done by Kalikhanova Aruzhan

• The nose is relatively small, the nasal passages are narrow, there is no lower nasal passage.Due to
the narrowness of the nasal passages and the abundant blood supply to their mucous membranes,
even minor inflammation causes difficulty in breathing through the nose in young children.
• Breathing through the mouth in children of the first half of life is impossible, since the large tongue
pushes the epiglottis posteriorly.
• Narrow choana is cause of a prolonged violation of their nasal breathing.- The paranasal sinuses of
the nose are very poorly developed or completely absent.
• By the age of 2, the frontal sinus appears, the maxillary cavity increases in volume.By the age of 4 ,
the lower nasal passage appears. Due to the insufficient development of cavernous tissue, the
inhaled air is poorly warmed

Nose
 Pharynx & Larynx
• The pharynx is relatively narrow and has a more vertical
direction than in adults.
• The larynx is funnel-shaped (later cylindrical) and is located
slightly higher than in adults (at the level of the 4th cervical
vertebra in a child and the 6th cervical vertebra in an adult).
The larynx is relatively longer and narrower than in adults,
its cartilages are very malleable.
• -The false vocal cords and mucous membrane are tender,
rich in blood and lymphatic vessels, elastic tissue is poorly
developed. The glottis is narrow.
 Trachea
• The trachea is funnel-shaped, its lumen is narrow, the posterior wall has a wider fibrous
part, the walls are more malleable, the cartilage is soft, easily squeezed. Its mucous
membrane is tender, rich in blood vessels and dry due to insufficient development of
mucous glands, elastic tissue is poorly developed.The growth of the trachea occurs in
parallel with the growth of the trunk, most intensively - at the 1st year of life and in the
puberty period.
 Bronchus
• The right bronchus is like a continuation of the trachea, it is shorter and wider
than the left one. The lungs of newborns weigh about 50 g, by 6 months their
weight doubles, by the year it triples, by the age of 12 it increases 10 times, by the
age of 20 it increases 20 times. The pulmonary slits are weakly expressed.
Acinuses are insufficiently differentiated.
What is bronchitis in children?
Bronchitis is an inflammatory disease of the
bronchi, mainly of infectious etiology,
manifested by a cough (dry or productive)
lasting no more than 3 weeks.
Etiology
There are 3 groups:
• Infectious bronchitis: viruses, bacteria, atypical microorganisms, fungus,
protozoal)

• Noninfectious: influence of various allergens, toxic substances, physical

factors on mucous membrane

• Mixed etiology influence: infectious factors as well noninfectious

Infectious bronchitis
• Viral – typical for predominant acute and recurrent forms of disease (65-
90%). More frequently are influenza, parainfluenza, rhino-syncitial, adeno-,
rhino-, corona-, rota- entero- viruses, Kawasaki, .
• Bacterial – usually complications of viral process in respiratory tract .
Streptococcus pneumoniae +
Streptococcus viridans ++
Klebsiella pneumoniae
Haemophilus influenzae
Moraxella catarrhalis ++++++
Staphilococcus aureus
Mycoplasma pneumoniae
Chlamidia pneumoniae
The most significant are Candida, Aspergillus among fungal infection
 Pathogenesis
Etiological factor

Phagocyte migration, proinflammatory mediators releasing

(cytokines, enzymes), their storage in mucous membrane

Vessel reaction
Respiratory tract mucous
membrane direct
impairment vasodilation
Bronchial
hypersecretion: increased permeability of
due to irritation and dilation vessel wall
of goblet cells

exudation

mucous membrane edema

Pathologic microorganisms damage local tissues
and stimulate releasing of prostglandins and
hystamine. They cause edema, pain and attract
neutrophils and another effector cells.

Microorganisms release toxins, stimulate

neutrophils’ permeability from circulation
(neutrophils by diapedesis penetrate through
pores in vessels’ endothelium and direct towards
affected site).
Antibodies are special proteins that can attach to
microorganisms. New neutrophils has receptors
to recognize antibodies and pathogens and they
also attach to complexes.

Neutrophils create pseudopodias and absorb

pathogens by this structures. Digestion of
microbes is performed by enzymes in
phagolyzosomes ( i.e. phagocytosis is performed)
Microorganisms are destroyed. Remnants of
pathogens can be excreted on cell membrane.
Clinic groups of bronchitis in
children
Pathogenesis Forms:
• Primary • Catarrhal
• Secondary • Purulent
Etiology • Fibrinous
• Viral • Hemorrhagic
• Bacterial • Ulcerative
• Mixed (viral-bacterial) • Necrotic
• Fungal • Mixed
• Allergic Clinical type
Mixed due to infectious and noninfectious • Simple (nonobstructive)
factors • Obstructive
Course Affected level
• Acute (until 4 weeks) • Tracheitis
• Prolonged (more than 4 weeks) • Tracheobronchitis
• Recurrent/chronic (repeat >3 times/year with • Bronchitis
exacerbation & remission) • Bronchiolitis
 Bronchitis diagnostics
All clinical symptoms can be
divided for:
● Main constant ( cough,
production of sputum)
● Additional, transient (
rales, obstructive
syndrome, dyspnea)
 Acute simple bronchitis
● Symptoms of viral intoxication: common condition
impairment, chills, decreased appetitie, behavioral
changes of child, flaccidity, weakness or excitability,
impairment of sleeping, fever, head ache, transient
muscle pains, catarrhal events in nasopharynx
● Symptoms of bronchitis: Physical examination:· rapid or difficult breathing
(children under 2 months of BH ≥60 per minute; from 2 months- up to 1 year
≥50 per min; 1-5 years ≥40 per minute; older than 5 years >28 per minute);·
● retraction of the lower chest
● percussion and palpation without changes
● Auscultative changes: rough bronchial sound,
prolonged expiration, bilateral rales in various parts
of lungs changes after cough
● Hemogram changes: elevated ESR, leukopenia
● Chest X-ray: enhancing of bronchial linearity, root
shadow is wide, not clear
 Obstructive bronchitis
● Due to inflammatory decreasing of bronchial
aperture
● Diagnostic criteria
Common condition impairment, rhinitis symptoms,
nasopharyngitis, catarrhal symptoms
Body temperature normal sometimes subfebrile,
rarely
hyperthermia
Manifested respiratory failure
Signs of bronchial patency abnormality
● During percussion: tympanic sound
● Auscultation – rough bronchial sound, prolonged
expiratory sound, moist bubbling rales, during
expiration
dry whistling (wheezing) rales
● X-ray picture - intensification of vascular picture,
increased clearance of lungs due to emphysema,
amplification of bronchial picture
 Chronic bronchitis
Disease is characterized by episodic or constant cough
and sputum production for 2 or more years,
summary duration of productive cough is more than
3 mo per year
Diagnostic criteria of chronic bronchitis in children
● Prolonged pulmonologic anamnesis
● Stable clinic signs, impaired tolerance of physical
loadings, changed shape or deformities of chest,
thickening of distal phalangs and nails
● Stable (local or spread) physical changes in lungs
● Radiologic signs “Solidified” X-ray picture with
emphysema signs, pneumofibrosis, manifested
deformity of lung picture
● Deformity of bronchi
● Stable, sometimes progressive respiratory function
impairment
 Bronchitis treatment
Non-drug treatment:· for the
period of temperature rise - bed
rest;
adequate hydration (plenty of
warm drink);·
encouraging breastfeeding and
adequate nutrition according to
age;
compliance with the sanitary and
hygienic regime
 Treatment
Obstructive bronchitis
Salbutamol, a metered aerosol of 100
micrograms or an inhalation solution
older than 12 years - 2-4 mg 3-4 times /
day, if necessary, the dose can be
increased to 8 mg 4 times / day.
Children aged 6-12 years - 2 mg 3-4
times / day; children 2-6 years - 1-2 mg
3 times / day.
Ipratropium bromide/phenoterol
20 ml 4 times a day
 Treatment
Bacterial bronchitis

Amoxicillin + clavulanic
acid, suspension for oral
administration 125 mg / 5 ml

Macrolide - Azithromycin,
powder for suspension
preparation 100 mg/5 ml (200
mg/5 ml)
 Bronchiolitis
Acute generalized obstructive disease of distal
respiratory tract – terminal bronchi
Disease develops only in infants
Clinical peculiarities of bronchiolitis
● Progressive dyspnea
● Nonproductive cough
● Manifested signs of severe bronchoobstructive syndrome
● Signs of respiratory failure
● Another organs and systems reactions
(cardiovascular syndrome, hypoxic changes of CNS)
● Percussion tympanic resonance
● Auscultation bilateral manifested respiratory sound
attenuation, expiratory sound isn’t audible. In basal
part of lung crepitation or bubbling sound on the
ground of attenuated breathing sound, special
“inspiratory” peep is audible