International Journal of Scientific Pediatrics
ABOUT MODERN METHODS OF TREATMENT OF ACUTE
STENOSING LARYNGOTRACHEITIS IN CHILDREN
Uralov Sh.M.
, Aralov M.Zh.
2
3
, Nazhimov Sh.R.
4
1. Candidate of Medical Sciences, Associate Professor, Samarkand State Medical
University, Samarkand, Uzbekistan.
2.Candidate of Medical Sciences, Associate Professor, Samarkand State Medical
University, Samarkand, Uzbekistan.
3. Assistant, Samarkand State Medical University, Samarkand, Uzbekistan.
4. Assistant, Samarkand State Medical University, Samarkand, Uzbekistan.
Academic Editor:
Arzikulov A.
Professor, Andijan State Medical
Institute
Received:
15
September
2022
Accepted:
25
September
2022
Published:
30
September
2022
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authors. Licensee IJSP, Andijan,
Uzbekistan. This article is an open
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(CC BY-NC-ND) license (https://
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Annotation:
Acute infectious and inflammatory processes in the upper respiratory
tract still form the main list of diseases in childhood, which maintains the constant
interest in this pathology of specialists in various fields, such as pediatricians, infectious
disease specialists, otorhinolaryngologists, allergists, and immunologists. Particular
attention of researchers and clinicians is attracted by the study of the etiopathogenetic
mechanisms of the occurrence of laryngotracheitis, which is caused, first of all, by the
development of a life-threatening condition of acute stenosis of the respiratory tract in
children. According to our observations and according to the literature, there has recently
been a clear trend towards an increase in the frequency of repeated episodes of acute
stenosing laryngotracheitis (ASLT) in children, which makes it obvious that further study
of the underlying mechanisms of not only the occurrence, but also the recurrence of
ASLT is necessary. Recurrence of laryngotracheitis contributes to the formation of chronic
inflammatory processes and hyperreactivity of the upper respiratory tract, negatively
affects the maturation of the child’s immune system, which leads to the development of
secondary immunosuppression. Each new respiratory infection provokes more and more
serious disorders of the immune system, contributing to the formation of both chronic
inflammatory diseases of the pharynx and respiratory allergies. The modern concept of the
etiopathogenesis of laryngotracheitis takes into account the action of multiple infectious
and allergic trigger factors, the most significant in immunocompromised children. Currently,
the primary tasks awaiting solution are timely prevention and diagnosis, the provision
of highly qualified medical care, including bronchopulmonary diseases in children by
expanding the use of modern methods of diagnosis and treatment, which will improve the
quality of life of children.
Introduction.
The urgency of the problem of acute stenosing
laryngotracheitis (ASLT), which accompanies acute respiratory viral
infections, is due to its high prevalence in childhood, pronounced
dynamism of clinical symptoms, the possibility of rapid development
of bacterial complications and death. The modern concept of the
pathogenesis of recurrent ASLT provides for the development of
a pathological process as a result of the complex effect of various
etiological factors, including infectious, allergic ones, however, until
now, laboratory diagnostics of the latter in practice has not become
widespread. The main pathogenetic mechanisms that form respiratory
disorders: swelling of the mucous membrane of the larynx and
trachea, spasm of the muscles of the larynx, trachea and bronchi,
hypersecretion of the glands of the mucous membrane of the larynx,
trachea and bronchi, become the leading ones that determine the
clinic, and ultimately therapy.It should be noted that the search for
new approaches to ASLT therapy, which would allow influencing both
the etiological and pathogenetic mechanisms of the disease, remains
relevant so far.
When analyzing the literature on the treatment of ASLT, the
greatest number of different views of clinicians on this problem was
Key words:
acute stenosing laryngotracheitis, childhood, etiopathogenesis,
treatment methods
Article
OPEN ACCESS
25
IJSP
published: 30 September 2022
doi.org/10.56121/2181-2926-2022-5-25-31
2022 / Issue 05 / Article 05
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found [1]. A necessary condition for the successful treatment of ASLT
is the mandatory transportation of the child to the hospital. Children
with compensated and subcompensated ASLT should be hospitalized
in the infectious-box departments of children’s hospitals. Treatment
of decompensated forms is carried out in intensive care units. A
number of authors adhere to the point of view that a specialized
laryngitis department based on a multidisciplinary children’s hospital
is the most rational form of providing assistance to patients with acute
laryngotracheitis [2].
Results end Discussion.
In recent years, various methods have
been proposed for the treatment of children with acute respiratory viral
infection, which occurs with symptoms of stenosing laryngotracheitis.
So far, questions about the appropriateness of certain methods of
treatment have been discussed [2, 3]. It must be remembered that
glucocorticoids, especially those used for a long time and in high
doses, cause hormonal immunosuppression and the progression of
the inflammatory process in the presence of bacterial flora. And if we
take into account that, according to the majority of authors, with ASLT
in the stage of laryngeal stenosis I-II, it is possible to achieve a positive
clinical effect without the use of steroid hormones.Some investigators
prescribed sedative therapy (valerian, relanium, 1-3% sodium bromide
solution, pipolfen, sodium hydroxybutyrate, etc.) during ASLT in order
to relieve psychomotor agitation. There is a lot of controversy about
the use of antibiotics in this disease. There are studies that have
shown a high prevalence of persistent chlamydial infection in children
with recurrent stenosing laryngotracheitis. The authors propose to use
«new» macrolides with a wide spectrum of action (including against
chlamydia) - sumamed, rulid, rovamycin, josamycin (vilprafen).
VF Uchaikin with co-authors, noting that the main cause of
stenosis of the larynx in children is influenza or parainfluenza infection,
as an etiotropic method of treatment suggests the use of a complex
homeopathic preparation Aflubin. At the same time, the scientist notes
that in each case, especially with croup syndrome in a child, it can be
difficult to exclude the role of the bacterial flora. And the use of Aflubin
against the background of antibiotic therapy significantly reduces the
time of its implementation and reduces the frequency of side effects
of the antibiotic [4].
The need for immunotherapy in the period of convalescence is
indicated by many authors. The duration of immunotherapy courses
and the choice of the drug is determined by the presence of an
etiotropic pathogen and concomitant microflora, the prevalence of
the inflammatory process, and the age of the child [5]. Literature
data indicate an increasing incidence of the disease among children,
the lack of 100% effectiveness of existing methods of treatment and
prevention, and individual rehabilitation that has not been worked out.
For the treatment of children suffering from recurrent stenosing
laryngotracheitis, bacterial lysates such as Bronchomunal and
Ribomunil, which are stimulants of specific and nonspecific immunity,
have been used. In complex therapy, bifiform was also used - a
combined preparation, which includes natural bifidum bacteria and
enterococci, fenspiride hydrochloride, which has an anti-inflammatory
effect, retinol acetate or Triovit capsules containing vitamins C, E
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and β-carotene, phenibut - a nootropic drug , which was prescribed
to patients with significant disturbances in the bioelectrical activity of
the brain. The technical result of the proposed method consists in
choosing a therapy regimen depending on the degree of dysbiosis of
the mucous membranes of the nasopharynx and oropharynx, followed
by a complex effect on the microflora of the large intestine, airway
hypersensitivity and impaired brain bioelectric activity in children.
It was found that in children suffering from recurrent stenosing
laryngotracheitis, there are significant disturbances in the composition
of the microflora of the mucous membranes of the nasopharynx and
oropharynx, characterized by the development of dysbiosis of I or II
degree, associated disorders of the microbiocenosis of the digestive
tract, forming chronic inflammation of the mucous membranes,
contributing to the sensitization of the div, leading to violation of the
function of external respiration and threshold sensitivity, bioelectrical
activity of the brain, which causes a persistent course of the disease
and justifies the need to include drugs and methods in the complex of
therapy that allow correcting the identified changes.
Local use of hormonal preparations with the help of a nebulizer
accelerates the relief of laryngeal stenosis in acute stenosing
laryngotracheitis by 1.5-2 times, and reduces the time of recovery and
stay of patients in bed. The nebulizer has an advantage over other
types of inhalers, as it forms microparticles of a certain size and mass,
facilitating their deposition at the level of the upper respiratory tract.
The proposed method of treatment by T.V. Medvedeva is simple
in execution, available for any infectious diseases hospital equipped
with simple inhalers, reduces the load of therapeutic effects on the
child, as well as the load of the physiotherapy room [6]. Due to the
antiviral, immunomodulating effect of leukinferon, a decrease in the
frequency of recurrence of laryngeal stenosis in children, as well as the
frequency of acute respiratory viral infections, is expected. A method for
treating stenosing laryngotracheitis in children, including antibacterial,
hormonal, desensitizing, antispasmodic, muco-, secretolytic, enzyme
therapy and inhalation administration of a drug, characterized in that
leukinferon is used as a drug for inhalation administration on the first
day of treatment at a dose of 10,000 IU for interferon, diluted in 5 ml
of 0.9% sodium chloride solution, from the second day - physiological
sodium chloride solution, and inhalations are carried out three times a
day for 10 minutes with an interval of 4 hours until the disappearance
of clinical symptoms.
The developed method of extubation in patients with ASLT using
drugs: sodium oxybutyrate, diphenhydramine, prednisolone and
lasix, allows for effective antinociceptive protection of the trachea.
In addition, the method of antinociceptive protection of the trachea
during extubation helps to reduce the time of prolonged intubation
by 3-5 days compared to traditional methods, and also reduces the
number of post-intubation complications by 1.5-3 times.
The approach to choosing a complex of therapeutic and
rehabilitation measures should be individual and determined by the
nature of dysbiotic disorders on the mucous membranes of the upper
respiratory tract and large intestine, the sensitivity of the respiratory
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tract and the established changes in the bioelectric activity of the brain.
Some investigators prescribed sedative therapy (valerian, relanium,
1-3% sodium bromide solution, pipolfen, sodium hydroxybutyrate,
etc.) during ASLT in order to relieve psychomotor agitation.
For the successful treatment of stenosing laryngotracheitis,
early hospitalization of patients in a specialized department for the
management of patients with ASLT or in a somatic children’s (infectious)
department in the presence of an intensive care unit is mandatory.
Patients with ASLT of the 3rd degree, as well as the 2nd degree, are
subject to hospitalization in the intensive care unit if the course of the
disease does not improve within 24-48 hours against the background
of ongoing therapy adequate to the severity of the condition. The need
for immunocorrective therapy in the complex treatment of acute and
recurrent laryngotracheitis can be caused by the severity of immune
and immunoregulatory disorders, as well as the characteristics of the
adaptive immune response in children [7, 8, 9].
In the literature of recent years, there is more and more evidence
that it is almost impossible to cope with the growth of infectious morbidity
with the help of antibiotics, antiviral and other chemotherapeutic
drugs alone [10, 11]. The above drugs suppress the reproduction of
the pathogen, but its final elimination from the div is the result of
the activity of immunity factors. Therefore, against the background
of suppressed immunoreactivity, the action of antiviral, antibacterial
agents will be ineffective or ineffective. In addition, immunotherapy
is of particular importance due to the increase in antibiotic-resistant
3-lactamase-producing strains, the strengthening of the role of
opportunistic microbial flora in the etiology of laryngitis in children.
In this regard, at present, the interest of researchers and
practitioners in drugs that affect immunity, used in the complex
treatment of various pathologies of both infectious and other
genesis, has significantly increased. Immunotherapy is prescribed in
combination with other drugs (antibiotics, NSAIDs). Its effectiveness
depends on the correct assessment of the initial state of the patient’s
immunoreactivity, the nature and severity of pathological changes,
the choice of the optimal drug and the scheme of its use. It is also
necessary to have an idea about the mechanisms of action of
prescribed drugs, their side effects, compatibility with other methods
of treating laryngotracheitis, and allergenic properties.
Taking into account the pathogenetic features of acute and
recurrent laryngotracheitis in children, one of the main problems of
treatment should be considered the search for optimally effective
and safe means of etiotropic, immunomodulatory therapy that is
compliant for the child. According to the requirements, drugs used
in the treatment of acute and recurrent viral infections in children of
various localizations must combine the properties of an inhibitor of
viral reproduction and an effective stimulator of the div’s immune
defense in order to eliminate the inertia of a specific antiviral immune
response in children.
Among the whole variety of immunocorrectors, the most
promising is the use of drugs from the class of recombinant interferons,
in particular viferon, endogenous interferon inducers - drugs with
a universally broad spectrum of action (arbidol), as well as drugs
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belonging to the group of thymic factors (imunofan).
Viferon is a complex immunomodulatory and antiviral drug with a
virocidal effect, as well as the ability to modulate and enhance antiviral
resistance. The composition of Viferon includes membrane-stabilizing
components (vitamin E and ascorbic acid), the combination with which
causes an increase in the antiviral activity of recombinant interferon,
an increase in its immunomodulatory effect on T- and B-lymphocytes.
When exposed to exogenous interferon in the div, the activity of
natural killers, T-helpers, cytotoxic T-lymphocytes, phagocytic activity,
and the intensity of differentiation of B-lymphocytes increase.
The listed properties of interferon allow it to effectively participate
in the processes of pathogen elimination, prevention of infection and
possible complications. Viferon is quite widely used for the treatment
of uncomplicated forms of respiratory viral infections, however, the
effectiveness of its use in acute and recurrent laryngo-racheitis has
not been evaluated. At the same time, given the disturbances in
the interferon status that occur in acute, and especially in recurrent
laryngitis / laryngotracheitis, we assume that this drug will be quite
effective in the treatment of children with this pathology.
Imunofan is a drug with immunostimulating, detoxifying,
hepatoprotective and antioxidant effects.Its action is based on the
enhancement of phagocytosis reactions and the death of intracellular
bacteria and viruses, as well as the restoration of disturbed indicators
of cellular and humoral immunity, by enhancing the proliferation of
T-lymphocytes, increasing the production of interleukin-2, TNF-α,
IFN-γ. As shown by the analysis of literature data, this drug has
not been previously used in acute and recurrent laryngotracheitis.
However, in our opinion, the range of immunocorrective action of
imunofan suggests the effectiveness of its use in the complex therapy
of acute respiratory infections, in general, and in laryngotracheitis in
particular.
Recently, Arbidol has been widely used for the treatment and
prevention of respiratory viral infections. Since this drug, in addition
to virus-specific and antioxidant, also has immunomodulatory and
interferon-inducing effects, it seems interesting to compare the
effectiveness of arbidol in LT in children with the effectiveness of the
above drugs. Arbidol is a synthetic antiviral drug that can also stimulate
the synthesis of endogenous interferon, activate phagocytosis and
affect the state of the T-cell immunity. The mechanism of its antiviral
action is associated with the inhibition of the translation of virus-specific
proteins in infected cells, as a result of which the reproduction of
viruses is suppressed. It has been established that arbidol specifically
inhibits influenza A and B viruses and increases the div’s resistance
to other respiratory viruses. Arbidol refers to low-toxic drugs. When
administered orally in recommended doses, it does not have any
negative effect on the child’s div. The use of arbidol in ARVI is
widespread, but the effectiveness of its use for the treatment of acute
and recurrent laryngotracheitis has not been evaluated.
Cytokines are the main mediators of local inflammation and
acute phase response at the div level. Changes in the state of
the immune system of children with ASLT, as well as the possibility
of regulating these disorders with the help of cytokines, provide a
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basis for searching for immunological approaches to the treatment
of this disease.Currently, to correct the identified disorders in ASLT
in children, monopreparations of cytokines of both natural (human
leukocyte interferon) and genetically engineered origin (reaferon) have
been used, the use of which contributes to the relief of symptoms of
the disease at an earlier time.
At the same time, it is of interest to study the role of complex
preparations of cytokines in the treatment of ASLT in children, given the
variety of immunological disorders in this disease. Leukinferon is one
of the complex drugs. The clinical efficacy of leukinferon in children for
the immunocorrection of diseases of the bronchopulmonary system,
as well as viral infections (caused by the herpes virus, hepatitis B, C, D
viruses, etc.) has been shown. In these cases, the immunomodulatory
effect of the drug is combined with its antiviral effect. Due to the
biological characteristics of cytokines (short half-life, etc.), in order to
achieve the greatest clinical effect of the drug, it is optimal to create
a high local concentration in the area of inflammation. A similar effect
can be achieved with the inhalation of leukinferon.
The inhalation use of cytokines (leukinferon) in the complex
therapy of ASLT is recommended as an effective, safe and easily
performed method of treating children with grade 1-2 laryngeal
stenosis, which allows to reduce the amount of therapeutic burden
on patients and reduce their length of stay in the hospital. In addition,
the study of cytokine, in particular interferon, status is fundamentally
important for clarifying the most important pathogenetic mechanisms
of the development of this pathology in childhood, which is not only an
important criterion in prescribing adequate individual anti-inflammatory
and immunocorrective therapy, but also, possibly , will allow to
individualize the prognosis of the disease. This will contribute to a
differentiated approach to the choice of the method of rehabilitation
and anti-relapse treatment, as well as to single out children from the
risk group for the occurrence of ASLT relapses in the future [8].
Thus, ASLT in children currently remains a serious public
health problem due to their wide prevalence, the economic damage
they cause to society as a whole and to individuals in particular.
Attention is drawn to the increase in the frequency of recurrence
of laryngotracheitis, which contributes to the formation of chronic
pathology of the respiratory organs, can lead to a delay in the physical
and psychomotor development of children, adversely affect the
formation of the child’s immune system, and lead to the development
of secondary immunosuppression.
REFERENCES
1. Царькова С.А. Острый стенозирующий ларинготрахеит у
детей // Российский вестник перинатологии и педиатрии. – 2016.
- №1. – 96-103.
2. Самиева Г.У. Совершенствование комплексной диагности
-
ки, лечения и профилактики стенозирующих ларингитрахеитов у
детей. Автореф. Дисс… д.м.н. Ташкент, 2017. – 52 с.
3. Самиева Г.У., Карабаев К.А. Современные подходы к ди
-
агностике и лечению острого стенозирующего ларинготрахеита у
детей // Вестник врача. – 2012. - №3. – 165-170.
4. Учайкин В.Ф., Харламова Ф.С., Савенкова М.С., Афанасье
-
ва А.А. Лечение афлубином острых респираторных заболеваний
International Journal of Scientific Pediatrics
31
published: 30 September 2022
2022 / Issue 05 / Article 05
со стенозирующим ларинготрахеитом у детей // Эпидемиология и
инфекционные болезни. - 2009. - №5. - С. 63-67.
5. Учайкин В.Ф., Савенкова М.С., Карасева Е.И. Синдром
крупа как проявление респираторного аллергоза // Педиатрия. –
2006. - №6. - С. 33-37.
6. Медведева Т.В., Яснецова А.Ф., Мешкова Р.Я. Ингаляци
-
онная цитокинотерапия детей с острым стенозирующим ларин
-
готрахеитом при острых респираторных вирусных инфекциях:
Сб.: научн. трудов, посвященных 80-летию кафедры фармаколо
-
гии СГМА. - Смоленск, 2001. - С. 93-94.
7. Медведева Т.В., Мешкова Р.Я, Яснецова А.Ф., Шевцова
Н.С. Изучение корреляционной зависимости концентрации им
-
муноглобулинов А, М, G от степени тяжести и возраста детей с
острым стенозирующим ларинготрахеитом // Вестник Смоленской
медицинской академии. - 2000. - №4. - С. 118.
8. Медведева Т.В., Мешкова Р.Я, Яснецова А.Ф., Шевцова
Н.С. Цитокиновый профиль детей с острым стенозирующим ла
-
ринготрахеитом после ингаляционного применения лейкинфе
-
рона // Факторы клеточного и гуморального иммунитета при раз
-
личных физиологических и патологических состояниях: Тезисы
докладов XIV Российской научной конференции. - Челябинск,
2000. - С. 72.
9. Медведева Т.В., Мешкова Р.Я, Яснецова А.Ф., Шевцова
Н.С., Егоров A.C. Изучение корреляционной зависимости синтеза
ИЛ- 1 ß и ФНО-а у детей с острым стенозирующим ларинготрахе
-
итом // Материалы 1 конгресса педиатров-инфекционистов Рос
-
сии «Актуальные вопросы инфекционной патологии у детей». -
М., 2002. - С. 124-125.
10. Khalikova, G. A. (2022). Evaluation of the effectiveness of
the drug «Genferon-lite» in acute bronchiolitis in children. Web of
Scientist: International Scientific Research Journal, 3(5), 1430-1439.
11. Ibatova, S. M., Uralov, S. M., & Mamatkulova, F. K. (2022).
Bronchobstructive syndrome in children. Web of Scientist: International
Scientific Research Journal, 3(5), 518-522.
