Recurrent bronchitis is a recurrent, prolonged inflammation of the bronchial mucosa that repeats up to 3 or more times throughout the year, but does not lead to irreversible violations of the function of the respiratory organs. Recurrent bronchitis is accompanied by subfebrility, wet, rough cough, sometimes bronchospasm and wheezing. The diagnosis is made according to the data of lung radiography, bronchography, FER, sputum bacposev, allergoprob. When bronchitis recurs, pharmacotherapy (mucolytics, bronchodilators, antihistamines) and rehabilitation measures (respiratory gymnastics, vibration massage, physiotherapy) are used. According to the indications, antibiotics and antiviral drugs are prescribed.
J40 Bronchitis, not specified as acute or chronic
Recurrent bronchitis – repeatedly (up to 3-4 times a year) recurring episodes of bronchitis lasting up to 2-3 weeks, occurring with or without bronchospasm and reversible changes in the bronchopulmonary system. Recurrent bronchitis is characteristic of the children’s contingent, usually preschoolers, less often schoolchildren. By adulthood, such patients already have chronic bronchitis, which proceeds with periodic exacerbations and persistent damage to the structure of the walls of the bronchi. Recurrent bronchitis usually debuts in the second year of a child’s life; this clinical variant accounts for up to a third of all respiratory pathology at an early age. The greatest incidence is registered among children 4-6 years old, then gradually decreases in the pre- and puberty period.
Simple recurrent bronchitis has no signs of obstruction. In the case of repeated episodes of bronchitis accompanied by bronchoobstructive syndrome (BOS), not mediated by non-infectious allergens, pulmonology speaks of its recurrent obstructive form. Relapses of bronchitis occur more often in the cold period, with an obstructive variant – usually in the spring and autumn seasons. Recurrent bronchitis has no tendency to progression and development of sclerosis phenomena in the bronchi and lungs, but forms favorable conditions for the appearance of chronic bronchitis, bronchial asthma and acute pneumonia.
Causes of recurrent bronchitis
There is an obvious connection of recurrent bronchitis with acute respiratory infections of viral, mycoplasmic, chlamydial, less often bacterial etiology (whooping cough, tuberculosis). Episodes of bronchitis are very often repeated against the background of acute viral infection (rhinovirus, RSV, parainfluenza, measles), acute pneumonia. The tendency to recurrent bronchitis is observed in children who are often ill.
Viral damage to the mucous membrane of the tracheobronchial tree leads to diffuse inflammation, decreased function of the atrial fibrillation, insufficiency of mucociliary clearance, neuroregulatory disorders and the development of nonspecific hyperreactivity of the bronchi. The bronchi begin to react inadequately to the usual stimuli (a sharp smell, cold air, physical exertion).
Predisposing factors play an essential role in the development of recurrent bronchitis. First of all, these are the features of the child’s body – the immaturity of the tissue structures of the bronchi and the immunocompetent system, frequent chronic pathology of the lymphoid tissue of the ENT organs, allergic mood, as well as the presence of malformations of the respiratory tract and immunodeficiency conditions (congenital and secondary). Alcoholic fetopathy, smoking of the mother during pregnancy and after the birth of the child, aspiration syndrome, ventilator can lead to the development of nonspecific hyperreactivity of the bronchi. Cystic fibrosis and undiagnosed foreign bodies of the respiratory tract are also accompanied by the phenomena of recurrent bronchitis. Relapses of bronchitis can occur under the influence of difficult climatic conditions (high humidity, temperature changes), industrial and domestic air pollution.
In 70-80% of children there is a recurrent obstructive form of bronchitis, occurring in the absence of other obstructive bronchopulmonary diseases. Due to the sufficient narrowness of the airway lumen in young children, bronchial obstruction is initiated by inflammatory changes in the bronchial mucosa against the background of ARVI. The presence of allergies in the patient (skin rashes, positive skin tests), connective tissue dysplasia allows him to be attributed to the risk group for the development of obstructive bronchitis. RSV infection can disrupt the formation of a normal immune response in young children and form an atopic version of the immune response and sensitization to aeroallergens. With recurrent obstructive bronchitis without signs of allergy and a low level of Ig E, most episodes of obstruction stop at 3-4 years of age.
Symptoms of recurrent bronchitis
Recurrent bronchitis is characterized by annual periodic exacerbations (3-4 times a year), usually lasting 2-4 weeks.
Relapses usually occur more easily than primary acute inflammation of the bronchi and begin with clinical manifestations of acute respiratory viral infections. There is a moderate rise in temperature, catarrhal phenomena: nasal congestion, runny nose, sore throat, sometimes headache. Gradually, within 3-6 days, a cough appears: at first dry and painful, then moist with a rough shade, less often paroxysmal. Viscous mucous or mucopurulent sputum is secreted. Cough, observed throughout the day (more pronounced in the morning), gradually begins to dominate the clinical picture of the disease. It is possible to provoke a cough by physical exertion.
With relapses of obstructive bronchitis, breathing becomes wheezing with audible wheezing, cough is obsessive. With a sluggish variant of recurrent bronchitis, exacerbations can occur for a long time (from 3 weeks to 3 months) with a normal temperature and scant sputum secretion. During the period of clinical remission, the child is quite healthy.
When making a diagnosis, the anamnesis is clarified, lung x-ray, bronchography, FER, a general blood test, sputum removal, skin allergy tests are performed. The exacerbation of recurrent bronchitis is characterized by hard breathing, dry and wet multi-caliber wheezing of an unstable nature and localization. Paravertebral bilateral shortening of the percussion tone, elongation of exhalation is determined. During the period of remission, there is an increased cough readiness with a little cooling, physical exertion and fatigue.
Lung radiography in recurrent bronchitis demonstrates a prolonged stable reactive enhancement of the pulmonary pattern mainly in the basal areas, its preservation to some extent during remission and a slow return to normal.
Bronchoscopy helps to assess the presence of secretions and changes in the bronchial tree. With relapses of bronchitis, minor fibrinous overlays or individual lumps and elongated filaments of mucous (mucopurulent) sputum are detected on the walls of the bronchi. Diffuse changes in the contours of the bronchial lumen are visible, more pronounced in the upper parts of the main bronchi. The study of FER may reveal fuzzy reversible obstructive disorders, latent bronchospasm outside of relapse, a weak degree of bronchial hyperreactivity.
In peripheral blood, minor leukocytosis, an increase in ESR is possible, with allergic genesis – eosinophilia. To assess the sensitivity to infection, skin tests with bacterial (staphylococcal and streptococcal) allergens are performed. In case of diagnostic difficulties, the referral of the child to a consultation with a pediatric pulmonologist and allergist is indicated. Recurrent bronchitis should be differentiated from pneumonia, bronchial asthma, cystic fibrosis, obliterating bronchiolitis, tuberculosis, foreign body in the bronchi.
Treatment of recurrent bronchitis
Treatment of exacerbation of recurrent bronchitis is carried out on an outpatient basis with the appointment of rest, an abundant drinking regime, a fortified diet. In cases of acute respiratory viral infections, antiviral drugs (remantadine, umifenovir) are used, in the case of mycoplasma or chlamydia genesis of bronchitis, systemic antibiotic therapy (macrolides) is performed in combination with immunomodulators (echinacea tincture, tiloron), anti-inflammatory drugs (fenspiride).
With a pronounced productive cough, inhalations with alkaline solutions and mucolytics (ambroxol, carbocysteine), UHF, therapeutic breathing exercises, vibration massage, postural drainage are necessary. In the acute period of bronchitis with bronchial obstruction, inhaled bronchodilators (salbutamol, phenoterol) are recommended, in severe cases – glucocorticoids (dexamethasone, prednisolone) aerosol or systemically. Children with allergies have a history of using antihistamines.
Prognosis and prevention
Patients with recurrent bronchitis are shown dispensary observation until the complete cessation of relapses for 2 years, sanatorium treatment. The prognosis of recurrent bronchitis is relatively favorable, the disease is reversible in most cases. The risk of recurrent bronchitis turning into an asthmatic form or bronchial asthma is determined by the presence of bronchospasm and the age of the sick child. Prevention of recurrent bronchitis covers prevention of acute respiratory viral infections, early initiation of antiviral treatment, elimination of allergic factors, hardening and physical activity, timely vaccination of children against influenza, measles, pneumococcal infection.