RS infection. Other possible causes:
congenital heart defects and bronchopulmonary system, RDS, genetic diseases,
immunodeficiency states, bronchopulmonary dysplasia, aspiration of foreign bodies,
GERD, roundworms, hyperplasia of regional lymph nodes, neoplasms of the bronchi
and adjacent tissues, side effects of medications.
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In addition to the main causes of broncho-obstructive syndrome in children, there
are contributing factors that significantly increase the risk of developing the disease
and worsen its course. In pediatrics, these include a genetic predisposition to atopic
reactions, passive smoking, increased reactivity of the bronchial tree and its anatomical
and physiological features in infancy, hyperplasia of the thymus gland, vitamin D
deficiency, artificial feeding, low div weight, and intrauterine diseases. All of them
can enhance each other's influence on the child's div and aggravate the course of
broncho-obstructive syndrome in children.
Pathogenetically, broncho-obstructive syndrome in children can be caused by an
inflammatory reaction of the bronchial wall, spasm of smooth muscles, occlusion or
compression of the bronchus. The above mechanisms can cause narrowing of the
bronchial lumen, impaired mucociliary clearance and thickening of secretions, edema
of the mucous membrane, destruction of the epithelium in large bronchi and its
hyperplasia in small ones. As a result, deterioration of patency, dysfunction of the lungs
and respiratory failure develop.
The clinical picture
of broncho-obstructive syndrome in children largely
depends on the underlying disease or factor that provokes this pathology. The general
condition of the child in most cases is moderate, there is general weakness,
capriciousness, sleep disturbance, loss of appetite, signs of intoxication, etc. BOS itself,
regardless of the etiology, has characteristic symptoms: noisy loud breathing, wheezing
that can be heard from a distance, a specific whistle when exhaling.
Also observed is the participation of accessory muscles in the act of breathing,
attacks of apnea, dyspnea of expiratory (more often) or mixed nature, dry or
unproductive cough. With a protracted course of broncho-obstructive syndrome in
children, a barrel-shaped chest can form - expansion and protrusion of the intercostal
spaces, horizontal course of the ribs. Depending on the background pathology, fever,
div weight deficit, mucous or purulent discharge from the nose, frequent
regurgitation, vomiting, etc. may also be present.
Diagnosis
of broncho-obstructive syndrome in children is based on the collection
of anamnestic data, objective examination, laboratory and instrumental methods. When
interviewing the mother, the pediatrician or neonatologist focuses on possible
etiological factors: chronic diseases, developmental defects, allergies, BOS episodes in
the past, etc. Physical examination of the child is very informative in case of broncho-
obstructive syndrome in children. Percussion reveals increased pulmonary sound up to
tympanitis. Auscultatory picture is characterized by harsh or weakened breathing, dry,
whistling, in infancy - small-caliber wet rales.
Laboratory diagnostics for broncho-obstructive syndrome in children includes
general tests and additional tests. In the CBC, as a rule, non-specific changes are
determined that indicate the presence of an inflammatory focus: leukocytosis, a shift
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in the leukocyte formula to the left, an increase in ESR, and in the presence of an
allergic component - eosinophilia. If it is impossible to establish the exact etiology,
additional tests are indicated: ELISA with the determination of IgM and IgG to
probable infectious agents, serological tests, a test to determine the level of chlorides
in sweat if cystic fibrosis is suspected, etc.
Among the instrumental methods that can be used for broncho-obstructive
syndrome in children, the most commonly used are chest radiography, bronchoscopy,
spirometry, and less often CT and MRI. Radiography makes it possible to see dilated
lung roots, signs of concomitant parenchymal damage, the presence of neoplasms or
dilated lymph nodes. Bronchoscopy allows you to identify and remove a foreign div
from the bronchi, assess the patency and condition of the mucous membranes.
Spirometry is performed in the case of a long-term course of broncho-obstructive
syndrome in children in order to assess the function of external respiration, CT and
MRI - when radiography and bronchoscopy are low in information content.
Treatment
of broncho-obstructive syndrome in children is aimed at eliminating
the factors causing obstruction. Regardless of the etiology, in all cases, hospitalization
of the child and emergency bronchodilator therapy using β2-adrenergic agonists are
indicated.
Anticholinergic
drugs,
inhaled
corticosteroids,
systemic
glucocorticosteroids can be used later. Mucolytic and antihistamine agents,
methylxanthines, and infusion therapy are used as auxiliary drugs. After determining
the origin of broncho-obstructive syndrome in children, etiotropic therapy is
prescribed: antibacterial, antiviral, anti-tuberculosis agents, chemotherapy. In some
cases, surgical intervention may be required. If there are anamnestic data indicating the
possible ingress of a foreign div into the respiratory tract, emergency bronchoscopy
is performed.
The prognosis for broncho-obstructive syndrome in children is always serious.
The younger the child, the more severe his condition. Also, the outcome of BOS largely
depends on the underlying disease. In acute obstructive bronchitis and bronchiolitis,
recovery is usually observed, bronchial tree hyperreactivity rarely persists. BOS in
bronchopulmonary dysplasia is accompanied by frequent acute respiratory viral
infections, but often stabilizes by the age of two. In 15-25% of such children, it
transforms into bronchial asthma. BA itself can have different courses: a mild form
goes into remission already in primary school age, a severe form, especially against the
background of inadequate therapy, is characterized by a deterioration in the quality of
life, regular exacerbations with a fatal outcome in 1-6% of cases. BOS against the
background of obliterating bronchiolitis often leads to emphysema and progressive
heart failure.
Prevention
of broncho-obstructive syndrome in children involves eliminating all
potential etiological factors or minimizing their impact on the child's div. This
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includes antenatal care of the fetus, family planning, medical and genetic counseling,
rational use of medications, early diagnosis and adequate treatment of acute and
chronic respiratory diseases, etc.
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