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• prolonged exhale
• wheezing, noisy breathing (expiratory dyspnea, BH 50 and
more per minute)
• asthmatic fits
• auxiliary muscles participating in breathing
• poorly productive cough
• decrease in oxygen partial pressure.
BOS Predispose Factors
Anatomical and physiological factors in young children:
• the relative narrowness of the respiratory tract
• hyperplasia of glandular tissue
• rich vascularization of the mucous
• predominantly viscous mucus secretion
• low collateral ventilation
• insufficient local immunity
• relative weakness of the diaphragm
Factors of premorbid background:
• coupled allergic history
• a genetic predisposition to atopy
• perinatal pathology
• bronchial hyperreactivity
• rickets
• malnutrition
• early formula feeding
• respiratory diseases
Environmental Factors:
• unfavorable environmental conditions
• passive smoking
• smoke inhalation promotes disruption of mucociliary clearance, causes
hypertrophy of bronchial mucous glands, destruction of bronchial
epithelium, reduces phagocytic activity of macrophages, reduces the
activity of T- lymphocytes, stimulates IgE synthesis, increases the activity
of the vagus nerve
• in children with alcohol fetopathy atopy develops, mucociliary clearance is
broken, protective immunological reactions are slowed.
Etiology of BOS
• Acute stenosing laryngotracheobronchitis of viral, bacterial
and viral etiology of diphtheria.
• Peritonsillar abscess, retropharyngeal abscess, epiglotit,
congenital stridor, hypertrophy of the tonsils and adenoids,
cysts, hemangioma and papillomatosis of the larynx.
• In infants - aspiration caused by swallowing disorders,
congenital abnormalities of the nasopharynx, chalasia and
achalasia of the esophagus, tracheobronchial fistulas,
gastroesophageal reflux disease.
• Malformations of trachea, bronchi, RDS, cystic fibrosis,
bronchopulmonary dysplasia, immunodeficiency, intrauterine
infection.
• At the 2nd and 3rd year of life BOS occurs in children with
asthma, with foreign body aspiration, during migration of
round helminths, in bronchiolitis obliterans, in patients with
congenital and hereditary diseases of the respiratory system, in
children with CHD, proceeding with pulmonary hypertension.
• However, the main causes of bronchial
obstruction in children are acute obstructive
bronchitis and bronchial asthma!
The pathogenesis of bronchial obstruction
About 100 diseases associated with BOS are known . There is no common
classification. Considering the data from the literature, the following groups of the
diseases involving BOS can be defined.
1. Diseases of the respiratory system.
• infectious inflammation (bronchitis, bronchiolitis).
• bronchial asthma
• aspiration of foreign bodies
• bronchopulmonary dysplasia
• malformations of the respiratory system
• obliterating bronchiolitis
• tuberculosis
2. Diseases of the digestive tract
•esophageal chalasia and achalasia
•gastroesophageal reflux disease
•tracheoesophageal fistula
•diaphragmatic hernia
3. Hereditary diseases
•cystic fibrosis,
•deficiency of alpha-1-antitrypsin
•mucopolysaccharidoses
•rickets-like diseases
4. Parasitic infections (toxocariasis)
5. Diseases of the CAS
6. Diseases of the central and peripheral nervous system (birth trauma, myopathy, etc.).
7. Congenital and acquired immunodeficiency
8. The impact of various physical and chemical environmental factors
9. Other reasons (endocrine diseases, systemic vasculitis, Thymomegalia et al.)
From a practical point of view, 4 basic groups
of BOS causes are distinguished:
• infectious
• allergic
• obstructive
• hemodynamic
By duration, BOS can be:
• acute (BOS clinical manifestations persist for more than 10 days)
• protracted
• recurrent
• continuously recurring
• wheezing
• dyspnea of expiratory character
• cyanosis
• auxiliary muscles participating in breathing
• lung function (LF) and blood gases indices
• cough is seen with any degree of BOS
Mild BOS
• wheezing on auscultation
• no breathlessness and cyanosis at rest
• indices of blood gases are within the normal range
• ERF indices (FEV1, PSV) are moderately reduced
• state of health of the child, as a rule, does not suffer
BOS of moderate severity
The most informative indicators at the presence of airflow obstruction are the
reduced:
1) forced expiratory volume in 1 second (FEV1);
2) peak expiratory flow rate (PSV).
An unsatisfactory answer:
A good answer •Transfer to the emergency
department
•ALV
Indications for hospitalization of children
with BOS, developed against ARVI