Treatment of acute obstructive bronchitis

Hospitalization is indicated for infants and young children with moderate to severe acute obstructive bronchitis. A gentle regimen is prescribed, excluding external irritants (unnecessary procedures, examinations). The presence of the child's mother is mandatory. Maximum access to fresh air is necessary (frequent ventilation of the room in which the sick child is located). A physiological diet is given the child's age; force-feeding should not be done. It is important to ensure sufficient water intake not only taking into account age-related needs, but also to ensure sufficient hydration of sputum to improve its evacuation from the respiratory tract. Taking into account what has been eaten, it is recommended to increase the volume of liquid by 1.3-1.5 times. Tea, fruit decoctions, vegetable and fruit juices are used.

Antibiotics are not indicated unless there are changes in blood tests indicating bacterial inflammatory changes. The main treatment for acute obstructive bronchitis is the successful elimination of bronchial obstruction. This is the use of beta2-adrenergic agonists, which give a positive effect quite quickly in most cases. In case of mild obstruction, salbutamol can be prescribed orally 1 mg per dose for children aged 2-4 months and 2 mg per dose for children aged 2-3 years 2-3 times a day.

In moderate to severe acute obstructive bronchitis, inhalation forms of sympathomimetics are used through a nebulizer or spacer. For children in the first years of life, nebulizers with an air compressor are used. At the age of 2-3 years (if the child can), inhalation is best done through the mouth, with the child breathing through a mouthpiece.

For nebulizer therapy use:

• salbutamol sulfate - a selective beta-adrenergic receptor antagonist. Plastic ampoules of 2.5 ml contain 2.5 mg of salbutamol. It is used undiluted;
• fenoterol hydrobromide is a selective beta2-agonist. 1 ml of solution (20 drops) contains 1 mg of the active substance. For children under 6 years of age (body weight up to 22 kg), fenoterol is prescribed at a dose of 50 mcg per 1 kg of body weight per inhalation, which is 5-20 drops (0.25-1 mg). Physiological solution is poured into the nebulizer chamber and the appropriate dose of fenoterol is added, since for inhalation through a nebulizer the total volume of the sprayed drug should be 2-3 ml;
• ipratropium bromide - M-cholinergic receptor blocker, 1 ml (20 drops) contains 250 mcg of ipratropium. The dose of ipratropium bromide for children in the first year of life is 125 mcg (10 drops), over 1 year 250 mg (20 drops) per inhalation;
• Berodual is a combination drug, 1 mg contains 500 mcg of fenoterol and 250 mcg of ipratropium bromide. The combination of a beta2-agonist, which has a rapid effect in 5-15 minutes, and ipratropium bromide with a maximum effect in 30-50 minutes allows for a rapid and prolonged effect, exceeding the effect of single-component drugs. For children under 6 years (less than 22 kg), 0.5 ml (10 drops) is recommended up to 2-3 times a day.

In mild cases of acute obstructive bronchitis, a single inhalation of a bronchodilator through a nebulizer is sufficient, if necessary, it is repeated after 4-6 hours. In moderate and severe cases, inhalations are repeated every 20 minutes (3 doses in total) for an hour, then every 4-6 hours until a positive effect is achieved. The duration of inhalation through a nebulizer is 5-10 minutes (until the drug spraying stops completely).

In mild to moderate cases of acute obstructive bronchitis, nebulizer therapy can be carried out at home.

If there is no effect from the use of sympathomimetics (due to poor airway patency), salbutamol (0.2 ml for children 2-12 months and 0.4 ml for children 2-3 years old) or 0.05% alupent solution can be administered intramuscularly.

Inhalation corticosteroids (becotide, ventolin) are indicated, especially in cases where the process is not complete after 2 weeks. From the 2nd-3rd day of illness, postural drainage with vibration massage can be started to free the respiratory tract from secretions. Secretolytic agents are used. Inhalations of sodium cromoglycate (Intal) are effective, especially in patients with allergies, with a 0.5% solution of solutan from 2 to 5 drops together with one ampoule of Intal. Inhalation duration is 10-15 minutes.

Depending on the condition and severity of obstruction in young children, the treatment tactics involve a staged application of various agents. In case of a satisfactory condition and grade I bronchial obstruction (mild retraction of the compliant areas of the chest and a respiratory rate of up to 50-60 breaths per minute), beta2-adrenergic agonists are prescribed orally. In case of grade II bronchial obstruction (pronounced retraction of the compliant areas of the chest, the child is restless, the respiratory rate is more than 60 breaths per minute), nebulizer therapy is used. In case of grade III - severe bronchial obstruction (pronounced involvement of accessory muscles in breathing, the respiratory rate is more than 70 breaths per minute, the child is periodically lethargic), nebulizer therapy and inhaled glucocorticosteroids are used. A severe condition that persists during the first 24 hours is an indication for intravenous administration of prednisolone at a rate of 1-2 mg/kg of body weight, usually once.

In mild cases, exercise therapy, chest massage, and breathing exercises are prescribed.