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PRINCIPLES OF THERAPY OF ACUTE BRONCHIOLITHIS IN
CHILDREN
Азимова Камола Талатовна
Ассистент кафедры
Педиатрии №3 и медицинской генетики
Самаркандского Государственного
Медицинского Университета,
Каримова Шахнозабону
студентка 415 группы педиатрического факультета
Почта:
Abstract.
Acute bronchiolitis is one of the most common lower respiratory tract
infections in children and causes airway obstruction in 10%-30% of cases. In this
regard, the aim of the study was to optimize the principles of therapy and enhance the
prevention of recurrence of the disease. 54 children with acute bronchiolitis under the
age of two were examined. The study revealed irrational use of antibiotics and
incorrectly selected starting doses for children with acute bronchiolitis. Despite the
existence of a large number of risk factors, in order to reduce the incidence of acute
respiratory infections and bronchiolitis, breastfeeding should be recommended for at
least the first 6 months of life. In case of bronchiolitis, antibiotic therapy is possible
only in the presence of bacterial complications.
Introduction:
One of the most common lower respiratory tract infections in
children is acute bronchiolitis, which causes airway obstruction in young children with
a frequency of 10% to 30% [1,2].
Infectious bronchiolitis is common in young children. By the age of three, almost
every child is infected with the respiratory syncytial virus, which most often affects the
lower respiratory tract. Every year, 7-13% of patients with acute bronchiolitis
worldwide require inpatient treatment and 1-3% require hospitalization in the intensive
care unit [3]. The role of the etiological factor in the development of the disease
depends on the child’s age, time of year, somatic status and a number of other factors
[4].
Management of patients with acute bronchiolitis occupies a special place in
pediatric practice due to the severity of the course and the tendency to relapse [5].
Repeated episodes of broncho-obstruction create conditions for the subsequent
formation of chronic forms of allergic diseases of the respiratory tract, in particular,
bronchial asthma [6]. An analysis of the literature indicates that antibiotics are not
indicated for acute bronchiolitis, except in situations where there is a concomitant
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bacterial infection or a strong suspicion of it [7,8]. The severe course of acute
bronchiolitis, the tendency to relapses of broncho-obstruction, transformation into
respiratory allergies, determine the need for further study of immune-dependent
pathogenetic mechanisms, the deciphering of which will increase the effectiveness of
treatment measures for obstructive complications in young children.
The aim of the study:
based on the analysis of the treatment of children
suffering from acute bronchiolitis, to optimize the principles of therapy and enhance
the prevention of recurrence of the disease.
Material and methods of the study
. 54 children with acute bronchiolitis under
the age of two were examined. The patients were hospitalized in the I and II
departments of emergency pediatrics of the Samarkand branch of the Republican
Scientific Center for Emergency Medical Care in the period from January to December
2024. All patients were diagnosed based on standard clinical and laboratory data and
instrumental research methods. A general blood and urine test, a biochemical blood
test with determination of C-reactive protein, a blood gas test, oxygen saturation
(SpO2), chest X-ray, and a bacteriological examination of feces using a modified
method by M.A. Akhtamova et al. (1979) were studied.
The following were used as markers of bacterial infection: leukocytosis above
15x109/l; neutrophilia above 10x109/l; neutrophilic index: the ratio of young forms of
neutrophils (myelocytes, metamyelocytes, promyelocytes, band neutrophils) to mature
forms (segmented neutrophils) more than 0.2; CRP above 5 mg/l.
RSV etiology of bronchiolitis was confirmed by polymerase chain reaction. The
severity of broncho-obstruction was determined using the W. Tal scale (1996) [10]. To
assess the severity of broncho-obstructive syndrome and determine indications for
hospitalization [10], the M. H. Gurelick, S. B. Singh Scale (2001) was used, based on
clinical and radiological data.
Research Results
.
Indications for hospitalization of children with bronchiolitis
were: cases of apnea in the anamnesis; signs of respiratory failure of 2-3 degrees; age,
premature babies; dehydration, and aggravated premorbid background. Our studies
have shown a slight predominance of girls (61.1% - 33) over boys (38.9% - 21) (p>
0.05). A study of the anamnesis of life showed that sick children were born with a div
weight of 2100 - 4400 g. 5-9.3% of premature babies had a div weight of less than
2500 g, and 3-5.7% of children were delivered by Caesarean section with a div weight
of over 4 kg. The patients had a history of a number of risk factors for severe acute
bronchiolitis: 6-11.1% of children were born from multiple pregnancies, 8-14.8% were
born with intrauterine pneumonia. 28-51.9% of children were breastfed, 5-9.3% of
infants were bottle-fed from birth, the rest - 21-38.9% of patients at the age of 2 months
were transferred to milk substitutes. The largest number of patients with acute
bronchiolitis - 24.1% (22) were admitted to hospital in February, 14.1% (13) - in
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March, 18.5% (10) in November, while from May to October 16.7% (9) of children
were hospitalized, which confirms the literature data on the increase in the incidence
of PCB infection in late autumn, winter and early spring. According to the
classification of respiratory failure by S.N. Avdeev (2007), a decrease in SpO2 within
90-94% is assessed as respiratory failure of the first degree, 75-89% — respiratory
failure of the second degree, and below 75% — respiratory failure of the third degree.
Upon admission to hospital, respiratory failure of the first degree was diagnosed in
66.7% (36) of cases, respiratory failure of the second degree — in 24.1% (13) of
patients, and respiratory failure of the third degree — in 9.3% (5) of patients. In this
regard, the patients required oxygen therapy, of which 5 patients were on mechanical
ventilation and received therapy in the pediatric intensive care unit.
All examined children had broncho-obstruction of varying degrees. According
to the W.Ta1 scale (1996), severe broncho-obstruction was diagnosed in 7-12.9% of
patients and moderate in 15-27.8% of children.
When assessing the severity of bronchiolitis using the scale of M.N. Gorelick,
S.B. Singh (2001), the average score in the sample was 6.71±0.22, the distribution of
scores was as follows: 4-7.4% of children had 4 points, 6-11.1% of patients had 5
points, 16-29.6% of patients had 6 points, 14-25.9% of children had 7 points, 8-14.8%
had 8 points, and 6-11.1% of patients had 9 points. In the blood of patients, leukocytosis
above 15 x109/l, neutrophilia more than 10 x109\l were observed, and every third
patient had an increase in the level of CRP.
In 2 children, the chest X-ray was practically unchanged; in the remaining
patients, various combinations of increased pulmonary markings, signs of emphysema,
hypoventilation, and interstitial edema were detected.
In children under 3 months of age, the disease lasted longer (12.48±1.08 days),
a shorter duration (7.71±0.60 days) was recorded at the age of 5-6 months. Patients
stayed in hospital for an average of 10.09±0.71 bed/days.
Studies have shown that the development of acute bronchiolitis is varied and,
under the influence of external and internal factors, it occurs with varying degrees of
severity - from mild to life-threatening, accompanied by respiratory failure, which
requires hospitalization in the intensive care unit.
Long-term repeated courses of antibacterial and hormonal therapy, the presence
of concomitant pathology contributed to the weakening of non-specific and adaptive
immunity in sick children.
In children with acute bronchiolitis, a microbial imbalance and bacterial
colonization of the intestine with opportunistic flora have been identified, which
indicates the need to use eubiotics from the first days of the disease.
The main goal of bronchiolitis therapy is to normalize the function of external
respiration. It is important to ensure the patency of the upper respiratory tract. In severe
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cases (with respiratory failure of stage II and higher), oxygenation and oral hydration
are performed.
The patients received inhalation therapy. The effect was achieved in 10-20
minutes (increase in SaO2, decrease in respiratory rate by 10-15 per 1 minute, decrease
in the intensity of wheezing, decrease in intercostal retractions, relief of breathing),
which justified continuation of inhalation therapy until the disappearance of respiratory
failure.
Sodium chloride in the form of inhalation through a nebulizer is not accepted by
all researchers, but it is recommended by the American Academy of Pediatrics (AAP)
for children hospitalized for bronchiolitis [9].
It was established that all children with acute bronchiolitis received antibacterial
therapy in hospital conditions. However, only in 10 cases were there justified
indications for this. All patients used the injection route of antibiotic administration;
the stages of their use were not noted in any case.
In addition, 6 children received the same antibiotic at the same time; and in 8
cases, the antibacterial drug was replaced on the 3rd day of hospitalization, which is
probably associated with superinfection. As a starting therapy, the overwhelming
majority of 6 children received the "gold standard" antibiotics, cephalosporins of the
third generation - cefotaxime, and in most cases, cephalosporins of the first generation
- cefazolin.
The most effective method of treating acute bronchiolitis is primary prevention.
Particular attention should be paid to identifying and eliminating risk factors [1,2] for
the development of the disease, such as treating community-acquired respiratory viral
infections, reducing the risk of aspiration by changing lifestyle [6].
The results obtained in practical medicine will contribute to improving the
quality of medical care, reducing medical diagnostic errors, and developing an
individualized approach to the treatment of children with acute bronchiolitis
accompanied by broncho-obstruction.
Conclusions
. The study revealed: irrational use of antibiotics, incorrectly
selected starting doses in children with acute bronchiolitis. In bronchiolitis, antibiotic
therapy is possible only in the presence of bacterial complications.
Despite the existence of a large number of risk factors, in order to reduce the
incidence of acute respiratory infections and bronchiolitis, breastfeeding should be
recommended for at least the first 6 months of life.
1. Azimova K.T., Garifullina L.M. Risk factors for severe acute bronchiolitis in
young children Journal of Problems of Biology and Medicine No. 2 (142), 2023 Pp.
25-31
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2. Azimova K.T., Garifullina L.M. Bolalarda Ўtkir bronchiolitis diagnostics of
clinical practice roles Journal of Biomedicine and Practice Vol. 8, No. 6, 2023 Pp. 196-
202
3. Ovsyannikov D. Yu. (2010). Acute bronchiolitis in children. Proc. prakt.
Pediatrics, 5 (2), 75-8470.
4. Ovsyannikov D. Yu. co-authors. (2015). Lower respiratory tract infections of
respiratory syncytial virus etiology in premature infants and children with
bronchopulmonary dysplasia Children's infections, (3), pp. 5-10
5. Zakirova B.I., Lim M.V., Shavazi N.M. et al. Broncho-obstructive syndrome:
prognostic significance of intestinal dysbiosis in its development. 2020, Journal of
Achievements of Science and Education. Issue 10 (64). Pages 83-85.
6. Shavazi N.M., Lim M.V., Lim V.I., Ruzikulov B.Sh., Azimova K.T. Use of
inhalations of 10% acetylcysteine in children with acute obstructive bronchitis. 2020,
Journal of Issues of Science and Education, Issue 35 (119), Pages 14-18
7. Risk Factors for Bronchiolitis-Associated Deaths Among Infants in the United
States / R.C. Holman [et al.] // Pediatr Infect Dis J. - 2003. - № 22, Vol.6. - P. 483-490
8. Martinez F.D. Respiratory syncytial virus bronchiolitis and the pathogenesis
of childhood asthma / F.D. Martinez // Pediatr Infect Dis J. - 2003. - №22. - P. 76-82;
9. Paediatric Respiratory Medicine. ERS. Handbook. 1st Edition Editors E. Eber,
F. Midulla. 2013. 719 p.
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