Allocate two kliniko-morfologicheky options of a bronchiolitis: proliferative and konstriktivny.
Etiology and pathogeny of a disease
The acute bronchiolitis at first was described as an independent disease. Now it is known that it can develop, first, as a result of a wide range of toxic influences, secondly, within general diseases of connecting fabric. A classical example of an acute bronchiolitis is defeat of a respiratory organs at a pseudorheumatism.
Can lead use of the following medicines to development of an acute bronchiolitis: • Amiodaronum (25%); • nitrofurans; • streptocides; • penicillin; • cytostatics; • gold salts. In a pathogeny of an acute bronchiolitis the importance is allocated for disturbances of intercellular interactions both at the level of bronchial tubes, and in lungs. The role of neutrophils as sources of the free radicals who are considered as leaders in development of damage and a bronkhokonstriktion is established. The importance in change of rheological properties of a bronchial secret plays deficit alpha 1 - antitrypsin. The main morphological substrate of a bronchiolitis is the productive inflammation with damage of an epithelium, growth to respiratory bronchioles and alveoluses of granulyatsionny fabric and accumulation to them fibrotichesky masses — Masson's little bodies. Recently there are more and more data on a possibility of development of an acute bronchiolitis against therapy of medicines, regulating a lipidic exchange (for example simvastatiny). These medicines cause changes in lungs as a phospholipidosis. The morphological picture of damages of the lungs caused by statines has similarity to that at a fibroziruyushchy alveolitis and an acute bronchiolitis.
Clinical signs and symptoms of an illness
The acute bronchiolitis is characterized by short wind, unproductive cough. When progressing respiratory insufficiency "pulmonary" heart forms.
The diagnosis and the recommended clinical trials
At auscultation the dry whistling rattles, "popiskivany" on an exhalation are listened. All patients with suspicion on an acute bronchiolitis need performance of KT.
At a X-ray analysis and KT reveal strengthening of pulmonary drawing, alternation of sites of emphysema and "opaque glass". At research of function of external respiration the mixed type of respiratory disturbances is noted. The most informative diagnostic method of an acute bronchiolitis is the lung biopsy (transbronchial, transthoracic). At histologic research reveal proliferative and sclerous changes (the picture depends on a kliniko-morphological form of an acute bronchiolitis).
It is necessary to carry out differential diagnosis with a fibroziruyushchy alveolitis, a histiocytosis, emphysema of lungs.
General principles of treatment
The pharmacotherapy is carried out according to the scheme of treatment of a bronkhoobstruktivny syndrome of medicinal genesis (see. "Bronchospasm and bronchial asthma. General principles of treatment"). Criterion to a dose decline or cancellation of GKS for system use is positive clinicoradiological dynamics. Use of Mucolyticums is reasonable: Acetylcysteinum in 600 mg/days before stopping of symptoms and within the next 1 month
Assessment of efficiency of treatment
Criterion of efficiency of treatment is reduction of expressiveness of respiratory disturbances, positive clinicoradiological dynamics.
Complications and side effects of treatment
At long reception of GKS development of the following complications is possible: • steroid diabetes mellitus; • peptic ulcer of a stomach; • syndrome of Kushinga; • poleneyropatiya.
Mistakes and unreasonable appointments
Premature cancellation of GKS can lead to progressing of a disease.
The forecast at an acute bronchiolitis serious. For lack of adequate pharmacotherapy of change can progress even after medicine cancellation.